• Journal of Trauma and Injury
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• 제35권1호
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• pp.25-33
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• 2022

Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0-1 (age and Injury Severity Score) or 0-3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0-11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018-1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.

• Environmental Analysis Health and Toxicology
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• 제25권3호
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• pp.181-186
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• 2010

Perfluorinated Compounds (PFCs) are anthropogenic compounds found in trace amounts in many environmental compartments far from areas of production. Along with the highly persistent nature of PFCs, there are increasing concerns over the potential adverse effects of them on the ecosystems. Most of highly fluorinated compounds degrade into PFOS and PFOA that are very stable compounds hard to break down. So, in this study, we tried to determine the toxicity of PFOS and PFOA in the terrestrial invertebrate. Acute toxicity test using earthworm, Eisenia fetida, was performed according to the OECD test guideline 207 (Earthworm, Acute Toxicity Tests). In the 14 day acute toxicity tests, the highest concentration causing no mortality and the lowest concentration causing 100% mortality of PFOS were 160 and 655 mg/kg (dry weight), respectively. And the highest concentration causing no mortality and the lowest concentration causing 100% mortality were 500 and 1,690 mg/kg (dry weight), respectively in the PFOA-exposure group. 14 day-LC50 values were estimated at the level of 365 and 1,000 mg/kg (dry weight) in the PFOS and PFOA-exposed group. These results indicate that under laboratory conditions PFOS is about 3 times more toxic to earthworms than PFOA. Based on known environmental concentrations of PFOS in the soil of Korea, which occur in the 0.42~0.73 ng/L range, there is no apparent risk to terrestrial invertebrate, earthworms. However, further work is required to investigate long-term effects on these and other terrestrial organisms.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.32.1-32.6
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• 2016

Background: This study aimed to analyze and describe the morbidity and mortality associated with tracheostomy in patients with oral cancer and to identify the risk factors associated with tracheostomy complications. Methods: We performed a retrospective chart review of patients who underwent tracheostomy during a major oral cancer resection between March 2001 and January 2016 at the National Cancer Center, Korea. Overall, we included 51 patients who underwent tracheostomy after oral cancer surgery. We assessed the morbidity and mortality of tracheostomy and determined the risks associated with tracheostomy complications. Results: Twenty-two tracheostomy-related complications occurred in 51 patients. The morbidity and mortality rates were 35.2 % (n = 18) and 0 % (n = 0), respectively. Tracheostomy-related complications were tracheitis (n = 4), obstructed tracheostomy (n = 9), displaced tracheostomy (n = 5), air leakage (n = 1), stomal dehiscence (n = 1), and decannulation failure (n = 2). Most complications (19/22) occurred during the early postoperative period. Considering the risk factors for tracheostomy complications, the type of tube used was associated with the occurrence of tracheitis (p < 0.05). Additionally, body mass index and smoking status were associated with tube displacement (p < 0.05). However, no risk factors were significantly associated with obstructed tracheostomy. Conclusions: Patients with risk factors for tracheostomy complications should be carefully observed during the early postoperative period by well-trained medical staff.

• 디지털융복합연구
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• 제11권5호
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• pp.371-384
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• 2013

본 연구에서는 한국 및 미국의 퇴원환자 자료를 이용하여 한국 및 미국의 중증도 보정 사망 모형을 개발하고 개발된 중증도 보정 사망모형에 따라 중증도 보정 사망률 지표를 산출 및 비교한 다음 이를 통해 국내 의료기관 사망률 관리 방안을 제시하고자 하였다. 한국 및 미국 의료기관의 중증도 보정 사망 모형은 데이터마이닝기법인 다중 로지스틱회귀분석 기법, 의사결정나무분석 기법을 이용하여 개발하였다. 개발된 의료기관의 중증도 보정 사망모형에 따라 한국 및 미국 의료기관의 중증도 보정 사망률을 산출한 결과 한국은 매년 증가하고 있는 반면 미국은 매년 감소하고 있는 것으로 나타나 한국과 미국간에 차이가 있었다. 의료기관의 병상규모별 중증도 보정 사망률의 변이 또한 한국이 미국보다 높았다. 국내 의료기관의 사망률 관리를 위해서는 의료기관 자체내에서 사망환자 관리가 가능한 대형 의료기관들의 경우 의료기관 중증도 보정 사망률 평가 결과 공개를 통해 지속적으로 사망률 관리를 유도하고, 의료기관 자체내에서 사망률 관리가 힘든 중소병원들은 국가 차원에서 파악한 국내 의료기관 사망환자 관리의 문제점 및 이를 개선할 수 있는 개선방안을 토대로 사망률 관리 컨설팅을 시행하는 등 의료기관 사망환자 관리 사업을 진행하여야 한다.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1159-1164
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• 1998

