• Title/Summary/Keyword: logistic procedure

검색결과 150건 처리시간 0.036초

Is Diabetes a Contraindication to Lower Extremity Flap Reconstruction? An Analysis of Threatened Lower Extremities in the NSQIP Database (2010-2020)

  • Amy Chen;Shannon R. Garvey;Nimish Saxena;Valeria P. Bustos;Emmeline Jia;Monica Morgenstern;Asha D. Nanda;Arriyan S. Dowlatshahi;Ryan P. Cauley
    • Archives of Plastic Surgery
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    • 제51권2호
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    • pp.234-250
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    • 2024
  • Background The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined. Methods Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using Current Procedural Terminology and International Classification of Diseases-9/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed. Results Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and <1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p = 0.5969; NIDDM: p = 0.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay > 30 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p = 0.0004). Conclusion Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.

Copula 모형을 이용한 이변량 강우빈도해석 (Bivariate Frequency Analysis of Rainfall using Copula Model)

  • 주경원;신주영;허준행
    • 한국수자원학회논문집
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    • 제45권8호
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    • pp.827-837
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    • 2012
  • 확률강우량은 수공구조물의 설계에 있어 중요한 역할을 하며 이러한 확률강우량의 산정은 일반적으로 일변량 빈도해석을 수행하고 최적의 확률분포형을 찾아냄으로써 계산된다. 하지만 일변량 빈도해석은 수행 시 지속기간이 제한적이라는 단점이 있으며 이를 보완하기 위해 본 연구에서는 이변량 빈도해석을 수행하였다. 다변량 모형인 copula 모형 중3가지의 분포형을 이용하여 5개 지점의 연최대강우사상에 대해 이 변량 빈도해석을 수행하였으며 확률변수로 강우량과 지속기간을 사용하였다. 주변분포형은 강우량에는 Gumbel (GUM), generalized logistic (GLO) 분포형, 지속기간에는 generalized extreme value (GEV), GUM, GLO 분포형이사용됐으며 copula 모형은Frank, Joe, Gumbel-Hougaard 모형을 이용하였다. 주변분포형의 매개변수는 확률가중모멘트법을 이용하여 추정하였으며, copula 모형의 매개변수는 준모수방법인 의사최우도법을 사용하여 구하였다. 이를 통해 얻어진 확률강우량을 주변분포형과 copula 모형을바꾸어가며 비교하였다. 그 결과, 주변분포형의 종류에 따른 변화에서는 지속기간의 분포형에는 크게 영향을 받지 않는 것으로 나타났다. 강우량의 분포형에 따라서는 조금씩 차이가 났으며 강우량의 분포형이 GUM일 경우, GLO일 때에 비해 재현기간이 증가할수록 확률강우량이 증가하는 경향이 두드러졌다. Copula 모형별로 비교해보았을 때, Joe, Gumbel-Hougaard 모형은 비슷한 경향을 나타내었으며 Frank 모형은 재현기간의 증가에 따른 확률강우량의 증가가 강하게 나타냈다.

항공화물 물류관리 서비스와 경영성과의 상관성: Forwarder의 수익률 효과분석 (Correlations between Air Freight Logistic Service and Business Performance of Forwarder)

