Quantitative Vertebral Bone Density Seen on Chest CT in Chronic Obstructive Pulmonary Disease Patients: Association with Mortality in the Korean Obstructive Lung Disease Cohort
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- Korean Journal of Radiology
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- 제21권7호
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- pp.880-890
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- 2020
Objective: Patients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (DThorax) and clinical variables, including survival, in patients with COPD. Materials and Methods: A total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. DThorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between DThorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated. Results: The median follow-up time was 7.3 years (range: 0.1-12.4 years). Fifty-six patients (17.4%) died. DThorax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. DThorax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119-6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122-6.071, p < 0.001), lower forced expiratory volume in one second (FEV1) (HR, 2.975; 95% CI, 1.682-5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DLCO) (HR, 4.595; 95% CI, 2.665-7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192-6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154-3.683, p = 0.015), and lower DThorax (HR, 2.773; 95% CI, 1.620-4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower DThorax (HR, 1.957; 95% CI, 1.075-3.563, p = 0.028) along with older age, lower BMI, lower FEV1, and lower DLCO were independent predictors of all-cause mortality. Conclusion: The thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.
목적: 본 연구의 목적은 가철성 다이 시스템으로 제작된 작업 모형과 솔리드 작업 모형을 이용해 치과용 캐드캠 시스템(CAD/CAM)으로 제작된 지르코니아 3본 고정성 치과 보철물의 변연 및 내부 적합성을 평가하고자 하였다. 연구 재료 및 방법: 하악 우측 제1소구치와 하악 우측 제1대구치에 지르코니아 크라운을 위한 치아 삭제 프로토콜을 수행하고, 하악 우측 제2소구치가 없는 레퍼런스 모델을 만들었다. 레퍼런스 모델은 폴리비닐 실록산 인상체를 사용하여 복제되었고, 일반적인 치과 기공 절차에 따라 20개의 작업 모형이 제작되었다. 비교 분석을 위해, 10개의 지르코니아 3본 고정성 치과 보철물은 가철성 다이 시스템에서, 나머지 10개는 솔리드 작업 모형에서 제작되었다. 모든 작업 모형은 치과용 데스크탑 스캐너를 사용하여 디지털화되었고, 캐드 소프트웨어에서 보철물을 설계하였다. 최종 3본 고정성 치과 보철물은 밀링 과정을 통해 제작되었다. 변연 및 내부 적합도 평가는 레퍼런스 모델에 제작된 보철물을 위치시키고, 디지털 평가 방법으로 적합도가 측정되었다. 두 그룹 간의 통계 비교를 위해 Mann-Whitney U 검정이 적용되었다(α = 0.05). 결과: 가철성 다이 그룹은 솔리드 작업 모형 그룹에 비해 소구치와 대구치에서 유의하게 높은 적합도 차이를 보였으며(P < 0.05), 특히 변연 및 교합 간격에서 유의하게 높은 편차를 보였다. 색상 편차 맵에서도 가철성 다이 그룹이 변연 및 교합 영역에서 더욱 높은 편차를 보였다. 결론: 3본 고정성 치과 보철물의 적합도 차이는 가철성 다이 시스템의 작업 모형 상에서 제작된 치과 보철물에서 초래되었으며, 이를 통해 가철성 다이 제작 방법이 치과 고정성 보철물의 정확성에 영향이 있었음을 검증하였다.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
종횡비, 다각형 모양에 따른 평판과 범포의 유체역학적 특성을 규명하고자 직사각형, 사다리꼴 모양으로 모형 평판과 범포를 제작하고 회류수조에서 양
Digital Convergence means integration between industry, technology, and contents, and in marketing, it usually comes with creation of new types of product and service under the base of digital technology as digitalization progress in electro-communication industries including telecommunication, home appliance, and computer industries. One can see digital convergence not only in instruments such as PC, AV appliances, cellular phone, but also in contents, network, service that are required in production, modification, distribution, re-production of information. Convergence in contents started around 1990. Convergence in network and service begins as broadcasting and telecommunication integrates and DMB(digital multimedia broadcasting), born in May, 2005 is the symbolic icon in this trend. There are some positive and negative expectations about DMB. The reason why two opposite expectations exist is that DMB does not come out from customer's need but from technology development. Therefore, customers might have hard time to interpret the real meaning of DMB. Time is quite critical to a high tech product, like DMB because another product with same function from different technology can replace the existing product within short period of time. If DMB does not positioning well to customer's mind quickly, another products like Wibro, IPTV, or HSPDA could replace it before it even spreads out. Therefore, positioning strategy is critical for success of DMB product. To make correct positioning strategy, one needs to understand how consumer interprets DMB and how consumer's interpretation can be changed via communication strategy. In this study, we try to investigate how consumer perceives a new product, like DMB and how AD strategy change consumer's