배경: 수술수기와 심근보호법의 발달로 인하여 최근 관상동맥우회로 이식술의 수술성적이 향상되고 있지만 술후 사망과 이환에 직면하고 있는 일부 환자들은 점점 증가하고 있어 수술후 이환과 사망에 대한 관심이 높아지고 있다. 대상 및 방법: 저자들은 관상동맥우회로 이식술을 받은 총 137명을 대상으로 술전 위험요인과 술후 이환 및 사망(이하 이환)과의 관계를 후향적으로 조사하였다. 수술전 위험요인으로는 나이, 성별, 술전심근경색, 응급수술, 좌심실박출계수, 비만 그리고 3혈관 질환 등 7개의 변수를 선택하였으며 수술후 이환은 부정맥, 상처감염, 뇌손상, 술후입원기간의 장기화, 폐렴, 급성신부전증, 인공호흡기의 장기간 사용 그리고 수술사망 등으로 하고 이중 하나만 발생하여도 이환이 있다고 간주하였다. 결과: 전체 환자의 평균 나이는 56.7세였고, 27세부터 74세까지의 분포를 보였다. 전체 환자의 수술사망률은 6.6%였고 이중 계획수술은 3.9%(5/128), 응급 또는 긴급수술은 44.4%(4/9)의 사망률을 보였다. 65세 이상의 환자에서 이환율은 65세 미만의 환자보다 통계적으로 유의하게 높았다. 성별에 의한 이환율의 차이는 없었으나 수술 사망률은 여자(5/41, 12.19%)에게서 남자(4/96, 4.17%)보다 더 높게 나타났다. 응급수술의 이환율은 100%로 계획수술의 환자에서보다 유의하게 높게 나타났다. 술전 좌심실 박출계수가 50% 미만인 환자에서 50% 이상인 환자보다 사망률이 유의하게 높게 나타났다. 결론: 결론적으로 관상동맥우회로 이식술 후 이환의 위험요인은 65세 이상의 고령과 응급 또는 긴급수술이었고 수술사망의 위험요인은 50% 미만의 술전 좌심실 박출계수와 응급 또는 긴급수술이었다.

• Clinical and Experimental Pediatrics
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• 제48권7호
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• pp.685-690
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• 2005

Recently, twinning rate increases in Korea since the early 1990s by delayed marriage and prevailing of assisted reproductive technology. But twin and higher-order multiples are at increased risk for perinatal and neonatal mortality over 5 fold despite of dramatic improvement of perinatal and neonatal care. Because twins are born more prematurely and have lower birth weights than singleton. In addition, twins are at increased risk for cerebral palsy mainly in monochorionic twins due to co-twin fetal death, twin to twin transfusion and congenital anomaly. So, this article reviews the factors contributing to the mortality and morbidity of the twins and the efforts to decrease the neonatal mortality of twins.

• Journal of Preventive Medicine and Public Health
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• 제45권5호
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• pp.323-328
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• 2012

Objectives: Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future. Methods: We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time. Results: All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women. Conclusions: The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

• Korean Journal of Radiology
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• 제23권10호
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• pp.998-1008
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• 2022

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion: Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

• Journal of Chest Surgery
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• 제37권3호
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• pp.235-244
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• 2004

동맥전환술은 대혈관전위증이나 Taussig-Bing 기형의 가장 보편적인 수술법으로 인정되고 있다. 동맥전환술 후 수술사망에 영향을 미치는 위험인자와 함께 관상동맥 이식 수기변형의 유효성을 알아보고자 하였다. 1994년부터 2002년 7월까지 동맥전환술을 동아대학교 병원에서 한 명의 외과의에 의하여 시행된 85예의 대혈관전위증과 양대혈관 우심실기시증 환아를 대상으로 후향적 조사를 하였다. 관상동맥이식 수기변형 등 수술(병원)사망에 관여한다고 생각하는 여러 인자들을 다변량 회귀분석을 통해 수술사망에 미치는 위험인자들을 파악하였다. 전체 수술사망(병원사망)은 모두 17예(20%)였으며 수술사망률이 98년 이전은 31.0% (13/42), 98년 이후는 9.3% (4/43)로 감소하였다. 대동맥궁 기형을 동반하지 않은 경우는 전체 사망률이 12.5% (9/72)였으나 동반된 경우는 61.5% (8/13)로 높은 사망률을 보였다. 관상동맥이식 수기변형을 하지 않은 경우 사망률은 28.1%(18/64)를 보인 반면 관상동맥이식 수기변형을 한 경우는 4.8% (1/21)로 많은 사망률의 감소가 관찰되었다. 다변량 회귀분석에서 심폐기가동시간($\geq$ 250분), 대동맥차단시간($\geq$ 150분), 대동맥궁기형이 동반된 경우, 수술 전 사건(event)이 있었던 경우, 개방 관상동맥 이식술(open coronary reimplantation technique)이 수술사망의 위험인자로 파악되었다. 동맥전환술의 수술사망률은 수술시기가 경과함에 따라 감소하였으며, 대동맥궁 기형의 동반과 술 전 사건(event)이 수술사망의 중요 위험인자였다. 비전형적 관상동맥 형태는 수술사망의 위험요소가 아니었으며 관상동맥 이식의 수기변형이 수술사망을 낮추는 데 매우 유효하였던 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제43권3호
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• pp.279-282
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• 2010

Objectives: This study investigates whether Korean news media pay more attention to emerging diseases than chronic ones, and whether they closely follow the changes in the magnitude of health risks of chronic or well-known diseases. These two features are expected to appear as the result of surveillance function served by health journalism that should be the main source of the public's risk perception. Methods: The number of stories published in 10 newspapers containing the words, 'SARS,' 'Bovine Spongiform Encephalopathy,' 'Avian Influenza,' and 'Influenza A virus' was compared with the number of stories on chronic or wellknown diseases. We also counted the annual number of stories, published in a 12-year period, containing following terms: 'cancer,' 'diabetes,' 'hypertension,' 'pneumonia,' and 'tuberculosis.' The number was compared with the actual mortality of each disease. Results: Although cancer represented the primary cause of mortality, the newspapers covered key emerging diseases more than cancer or other well-known diseases. Also, media coverage of 'pneumonia' and 'tuberculosis' did not vary in accordance with changes in the mortality of each disease. However, the news media coverage did vary in accordance with the mortality of 'cancer,' 'diabetes,' and 'hypertension.' Conclusions: Korean health journalism was found to have both strong and weak points. The news media reduced the relative level of attention given to pneumonia and tuberculosis. Bearing in mind the major influence of news coverage on risk perception, health professionals need to be more proactive about helping to improve Korean health journalism.