• 대한한방내과학회지
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• 제44권3호
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• pp.313-353
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• 2023

Objectives: Heart failure is a chronic disease with increasing prevalence rates despite advancements in medical technology. Korean medicine utilizes herbal prescriptions to treat heart failure, but little is known about the specific herbal medicines comprising the network of herbal prescriptions for heart failure. This study proposes a novel methodology that can efficiently develop prescriptions and facilitate experimental research on heart failure by utilizing existing databases. Methods: Herbal medicine prescriptions for heart failure were identified through a PubMed search and compiled into a Google Sheet database. NetMiner 4 was used for network analysis, and the individual networks were classified according to the herbal medicine classification system to identify trends. K-HERB NETWORK was utilized to derive related prescriptions. Results: Network analysis of heart failure prescriptions and herbal medicines using NetMiner 4 produced 16 individual networks. Uhwangcheongsim-won (牛黃淸心元), Gamiondam-tang (加味溫膽湯), Bangpungtongseong-san (防風通聖散), and Bunsimgi-eum (分心氣飮) were identified as prescriptions with high similarity in the entire network. A total of 16 individual networks utilized K-HERB NETWORK to present prescriptions that were most similar to existing prescriptions. The results provide 1) an indication of existing prescriptions with potential for use to treat heart failure and 2) a basis for developing new prescriptions for heart failure treatment. Conclusion: The proposed methodology presents an efficient approach to developing new heart failure prescriptions and facilitating experimental research. This study highlights the potential of network pharmacology methodology and its possible applications in other diseases. Further studies on network pharmacology methodology are recommended.

• 대한화상학회지
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• 제22권1호
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• pp.1-9
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• 2019

Purpose: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. Methods: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. Results: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. Conclusion: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

• 한국컴퓨터그래픽스학회논문지
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• 제29권5호
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• pp.21-30
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• 2023

부분신장절제술 전 수술 계획을 세우기 위해서는 신장 종양의 위치, 형태 및 수술 시 안전 마진 파악이 중요하므로 신장 종양을 정확히 분할하는 것이 필요하다. 그러나 신장 종양은 환자마다 위치 및 크기가 다양하며 소장과 비장 같은 주변 장기와 형태와 밝기값이 유사하여 신장 종양을 분할하는 것에 어려움이 있다. 본 논문에서는 레이블이 있는 데이터와 없는 데이터를 함께 사용하는 준지도학습 방법 중 하나인 평균-교사모델을 활용하여 신장의 여러 위치에서 발생하는 작은 크기의 신장 종양을 분할하기 위해 신장 위치 정보를 가지는 신장 로컬 가이드 맵을 이용해 신장 종양에 집중하는 평균-교사 네트워크를 제안하고, 신장 종양의 크기에 따른 성능을 분석한다. 실험 결과, 제안 방법은 신장 주변에 존재하는 종양의 위치를 찾기 위해 신장 로컬 가이드 맵을 사용하여 신장의 국소 정보를 고려함으로써 75.24%의 F1-score를 보였다. 특히 분할이 어려운 작은 크기의 종양에 대한 과소분할을 개선하였으며 nnU-Net보다 적은 양의 레이블 데이터를 사용하여도 13.9% 높은 F1-score를 보였다.

• Korean Circulation Journal
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• 제53권7호
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

• Clinical and Experimental Vaccine Research
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• 제12권3호
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• pp.249-259
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• 2023

