• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제25권1호
• /
• pp.30-40
• /
• 2022

Purpose: Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods: The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann-Whitney tests and logistic regression. Results: This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion: PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.

• Childhood Kidney Diseases
• /
• 제25권2호
• /
• pp.84-91
• /
• 2021

Purpose: We aimed to study the association of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and leukocyte differential count in children with febrile urinary tract infection (UTI). Methods: Medical records of 154 children aged 1 month to 13 years with febrile UTI who were hospitalized were retrospectively reviewed. Associations between pNGAL levels and blood leukocyte differential count at admission and after 48 hours of treatment were investigated in children with or without acute pyelonephritis (APN). Results: The APN group (n=82) showed higher pNGAL levels, neutrophil count, monocyte count, and neutrophil-to-lymphocyte ratio (NLR), compared to the non-APN group (n=72) (all P<0.05). After adjustment for age and sex, pNGAL showed positive correlations with neutrophil count and NLR in both groups (all P<0.05). Additionally, it was correlated with the monocyte-to-lymphocyte ratio (MLR) only in the APN group (P<0.05). Before and after treatment, pNGAL was positively correlated with neutrophil count, NLR, and MLR in patients with APN while it was related with neutrophil count and NLR in those without APN (all P<0.05). Areas under the receiver operating curve of pNGAL, neutrophil count, NLR, and MLR for predicting APN were 0.804, 0.760, 0.730, and 0.636, respectively (all P<0.05). Only pNGAL was independently associated with the presence of APN in a multivariable logistic regression analysis (P<0.05). Conclusion: In children with febrile UTIs, pNGAL might be associated with leukocyte differential count and the presence of APN.

• Tuberculosis and Respiratory Diseases
• /
• 제85권4호
• /
• pp.349-357
• /
• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• Communications for Statistical Applications and Methods
• /
• 제29권5호
• /
• pp.499-512
• /
• 2022

Intervention measures have been implemented worldwide to reduce the spread of the COVID-19 outbreak. The COVID-19 outbreak has occured in several waves of infection, so this paper is divided into three groups, namely those countries who have passed the pandemic period, those countries who are still experiencing a single-wave pandemic, and those countries who are experiencing a multi-wave pandemic. The purpose of this study is to develop a multi-wave Richards model with several changepoint detection methods so as to obtain more accurate prediction results, especially for the multi-wave case. We investigated epidemiological trends in different countries from January 2020 to October 2021 to determine the temporal changes during the epidemic with respect to the intervention strategy used. In this article, we adjust the daily cumulative epidemiological data for COVID-19 using the logistic growth model and the multi-wave Richards curve development model. The changepoint detection methods used include the interpolation method, the Pruned Exact Linear Time (PELT) method, and the Binary Segmentation (BS) method. The results of the analysis using 9 countries show that the Richards model development can be used to analyze multi-wave data using changepoint detection so that the initial data used for prediction on the last wave can be determined precisely. The changepoint used is the coincident changepoint generated by the PELT and BS methods. The interpolation method is only used to find out how many pandemic waves have occurred in given a country. Several waves have been identified and can better describe the data. Our results can find the peak of the pandemic and when it will end in each country, both for a single-wave pandemic and a multi-wave pandemic.

• Journal of Chest Surgery
• /
• 제56권2호
• /
• pp.99-107
• /
• 2023

Background: The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a novel predictive marker of cardiovascular disease. However, its prognostic role in patients under-going coronary artery bypass grafting (CABG) is unclear. This study aimed to determine the association between the preoperative NLR and early mortality in patients undergoing CABG. Methods: Cardiac surgery was performed in 2,504 patients at Seoul St. Mary's Hospital from January 2010 to December 2021. This study retrospectively reviewed 920 patients who underwent isolated CABG, excluding those for whom the preoperative NLR was unavailable. The primary endpoints were the 30- and 90-day mortality after isolated CABG. Risk factor analysis was performed using logistic regression analysis. Based on the optimal cut-off value of preoperative NLR on the receiver operating characteristic curve, high and low NLR groups were compared. Results: The 30- and 90-day mortality rates were 3.8% (n=35) and 7.0% (n=64), respectively. In the multivariable analysis, preoperative NLR was significantly associated with 30-day mortality (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.17-1.39; p<0.001) and 90-day mortality (OR, 1.17; 95% CI, 1.07-1.28; p<0.001). The optimal cut-off value of the preoperative NLR was 3.4. Compared to the low NLR group (<3.4), the high NLR group (≥3.4) showed higher 30- and 90-day mortality rates (1.4% vs. 12.1%, p<0.001; 2.8% vs. 21.3%, p<0.001, respectively). Conclusion: Preoperative NLR was strongly associated with early mortality after isolated CABG, especially in patients with a high preoperative NLR (≥3.4). Further studies with larger cohorts are necessary to validate these results.

