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The Prognostic Value of the First Day and Daily Updated Scores of the APACHE III System in Sepsis (패혈증환자에서 APACHE III Scoring System의 예후적 가치)

  • Lim, Chae-Man;Lee, Jae-Kyun;Lee, Sung-Soon;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Hwan;Choi, Jong-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.871-877
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    • 1995
  • Background: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. Methods: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1(D1), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the D1 score, and also in respect to the changes of the updated D2 and D3 scores. Results: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older($62.7{\pm}12.6$ vs $51.1{\pm}18.1$ yrs), presented with lower mean arterial pressure($56.9{\pm}26.2$ vs $67.7{\pm}14.2\;mmHg$) and showed greater number of multisystem organ failure($1.2{\pm}0.8$ vs $0.2{\pm}0.4$) than the survivors(p<0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The D1 score was lower in the survivors (n=21) than in the nonsurvivors ($44.1{\pm}14.6$, $78.5{\pm}18.6$, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (D1 vs D2, $44.1{\pm}14.6$ : $37.9{\pm}15.0$, p=0.035; D2 vs D3, $37.9{\pm}15.0$ : $30.1{\pm}9.3$, p=0.0001) but showed a tendency to increase in the nonsurvivors (D1 vs D2 (n=21), $78.5{\pm}18.6$ : $81.3{\pm}23.0$, p=0.1337; D2 vs D3 (n=11), $68.2{\pm}19.3$ : $75.3{\pm}18.8$, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, $53.8{\pm}10.0$ in the survivors, $55.3{\pm}10.3$ in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(D1 vs D2, $53.3{\pm}10.0$ : $43.6{\pm}16.4$, p=0.0278; D2 vs D3, $43.6{\pm}16.4$ : $31.2{\pm}10.3$, p=0.0005), but showed a tendency to increase in the nonsurvivors(D1 vs D2 (n=6), $55.3{\pm}10.3:66.7{\pm}13.9$, p=0.1562; D2 vs D3 (n=4), $64.0{\pm}16.4:74.3{\pm}18.6$, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors ($5.5{\pm}2.9$ vs $1.9{\pm}3.7$, p=0.046) in this group. Conclusion: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.

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Talc Mineralization in the Middle Ogcheon Metamorphic Belt (I): with Emphasis of the Stable Isotope Studies of the Dongyang Talc Deposit (중부 옥천변성대내의 활석광화작용 (I): 동양활석광상의 안정동위원소연구를 중심으로)

  • Park, Hee-In;Lee, Insung;Hur, Soondo
    • Economic and Environmental Geology
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    • v.28 no.6
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    • pp.635-646
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    • 1995
  • Mineralized zone in the Dongyang talc deposits occurs on the lowest dolomite member of the Hyangsanri Dolomite belonging to the Ogcheon Supergroup. Ore bodies are emplaced as pipe-like body along the axis of minor folds plunging $40^{\circ}$ to the west developed in these dolomite layers. Amphibolite and chlorite schist are found along the upper or lower contact of all ore bodies (Kim et al., 1963; Park and Kim, 1966). Following the recrystallization and silicification of dolomite, tremolite and tabular and leafy talc(I) of the earlier stage formed, and microcrystalline talc(II) formed in the later stage. Talc(l) and tremolite formed by the reaction between dolomite and the fluid. Whereas talc (II) formed by the reaction between dolomite and fluid, or by the reaction between early formed tremolite and fluid. During the early stage of mineralization, the fluid was the $H_2O-CO_2$ system dominant in $CO_2$, In the later stage, the composition of the fluid changed to $H_2O-NaCl-CO_2$system, and finally to the $H_2O-NaCl$ system. The pressure and temperature conditions of the formation of tremolite associated with talc(I) were 1,640~2,530 bar, and $440{\sim}480^{\circ}C$, respectively. The pressure and temperature condition of talc(II) ore formation was 1,400~2,200 bar, and $360{\sim}390^{\circ}C$, respectively. These conditions are much lower than the metamorphic pressure and temperature of the rocks from the Munjuri Formation located about 5 km to the noJ:th of Dongyang talc deposit ${\delta}^{13}C$ and ${\delta}^{18}O$ values of dolomite which is the host rock of the talc ore deposit are 2.9~5.7‰ (PDB), and -7.4~l6.8‰ (PDB), respectively. These values are little higher than those from the Cambro-Ordovician limestones of the Taebaeksan region, but belong to the range of the unaltered sedimentary dolomite. ${\delta}^{18}O$and ${\delta}D$ values of the talc from Dongyang deposit are 8.6~15.8‰ (vs SMOW), and -65~-90‰ (vs SMOW), respectively, belonging to the range of magmatic origin. These values are quite different from those measured in the metamorphic rocks of Munjuri and Kyemyungsan Formation. ${\delta}^{34}S$ value of anhydrite is 22.4‰ (CDT), which is much lower than ${\delta}^{34}S$ (30‰ vs COT) of sulfate of early Paleozoic period, and indicates the possibility of the addition of magmatic sulfur to the system. Talc ores show the textures of weak foliation and well developed crenulation cleavages. Talc ore deposit in the area is concluded as hydrothermal replacement deposit formed before the latest phase of the deformations that Ogcheon Belt has undergone.

