• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.1
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• pp.16-25
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• 2016

Purpose: Patients suffering from acute poisoning by different substances often visit the emergency department (ED) and receive various prognoses according to the toxic material and patients' condition. Hyperlactatemia, which is an increased blood lactate level that generally indicates tissue hypoperfusion, is commonly utilized as a prognostic marker in critically ill patients such as those with sepsis. This study was conducted to investigate the relationships between blood lactate and clinical prognosis in acute poisoned patients. Methods: This retrospective study was conducted from January 2013 to June 2014 at a single and regional-tertiary ED. We enrolled study patients who were examined for blood test with lactate among acute intoxicated patients. The toxic materials, patient demographics, laboratory data, and mortalities were also reviewed. Additionally, we analyzed variables including blood lactate to verify the correlation with patient mortality. Results: A total of 531 patients were enrolled, including 24 (4.5%) non-survivors. Patient age, Glasgow coma scale (GCS), serum creatinine (Cr), aspartate transaminase (AST), and serum lactate differed significantly between survivors and non-survivors in the binary logistic regression analysis. Among these variables, GCS, AST, and lactate differed significantly. The median serum lactate levels were 2.0 mmol/L among survivors and 6.9 mmol/L among non-survivors. The AUC with the ROC curve and odds ratio of the initial serum lactate were 0.881 and 3.06 (0.89-8.64), respectively. Conclusion: Serum lactate was correlated with fatalities of acute poisoning patients in the ED; therefore, it may be used as a clinical predictor to anticipate their prognoses.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.18 no.2
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• pp.79-88
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• 2015

Preparations need to be made for Korean pine(Pinus koraiensis) in anticipation of climate change because Korean pine is an endemic species of South Korea and the source of timber and pine nut. Therefore, climate change adaptation policy has been established to conduct an impact assessment on the distribution of Korean pine. Our objective was to predict the distribution of Korean pine while taking into account uncertainty and afforestation conditions. We used the 5th forest types map, a forest site map and BIOCLIM variables. The climate scenarios are RCP 4.5 and RCP 8.5 for uncertainty and the climate models are 5 regional climate models (HadGEM3RA, RegCM4, SNURCM, GRIMs, WRF). The base period for this study is 1971 to 2000. The target periods are the mid-21st century (2021-2050) and the end of the 21st century (2071-2100). This study used the MaxEnt model, and 50% of the presences were randomly set as training data. The remaining 50% were used as test data, and 10 cross-validated replicates were run. The selected variables were the annual mean temperature (Bio1), the precipitation of the wettest month (Bio13) and the precipitation of the driest month (Bio14). The test data's ROC curve of Korean pine was 0.689. The distribution of Korean pine in the mid-21st century decreased from 11.9% to 37.8% on RCP 4.5 and RCP 8.5. The area of Korean pine at an artificial plantation occupied from 32.1% to 45.4% on both RCPs. The areas at the end of the 21st century declined by 53.9% on RCP 4.5 and by 86.0% on RCP 8.5. The area of Korean pine at an artificial plantation occupied 23.8% on RCP 4.5 and 7.2% on RCP 8.5. Private forests showed more of a decrease than national forests for all subsequent periods. Our results may contribute to the establishment of climate change adaptation policies for considering various adaptation options.

• Journal of Environmental Health Sciences
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• v.40 no.6
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• pp.492-501
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• 2014

Objectives: The purpose of this study was to assess the validity of self-reported cigarette smoking status and investigate factors associated with the accuracy self-reported and measured urinary cotinine in Korean adults. Methods: We used data from the $1^{st}$ Korean National Environmental Health Survey (2009-2011) among adults aged ${\geq}19$ years (N=6,246). The survey examined self-reported smoking status, and urinary cotinine was regarded as the biomarker of exposure to tobacco smoke. Urinary cotinine was analyzed using a gas chromatography-mass spectrometry (GC/MS) and data analysis was conducted using IBM SPSS version 20.0, which uses the sample weight and calculates variance estimates to adjust for the unequal probability of selection into the survey. Results: We calculated a cut-off point (53.3 ug/L) by using a ROC (Receiver Operating Characteristic) curve. The smoking prevalence was 24.6% based on self-reported data and 28.2% based on urinary cotinine concentrations. When we assessed the agreement between self-reported and urinary cotinine, we found an average agreement of 97.7% among self-reported smokers and 94.5% among self-reported non-smokers. Among self-reported smokers, factors affected the discrepancy were age, household economic status and average number of cigarettes smoked per day. On the other hand, gender, former smoking experience, and exposure to SHS (second hand smoke) were associated with discrepancies among self-reported non-smokers. Conclusion: These results suggest that self-reported data on smoking status provide a valid estimate of actual smoking status. In future research, we will conduct a continuous monitoring study for reliability verification of the data to reduce potential interpretation errors.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.5043-5047
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• 2015

