• Korean Circulation Journal
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• v.54 no.2
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• pp.63-75
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• 2024

Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. Conclusions: ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.

• Journal of Nutrition and Health
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• v.48 no.4
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• pp.344-351
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• 2015

Purpose: During the recent decades, the age at menarche continued to decline in Korea and worldwide. Prior studies have suggested that early menarche may increase the risk of various social, psychological, and physical health problems in young adolescent girls, but little is known about the determinants associated with early menarche. The purpose of this study is to evaluate independent determinants of early menarche among 5th~6th female graders in South Korea. Methods: Our analysis was conducted in 95 menarcheal girls and 95 age-matched pre-menarcheal girls residing in Daegu, South Korea. Demographic and lifestyle characteristics were collected using survey questionnaires for children and parents. Dietary information was assessed by 2 day~24 hour food records and survey questionnaires, which were completed by both children and their parents. Anthropometric data were obtained from the student health check-ups at the school. Results: A multiple logistic regression analysis using a conditional likelihood method was performed for simultaneous evaluation of several risk factors. There were significant differences in that higher proportion of obesity (OR, odds ratio = 5.60, 95% CI, confidence interval = 1.34~23.42), shorter sleep duration (OR = 0.45, 95% CI = 0.23~0.87), and younger mother's age at menarche (OR = 0.64, 95% CI = 0.44~0.93) were observed in the menarcheal group compared to the pre-menarcheal group. Conclusion: These findings indicate a possible association of sleep duration, mother's menarcheal age, and obesity with age at menarche. A well-planned, prospective cohort study is warranted to examine causal relationship.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.504-508
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• 2004

Surgical process of oral and maxillofacial area as well as dental treatment are stressful situations to the patients. It is well known that serum level of stress hormones including adrenocorticotropic hormone(ACTH) and cortisol increase when the body is exposed to stress. However, there have been few studies on demographic and clinical factors related with stress. Therefore, the purpose of this study was to supply data to cope with stress more comprehensively and efficiently by analyzing the effect of factors related with stress in addition to surgical procedure. Prospective cohort study method was selected. Serum levels of ACTH and cortisol were measured by sampling bloods pre-operatively and post-operatively from 45 patients who had been operated at the Bundang Jesaeng Hospital department of oral and maxillofacial surgery. To evaluate factors associated with stress, patients were classified according to gender, age, method of payment(insurance or self), experiences of operation, kind of operations(expected operations or unexpected operations). Relative risk was calculated to assess relationships between changes of serum level of ACTH and cortisol and factors related with stress, whereas Chi-square analysis was executed to evaluate statistical significance. With regard to serum level of ACTH, relative risk was 1.3 in the group of the patients who were less than 40 years old. With regard to serum level of cortisol, relative risk was 1.8 for women compared with men, 1.4 in the group of the patients who were less than 40 years old and 1.6 in the group of the patients who had not experienced any other operations. In addition to surgical procedure, factors related with stress included gender, age, method of payments, experiences of operation and kind of operations. Therefore, we should provide comprehensive schemes to reduce stress of the patients going through oral and maxillofacial surgery.

• Journal of Nutrition and Health
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• v.46 no.1
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• pp.61-71
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• 2013

The aim of this study was to examine the relationship between dietary variables and the prevalence of insulin resistance (IR) in middle-aged Korean adults using data from the 2007-2009 Korea National Health and Nutrition Examination Survey. Because IR is closely linked with metabolic syndrome, subjects were divided into three groups according to symptoms of metabolic syndrome: the 'Normal group' without any symptoms, the 'Risk group' with one or two symptoms, and the Metabolic syndrome (MetS) group' with three or more symptoms. Subjects between the ages of 30 and 65 years with no prior diagnosis or treatment for diabetes, hypertension, or dyslipidemia were selected. The number of subjects per group was as follows: 2,085 adults in the Normal group, 3,699 adults in the Risk group, and 1,160 adults in the MetS group. Metabolic syndrome was defined according to Adult Treatment Panel III criteria with modified waist circumference cutoff values (men ${\geq}$ 90 cm, women ${\geq}$ 85 cm). Subjects with HOMA-IR > 2.0 were classified as IR. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was calculated using the following formula: (fasting plasma glucose ${\times}$ fasting plasma insulin)/22.5. Nutrients and food groups intake were obtained from a single 24-hour recall. Subjects with IR in the Normal group were more obese and less physically active than non-IR subjects. In the MetS group, subjects with IR were more obese and had a lower prevalence of smoking and drinking, compared with non-IR subjects. Men with IR in the Normal group had a tendency to consume more oils and sugars than non-IR men, while women with IR in the same group had higher intake of carbohydrate, dietary glycemic index, and dietary glycemic load than non-IR women. Women with IR in the Risk group had lower energy intake but higher intake of oils and sugars than non-IR women. In the MetS group, consumption of fruits was higher in subjects with IR than in non-IR subjects. In conclusion, findings of this study suggest that dietary carbohydrate intake, including glycemic index, may be associated with IR in healthy women. Further research in prospective cohort studies in order to examine the effects of dietary carbohydrate on IR incidence will be necessary.

