• Tuberculosis and Respiratory Diseases
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• v.86 no.2
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

• Korean Journal of Radiology
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• v.22 no.12
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• pp.1985-1995
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• 2021

Objective: Although the liver-to-spleen volume ratio (LSVR) based on CT reflects portal hypertension, its prognostic role in cirrhotic patients has not been proven. We evaluated the utility of LSVR, automatically measured from CT images using a deep learning algorithm, as a predictor of hepatic decompensation and transplantation-free survival in patients with hepatitis B viral (HBV)-compensated cirrhosis. Materials and Methods: A deep learning algorithm was used to measure the LSVR in a cohort of 1027 consecutive patients (mean age, 50.5 years; 675 male and 352 female) with HBV-compensated cirrhosis who underwent liver CT (2007-2010). Associations of LSVR with hepatic decompensation and transplantation-free survival were evaluated using multivariable Cox proportional hazards and competing risk analyses, accounting for either the Child-Pugh score (CPS) or Model for End Stage Liver Disease (MELD) score and other variables. The risk of the liver-related events was estimated using Kaplan-Meier analysis and the Aalen-Johansen estimator. Results: After adjustment for either CPS or MELD and other variables, LSVR was identified as a significant independent predictor of hepatic decompensation (hazard ratio for LSVR increase by 1, 0.71 and 0.68 for CPS and MELD models, respectively; p < 0.001) and transplantation-free survival (hazard ratio for LSVR increase by 1, 0.8 and 0.77, respectively; p < 0.001). Patients with an LSVR of < 2.9 (n = 381) had significantly higher 3-year risks of hepatic decompensation (16.7% vs. 2.5%, p < 0.001) and liver-related death or transplantation (10.0% vs. 1.1%, p < 0.001) than those with an LSVR ≥ 2.9 (n = 646). When patients were stratified according to CPS (Child-Pugh A vs. B-C) and MELD (< 10 vs. ≥ 10), an LSVR of < 2.9 was still associated with a higher risk of liver-related events than an LSVR of ≥ 2.9 for all Child-Pugh (p ≤ 0.045) and MELD (p ≤ 0.009) stratifications. Conclusion: The LSVR measured on CT can predict hepatic decompensation and transplantation-free survival in patients with HBV-compensated cirrhosis.

• Korean Journal of Radiology
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• v.23 no.6
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• pp.615-624
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• 2022

Objective: To compare the therapeutic outcomes of laparoscopic hepatic resection (LHR) and laparoscopic radiofrequency ablation (LRFA) for single subcapsular hepatocellular carcinoma (HCC). Materials and Methods: We screened 244 consecutive patients who had received either LHR or LRFA between January 2014 and December 2016. The feasibility of LRFA in patients who underwent LHR was retrospectively assessed by two interventional radiologists. Finally, 60 LRFA-feasible patients who had received LHR and 29 patients who had received LRFA as the first treatment for a solitary subcapsular HCC between 1 cm and 3 cm were finally included. We compared the therapeutic outcomes, including local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) between the two groups before and after propensity score (PS) matching. Multivariable Cox proportional hazard regression was also used to evaluate the difference in OS and RFS between the two groups for all 89 patients. Results: PS matching yielded 23 patients in each group. The cumulative LTP and OS rates were not significantly different between the LHR and LRFA groups after PS matching (p = 0.900 and 0.003, respectively). The 5-year LTP rates were 4.6% and 4.4%, respectively, and OS rates were 100% and 90.7%, respectively. The RFS rate was higher in LHR group without statistical significance (p = 0.070), with 5-year rates of 78.3% and 45.3%, respectively. OS was not significantly different between the LHR (reference) and LRFA groups in multivariable analyses, with a hazard ratio (HR) of 1.33 (95% confidence interval, 0.12-1.54) (p = 0.818). RFS was higher in LHR (reference) than in LRFA without statistical significance in multivariable analysis, with an HR of 2.01 (0.87-4.66) (p = 0.102). Conclusion: There was no significant difference in therapeutic outcomes between LHR and LRFA for single subcapsular HCCs measuring 1-3 cm. The difference in RFS should be further evaluated in a larger study.