perception. More specifically, the paper segment consumers into sub-groups based on their DMB perceptions and compare their characteristics in order to understand how they perceive DMB. And, expose them different printed ADs that have messages guiding consumer think DMB in specific ways, either cellular phone or personal TV. Research Question 1: Segment consumers according to perceptions about DMB and compare characteristics of segmentations. Research Question 2: Compare perceptions about DMB after AD that induces categorization of DMB in direction for each segment. If one understand and predict a direction in which consumer perceive a new product, firm can select target customers easily. We segment consumers according to their perception and analyze characteristics in order to find some variables that can influence perceptions, like prior experience, usage, or habit. And then, marketing people can use this variables to identify target customers and predict their perceptions. If one knows how customer's perception is changed via AD message, communication strategy could be constructed properly. Specially, information from segmented customers helps to develop efficient AD strategy for segment who has prior perception. Research framework consists of two measurements and one treatment, O1 X O2. First observation is for collecting information about consumer's perception and their characteristics. Based on first observation, the paper segment consumers into two groups, one group perceives DMB similar to Cellular phone and the other group perceives DMB similar to TV. And compare characteristics of two segments in order to find reason why they perceive DMB differently. Next, we expose two kinds of AD to subjects. One AD describes DMB as Cellular phone and the other Ad describes DMB as personal TV. When two ADs are exposed to subjects, consumers don't know their prior perception of DMB, in other words, which subject belongs 'similar-to-Cellular phone' segment or 'similar-to-TV' segment? However, we analyze the AD's effect differently for each segment. In research design, final observation is for investigating AD effect. Perception before AD is compared with perception after AD. Comparisons are made for each segment and for each AD. For the segment who perceives DMB similar to TV, AD that describes DMB as cellular phone could change the prior perception. And AD that describes DMB as personal TV, could enforce the prior perception. For data collection, subjects are selected from undergraduate students because they have basic knowledge about most digital equipments and have open attitude about a new product and media. Total number of subjects is 240. In order to measure perception about DMB, we use indirect measurement, comparison with other similar digital products. To select similar digital products, we pre-survey students and then finally select PDA, Car-TV, Cellular Phone, MP3 player, TV, and PSP. Quasi experiment is done at several classes under instructor's allowance. After brief introduction, prior knowledge, awareness, and usage about DMB as well as other digital instruments is asked and their similarities and perceived characteristics are measured. And then, two kinds of manipulated color-printed AD are distributed and similarities and perceived characteristics for DMB are re-measured. Finally purchase intension, AD attitude, manipulation check, and demographic variables are asked. Subjects are given small gift for participation. Stimuli are color-printed advertising. Their actual size is A4 and made after several pre-test from AD professionals and students. As results, consumers are segmented into two subgroups based on their perceptions of DMB. Similarity measure between DMB and cellular phone and similarity measure between DMB and TV are used to classify consumers. If subject whose first measure is less than the second measure, she is classified into segment A and segment A is characterized as they perceive DMB like TV. Otherwise, they are classified as segment B, who perceives DMB like cellular phone. Discriminant analysis on these groups with their characteristics of usage and attitude shows that Segment A knows much about DMB and uses a lot of digital instrument. Segment B, who thinks DMB as cellular phone doesn't know well about DMB and not familiar with other digital instruments. So, consumers with higher knowledge perceive DMB similar to TV because launching DMB advertising lead consumer think DMB as TV. Consumers with less interest on digital products