• Journal of Korean Neurosurgical Society
• /
• 제66권6호
• /
• pp.664-671
• /
• 2023

Objective : The optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio is a more reliable marker of intracranial pressure than the ONSD alone. We aimed to investigate the predictive value of the ONSD/ETD ratio (OER) for neurological outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods : Adult patients with aSAH who visited the emergency department of a tertiary hospital connected to a South Korean university between January 2015 and December 2021 were included. Data on patient characteristics and brain computed tomography scan findings, including the ONSD and ETD, were collected using a predefined protocol. According to the neurological outcome at hospital discharge, the patients were divided into the unfavorable neurological outcome (UNO; cerebral performance category [CPC] score 3-5) and the favorable neurological outcome (FNO; CPC score 1-2) groups. The primary outcome was the association between the OER and neurological outcomes in patients with aSAH. Results : A total of 171 patients were included in the study, of whom 118 patients (69%) had UNO. Neither the ONSD (p=0.075) nor ETD (p=0.403) showed significant differences between the two groups. However, the OER was significantly higher in the UNO group in the univariate analysis (p=0.045). The area under the receiver operating characteristic curve of the OER for predicting UNO was 0.603 (p=0.031). There was no independent relationship between the OER and UNO in the multivariate logistic regression analysis (adjusted odds ratio, 0.010; p=0.576). Conclusion : The OER was significantly higher in patients with UNO than in those with FNO, and the OER was more reliable than the ONSD alone. However, the OER had limited utility in predicting UNO in patients with aSAH.

• 수산해양기술연구
• /
• 제40권1호
• /
• pp.86-94
• /
• 2004

새우조망 끝자루의 망목선택성을 조사하기 위한 시험조업은 여수 거문도 주변해역에서 2002년 10월 중에 끝자루의 망목을 28, 38, 51 그리고 61mm로 구성하여 덮그물 방식으로 각각 5 회씩, 총 20회 거문도 주변해역에서 실시하였다. 주 어획대상 어종인 수염대롱새우의 끝자루 망목별 어획률과 망목선택성 곡선 S=1/(1+exp$^{-{\alpha}CL+{\beta}})$)의 기울기 (a)와 절편 (b) 및 선택계수 그리고 표본망목선택성곡선 S=1/(1+exp$(^{-{\alpha}(CL/M)+{\beta}}))$)의 기울기(a)와 절편 (b) 및 적정망목을 추정한 결과는 다음과 같다. 1. 시험조업 결과 어획미수는 끝자루 11,504마리, 덮그물 12,879마리로 총 24,374마리, 313.1kg이 어획되었고 종별구성은 새우류, 어류, 게류, 연체동물 순이었으며, 부수 어획물은 어류의 자치어가 대부분을 차지하였다. 2. 끝자루 망목 28.0, 38.0, 51.0, 61.0 mm에 어획되는 대롱수염새우의 어획률은 각각 0.72, 0.63, 0.46, 0.29로 나타났다. 3. 끝자루 망목 28.0, 38.0, 51.0, 61.0 mm에 대한 선택성곡선의 a와 b 값은 0.53 -12.65, 0.35 -9.40, 0.28 -8.97과 0.24 -8.27이었고, 선택계수는 0.85, 0.71, 0.62, 0.55이었다. 4. 표본망목선택성곡선의 기울기(${\alpha}$)와 절편(${\beta}$) 값 은 8.44, -5.49이었고, 대롱수염새우의 최소성숙갑각장 20.6 mm에 대한 적정망목은 30.7 mm, 상품(上品) 최소갑각장 25 mm에 대한 적장망목은 38.5 mm로 나타났다.

