• 대한핵의학회지
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• 제33권4호
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• pp.368-380
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• 1999

목적: 일차성 및 이차성 부갑상선기능항진증 환자에서 Tc-99m-sestamibi double-phase 스캔이 병변의 국소화에 보이는 성적을 비교 분석하고자 하였다. 대상 및 방법: 수술로 확진된 14예의 단일 병변과 2예의 다발성 병변을 가지는 총 16명의 18개의 일차성 병변과 11명의 44개의 이차성 병변을 대상으로 Tc-99m-sestamibi 스캔 소견에서의 섭취 정도, 지연 스캔에서의 섭취 변화 등의 영상을 분석하고 진단율을 알아보았다. Tc-99m-sestamibi double-phase 스캔은 LEM (Seimens, Germany) 카메라를 사용하여 얻었으며 740 MBq을 순간 주사한 후 평행 그리고 바늘구멍 조준기를 사용하여 기저 및 지연 영상을 각각 얻었다. 남녀비는 일차성 2명 및 이차성 질환의 3명을 제외한 모든 증례가 여자였으며 (M:F=5 :22) 연령분포는 $29{\sim}65$세로 평균 49.1세였다. 결과, 일차성 병변의 경우는 총 18병변 중 13예는 선종, 5예는 부갑상선증식증이었으며 이차성 병변의 경우는 모두 부갑상선증식증이었다. 일차성 병변은 조직 소견상 선종으로 진단된 13예를 스캔 상에서 모두 발견한 반면 부갑상선증식증에서는 5예중 2예(40%)만이 스캔에서 발견되었다. 또한 일차성 병변 중 3예에서는 기저 스캔에 비하여 지연 스캔에서 섭취의 감소를 보였다. 일차성 병변에서 Double phase 스캔에 의한 민감도는 58.8% (10/17), 특이도 83.3% (10/12), 양성 예측률 83.3% (10/12) 및 정확도 75.9% (22/29)였으며 이차성 병변에서는 민감도 37.5% (15/40), 특이도 50% (2/4), 양성 예측률 88.2% (15/17) 그리고 정확도 38.6% (17/44)였다. 일차성 및 이차성 병변 모두에서의 전체적인 민감도는 43.9% (25/57), 특이도는 73% (12/16), 양성 예측률 86.2% (25/29) 및 정확도 53.4% (39/73) 였다. 그 외에 일차성 및 이차성 부갑상선 병변 간에 무게의 차이는 없었다(p>0.05). 결론: Tc-99m-sestamibi 스캔은 일차성 부갑상선 병변의 국소화에 높은 민감도 및 특이도를 보이지만 일부에서는 지연스캔상의 섭취가 감소하므로 기저 스캔 영상을 참조하는 것이 진단에 도움을 줄 수 있으며 이차성 병변의 경우, 전반적으로 낮은 예민도를 보이지만 이소성 병변을 수술 전에 검사함으로써 수술의 성공률을 높이는 데 도움을 줄 수 있으므로 계속된 연구가 필요하겠다.

• 대한간호학회지
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• 제19권3호
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• pp.240-248
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• 1989

The increase in size and numbers of general hospitals in the process of conspicuous development of modem medicine has been accompanied by a serious increase in hospital acquired infections. Hospital aquired infections cause pain and discomfort, may threaten life, adds an economic burden, and delays recovery and return to society. Even though respiratory hospital infection rates resulting for tracheostomy and respiratory inhalation therapy, may be low, they are serious because of their bad prognosis and high mortality rates. This study was designed to assess certain aspects of respiratory infections of patients with a tracheostomy and thus provide baseline data for further research related to preventive or therapeutic nursing interventions. The specific objectives were to determine the incidence of colonization in the trachea, clinical signs, type of colonized bacteria and sensitivity to antibiotics. Data were collected from July 1 to December 10, 1989 at two university Hospital in Seoul. Subjects were 20 patients with a tracheostomy admitted to the Intensive Care Unit or Cerebral Vascular Accident Center. Clinical signs related to respiratory infection were observed using a checklist based on previous study outcomes. Bacterial culture, sensitivity test to antibiotics, WBC counts and chest X-ray were also performed. Cultures were done on the day of tracheostomy, and on the third, fifth and seventh day. Cultures were then done on seventh days after the first colonization. The results were as follows : 1. The incidence of bacteria colonization in a week was 90%(18 patients) 50% (10/20 patients) on the day of tracheostomy, 70%(7/10 patients) on the third day, and 0% on the fifth day, and 33%(1/3 patient) on the seventh day. 3 of 18 patients (16.7%) were colonies of mixed growth isolated. 2. The observed clinical signs related to respiratory infection were high fever 38.9%(7 patients), prulent secretion 16.7%(12 patients) and infiltration seen on chest X-ray 33.3%(6 patients). 3. The total number of types of bacteria isolated among the 18 subjects was 21 ; gram negative 71.4%, gram postive 28.6%. The dominant bacteria type was Staphylococcus aureus(5 cases) for gram(equation omitted) and Pseudomonas aeruginosa(3 cases), Klebsiella (4 cases), Enterobacter(3 cases) for gram (equation omitted). The results of culture on 7th day after the first colonization, 6 cases showed same type of bacteria, 3cases showed different type of bacteria and 1 cases showed no growth. 4. The sensitivity tests to antibiotics showed that Pseudomonas aeruginosa and Staphylococcus were strongly resistant to most kinds of antibiotics, but Klebsiella and the rest of gram negative bacteria were moderately sensitive to antibiotics.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.114-118
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• 2002