Purpose: Since patients on hemodialysis (HD) are known to be vulnerable to coronavirus disease 2019 (COVID-19), many studies were conducted regarding the effectiveness of the COVID-19 vaccine in HD patients in Western countries. Here, we assessed antibody response of HD patients for 6 months post-vaccination to identify the duration and effectiveness of the COVID-19 vaccine in the Asian population. Materials and Methods: We compared antibody response of the COVID-19 vaccine in HD patients with healthy volunteers. Patient and control groups had two doses of ChAdOx1 nCoV-19 and mRNA-1273, respectively. Immunoglobulin G (IgG) was measured before vaccination, 2 weeks after the first dose, 2 and 4 weeks, 3 and 6 months after the second dose. Neutralizing antibody was measured before vaccination and at 2 weeks, 3 and 6 months after second dose. Since the third dose was started in the middle of the study, we analyzed the effect of the third dose as well. Results: Although antibody production was weaker than the control group (n=22), the patient group (n=39) showed an increase in IgG and neutralizing antibody after two doses. And, 21/39 patients and 14/22 participants had a third dose (BNT162b2 or mRNA-1273 in the patient group, mRNA-1273 in the control group), and it did not affect antibody response in both group. Trend analysis showed IgG and neutralizing antibody did not decrease over time. Age, sex, and HD vintage did not affect antibody production in HD patients. Patients with higher body mass index displayed better seroresponse, while those on immunosuppressants showed poor seroresponse. Conclusion: Two doses of vaccination led to significant antibody response in HD patients, and the antibody did not wane until 6 months.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.84-93
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• 2024

Objective : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.

• 생명과학회지
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• 제34권1호
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• pp.1-8
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• 2024

Brain-type natriuretic peptide (BNP)은 뇌나트륨이뇨펩티드로, 좌심실의 심근세포에서 분비되는 호르몬으로, 심장과 신장에 작용하여 혈관 확장과 나트륨 이뇨 작용 등을 하는 것으로 알려져 있으나, 최근에는 다양한 조직에서 대사 작용을 조절하는 것으로 보고된다. 본 연구에서는 간 조직에서 BNP의 영향을 알기 위해 BNP가 고지방식이에 의해 유도되는 인슐린 저항성을 개선하는지를 조사하였다. BNP을 주입한 쥐와 control로서 saline을 주입한 쥐들 간에는 몸무게, 체지방양(fat mass), 제지방량(lean body mass)의 변화는 없었다. 고인슐린혈증 정상혈당 글루코스 클램프(Hyperinsulinemic Euglycemic Glucose Clam) 동안, BNP를 주입한 고지방 식이 쥐들은 saline을 주입한 고지방식이 쥐에 비해 혈당(blood glucose)은 감소하였으며, 포도당 주입 속도(glucose infusion rate)는 증가하였다. 또한 BNP은 포도당 신생 및 중성지방 합성 관련 유전자들의 발현을 감소시켜, 간에서 포도당 생성과 중성지방의 양을 감소시켰다. BNP는 saline을 주입한 쥐에 비해 간 조직에서 Akt와 AMP-activated protein kinase (AMPK)의 인산화를 증가시켰는데, 이는 BNP을 처리한 AML12 간세포에서도 BNP는Akt와 AMPK 인산화를 증가시켰다. 이상의 결과는 BNP가 간에서 인슐린 저항성을 개선하여 포도당 생성과 중성 지방 생성을 억제함을 알 수 있었다.

• 대한영상의학회지
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• 제83권3호
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• pp.658-668
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• 2022