• 기술혁신학회지
• /
• 제10권4호
• /
• pp.654-686
• /
• 2007

과학기술 수준을 정확히 측정 분석하기 위해서는 우리 기술수준과 비교대상의 위치, 그리고 해당 기술의 이론적인 상한 수준을 우선 전제해야만 한다. 그리고 각각의 기술변화 정도를 파악하는 것이 추가적으로 필요하다. 우리나라 및 비교대상에 대한 동태적 측면이 고려되어 현재의 위치와 함께 과정과 경로도 중요시 되어야 한다. 이를 위해서 이 연구는 기술발전 단계와 성장곡선 개념을 활용하는 방안을 제시한다. 이론적 및 가상적 사례 적용 결과, 우리나라 기술수준의 향상은 뚜렷하게 보이고 있으나 같은 기간에 지속적으로 변화하고 있는 세계최고기술 수준과는 여전히 격차가 존재하는 것으로 추정된다. 추정 결과가 사실이라고 가정할 경우, 우리나라 기술의 실질적인 추격의 가능성은 그리 크지 않은 것으로 보인다. 특히, 바이오신약 장기 분야와 지능형로봇 분야의 경우에는 세계최고기술 수준과의 격차기간이 더욱 벌어지고 있는 것으로 추정되어 해당 분야에 대한 실질적이고, 심층적인 검토 및 분석이 시급히 요구된다. 이 연구는 기술수준 측정과 분석을 성장곡선 유형의 추정을 통해 위상분석과 변화과정을 파악하여 궁극적인 추격의 가능성을 제시한다. 이론적 타당성과 현실적 적용성에 대한 검증을 위해 향후 구체적인 사례분석이 필요하다.

• 기술혁신연구
• /
• 제11권1호
• /
• pp.147-176
• /
• 2003

This Paper Presents a new measurement technique to derive the level of BSRC (Basic Science and Research Capacity) index by use of the factor analysis which is extended with the assumption of the standard normal probability distribution of the selected explanatory variables. The new measurement method is used to forecast the gap of Korea's BSRC level compared with those of major OECD countries in terms of time lag and to make their international comparison during the time period of 1981∼1999, based on the assumption that the BSRC progress function of each country takes the form of the logistic curve. The US BSRC index is estimated to be 0.9878 in 1981, 0.9996 in 1990 and 0.99991 in 1999, taking the 1st place. The US BSRC level has been consistently the top among the 16 selected variables, followed by Japan, Germany, France and the United Kingdom, in order. Korea's BSRC is estimated to be 0.2293 in 1981, taking the lowest place among the 16 OECD countries. However, Korea's BSRC indices are estimated to have been increased to 0.3216 (in 1990) and 0.44652 (in 1999) respectively, taking 10th place. Meanwhile, Korea's BSRC level in 1999 (0.44652) is estimated to reach those of the US and Japan in 2233 and 2101, respectively. This means that Korea falls 234 years behind USA and 102 years behind Japan, respectively. Korea is also estimated to lag 34 years behind Germany, 16 years behind France and the UK, 15 years behind Sweden, 11 years behind Canada, 7 years behind Finland, and 5 years behind the Netherlands. For the period of 1981∼1999, the BSRC development speed of the US is estimated to be 0.29700. Its rank is the top among the selected OECD countries, followed by Japan (0.12800), Korea (0.04443), and Germany (0.04029). the US BSRC development speed (0.2970) is estimated to be 2.3 times higher than that of Japan (0.1280), and 6.7 times higher than that of Korea. German BSRC development speed (0.04029) is estimated to be fastest in Europe, but it is 7.4 times slower than that of the US. The estimated BSRC development speeds of Belgium, Finland, Italy, Denmark and the UK stand between 0.01 and 0.02, which are very slow. Particularly, the BSRC development speed of Spain is estimated to be minus 0.0065, staying at the almost same level of BSRC over time (1981 ∼ 1999). Since Korea shows BSRC development speed much slower than those of the US and Japan but relative]y faster than those of other countries, the gaps in BSRC level between Korea and the other countries may get considerably narrower or even Korea will surpass possibly several countries in BSRC level, as time goes by. Korea's BSRC level had taken 10th place till 1993. However, it is estimated to be 6th place in 2010 by catching up the UK, Sweden, Finland and Holland, and 4th place in 2020 by catching up France and Canada. The empirical results are consistent with OECD (2001a)'s computation that Korea had the highest R&D expenditures growth during 1991∼1999 among all OECD countries ; and the value-added of ICT industries in total business sectors value added is 12% in Korea, but only 8% in Japan. And OECD (2001b) observed that Korea, together with the US, Sweden, and Finland, are already the four most knowledge-based countries. Hence, the rank of the knowledge-based country was measured by investment in knowledge which is defined as public and private spending on higher education, expenditures on R&D and investment in software.