Background: Relatively little is known with certainty about the status and role of p53 or MDM2 in predicting prognosis and survival of renal cell carcinoma. The present study aimed to determine the value of P53 and MDM2 over-expression, alone and simultaneously, to predict five-year survival of patients with kidney cancer in Iran. Materials and Methods: Patients with kidney cancer referred to Hasheminejad Kidney Center between 2007 and 2009, underwent radical nephrectomy and had pathology reports of clear cell, papillary or chromophobe renal cell carcinoma were included in our cohort study. Other histological types of renal cell carcinoma were not included. The patients with missed, incomplete or poor quality paraffin blocks were also excluded. Overall ninety one patients met the inclusion and exclusion criteria. To assess the histopathological features of the tumor, immunohistochemical (IHC) staining of formalin fixed, paraffin-embedded tumor samples were performed. The five-year survival was determined by the patients' medical files and telephone following-up. Results: In total, 1.1% of all samples were revealed to be positive for P53. Also, 20.8% of all samples were revealed to be positive for MDM2.The patients were all followed for 5 years. In this regard, 5-year mortality was 30.5% and thus 5-year survival was 85.3%. According to the Cox proportional hazard analysis, positive P53 marker was only predictor for patients' 5-year survival that the presence of positive p53 increased the risk for long-term mortality up to 2.8 times (HR=2.798, 95%CI: 1.176-6.660, P=0.020). However, the presence of MDM2 could not predict long-term mortality. In this regard, analysis by the ROC curve showed a limited role for predicting long-term survival by confirming P53 positivity (AUC=0.610, 95%CI: 0.471-.750, P=0.106). The best cutoff point for P53 to predict mortality was 0.5 yielding a low sensitivity (32.0%) but a high specificity (97.9%). In similar analysis, measurement of MDM2 positivity could not predict mortality (AUC=0.449, 95%CI: 0.316-.583, P=0.455). Conclusions: The simultaneous presence of both P53 and MDM2 markers in our population is a rare phenomenon and the presence of these markers may not predict long-term survival in patients who undergoing radical nephrectomy.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.5095-5099
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• 2015

Background: The statistical methods to analyze and predict the related dangerous factors of deep fungal infection in lung cancer patients were several, such as logic regression analysis, meta-analysis, multivariate Cox proportional hazards model analysis, retrospective analysis, and so on, but the results are inconsistent. Materials and Methods: A total of 696 patients with lung cancer were enrolled. The factors were compared employing Student's t-test or the Mann-Whitney test or the Chi-square test and variables that were significantly related to the presence of deep fungal infection selected as candidates for input into the final artificial neural network analysis (ANN) model. The receiver operating characteristic (ROC) and area under curve (AUC) were used to evaluate the performance of the artificial neural network (ANN) model and logistic regression (LR) model. Results: The prevalence of deep fungal infection from lung cancer in this entire study population was 32.04%(223/696), deep fungal infections occur in sputum specimens 44.05%(200/454). The ratio of candida albicans was 86.99% (194/223) in the total fungi. It was demonstrated that older (${\geq}65$ years), use of antibiotics, low serum albumin concentrations (${\leq}37.18g/L$), radiotherapy, surgery, low hemoglobin hyperlipidemia (${\leq}93.67g/L$), long time of hospitalization (${\geq}14$days) were apt to deep fungal infection and the ANN model consisted of the seven factors. The AUC of ANN model($0.829{\pm}0.019$)was higher than that of LR model ($0.756{\pm}0.021$). Conclusions: The artificial neural network model with variables consisting of age, use of antibiotics, serum albumin concentrations, received radiotherapy, received surgery, hemoglobin, time of hospitalization should be useful for predicting the deep fungal infection in lung cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6449-6453
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• 2014