목적 혈액투석경로의 기능부전에 대한 인터벤션 치료 시 경요골 동맥 접근법의 유용성을 연구하고자 한다. 대상과 방법 2008년 1월부터 2019년 4월까지 73명의 환자에서(남성 43명, 여성 30명, 평균 연령 67.4세; 범위 42-92세) 경요골 동맥 접근법을 이용한 시술을 시행한 환자들에 대해 후향적 연구를 시행하였다. 환자들의 기본적인 특성과 병변의 특성, 경요골 동맥 접근을 통한 인터벤션 시술의 기술적 및 임상적 성공률, 시술과 연관된 합병증에 대해 조사하였고 장기 개통성에 대해서는 카플란-마이어 방법을 이용하여 분석하였다. 결과 모든 환자에서 요골 동맥을 통한 혈관조영술을 성공적으로 시행하였고, 기술적 성공률은 98.6%(72/73), 임상적 성공률은 91.7%(67/73)였다. 일차적 개통률의 중앙값은 18.8 ± 15.9개월이었고, 3, 6, 12개월 누적 개통률은 각각 82.1%, 68.6%, 그리고 63.9%였다. 모든 환자에서 손의 허혈과 같은 주요한 합병증은 발생하지 않았으며 경요골 동맥 천자와 연관한 즉각적인 합병증 또한 발생하지 않았다. 결론 혈액투석경로 기능 부전 환자에서 경요골 동맥 접근법을 통한 인터벤션 시술은 안전하고 임상적으로 유용한 방법으로 생각된다. 또한 선별된 환자에서 전통적인 경정맥 접근법에 대해 대안으로 기능할 수 있을 것으로 생각된다.

• 대한영상의학회지
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• 제81권4호
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• pp.912-919
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• 2020

목적 만성 콩팥병 환자에서 뇌 관류상태를 측정하여 정상 대조군과 차이가 있는지 알아보고자 하였다. 대상과 방법 만성 콩팥병으로 혈액 투석을 받는 환자 36명과 정상 대조군 36명에 대해 동맥스핀 표지 기법을 이용한 자기공명영상으로 뇌의 관류상태를 측정한 뒤 이를 voxel-wise로 분석하여 유의한 차이를 보이는 부위를 표준 영상 공간에 나타냈다. 결과 만성 콩팥병 환자들은 우측 전두엽, 두정엽, 측두엽과 좌측 두정엽과 후두엽의 백질 부위에 걸쳐 큰 군집의 형태로 관류 증가가 나타났다. 또한 양측 시상 부위와 중뇌, 뇌교 및 양측 소뇌에서도 관류 증가 소견을 보였다(p < 0.01, family-wise error corrected). 결론 만성 콩팥병 환자에서 뇌의 관류는 증가되어 있는 것으로 생각되며 이는 요독증 물질의 독성에 의한 미시적인 혈관 및 혈관 주위 구조물의 손상에 의한 것으로 생각된다.

• Korean Journal of Radiology
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• 제23권10호
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• pp.949-958
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• 2022

Objective: To investigate the feasibility of using a deep learning-based analysis of auscultation data to predict significant stenosis of arteriovenous fistulas (AVF) in patients undergoing hemodialysis requiring percutaneous transluminal angioplasty (PTA). Materials and Methods: Forty patients (24 male and 16 female; median age, 62.5 years) with dysfunctional native AVF were prospectively recruited. Digital sounds from the AVF shunt were recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA), and the audio files were subsequently converted to mel spectrograms, which were used to construct various deep convolutional neural network (DCNN) models (DenseNet201, EfficientNetB5, and ResNet50). The performance of these models for diagnosing ≥ 50% AVF stenosis was assessed and compared. The ground truth for the presence of ≥ 50% AVF stenosis was obtained using digital subtraction angiography. Gradient-weighted class activation mapping (Grad-CAM) was used to produce visual explanations for DCNN model decisions. Results: Eighty audio files were obtained from the 40 recruited patients and pooled for the study. Mel spectrograms of "pre-PTA" shunt sounds showed patterns corresponding to abnormal high-pitched bruits with systolic accentuation observed in patients with stenotic AVF. The ResNet50 and EfficientNetB5 models yielded an area under the receiver operating characteristic curve of 0.99 and 0.98, respectively, at optimized epochs for predicting ≥ 50% AVF stenosis. However, Grad-CAM heatmaps revealed that only ResNet50 highlighted areas relevant to AVF stenosis in the mel spectrogram. Conclusion: Mel spectrogram-based DCNN models, particularly ResNet50, successfully predicted the presence of significant AVF stenosis requiring PTA in this feasibility study and may potentially be used in AVF surveillance.