• Journal of Veterinary Clinics
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• v.31 no.4
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• pp.272-277
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• 2014

This retrospective study evaluated the effect of somatic cell count (SCC) in milk during early lactation on reproductive performance in dairy cows. Data were collected on 774 cows from six dairy farms, including cow parity, dates of previous calving, artificial insemination, pregnancy diagnosis, incidence of postpartum endometritis, reproductive performance (the intervals from calving to first insemination and conception), milk production and SCC. Data on 774 lactations were grouped based on the average first 3 months postpartum linear somatic cell score (SCS) as T1 (< 3.0, n = 521), T2 (3.0 ${\leq}$ and < 4.0, n = 113), and T3 (${\geq}$ 4.0, n = 140) groups. The odds ratio (OR) for the probability of endometritis increased 1.6 (p < 0.05) and 3.2 times (p < 0.0001) in the T2 and T3 groups, respectively, compared with that in the T1 group. The hazard of first insemination by 150 days in milk (DIM) was lower in the T3 group (hazard ratio [HR]: 0.76, p < 0.01) than in the T1 group. First insemination conception rate did not differ among the 3 groups (28.7-34.2%, p > 0.05). The hazard of pregnancy by 365 DIM in the T3 group was lower (HR: 0.75, p < 0.05 respectively) than in the T1 and T2 groups. The SCS during 4 to 7 months postpartum differed (p < 0.0001) among the 3 groups. Farm and cow parity were important risk factors for higher SCS (${\geq}$ 4.0). Multiparous cows were more likely to have a higher SCS (OR: 2.26, p = 0.0005) compared with primiparous cows. In conclusion, higher SCS (${\geq}$ 4.0) during early lactation was associated with decreased reproductive performance of dairy cows.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.435-441
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• 2013

This retrospective study evaluated the effects of the interval from calving to first insemination (ICFI) and days open (DO) on the reproductive performance in dairy cows. In the first analysis, data from 705 cows were grouped based on the ICFI: short (30-60 days, n=217), medium (61-90 days, n=309), and long (91-150 days, n=179). The occurrence of endometritis was greater in the long group than in short and medium groups (p<0.05). The occurrence of ovarian cysts increased with increasing ICFI (p<0.05), while body condition score (BCS) during the 5 month postpartum period was lower with increasing ICFI (p<0.01). The hazard of pregnancy by 365 days in milk (DIM) was lower (hazard ratio [HR]=0.70, p<0.0001) in the long group, but higher (HR=1.41, p<0.0001) in the short group compared with the medium group. In the second analysis, data from 436 cows were grouped based on the DO: short (30-90 days, n=154), medium (91-180 days, n=183), and long (181-360 days, n=99). The occurrence of a retained placenta was greater in the long group than in the medium group (p < 0.05). Ovarian cysts occurred more frequently in medium and long groups than in the short group (p=0.08). BCS was lower in the short group compared with medium and long groups at month 1 postpartum (p<0.05). Milk yield (kg/day) was greater in the medium group compared with the short group at months 2 to 5 postpartum (p<0.05). The hazard of first insemination by 150 DIM was lower in the long group than in the short group (HR=0.73; p<0.02). The hazard of pregnancy by 365 DIM was lower (HR=0.64, p<0.0001) in the long group than in the medium group, while the hazard did not differ between short and medium groups (p>0.05). Moreover, the culling rate was greater in the long group than in the short group (p<0.05). In conclusion, a longer ICFI and DO resulted in reduced reproductive performance in dairy cows, which was attributable to an increase in postpartum diseases, a lower BCS and a greater milk yield.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.87-92
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• 2016

This field study investigated the effects of dystocia on the postpartum complications, milk production, and reproductive performance in Holstein dairy cows. Calving difficulty was scored on a rank scale of 1 to 5. Cows with a calving score of three or higher were judged to have dystocia. The cows (n = 565) were categorized based on the presence (n = 61) or absence (n = 504, control) of dystocia. The incidence of retained placenta (45.9% vs. 16.3%), metritis (39.3% vs. 17.1%), endometritis (47.5% vs. 16.3%) and pyometra (9.8% vs. 1.2%) were greater in cows from the dystocia group than those from the control group (p < 0.0001); however, there was no difference in the incidence of metabolic disorders (32.8% vs. 31.0%) between the two groups (p > 0.05). The prevalence of culling was higher in cows from the dystocia group (26.2%) than in those from the control group (14.5%, p < 0.05). During the 5-month postpartum period, milk production was lower (p < 0.05) in cows from the dystocia group than in those from the control group. Furthermore, the hazard of insemination by 150 days in milk (DIM) was lower in cows from the dystocia group (hazard ratio [HR] = 0.64, p < 0.005) than in those from the control group. Logistic regression analysis revealed that the odds ratio for the probability of pregnancy after the first artificial insemination was 0.36 times (p < 0.05) higher in cows from the dystocia group than in those from the control group. The hazard of pregnancy by 360 DIM was lower in cows from the dystocia group (HR = 0.45, p = 0.0001) than in those from the control group. In conclusion, dystocia resulted in increased postpartum complications, and decreased milk production and reproductive performance in Holstein dairy cows, leading to increased culling.