• 정신신체의학
• /
• 제27권2호
• /
• pp.101-110
• /
• 2019

연구목적 중환자실 환자들의 섬망 발생 유무와 관련이 되어 있는 것으로 알려진 많은 임상 지표들이 있지만, 이 중 실제 섬망군과 비섬망군을 분류하는 데 있어서 어떠한 지표가 보다 중요한 역할을 하는지에 대한 연구는 충분히 이루어지지 않았다. 본 연구는 중환자실 내에서 섬망이 발생한 군과 발생하지 않은 군 사이의 재실 기간 내 특징을 비교하고, 두 군을 효과적으로 구분할 수 있는 임상 지표들을 확인하고자 하였다. 방 법 2013년 3월 1일부터 2017년 5월 31일까지 강남세브란스병원 중환자실에 있던 6386명의 환자들 중, 섬망과 연관성을 보일 것으로 예상되는 40개의 임상 지표에 대한 데이터가 재실 기간 중 적어도 한 번 이상 측정되거나, 확인이 가능한 환자 1559명을 대상으로 하였다. 무작위 부분집합 특징 선택 방법 및 주성분분석을 사용하여 섬망과 비섬망을 구분하는 데에 기여도가 높은 특징들의 순위를 구하고, 몇 개의 상위 지표가 동시에 사용되었을 때에 섬망과 비섬망을 가장 효율적으로 판별할 수 있는지를 확인하였다. 확인된 상위 지표만을 이용한 것과 전체 임상 지표를 모두 사용하였을 때의 섬망과 비섬망을 구분할 수 있는 정확도에 대해서 비교 분석하였다. 결 과 총 40개 변수 중 32개의 변수에서 섬망과 비섬망군 간 유의미한 차이를 보였다. 주성분 분석(Principal Component Analysis, PCA)상, 상위 6개 변수인 리치몬드 흥분 진정 척도(Richmond Agitation Sedation Scale, RASS), 도뇨관 사용 유무, 혈관 카테터 사용 유무, 해밀턴 불안 척도(Hamilton Anxiety Rating Scale, HAM-A), 혈액 요소 질소(Blood Urea Nitrogen, BUN), 급성 생리학 및 만성 건강 평가-II (Acute Physiology and Chronic Health Examination II, APACHE II)를 사용했을 때에 섬망과 비섬망군이 가장 잘 구분되었다. 이들 상위 6개 변수에 대해 단일 변수 로지스틱 회귀분석 시행 시 모두 섬망 여부 결정에 대한 유의성을 보였다. 다중 변수 회귀분석 시행 시, 혈관 카테터 사용 유무 를 제외하고 나머지 5개 변수에서 모두 섬망 여부 결정에 대한 유의성을 보였다. 수신자판단특성곡선 분석 결과 신뢰구간 95%에서 곡선하면적 0.818로 높은 판별력을 보였다. 전체 임상 변수를 모두 사용한 수신자판단특성곡선 분석 결과에서는 곡선하면적 0.881로 매우 높은 판별력을 보였다. 결 론 본 연구 결과, 리치몬드 흥분 진정 척도, 도뇨관 사용 유무, 혈관 카테터 사용 유무, 해밀턴 불안 척도, 혈액 요소 질소, 급성 생리학 및 만성 건강 평가-II가 섬망이 발생한 군과 섬망이 발생하지 않은 군을 구분하는데 가장 유용하였다. 중환자실 환자 중 리치몬드 흥분 진정 척도 및 해밀턴 불안 척도 점수가 과도하게 낮거나, 도뇨관 및 혈관 카테터 등의 침습적인 시술을 사용하였을 경우 좀 더 집중적인 모니터링을 통해 섬망의 가능성을 살펴보아야 할 것이다.