Backgrounds : Carpal tunnel syndrome (CTS) is a common condition that is usually diagnosed by electrophysiologic studies. However, CTS provide limited information to determine the causes of CTS and to choose the treatment method. We evaluated diagnostic sensitivity of MR imaging and treatment decisions by MR imaging in electrodiagnosed CTS. Methods : 14 patients (26 wrists) with electrodiagnosed CTS were studied using MR imaging. In 26 wrists for which axial T1 & T2 weighted images were obtained at 1.5T with a decided wrist coil. Previously described MR imaging of CTS such as increased median nerve signal, flattening of median nerve, reticular bowing, tenosynovitis and space occupying lesions were retrospectively evaluated. Degree of improvement was evaluated by global symptom score (GSS). The GSS rated symptoms from 0 (no symptoms) to 10 (severe) in each of five categories: pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening. Subjects' GSS was recorded at baseline, 2 weeks, 1 month, 6 months after treatment. We decided to medical treatment that showed mainly inflammatory sign such as increased median nerve signal, tenosinovitis and to surgical treatment such as space occupying lesion, high canal pressure sign. Results : MR imaging showed that increased median nerve signal were in 20 wrists (77%), flattening of median nerve were in 6 wrists (23%), reticular bowing were in 3 wrists (12%), tenosynovitis were in 8 wrists (32%), decreased canal size in 2 wrists (7.6%), space occupying lesion were in 1 wrist (4%). A good outcome was revealed in 21 wrists by medical treatment that showed mainly increased median nerve signal, tenosynovitis. The mean GSS were 27.7 at baseline, 11.2 at 2 weeks, 11.0 at 6 months in medical treatment group. Another 5 wrist had surgical treatment shown by ganglion and high canal pressure sign such as median nerve flattening, reticular bowing, decreased canal size: 3 wrists had good prognosis, but 2 wrists (one patient) had no significant improvement due to small carpal tunnel size. Conclusions : Our results are in agreement with most previously described MR imaging signs of CTS. MR imaging plays an important role in several cases and especially in the assessment of failure of surgical treatment. Knowledge of MR findings may permit more rational choice of treatment.

• Journal of Periodontal and Implant Science
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• 제51권4호
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• pp.226-238
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• 2021

Purpose: Although several reports have described the relationship between periodontal disease and cardiovascular disease, information about the association between periodontal disease and the progression of degenerative aortic stenosis (AS) is lacking. Therefore, we performed a retrospective, single-center, pilot study to provide insight into this potential association. Methods: Data from 45 consecutive patients (19 men; median age, 83 years) with mild or moderate degenerative aortic stenosis were analyzed for a mean observation period of 3.3±1.9 years. The total amount of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and titers of serum immunoglobulin G (IgG) against periodontal bacteria and high-sensitivity C-reactive protein (hs-CRP) were evaluated. Aortic valve area (AVA), maximal velocity (Vmax), mean pressure gradient (mean PG), and the Doppler velocity index (DVI) were evaluated. The change in each parameter per year ([Parameter_LATEST-Parameter_BASELINE]/Follow-up Years) was calculated from the retrospective follow-up echocardiographic data (baseline vs. the most recently collected data [latest]). Results: No correlation was found between the concentration of periodontopathic bacteria in the saliva and AS status/progression. The anti-P. gingivalis antibody titer in the serum showed a significant positive correlation with AVA and DVI. Additionally, there was a negative correlation between the anti-P. gingivalis IgG antibody titer and mean PG. The hs-CRP concentration showed positive correlations with Vmax and mean PG. Meanwhile, a negative correlation was observed between the anti-P. gingivalis IgG antibody titer and ΔAVA/year and Δmean PG/year. The hs-CRP concentration showed positive correlations with Vmax and mean PG, and it was significantly higher in patients with rapid aortic stenosis progression (ΔAVA/year <-0.1) than in their counterparts. Conclusions: Our results suggest that periodontopathic bacteria such as A. actinomycetemcomitans and P. gingivalis are not directly related to the status/progression of degenerative AS. However, inflammation and a lower immune response may be associated with disease progression.