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Reproducibility Evaluation of Deep inspiration breath-hold(DIBH) technique by respiration data and heart position analysis during radiation therapy for Left Breast cancer patients (좌측 유방암 환자의 방사선치료 중 환자의 호흡과 심장 위치 분석을 통한 Deep inspiration breath-hold(DIBH) 기법의 재현성 평가)

  • Jo, Jae Young;Bae, Sun Myung;Yoon, In Ha;Lee, Ho Yeon;Kang, Tae Young;Baek, Geum Mun;Bae, Jae Beom
    • The Journal of Korean Society for Radiation Therapy
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    • v.26 no.2
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    • pp.297-303
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    • 2014
  • Purpose : The purpose of this study is reproducibility evaluation of deep inspiration breath-hold(DIBH) technique by respiration data and heart position analysis in radiation therapy for Left Breast cancer patients. Materials and Methods : Free breathing(FB) Computed Tomography(CT) images and DIBH CT images of three left breast cancer patients were used to evaluate the heart volume and dose during treatment planing system( Eclipse version 10.0, Varian, USA ). The signal of RPM (Real-time Position Management) Respiratory Gating System (version 1.7.5, Varian, USA) was used to evaluate respiration stability of DIBH during breast radiation therapy. The images for measurement of heart position were acquired by the Electronic portal imaging device(EPID) cine acquisition mode. The distance of heart at the three measuring points(A, B, C) on each image was measured by Offline Review (ARIA 10, Varian, USA). Results : Significant differences were found between the FB and DIBH plans for mean heart dose (6.82 vs. 1.91 Gy), heart $V_{30}$ (68.57 vs. $8.26cm^3$), $V_{20}$ (76.43 vs. $11.34cm^3$). The standard deviation of DIBH signal of each patient was ${\pm}0.07cm$, ${\pm}0.04cm$, ${\pm}0.13cm$, respectively. The Maximum and Minimum heart distance on EPID images were measured as 0.32 cm and 0.00 cm. Conclusion : Consequently, using the DIBH technique with radiation therapy for left breast cancer patients is very useful to establish the treatment plan and to reduce the heart dose. In addition, it is beneficial to using the Cine acquisition mode of EPID for the reproducibility evaluation of DIBH.

Complications and Perinatal Factors According to the Birth Weight Groups in the Infants of Diabetic Mothers (당뇨병 산모아에서 출생 체중군에 따른 합병증 및 주산기 인자)

  • Son, Kyung-Ran;Back, Hee-Jo;Cho, Chang-Yee;Choi, Young-Youn;Song, Tae-Bok;Park, Chun-Hak
    • Clinical and Experimental Pediatrics
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    • v.46 no.5
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    • pp.447-453
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    • 2003
  • Purpose : This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). Methods : Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. Results : Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. Conclusion : In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.

Differential Relations of Depression, Anxiety and Sleep Disturbances by Gender in Young Adolescents (청소년에서 우울 및 불안 증상과 수면 곤란의 성별에 따른 차별적 관련성)

  • Kim, Eun-Jin;Kang, Su-Gyeong;Moon, Myeong-Sung;Lim, Se-Won;Oh, Kang-Seob
    • Korean Journal of Psychosomatic Medicine
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    • v.18 no.2
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    • pp.62-71
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    • 2010
  • Objectives : The aim of the study was to investigate the prevalence by gender and to evaluate associations of depression, anxiety and sleep disturbances in a large sample of adolescents from the general population. Methods : 1422 subjects, aged 14 years students were recruited in the seven middle-school of the local community. The self-report questionnaire(Children's Depression Inventory : CDI, Beck Anxiety Inventory : BAI and Pittsburgh Sleep Quality Index : PSQI) was used for screening depression, anxiety and sleep disturbances in adolescent. CDI, BAI, and PSQI score was categorized into the following quartiles : $\leq$21, 22-25, 26-28, and $\geq$29 ; $\leq$21, 22-26, 27-31, and $\geq$32 ; $\geq$5, <5. The cut-off score is that CDI is 22, BAI is 22 and PSQI is 5. The result was analyzed using the independent t-test, the chi-square test and logistic regression analyses. Results : The mean CDI score($12.52{\pm}8.32$ vs. $10.39{\pm}7.52$ ; p=0.003), BAI($7.77{\pm}7.93$ vs. $9.84{\pm}9.04$ ; p<0.001) and PSQI($4.57{\pm}2.67$ vs. $3.64{\pm}2.30$ ; p=0.013) of girls were significantly higher than for boys. But, boys in the fourth quartile of CDI(CDI$\geq$29) and BAI(BAI$\geq$32) were at significantly elevated risk for sleep disturbances more than for girls after adjustment for sex, history of psychiatric treatment(CDI odd ratio, 14.66 ; 95% CI, 4.17-51.53, BAI odd ratio, 32.99 ; 95% CI, 4.26-255.39). Conclusion : The results suggest that high CDI, BAI score appears to increase the risk for developing sleep disturbances in boys more than girls.

