• Annals of Surgical Treatment and Research
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• 제95권5호
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• pp.278-285
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• 2018

Purpose: We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). Methods: Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). Results: The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). Conclusion: Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

• 생명과학회지
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• 제29권4호
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• pp.499-508
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• 2019

암줄기세포는 전이와 재발의 주요한 요인이 되는 자가재생능력, 분화할 수 있는 능력, 치료에 대한 저항성 및 암 형성 능력의 특성을 가진다. WNT/${\beta}$-catenin, Hedgehog, Notch, BMI1, BMP 및 TGF-${\beta}$와 같은 암줄기세포의 특성을 획득 및 유지할 수 있는 신호기전의 연구 결과가 존재하지만, 현재까지 선택적으로 암줄기세포를 표적할 수 있는 치료 전략은 미미하다. 최근, 면역관문억제제인 CTLA-4, PD-1/PD-L1 단일클론항체는 흑색종, 폐암, 췌장암 및 혈액암에 괄목할만한 임상 시험 결과를 나타냈으며, 긴 항암지속효과와 적은 부작용은 기존 항암제보다 개선 된 모습을 보였다. 또한 두경부편평상피암, 흑색종, 유방암 줄기세포를 선택적으로 제거 하였다. 위의 결과를 종합하면, 면역관문억제제는 이전 항암제에 비해 효과적인 항암전략이며, 동시에 암줄기세포를 선택적으로 제거할 수 있는 가능성을 시사한다. 따라서 본 리뷰에서는 암줄기세포와 면역관문억제제의 이해를 통해, 면역관문억제제의 암줄기세포 표적 가능성에 대해 고찰하고자 한다.

• Journal of Periodontal and Implant Science
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• 제49권3호
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• pp.171-184
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• 2019

Purpose: To evaluate the effects of intra-alveolar socket grafting, subepithelial connective tissue grafts, and individualized abutments on peri-implant hard and soft tissue outcomes following immediate implant placement. Methods: This randomized experimental study employed 5 mongrel dogs, with 4 sites per dog (total of 20 sites). The mesial roots of P3 and P4 were extracted in each hemimandible and immediate dental implants were placed. Each site was randomly assigned to 1 of 4 different treatment groups: standardized healing abutment (control group), alloplastic bone substitute material (BSS) + standardized healing abutment (SA group), BSS + individualized healing abutment (IA group), and BSS + individualized healing abutment + a subepithelial connective tissue graft (IAG group). Clinical, histological, and profilometric analyses were performed. The intergroup differences were calculated using the Bonferroni test, setting statistical significance at P<0.05. Results: Clinically, the control and SA groups demonstrated a coronal shift in the buccal height of the mucosa ($0.88{\pm}0.48mm$ and $0.37{\pm}1.1mm$, respectively). The IA and IAG groups exhibited an apical shift of the mucosa ($-0.7{\pm}1.15mm$ and $-1.1{\pm}0.96mm$, respectively). Histologically, the SA and control groups demonstrated marginal mucosa heights of $4.1{\pm}0.28mm$ and $4.0{\pm}0.53mm$ relative to the implant shoulder, respectively. The IA and IAG groups, in contrast, only showed a height of 2.6mm. In addition, the height of the mucosa in relation to the most coronal buccal bone crest or bone substitute particles was not significantly different among the groups. Volumetrically, the IA group ($-0.73{\pm}0.46mm$) lost less volume on the buccal side than the control ($-0.93{\pm}0.44mm$), SA ($-0.97{\pm}0.73mm$), and IAG ($-0.88{\pm}0.45mm$) groups. Conclusions: The control group demonstrated the most favorable change of height of the margo mucosae and the largest dimensions of the peri-implant soft tissues. However, the addition of a bone substitute material and an individualized healing abutment resulted in slightly better preservation of the peri-implant soft tissue contour.