• Radiation Oncology Journal
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• v.31 no.4
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• pp.199-205
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• 2013

Purpose: To assess the clinical efficacy and toxicity of whole pelvic intensity-modulated radiotherapy (WP-IMRT) for high-risk prostate cancer. Materials and Methods: Patients with high-risk prostate cancer treated between 2008 and 2013 were reviewed. The study included patients who had undergone WP-IMRT with image guidance using electronic portal imaging devices and/or cone-beam computed tomography. The endorectal balloon was used in 93% of patients. Patients received either 46 Gy to the whole pelvis plus a boost of up to 76 Gy to the prostate in 2 Gy daily fractions, or 44 Gy to the whole pelvis plus a boost of up to 72.6 Gy to the prostate in 2.2 Gy fractions. Results: The study cohort included 70 patients, of whom 55 (78%) had a Gleason score of 8 to 10 and 50 (71%) had a prostate-specific antigen level > 20 ng/mL. The androgen deprivation therapy was combined in 62 patients. The biochemical failure-free survival rate was 86.7% at 2 years. Acute any grade gastrointestinal (GI) and genitourinary (GU) toxicity rates were 47% and 73%, respectively. The actuarial rate of late grade 2 or worse toxicity at 2 years was 12.9% for GI, and 5.7% for GU with no late grade 4 toxicity. Conclusion: WP-IMRT was well tolerated with no severe acute or late toxicities, resulting in at least similar biochemical control to that of the historic control group with a small field. The long-term efficacy and toxicity will be assessed in the future, and a prospective randomized trial is needed to verify these findings.

• Journal of the Korean Society of Food Science and Nutrition
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• v.43 no.10
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• pp.1467-1476
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• 2014

Recent studies have shown that insufficient or deficient vitamin D status may be linked to increased risk of depressive conditions or depression. The aim of this study was to review all available evidence on vitamin D, depression, and any association between them. Cross-sectional, case-control, and cohort studies have reported contradictory results. Some have reported that low levels of vitamin D may be associated with higher risk of depression or depressive symptoms while others reported that vitamin D status may not be related to depression. Recent clinical trials examining the effects of vitamin D supplementation on depression have also showed discrepant results. However, meta-analysis study results are consistent regarding the beneficial effects of vitamin D. Several mechanisms that account for these beneficial effects of vitamin D on depression have been reported but remain largely speculative. Vitamin D deficiency is very common, and prevalence of depression is increasing in the Asian population, especially females. However, limited literature is available on this population. Considering research results of a potential inverse association between vitamin D level and prevalence of depression, it is important to advance our understanding of the role of vitamin D in depression and conduct well-designed prospective trials in the Asian population.

• Korean Journal of Community Nutrition
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• v.1 no.3
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• pp.376-394
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• 1996