• Gut and Liver
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• v.12 no.6
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• pp.714-721
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• 2018

Background/Aims: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been well-validated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p<0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (>2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p<0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.442-449
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• 2019

Objective : Bone mineral density (BMD) is an important consideration during fusion surgery. Although dual X-ray absorptiometry is considered as the gold standard for assessing BMD, quantitative computed tomography (QCT) provides more accurate data in spine osteoporosis. However, QCT has the disadvantage of additional radiation hazard and cost. The present study was to demonstrate the utility of artificial intelligence and machine learning algorithm for assessing osteoporosis using Hounsfield units (HU) of preoperative lumbar CT coupling with data of QCT. Methods : We reviewed 70 patients undergoing both QCT and conventional lumbar CT for spine surgery. The T-scores of 198 lumbar vertebra was assessed in QCT and the HU of vertebral body at the same level were measured in conventional CT by the picture archiving and communication system (PACS) system. A multiple regression algorithm was applied to predict the T-score using three independent variables (age, sex, and HU of vertebral body on conventional CT) coupling with T-score of QCT. Next, a logistic regression algorithm was applied to predict osteoporotic or non-osteoporotic vertebra. The Tensor flow and Python were used as the machine learning tools. The Tensor flow user interface developed in our institute was used for easy code generation. Results : The predictive model with multiple regression algorithm estimated similar T-scores with data of QCT. HU demonstrates the similar results as QCT without the discordance in only one non-osteoporotic vertebra that indicated osteoporosis. From the training set, the predictive model classified the lumbar vertebra into two groups (osteoporotic vs. non-osteoporotic spine) with 88.0% accuracy. In a test set of 40 vertebrae, classification accuracy was 92.5% when the learning rate was 0.0001 (precision, 0.939; recall, 0.969; F1 score, 0.954; area under the curve, 0.900). Conclusion : This study is a simple machine learning model applicable in the spine research field. The machine learning model can predict the T-score and osteoporotic vertebrae solely by measuring the HU of conventional CT, and this would help spine surgeons not to under-estimate the osteoporotic spine preoperatively. If applied to a bigger data set, we believe the predictive accuracy of our model will further increase. We propose that machine learning is an important modality of the medical research field.

• Journal of Korean Physical Therapy Science
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• v.31 no.1
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• pp.16-32
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• 2024

Background: Exercise equipments and assistive devices for the disabled are being developed, but improvements for usability are still needed. The purpose of this study was to improve and utilize the developed exercise equipment and assistance devices by conducting usability test for people with spinal cord injury. Design: Cross-sectional Study. Methods: Scenarios and usability indicators were derived by conducting a preliminary usability test, 5 non-disabled men and women aged 19 or older. In the scenario, a total of 9 tasks were sequentially performed, including 2 tasks of entry and exit, 5 tasks of assistance devices and weight stack adjustment, and 2 tasks of pre exercise and exercise. The usability indicators were task success (success or fail), execution time (sec), safety, and convenience. For safety, 7 questions (Likert scale, 1~5 point) related to safety, stability and hazard were derived, and for convenience, the system usability scale (SUS score) was used (range: 0~100, 50 percentile rank is 68 point). Results: As a result of the usability test of people with spinal cord injury, there was a large variation among subjects in the task of adjusting the position of the pulley and support in the execution time (11.64~25.44 seconds), and one person failed to adjust the pulley. The safety level showed a lower score (score = 3 points) than other items in the item of entrapment or skin pressure, and in the case of SUS, the average score was 64.5 points, which was close to the acceptable level. Conclusion: Through the usability test, it was confirmed that exercise equipment for the disabled needs improvement in operability, pinching, and pressure, and that it is necessary to develop an assistive device that provides unrestrained posture information (biofeedback) to maintain correct posture during exercise.

• Korean Circulation Journal
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• v.52 no.4
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• pp.324-337
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• 2022

Background and Objectives: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Methods: In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). Results: Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76-4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Conclusions: In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.