• 한국전문물리치료학회지
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• 제26권3호
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• pp.11-22
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• 2019

Background: Sling exercises are frequently used for the rehabilitation process of patients with shoulder joint injuries, but research on the significant frequency intensity and appropriate treatment duration for sling exercises with local vibration stimulation is lacking. Objects: The aim of this study was to investigate the effects of sling exercise with vibration on shoulder range of motion (ROM), muscle strength, pain, and dysfunction in patients with a medical diagnosis of shoulder joint injury. Methods: Twenty-two patients were randomly assigned to the experiment and control groups. Six sling exercises with and without 50 Hz vibrations were applied in the experiment and control groups, respectively. Each exercise consisted of 3 sets of 5 repetitions performed for 6 weeks. The assessment tools used included shoulder joint range of motion, muscle strength, pain level, and shoulder pain and disability index for functional disability. We conducted re-evaluations before and 3 and 6 weeks after intervention. The changes in the measurement variables were analyzed and compared between the two groups. Results: The ROM of the external rotation of the shoulder joint had a significant interaction between the group and the measurement point (F=3.652, p<.05). In both groups, we found a significant increase in external rotation angle between the measurement points (p<.05). The flexor strength of the shoulder joint significant interaction between the group and the measurement point (F=4.247, p<.05). Both the experiment (p<.01) and control groups (p<.05) showed a significant increase in shoulder flexor strength at the measurement points. After 6 weeks of the interventions, both the groups showed significantly improved VAS (p<.01), SPADI (p<.01), and orthopedic tests (p<.01). However, there was no significant difference between the group and the measurement point in terms of the clinical outcomes observed. Conclusion: The sling exercise with local vibration of 50 Hz affected the external rotation of the shoulder range of motion and improved shoulder flexor strength in the patients with shoulder injuries. Therefore, we propose the use of the sling exercise intervention with vibration in the exercise rehabilitation of patients with shoulder joint injuries.

• 대한두개안면성형외과학회지
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• 제20권2호
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• pp.101-108
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• 2019

Background: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. Methods: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. Results: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. Conclusion: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

• 대한임상독성학회지
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• 제16권2호
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• pp.86-92
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• 2018

Purpose: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. Methods: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. Results: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. Conclusion: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.

• 디지털융복합연구
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• 제19권4호
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• pp.467-475
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• 2021

목적: 병동에서 급성악화 환자가 발생할 때 환자에게 집중치료가 필요한지 여부에 대한 결정은 환자의 예후를 향상시키기 위해서는 매우 중요하나, 특히 사용 가능한 ICU 자원이 제한적일 때는 ICU 전동 여부를 결정하기에는 어려움이 있다. 따라서 본 연구는 일반병동 급성 악화 환자를 대상으로 중환자실 전동 위험요인을 확인하고자 한다. 연구방법: 후향적 조사연구로서 대상자는 일 상급종합병원 일반병동에 입원한 18세 이상의 성인 환자 중 악화상태를 보여 신속대응팀에 의뢰된 환자 2,945명을 대상으로 하였다. 중환자실 전동 위험요인을 파악하기 위해 다변량 로지스틱 회귀분석을 시행하였다. 연구결과: 다변량 로지스틱 회귀분석 결과 입원시 고형암을 진단받은 경우 (odds ratio [OR] 0.39, 95% CI 0.32-0.47), 악화원인이 호흡문제인 경우 (OR 1.51, 95% CI 1.17-1.95), MEWS (OR 1.22, 95% CI 1.17-1.28)와 SpO2/FiO2 score (OR 2.41, 95% CI 2.23-2.60)가 중환자실 전동 위험요인으로 나타났다. 결론: 본 연구 결과는 중환자실 전동 위험이 높은 환자의 조기 예측을 가능하게 하여 환자의 예후를 향상시키는데 도움이 될 것으로 사료된다.