  • 김중관
    • 통상정보연구
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    • 제16권1호
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    • pp.145-161
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    • 2014
  • 21세기에는 물류운송 시스템의 정보화가 국제적으로 이루어져서 항공화물운송에서도 화물운송 통합서비스가 구현되고 있다. 본 연구에서는 항공화물운송 관리체계의 핵심적인 연구 주제인 운송관리 시스템과 고객만족과의 상관성을 전제로 Forwarder의 수익률을 중심으로 경영성과의 상관성을 규명하였다. 소규모 운송관리 품질과 고객만족의 상관성 연구에서 기존에 연구주제로 채택되지 않았던 경영성과와 고객 만족도를 측정하였다. 연구목적의 달성을 위해 포워딩 이용 무역업체들을 대상으로 항공화물 운송관리 품질, 성과, 만족 관련 조사를 통하여 실증분석을 하였다. 항공화물의 운송과정의 제 단계에서 시스템의 서비스조건 측면의 운송관리 부분을 대상으로 성과변수를 단일항목으로 한정하여 측정하였다. 분석 결과, 국내 포워더의 운송시장에서 업무행태가 소비자 집단인 무역업체들의 업무에 긍정적인 영향을 주는 것으로 확인되었으며 이는 본 연구의 전제조건과 합치된다. 운송관리 품질 구성 차원들은 수익률 평가로 측정된 성과에 직접적인 영향을 주는 것으로 평가되었다. 아울러 성과는 고객만족에 긍정적인 영향을 주는 것이 분석되었다. 즉, 소규모 운송관리 품질은 화물위탁자의 만족도에 영향을 주는 한편, 성과를 통해 고객만족에 영향을 주는 것이 확인되었다. 이러한 분석결과는 항공화물 운송관리 상의 업무행태와 고객의 만족의 관계를 경영성과 측면에서 규명하였다는 점에서 실학적 가치를 극대화 하였으며, 운송실무 측면에서 포워더의 운송관리 시스템 향상을 위한 지속적인 투자의 타당성을 확보해준다는 측면에서 의미가 있다.

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위암에서 병기결정을 위한 최소 절제 림프절 수 (Minimum Number of Retrieved Lymph Nodes for Staging in Gastric Cancer)

  • 민병욱;김완배;김승주;김종석;목영재
    • Journal of Gastric Cancer
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    • 제3권3호
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    • pp.134-138
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    • 2003
  • Purpose: The lymph node (N) classification in the International Union Against Cancer (UICC) TNM staging system for gastric adenocarcinomas has been revised from the anatomic sites of metastatic lymph nodes to the number of metastatic lymph nodes. The purpose of this study was to investigate the proper number of retrieved lymph nodes for applying the new TNM staging system. Materials and Methods: We retrospectively studied 267 patients who had undergone a curative resection performed by one surgeon for gastric adenocarcinomas from March 1993 to December 1996 at Korea University Guro Hospital. We compared the old staging system to the new one and analyzed the number of retrieved and metastatic lymph nodes. We also analyzed the number of retrieved and metastatic lymph nodes according to the operative procedure and the extent of the lymphadenectomy, as well as the correlation of lymph-node metastasis to the number of retrieved lymph nodes. Results: The mean number of retrieved lymph nodes was $34.27\pm14.18$, of those $6.85\pm6.24$ were metastatic. According to the extent of the lymphadenectomy, these numbers were $17.8\pm9.3\;and\;7.0\pm5.3$ in D1, $33.1\pm14.6\;and\;3.0\pm3.0$ in $D1+\alpha$, $33.9\pm13.8\;and\;7.5\pm6.2$ in D2, and $40.6\pm13.3\;and\;7.9\pm7.5$ in $D2+\alpha$. There was no correlation between the percentage of the specimen with positive lymph nodes and the number of retrieved lymph nodes, but a logistic regres sion analysis showed that the probability of lymph-node metastasis increased as the number of retrieved lymph nodes increased. Conclusion: The mean number of retrieved lymph nodes was about 34. Although by logistic regression analysis, the probability of lymph-node metastasis increased as the number of retrieved lymph nodes increased, we failed to determine the minimum number of nodes retrieved during a lymphadenectomy needed for accurate staging in a gastric adenocarcinoma. Further study is required to identify the optimum number of lymph nodes that need to be retrieved.