• Korean Journal of Radiology
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• 제23권6호
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• pp.664-673
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• 2022

Objective: To evaluate the performance of baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping of the extraocular muscles (EOMs) in the prediction of treatment response to intravenous glucocorticoid (IVGC) therapy for active and moderate-to-severe thyroid-associated ophthalmopathy (TAO) and to investigate the effect of fat-suppression (FS) in T2 mapping in this prediction. Materials and Methods: A total of 79 patients clinically diagnosed with active, moderate-to-severe TAO (47 female, 32 male; mean age ± standard deviation, 46.1 ± 10 years), including 43 patients with a total of 86 orbits in the responsive group and 36 patients with a total of 72 orbits in the unresponsive group, were enrolled. Baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping with FS (i.e., FS T2 mapping) or without FS (i.e., conventional T2 mapping) of EOMs were compared between the two groups. Independent predictors of treatment response to IVGC were identified using multivariable analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the prediction models. Differences between the models were examined using the DeLong test. Results: Compared to the unresponsive group, the responsive group had a shorter disease duration, lower kurtosis (FS-kurtosis), lower standard deviation, larger 75th, 90th, and 95th (FS-95th) T2 relaxation times in FS mapping and lower kurtosis in conventional T2 mapping. Multivariable analysis revealed that disease duration, FS-95th percentile, and FS-kurtosis were independent predictors of treatment response. The combined model, integrating all identified predictors, had an optimized area under the ROC curve of 0.797, 88.4% sensitivity, and 62.5% specificity, which were significantly superior to those of the imaging model (p = 0.013). Conclusion: An integrated combination of disease duration, FS-95th percentile, and FS-kurtosis was a potential predictor of treatment response to IVGC in patients with active and moderate-to-severe TAO. FS T2 mapping was superior to conventional T2 mapping in terms of prediction.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.799-805
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• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• 천문학회지
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• 제47권6호
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• pp.235-253
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• 2014

Intensity interferometry, based on the Hanbury Brown-Twiss effect, is a simple and inexpensive method for optical interferometry at microarcsecond angular resolutions; its use in astronomy was abandoned in the 1970s because of low sensitivity. Motivated by recent technical developments, we argue that the sensitivity of large modern intensity interferometers can be improved by factors up to approximately 25 000, corresponding to 11 photometric magnitudes, compared to the pioneering Narrabri Stellar Interferometer. This is made possible by (i) using avalanche photodiodes (APD) as light detectors, (ii) distributing the light received from the source over multiple independent spectral channels, and (iii) use of arrays composed of multiple large light collectors. Our approach permits the construction of large (with baselines ranging from few kilometers to intercontinental distances) optical interferometers at the cost of (very) long-baseline radio interferometers. Realistic intensity interferometer designs are able to achieve limiting R-band magnitudes as good as $m_R{\approx}14$, sufficient for spatially resolved observations of main-sequence O-type stars in the Magellanic Clouds. Multi-channel intensity interferometers can address a wide variety of science cases: (i) linear radii, effective temperatures, and luminosities of stars, via direct measurements of stellar angular sizes; (ii) mass-radius relationships of compact stellar remnants, via direct measurements of the angular sizes of white dwarfs; (iii) stellar rotation, via observations of rotation flattening and surface gravity darkening; (iv) stellar convection and the interaction of stellar photospheres and magnetic fields, via observations of dark and bright starspots; (v) the structure and evolution of multiple stars, via mapping of the companion stars and of accretion flows in interacting binaries; (vi) direct measurements of interstellar distances, derived from angular diameters of stars or via the interferometric Baade-Wesselink method; (vii) the physics of gas accretion onto supermassive black holes, via resolved observations of the central engines of luminous active galactic nuclei; and (viii) calibration of amplitude interferometers by providing a sample of calibrator stars.