don't know well about DMB AD and then think DMB as cellular phone. In order to investigate perceptions of DMB as well as other digital instruments, we apply Proxscal analysis, Multidimensional Scaling technique at SPSS statistical package. At first step, subjects are presented 21 pairs of 7 digital instruments and evaluate similarity judgments on 7 point scale. And for each segment, their similarity judgments are averaged and similarity matrix is made. Secondly, Proxscal analysis of segment A and B are done. At third stage, get similarity judgment between DMB and other digital instruments after AD exposure. Lastly, similarity judgments of group A-1, A-2, B-1, and B-2 are named as 'after DMB' and put them into matrix made at the first stage. Then apply Proxscal analysis on these matrixes and check the positional difference of DMB and after DMB. The results show that map of segment A, who perceives DMB similar as TV, shows that DMB position closer to TV than to Cellular phone as expected. Map of segment B, who perceive DMB similar as cellular phone shows that DMB position closer to Cellular phone than to TV as expected. Stress value and R-square is acceptable. And, change results after stimuli, manipulated Advertising show that AD makes DMB perception bent toward Cellular phone when Cellular phone-like AD is exposed, and that DMB positioning move towards Car-TV which is more personalized one when TV-like AD is exposed. It is true for both segment, A and B, consistently. Furthermore, the paper apply correspondence analysis to the same data and find almost the same results. The paper answers two main research questions. The first one is that perception about a new product is made mainly from prior experience. And the second one is that AD is effective in changing and enforcing perception. In addition to above, we extend perception change to purchase intention. Purchase intention is high when AD enforces original perception. AD that shows DMB like TV makes worst intention. This paper has limitations and issues to be pursed in near future. Methodologically, current methodology can't provide statistical test on the perceptual change, since classical MDS models, like Proxscal and correspondence analysis are not probability models. So, a new probability MDS model for testing hypothesis about configuration needs to be developed. Next, advertising message needs to be developed more rigorously from theoretical and managerial perspective. Also experimental procedure could be improved for more realistic data collection. For example, web-based experiment and real product stimuli and multimedia presentation could be employed. Or, one can display products together in simulated shop. In addition, demand and social desirability threats of internal validity could influence on the results. In order to handle the threats, results of the model-intended advertising and other "pseudo" advertising could be compared. Furthermore, one can try various level of innovativeness in order to check whether it make any different results (cf. Moon 2006). In addition, if one can create hypothetical product that is really innovative and new for research, it helps to make a vacant impression status and then to study how to form impression in more rigorous way.
연구배경: 최대운동부하 검사는 심폐기능의 종합적인 평가를 위하여 널리 이용되고 있으나 아직 우리나라에는 최대운동시의 호흡성 가스교환이나 폐기능의 정상치가 제대로 확립되어 있지 않은 설정이다. 본 연구의 목적은 한국성인에서 최대운동시의 이들 지표의 연령과 성별에 따른 정상치 내지 참고치를 마련하는 동시에 이들 중 일부지표의 추정정상치를 산출하는 회귀방정식을 구하는데 있다. 방법: 건강한 성인 남성 603명, 여성 397명, 합계 1,000명(20~66세)을 대상으로 Bruce법으로 증상제한성 최대운동부하 검사를 실시하였으며, 이중 885명에서는 VC,
본 연구에서는 데이터마이닝 기법의 일종인 자기조직화지도(Self-Organizing Map, SOM)를 이용하여 비외감기업의 부실화 유형을 구분하고자 한다. 자기조직화지도는 인공 신경망을 기초로 자율학습을 통해 입력된 값을 유사한 군집끼리 묶어내는 방법으로, 기존의 통계적 군집 분류 방법보다 성능이 뛰어나고, 고차원의 입력데이터를 저차원으로 시각화할 수 있다는 장점 때문에 다양한 분야에서 각광받고 있다. 본 연구에서는 기존 연구의 주요 분석대상이었던 외감기업에 비해 부실화 빈도는 높지만 데이터 수집의 어려움으로 인해 분석대상에서 다소 제외되었던 비외감기업의 부실화 유형에 대해 알아보고, 유형별 구체적인 사례도 소개하고자 한다. 재무자료수집이 가능한 100개의 비외감 부실기업에 대해 분석한 결과, 비외감기업의 부실화 유형은 다섯 가지로 구분되었다. 유형 1은 전체 집단의 약 12%를 차지하며, 수익성, 성장성 등 재무지표가 다른 유형에 비해 열등하였다. 유형 2는 전체 집단의 약 14%로, 유형 1보다는 덜 심각하지만 재무지표가 대체로 열등하였다. 유형 3은 성장성 지표가 열등한 그룹으로 기업간 경쟁이 극심한 가운데 지속적으로 성장하지 못하고 부실화된 경우로 약 30%의 기업이 포함되었다. 유형 4는 성장성은 탁월하나 부채경영 등 과감한 경영으로 인해 유동성 부족이나 현금부족 등의 이유로 부실화된 그룹으로 약 25%의 기업이 포함되었다. 유형 5는 거의 모든 재무지표가 우수한 건전기업으로, 단기적인 경영전략의 실수 또는 중소기업의 특성상 경영자의 개인적 사정으로 부실화 되었을 가능성이 큰 그룹으로 약 18%의 기업이 포함되었다. 본 연구 결과는 부실화 유형을 구분하는데 기존의 통계적 방법이 아닌 자기조직화지도를 이용하였다는 점에서 학문적 의의가 있고, 비외감기업의 재무지표만으로도 1차적인 부실화 징후를 발견할 수 있다는 점에서 실무적 의의가 있다고 할 수 있다.