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Urinary Excretion of Various Urinary Proteins in Children with Vesicoureteral Reflux (방광요관 역류증 환아에서의 다양한 요단백의 배설)

  • Jung, Da Eun;Koo, Ja Wook
    • Clinical and Experimental Pediatrics
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    • v.46 no.10
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    • pp.977-982
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    • 2003
  • Purpose : This study aimed to examine the excretion of various urinary proteins in children with a history of urinary tract infection(UTI), with or without vesicoureteral reflux(VUR) or reflux nephropathy, and to identify means of predicting the severity of VUR or the presence of reflux nephropathy as indicated by these markers, and to know how these markers are changed after resolution of VUR. Methods : We studied 30 children with previous UTI, without VUR and renal scarring(group I), 12 children with VUR, without evidence of renal scarring(group II), and 34 children with VUR and renal scarring(group III). 24-hour or 12-hour urine ${\beta}_2$ microglobulin(${\beta}_2$ MG), microalbumin and N-acetyl-${\beta}$-D-glucosaminidase(NAG) were measured in each child. Urinary protein excretions were analyzed according to the degree of VUR(mild VUR : a grade reflux I-III, severe VUR : a grade reflux IV-V). Cases of bilateral VUR were graded by the higher grade of reflux detected. A total of 46 children with primary VUR were followed. Among these patients, VUR was completely resolved in 16 children. Voiding cystourethrography(VCUG) and DMSA scan were performed every year. Values for urinary markers were estimated every year. Results : 24 or 12 hour urine microalbumin and NAG excretions were significantly increased in group III compared to group I(microalbumin : $27.7{\pm}26.0mg/gCr$ vs $15.0{\pm}10.7mg/gCr$, P<0.05, NAG : $15.2{\pm}18.7U/gCr$ vs $3.4{\pm}2.2U/gCr$, P<0.05). Urinary ${\beta}_2$ MG excretions were not significantly different between groups. Urinary NAG excretions were elevated in the group of children with severe VUR compared to mild VUR($26.8{\pm}27.1U/gCr$ vs $7.6{\pm}3.8U/gCr$, P<0.05). After resolution of VUR, urinary microalbumin and NAG excretions were decreased(P<0.05). Conclusion : Urinary microalbumin and NAG may be useful clinical indicators to predict the presence of reflux nephropathy and the resolution of VUR. Especially, urinary NAG excretions may be used as a possible method to predict the severity of VUR.

Pilot Study for the Prediction of Response to Radiotherapy Using [$^{18}F$]Fluorothymidine PET in Nasopharyngeal Cancer: Comparison with [$^{18}F$]FDG PET (비인두암에서 [$^{18}F$]Fluorothymidine PET을 이용한 방사선치료 반응도 예측을 위한 예비 연구: [$^{18}F$]FDG PET와의 비교)

  • Baek, So-Ra;Chae, Sun-Young;Kim, Hye-Ok;Lee, sang-Wook;Oh, Seung-Jun;Im, Ki-Chun;Moon, Dae-Hyuk;Kim, Jae-Seung;Ryu, Jin-Sook
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.6
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    • pp.535-542
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    • 2009
  • Purpose: This study was performed to know whether [$^{18}F$]Fluorothymidine (FLT) positron emission tomography (PET) can be used to monitor early response to radiotherapy in comparison with [$^{18}F$]Fluorodeoxyglucose (FDG) PET, and to establish the optimal imaging time for prediction of therapy response. Materials and Methods: Two patients with nasopharyngeal cancer underwent serial FLT PET and FDG PET before and during radiotherapy. Three on-treatment FLT and FDG PET scans were performed on 1 week, 2 weeks and 3 weeks (at each time of 10 Gy, 20 Gy and 30 Gy delivered). The peak standardized uptake values ($SUV_{peak}$) of primary tumors were measured on FLT and FDG PET. Then, percent changes of $SUV_{peak}$ after therapy were calculated. Results: In two patients, baseline values of $SUV_{peak}$ on FDT PET were higher than those on FLT PET (FLT vs FDG; 3.7 vs 5.0, and 5.7 vs 15.0). In patient 1, FLT $SUV_{peak}$ showed 78%, 78% and 84% of decrease on 1 week, 2 and 3 weeks after treatment, whereas FDG $SUV_{peak}$ showed 18%, 52% and 66% of decrease, respectively. In patient 2, FLT $SUV_{peak}$ showed 75%, 75% and 68% of decrease, whereas FDG $SUV_{peak}$ showed 51%, 49% and 58% of decrease, respectively. Both patients reached to complete remission after radiotherapy. Conclusion: After radiotherapy, the decrease of FLT tumor uptake preceded the decrease of FDG tumor uptake in patients with nasopharyngeal cancer, and 1 week after therapy may be appropriate time for the assessment of early response. FLT PET might be more useful than FDG PET for monitoring early response to radiotherapy.