Background: Prior studies showed a relationship between serum albumin and the albumin to globulin ratio with different types of cancer. We aimed to evaluate the predictive value of the albumin-globulin ratio (AGR) for survival of patients with lung adenocarcinoma. Materials and Methods: This retrospective study included 240 lung adenocarcinoma patients. Biochemical parameters before chemotherapy were collected and survival status was obtained from the hospital registry. The AGR was calculated using the equation AGR=albumin/(total protein-albumin) and ranked from lowest to highest, the total number of patients being divided into three equal tertiles according to the AGR values. Furthermore, AGR was divided into two groups (low and high tertiles) for ROC curve analysis. Cox model analysis was used to evaluate the prognostic value of AGR and AGR tertiles. Results: The mean survival time for each tertile was: for the $1^{st}$ 9.8 months (95%CI:7.765-11.848), $2^{nd}$ 15.4 months (95%CI:12.685-18.186), and $3^{rd}$ 19.9 months (95%CI:16.495-23.455) (p<0.001). Kaplan-Meier curves showed significantly higher survival rates with the third and high tertiles of AGR in comparison with the first and low tertiles, respectively. At multivariate analysis low levels of albumin and AGR, low tertile of AGR and high performance status remained an independent predictors of mortality. Conclusions: Low AGR was a significant predictor of long-term mortality in patients with lung adenocarcinoma. Serum albumin measurement and calculation of AGR are easily accessible and cheap to use for predicting mortality in patients with lung adenocarcinoma.

• IMMUNE NETWORK
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• v.6 no.1
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• pp.43-51
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• 2006

Background: The DR-$70^{TM}$ immunoassay is a newly developed cancer diagnostic test which quantifies the serum fibrin degradation products (FDP), produced during fibrinolysis, by antibody reaction. The purpose of this study was to evaluate the potential of DR-$70^{TM}$ Immunoassay in screening malignant tumor. Methods: Sample subjects were 4,169 adults, both male and female, who visited the health promotion center of a general hospital from March 2004 to April 2005 and underwent the DR-$70^{TM}$ immunoassay test and other tests for cancer diagnosis. The patient group was defined as 42 adults out of the sample subjects who were newly diagnosed with cancer during the same time period when the DR-$70^{TM}$ immunoassay test was performed. Final confirmation of a malignant tumor was made by pathological analysis. Results: The mean DR-$70^{TM}$ level was $0.83{\pm}0.65{\mu}g/ml$ (range: 0.00 (0.0001)${\sim}7.42{\mu}g/ml)$ in the control group (n=4,127) as opposed to $2.70{\pm}2.33{\mu}g/ml$ (range: $0.12{\sim}9.30{\mu}g/ml)$ in the cancer group (n=42), and statistical significance was established (p<0.0001, Student t-test). When categorized by the type of malignant tumor, all cancer patients with the exception of the subgroups of colon and rectal cancer showed significantly higher mean DR-$70^{TM}$ levels compared with the control group (p<0.0001, Kruscal-Wallis test). The receiver operating characteristic (ROC) curve analysis revealed ${\geq}1.091{\mu}g/ml$ as the best cut-off value. Using this cut-off value, the DR-$70^{TM}$ immunoassay produced a sensitivity of 71.4%, a specificity of 70.1%, a positive predictability of 69.4%, and a negative predictability of 69.2% (1). Conclusion: A significant increase in the mean DR-$70^{TM}$ value was observed in the cancer group (thyroidal, gastric, breast, hepatic and ovarian) com pared with the control group. In particular, the specificity and sensitivity of the DR-$70^{TM}$ immunoassay was relatively high in the subgroups of breast, gastric, and thyroidal cancer patients. There is need for further studies on a large number of malignant tumor patients to see how the DR-$70^{TM}$ level might be changed according to the differentiation grade and postoperative prognosis of the malignant tumor.