폐 관류 스캔은 방사성 물질의 폐동맥 내 미세색전증을 이용하여 폐색전증의 진단에 이용되고 있으며, 만성 폐쇄성 질환이나 국소 폐 관류평가 및 조기 폐암발견 등에 이용된다. 또한 폐암환자에서의 수술 및 방사선 치료 전, 후 국소 폐 기능 예측을 위하여 이용된다. 이를 위하여 관류의 정확한 정량화가 필요하다. 이에 본 연구에서는 모든 병변 및 장기에 추적자의 흡수율 정량화가 가능한 SPECT/CT의 Q-Metrix (GE Healthcare, USA)프로그램을 활용하여 실제로 많이 이용되고 있는 평면영상의 두 가지 결과 산출 방법에 대한 상관관계 및 각 엽의 차이를 비교 평가하고자 한다. Discovery NM/CT 670 scanner (GE Healthcare, USA)장비에서 2015년 5월 1일부터 2016년 9월 13일까지 수술 전 폐암환자 50명을 대상으로 시행하였다. 환자에 대하여
2019년 3월 미세먼지 비상저감조치가 일주일 동안 발령되면서, 미세먼지로 인한 국민의 불안감은 점차 가중되고 있다. 본 연구는 공기정화식물이 적용된 바이오필터의 다중이용시설 내 적용성 평가를 위해 입자상 오염원의 실내 연속방출환경을 조성하여 오염원 저감효과에 대한 측정방법을 제안하고, 시스템의 실내공기질 개선 여부를 확인할 수 있는 기초연구를 진행하였다. 강의실을 대상으로 춘절기에 모니터링 1시간 전 모기향을 오염원으로 배경농도를 조성한 후, 스케줄에 따라 2시간 관수, 1시간 송풍하여 미세먼지의 저감능을 확인하였으며, 바이오필터 2m 전방에 PM10, PM2.5 및 온습도 센서를 설치하고, 3개 송풍구 중 중앙에 풍속 프로브를 설치하여 시계열 모니터링을 수행하였다. 바이오필터에 구비된 총 3개소의 송풍구 평균 면풍속은 0.38±0.16 m/s로 댐퍼 면적이 제외된 송풍구별 면적 0.29m×0.65m을 적용한 총 공조풍량이 776.89±320.16㎥/h로 산출되었다. 시스템 가동으로 평균온도 21.5~22.3℃, 평균상대습도 63.79~73.6%를 유지하여, 선행연구의 다양한 조건별 온습도 범위에 부합하는 것으로 판단된다. 시스템 공조부 구동을 통해 급격하게 상대습도를 상승시키는 효과를 효율적으로 운용할 경우, 계절에 따른 실내 미세먼지 저감과 적정한 상대습도 확보도 가능할 것으로 판단된다. 미세먼지 농도는 바이오필터 시스템 가동 전의 모든 주기에서 상승 현상이 동일하게 집계되었으며, 시스템 가동 후 1주기 송풍구간(B-1, β=-3.83, β=-2.45)에서 미세먼지(PM10)는 최대 28.8% 수준인 560.3㎍/㎥, 초미세 먼지(PM2.5)는 최대 28.0% 수준인 350.0㎍/㎥까지 저감되었다. 이후 미세먼지(PM10, PM2.5)의 농도는 2주기 송풍구간 감소(B-2, β=-5.50, β=-3.30)로 각각 최대 32.6% 수준인 647.0㎍/㎥, 32.4% 수준인 401.3㎍/㎥까지 저감되었고, 3주기 송풍구간감소(B-3, β=5.48, β=-3.51)로 최대 30.8% 수준인 732.7㎍/㎥, 31.0% 수준인 459.3㎍/㎥까지 저감된 것으로 확인되었다. 본 연구는 식생 바이오필터의 다중이용시설 내 설치와 유관한 관련 표준 및 규정을 참조하여, 객관적인 성능평가환경의 구축 방안을 제시할 수 있었다. 이를 통해 일반 강의실 환경 내에 보다 객관화된 모니터링 인프라를 조성하여, 상대적으로 신뢰성 있는 데이터 확보가 가능했던 것으로 판단된다.