Clinical Characteristics and Prognosis of Acinetobacter Nosocomial Pneumonia between MDR and non-MDR (Acinetobacter 병원내 폐렴에서 다제 내성군과 약제 감수성군 간의 임상적 특징과 예후)

  • Park, In-Il;Kim, Ick-Keun;Koo, Hyun-Cheol;Han, Jae-Pil;Kim, Young-Mook;Lee, Myung-Goo;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.1
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    • pp.13-19
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    • 2006
  • Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

Effects of environmental enrichments on performance and behavior characteristics of sows during gestating period (환경보조물이 임신모돈의 생산성 및 행동특성에 미치는 영향)

  • Jeong, Yong-Dae;Kim, Doo-Wan;Min, Ye-Jin;Jung, Hyun-Jung;Cho, Eun-Seok;Kim, Young-Hwa
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.4
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    • pp.428-434
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    • 2019
  • Many countries have interested animal welfare. Similarly, domestic people have concern for the welfare from companion animals to livestock. Environmental enrichments (EE) are tool to enforce the welfare, however, research with sows is limited. Therefore, this study was investigate to effects of environmental enrichments on performance and behavior properties of gestating sows. A total of 30 pregnant sows (Landrace) were assigned into three treatments that control, T1 (plastic device) and T2 (Rice straw). Period of trial was from Mar. 03. 18. to Mary 19. 18. The EE were allotted to center of experimental pen ($11.6{\times}6.0m$). Body weight (BW), backfat thickness (BF) and cortisol were identified at experimental initial or end date. Behavior was recorded during 24 hours on days 91 of gestation, and then analyzed the patterns. BF was reduced (15.73 vs. 16.56 mm; p>0.05) in T1 than control, but Ending BW, total litter size and alive piglets did not differ. Born dead piglets showed lower tendency (1.00 and 0.63 vs. 1.50 heads; p>0.05) in T1 and T2 than control. Similarly, the enrichments declined farrowing mortality (C, 8.68%; T1, 6.86%; T2, 3.40%; p>0.05). Cortisol was not differed among treatments. In the behavior characteristics, eating showed lower (1.81 vs. 9.68 and 6.99%; p<0.05) in T2 than control and T1. Furthermore, playing or digging were only observed (0.33 and 2.10%; p<0.05) in T1 and T2, respectively, whereas rubbing (0.91%, p<0.05) only showed in the control. These results suggest that the provision of EE would be not negatively affected the performance of the gestating sows and could be led to improvement of the livestock welfare.

The Evaluation of Optimized Inversion-Recovery Fat-Suppression Techniques for T2-Weighted Abdominal MR Imaging : Preliminary report (복부의 T2강조 영상에서 지방소거기법의최적의 평가)

  • Lee, Da-Hee;Goo, Eun-Hoe
    • Korean Journal of Digital Imaging in Medicine
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    • v.14 no.1
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    • pp.31-35
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    • 2012
  • To test the real image quality of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) techniquein clinical abdominal MRI by comparison to turbo spin echo inversion-recovery (TSEIR) fat-suppression (FS) technique. 3.0T MRI studies of the abdomen were performed in 30 patients with liver lesions (hemangiomas n: 15; HCC n: 15). T2W sequences were acquired using SPAIR TSEIR. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects. SPAIR-TSEIR images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR were 20.5, 10.2 and TSEIR were 43.2, 24.1 (P<0.05). SPAIR-TSEIR images produced higher CNR for both hemangiomas CNR 164.88 vs 126.83 (P<0.05) and metastasis CNR 75.27 vs 53.19 (P<0.05). Bowel wall visualization was significantly improved using in both SPAIR-TSEIR (P< 0.05). The real image quality of SPAIR was better than over conventional TSEIR FS on clinical abdominal MRI scans.

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