This study evaluated the reproducibility and validity of the self-administered semiquantitative food frequency questionnaire used in a large prospective cohort study(Korean Cancer Research Survey) in middle-aged men. The questionnaire was administered twice at an interval of approximately two years(December, 1992-January, 1995), and four or five 24-hour recalls for each subject were collected at intervals of approximately three months. The results were as follows; 1) Although the distributions of the data estimated by the questionnaire were somewhat wider, the mean nutrient intakes of group estimated by our questionnaires and the multiple 24-hour recalls were roughly comparable. 2) The reproducibility determined by correlation of absolute(unadjusted nutrient intake) and calorie adjusted nutrient intakes from two semiquantitative food frequency questionnaires were more than 0.5, and the weighted kappa values were more than 0.4. 3) The Pearson correlation coefficients between unadjusted nutrient intakes values were average 0.40 on the average(Ca, 0.13-Carbohydrate, 0.58) at the first questionnaire vs. 24-hour recalls, and 0.28 at the second questionnaire vs. 24-hour recalls. The spearman rank order correlation coefficients were similar. When energy intake was adjusted, there was a slight reduction : 0.28 at the second questionnaire, 0.25 average on the second. In order to correct the measurement error of 24-hour recall data, the deattenuated correlation coefficient was calculated. It averaged 0.53 on the first questionnaire, 0.37 on the second questionnaire for unadjusted nutrient intake. for calorie-adjusted nutrient intake, it averaged 0.44 on the first questionnaire, 0.37 on the second questionnarie. 4) There was lower agreement(k<0.4) between the questionnaries and the 24-hour recalls. And the subjects classified in the same quartile by 24-hour recalls and first questionnaire were average 37$\%$(energy-adjusted values) and 40$\%$(unadjusted values) on the average. More than k10$\%$(average) of subjects were in the extreme quartile of the questionnarie and 24-hour recall method. But 8.2$\%$(average) of subjects classified in the lowest quartile of unadjusted nutrient intake level by the 24-hour recalls were in the highest quartile by the first questionnaire. These data indicate that our self-administered semiquantitative food frequency questionnarie is reproducible. Correlation coefficients comparing nutrient intakes measured by two different dietary assessment methods were less than 0.5. The validity of our questionnarie is not high enough.

• KIPS Transactions on Software and Data Engineering
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• v.9 no.4
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• pp.137-144
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• 2020

Delirium is among the most common mental disorders encountered in patients with a temporary cognitive impairment such as consciousness disorder, attention disorder, and poor speech, particularly among those who are older. Delirium is distressing for patients and families, can interfere with the management of symptoms such as pain, and is associated with increased elderly mortality. The purpose of this paper is to generate useful clinical knowledge that can be used to distinguish the outcomes of patients with delirium in long-term care facilities. For this purpose, we extracted the clinical classification knowledge associated with delirium using a local covering rule acquisition approach with the rough lower approximation region. The clinical applicability of the proposed method was verified using data collected from a prospective cohort study. From the results of this study, we found six useful clinical pieces of evidence that the duration of delirium could more than 12 days. Also, we confirmed eight factors such as BMI, Charlson Comorbidity Index, hospitalization path, nutrition deficiency, infection, sleep disturbance, bed scores, and diaper use are important in distinguishing the outcomes of delirium patients. The classification performance of the proposed method was verified by comparison with three benchmarking models, ANN, SVM with RBF kernel, and Random Forest, using a statistical five-fold cross-validation method. The proposed method showed an improved average performance of 0.6% and 2.7% in both accuracy and AUC criteria when compared with the SVM model with the highest classification performance of the three models respectively.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.366-376
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• 2020

Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

• Journal of Hospice and Palliative Care
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• v.20 no.4
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• pp.235-241
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• 2017

Purpose: The Palliative Performance Scale (PPS) is a widely used prognostic tool in patients with advanced cancer. This study examines the association between changes in PPS score and survival in patients with advanced cancer. Methods: We identified a cohort of 606 inpatients who died at a Korean university hospital's hospice/palliative care center. For each patient, the PPS score was measured twice according to a standard procedure: 1) upon admission, and 2) three days after admission (D3). "Change on D3" was defined as a difference between initial PPS and PPS on D3. We used a Cox regression modeling approach to explore the association between this score change and survival. Results: The changes in scores were associated with survival. A score change of >30% yielded a hazard ratio for death of 2.66 (95% CI 2.19~3.22), compared to a score change of ${\leq}30%$. PPS of ${\leq}30$ on D3 also independently predicted survival, with a hazard ratio of 1.67 (95% CI 1.38~2.02) compared to PPS of >30. Conclusion: A change of over 30% in PPS appears to predict survival in hospitalized patients with terminal cancer, even after adjustment for confounders. Changes in PPS may be a more sensitive indicator of impending death than a single PPS measured on the day of admission in terminal cancer patients. Further prospective study is needed to examine this important finding in other populations.