• 대한치과의사협회지
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• 제46권11호
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• pp.683-688
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• 2008

Purpose : The aim of this study was to evaluate the clinical efficacy of two commercially available desensitizing agents over 3 weeks on patients with dentin hypersensitivity. Materials and Methods : An oxalate-based solution, Sensblok (NIBEC Inc. Seoul, Korea) & Superseal (Pheonix Inc. Michigan, USA), and a distilled water placebo were compared in a clinical setting. Seven volunteers exhibiting three or more teeth that were sensitive to tactile & air were enrolled in the study (35 teeth total). A visual analog scale (VAS) was used for recording each patient s level of sensitivity to tactile & air stimuli. A Florida probe was rubbed across the exposed dentin three times with a constant pressure 20 grams to measure the tactile stimulus. The air stimulus was generated by dental unit air syringe for 1-second blast from 1/2 inch distance. The desensitizing agents were applied according manufacture s guideline. VAS scores were recorded at baseline, 1 minute after treatment, at 1 week, 2weeks, 3weeks. VAS score were analyzed using a repeated measures ANOVA ( =0.05). Results : The Sensblok, Superseal, and distilled water placebo all decreased dentin sensitivity. A statistically significant difference existed between Sensblok and placebo when tactile stimulus was applied (P<0.05), but no significant difference was found among other desensitizing agents and tactile and air stimuli.

• 한국컴퓨터정보학회논문지
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• 제18권12호
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• pp.197-205
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• 2013

본 연구에서는 동적 임분 생장모델과 Simulated Annealing 휴리스틱 기법을 적용하여 최적의 산림시업체계를 도출하기 위한 임분탄소최적화 프로그램을 개발하였다. SA 휴리스틱 알고리즘은 다양한 경영목표를 다룰 때 비교적 짧은 시간 내에 만족할만한 수준의 경영안을 제공할 수 있는 최적화 기법으로서, 더 이상 최적해를 찾지 못하고 목표 값이 어떤 일정한 값(Local Optimum)에 계속 머무는 현상을 해결하기 위해 열균형 테스트를 이용하고 있다. 열균형 테스트에 적용되는 온도저감율 파라미터 값이 최적화 프로세스의 목적함수 값과 반복횟수에 미치는 영향을 분석하기 위해 본 연구에서는 온도저감율에 따른 민감도 분석을 실시하였다. 개발된 프로그램을 이용하여 기존의 산림경영에 주로 적용되고 있는 시업체계(베이스라인), 목재수확량 최대와 탄소저장량 최대의 3가지 산림시업 시나리오에 대해 비교 분석을 한 결과, 목재수확량 최대를 목표로 한 시나리오가 3개 시나리오 가운데 목재수확량이 가장 높은 것으로 나타났으며, 또한 탄소저장량을 최대로 하는 시나리오가 탄소저장량이 가장 높은 것으로 나타나, 본 연구에서 개발된 프로그램이 최적화된 결과를 도출하는 것으로 판단됐다. 온도저감율 파라미터 값에 대한 민감도 분석에서는 온도저감율에 따라 목적함수의 최적 값과 최적화 프로세스 반복횟수가 뚜렷한 영향을 받는 것으로 나타났다. 본 연구를 통해 개발된 임분탄소 최적화 프로그램은 앞으로 우리나라 산림의 탄소 최적화 시업체계 개발에 활용 될 것으로 기대된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2533-2540
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• 2013

Background: Although screening is necessary where gastric cancer is particularly common in Asia, the performance outcomes of mass screening programs have remained unclear. This study was conducted to evaluate cost-effectiveness outcomes of the national cancer screening program (NCSP) for gastric cancer in South Korea. Materials and Methods: People aged 40 years or over during 2002-2003 (baseline) were the target population. Screening recipients and patients diagnosed with gastric cancers were identified using the NCSP and Korea Central Cancer Registry databases. Clinical outcomes were measured in terms of mortality and life-years saved (LYS) of gastric cancer patients during 7 years based on merged data from the Korean National Health Insurance Corporation and National Statistical Office. We considered direct, indirect, and productivity-loss costs associated with screening attendance. Incremental cost-effectiveness ratio (ICER) estimates were produced according to screening method, sex, and age group compared to non-screening. Results: The age-adjusted ICER for survival was 260,201,000-371,011,000 Korean Won (KW; 1USD=1,088 KW) for the upper-gastrointestinal (UGI) tract over non-screening. Endoscopy ICERs were lower (119,099,000-178,700,000 KW/survival) than UGI. To increase 1 life-year, additional costs of approximately 14,466,000-15,014,000 KW and 8,817,000-9,755,000 KW were required for UGI and endoscopy, respectively. Endoscopy was the most cost-effective strategy for males and females. With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. For males, an upper limit of age 75 or 80 years could be considered. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective. Conclusion: Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.