• Journal of Environmental Impact Assessment
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• v.22 no.3
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• pp.219-230
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• 2013

Species distribution modeling is one of the most effective habitat analysis methods for wildlife conservation. This study was for evaluating the suitability of species distribution to distance between forest patches in Seoul city using tits. We analyzed the distribution of the four species of tits: varied tit (Parus varius), marsh tit (P. palustris), great tit (P. major) and coal tit (P. ater), using the landscape indexes and connectivity indexes, and compared the resulting suitability indexes from 100m to 1,000m. As factors affecting to the distribution of tits, we calculated landscape indices by separating them into intra-patch indices (i.e. logged patch area (PA), area-weighted mean patch shape index (PSI), tree rate (TR)) and inter-patch indices (i.e. patch degree (PD), patch betweenness (PB), difference probability of connectivity (DPC)), to analyze the internal properties of the patches and their connectivity by tits occurrence data using logistic regression modeling. The models were evaluated by AICc (Akaike Information Criteria with a correction for finite sample sizes) and AUC (Area Under Curve of ROC). The results of AICc and AUC showed DPC, PA, PSI, and TR were important factors of the habitat models for great tit and marsh tit at the level of distance 500~800m. In contrast, habitat models for coal tit and varied tit, which are known as forest interior species, reflected PA, PSI, and TR as intra-patch indices rather than connectivity. These mean that coal tit and varied tit are more likely to find a large circular forest patch than a small and long-shaped forest patch, which are higher rate of forest. Therefore, different strategies are required in order to enhance the habitats of the forest birds, tits, in a region that has fragmented forest patches such as Seoul city. It is important to manage forest interior areas for coal tit and varied tit, which are known as forest interior species and to manage not only forest interior areas but also connectivity of the forest patches in the threshold distance for great tit and marsh tit as adapted species to the urban ecosystem for sustainable ecosystem management.

• Journal of Biomedical Engineering Research
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• v.23 no.1
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• pp.1-8
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• 2002

Atrial fibrillation(AF). chronic or paroxysmal is the most frequent arrhythmia in human subjects Duration of P wave in signal-averaged electrocardiography(SAECG) reflects intra-atrial conduction time and therefore. could be used as an electrophysiological marker for atrial conduction chance at the earthy stave. So we apply the analysis method using SAECG to diagnose Paroxysmal atrial fibrillation(PAF) . Subjects Participated for the study consisted of two groups: a control group(n=34) of normal healthy volunteers and a group of AF Patients(n=38) with a documented history of PAF but no other history of cardiac disease. We evaluated the effect of several filtering and determination methods to find the starting and ending feints of the P wavy on its duration. To increase the measurement reliability of P wave duration. the automatic detection method was proposed. Also. to increase the detection rate for PAF risk, the decision threshold value was optimized using receiver operation characteristics(ROC) curve. Results showed that the highest statistical difference (p〈0.001) of the P wane duration between controls and subjects was obtained at the Processing condition, using absolute threshold vague(8.75 $\mu N$) , a least mean square(LMS) high pass filter and 30 Hz cutoff frequency. The most outstanding difference(sensitivity 88 % specificity 64.4 %) between controls and subjects was obtained at the decision threshold value of 112 ms.

• Tuberculosis and Respiratory Diseases
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• v.71 no.3
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• pp.188-194
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• 2011

Background: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity ($FEF_{25{\sim}75%}$) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between $FEF_{25{\sim}75%}$ and BDR in patients with suspicious asthma and normal spirometry. Methods: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [$FEV_1$]/forced vital capacity [FVC] ${\geq}70%$ & $FEV_1%$ predicted ${\geq}80%$) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of $FEV_1$ after bronchodilator (${\Delta}FEV_1%$). Results: Among the 440 patients with normal spirometry, $FEF_{25{\sim}75%}%$ predicted were negatively correlated with ${\Delta}FEV_1%$ (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of $FEF_{25{\sim}75%}%$ predicted were $64.0{\pm}14.5%$ in the BDR (+) group and $72.9{\pm}20.8%$ in the BDR (-) group (p<0.01). The negative correlation between $FEF_{25{\sim}75%}%$ predicted and ${\Delta}FEV_1%$ was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, $FEF_{25{\sim}75%}$ at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. Conclusion: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, $FEF_{25{\sim}75%}%$ predicted was well correlated with BDR.