• 정보처리학회논문지:소프트웨어 및 데이터공학
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• 제8권10호
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• pp.397-402
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• 2019

암 환자에게 적절한 치료계획을 제공하기 위해 암의 진행양상 또는 환자의 생존 기간 등에 해당하는 환자의 예후를 정확히 예측하는 것은 생물정보학 분야에서 다루는 중요한 도전 과제 중 하나이다. 많은 연구에서 암 환자의 유전자 발현량 데이터를 이용하여 환자의 예후를 예측하는 기계학습 모델들이 많이 제안되어 오고 있다. 유전자 발현량 데이터는 약 17,000개의 유전자에 대한 수치값을 갖는 고차원의 수치형 자료이기에, 기존의 연구들은 특징 선택 또는 차원 축소 전략을 이용하여 예측 모델의 성능 향상을 도모하였다. 그러나 이러한 접근법은 특징 선택과 예측 모델의 훈련이 분리되어 있어서, 기계학습 모델은 선별된 유전자들이 생물학적으로 어떤 관계가 있는지 알기가 어렵다. 본 연구에서는 유전자 발현량 데이터를 이미지 형태로 변환하여 예후 예측이 효과적으로 특징 선택 및 예후 예측을 수행할 수 있는 기법을 제안한다. 유전자들 사이의 생물학적 상호작용 관계를 유전자 발현량 데이터에 통합하기 위해 Node2Vec을 활용하였으며, 2차원 이미지로 표현된 발현량 데이터를 효과적으로 학습할 수 있도록 합성곱 신경망 모델을 사용하였다. 제안하는 모델의 성능은 이중 교차검증을 통해 평가되었고, 유전자 발현량 데이터를 그대로 이용하는 기계학습모델보다 우월한 예후 예측 정확도를 가지는 것이 확인되었다. Node2Vec을 이용한 유전자 발현량의 새로운 이미지 표현법은 특징 선택으로 인한 정보의 손실이 없어 예측 모델의 성능을 높일 수 있으며, 이러한 접근법이 개인 맞춤형 의학의 발전에 이바지할 것으로 기대한다.

• 디지털융복합연구
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• 제19권6호
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• pp.265-271
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• 2021

본 연구는 경추성 두통 환자의 진단 기준을 정립하고, 임상평가와 운동치료 시 효율적 방법 제공을 목적으로 경추성 두통환자들을 15명을 실험군으로 건강한 대상자 15명을 대조군으로 설정하여 그룹 간, 근육의 특성과 자세, 근활성도를 비교 분석하고, 실험군의 각 변수들 간 상관관계를 분석하였다. 연구결과 뒤통수밑근 경도와 위등세모근의 긴장도, 경도에서 통계적으로 유의한 차이를 보였다p<.001). 자세 변화 비교에서는 목 기울기 각도와 첫 번째 등뼈 경사각이 통계적으로 유의한 차이를 보였으며p<.05), 목빗근의 근활성도 변화 비교에서도 통계적으로 유의한 차이를 보였다(p<.001). 실험군에서 근육의 특성, 자세, 목빗근의 근활성도 간 상관관계를 분석한 결과, 뒤통수밑근의 긴장도가 증가할수록 뒤통수밑근의 경도가 증가함을 나타내 양의 상관관계를 보였고(p<.001), 위등세모근의 긴장도가 증가할수록 위등세모근의 경도도 증가하여 양의 상관관계를 보였다(p<.001). 경추성 두통환자의 평가와 치료 시 본 연구의 결과를 참고한다면, 보다 효율적으로 접근할 수 있을 것으로 기대된다. 향후 연구를 발전시켜 더 많은 연구대상자들을 평가하고 차이를 비교하는 연구와 다양한 직업군을 대상으로 하는 연구들이 필요할 것으로 생각된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권4호
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• pp.357-365
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• 2021

Purpose: A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change. Methods: The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC). Results: Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group (p<0.05). Conclusion: Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.