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여성의 개인적 특성과 생활양식요인을 이용한 골량감소 예측모형 (Prediction Model for Reduced Bone mass in Women using Individual Characteristics & Life Style Factors)

  • 이은남;이은옥
    • 근관절건강학회지
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    • 제5권1호
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    • pp.83-109
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    • 1998
  • This study was carried out to identify the Important modifiable risk factors for reduced bone mass and to construct prediction model which can classify women with either low or high bone mass. Through the literature review, individual characteristics such as age, body weight, height, education level, family history, age of menarche, postmenopausal period, gravity, parity, menopausal status, and breast feeding period were identified and factors of life style such as past milk consumption, past physical activity, present daily activity, present calcium intake, alcohol intake, cigarette smoking, coffee consumption were identified as influencing factors of reduced bone mass in women. Four hundred and eighty women aged between 28 and 76 who had given measurement bone mineral density by dual energy x-ray absortiometry in lumbar vertebrae and femur from July to October, 1997 at 4 general hospitals in Seoul and Pusan were selected for this study. Women were excluded if they had a history of any chronic illness such as rheumatoid arthritis, diabetes mellitus, hyperthroidism, & gastrointestinal disorder and any medication such as calcium supplements, calcitonin, estrogen, thyroxine, antacids, & corticosteroids known affect bone. As a result of these exclusion criteria, four hundred and seventeen women were used for analysis. Multiple logistic regression model was developed for estimating the likelihood of the presence or absence of reduced bone mass. A SAS procedure was used to estimate risk factor coefficient. The results are as follows For lumbar spine, the variables significant were age, body weight, menopause status, daily activity, past milk consumption, and past physical activity(p<0.01), while for femoral Ward's triangle, age, body weight, level of education, past milk consumption, past physical activity(p<0.001). Past physical activity, present daily activity and past milk consumption are the most powerful modifiable predictors in vertebrae and femur among the predictors. When the model performance was evaluated by comparing the observed outcome with predicted outcome, the model correctly identified 74.1% of persons with reduced bone mass and 84.5% of persons with normal bone mass in the lumbar vertebrae and 82.9% of persons with reduced bone mass and 75.0% of persons with normal bone mass in the femoral Ward's triangle. On the basis of these results, a number of recommendations for the management of reduced bone mass may be made : First, those woman who are classified as high risk group of the reduced bone mass in the prediction model should examine the bone mineral density to further examine the usefulness of this model. Second, the optimal amount of milk consumption and a regular weight bearing exercise in childhood, adolescence, and early adult should be ensured.

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2급/ 5급 와동 복합레진 수복 술식에 대한 남녀 치과 의사의 비교 (COMPARISON OF OPERATIVE TECHNIQUES BETWEEN FEMALE AND MALE DENTISTS IN CLASS 2 AND CLASS 5 RESIN COMPOSITE RESTORATIONS)

  • 장주혜;김혜영;손호현
    • Restorative Dentistry and Endodontics
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    • 제35권2호
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    • pp.116-124
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    • 2010
  • 본 연구에서는 복합 레진을 이용한 2급/5급 와동의 직접수복에 있어서 치과의사의 성별에 따른 술식의 차이를 비교하였다. 2008년 대한치과의사협회에 등록된 치과의사 12,193명을 대상으로 이 메일을 통한 설문조사를 실시하였다. 이 메일 수신이 확인된 2,632명 중 840명이 응답하였으며 응답자의 남녀 비율은(남 78.9%, 여 21.1%) 전체 치과의사의 남녀 비율과 유의한 차이를 보이지 않았다(p > 0.05). Chi-square test 와 multiple logistic regression analysis 를 이용하여 남녀간 술식의 차 이를 검증하였다. 2급 와동 수복에서 여자치과의사는 4회 이상의 적층 분할 수복을 하는 경향이 남자치과의사에 비해 1.87배 높았으며, 술식 당 30분 이상 소요하는 경향은 2.72배 높았다(p < 0.05). 5급 와동 수복에서 여자치과의사는 베이스를 사용하는 경향이 1.83배 높았으며, 술식 당 20분 이상 소요하는 경향은 1.63배 높았다(p < 0.05). 본 설문조사에 따르면 남녀 성별에 따라 복합 레진 수복 술식의 차이가 존재하는 것으로 나타났다.

성인의 비타민E 수준에 따른 대사증후군 및 대사증후군 요인과의 연관성 (Association of vitamin E levels with metabolic syndrome, and metabolic syndrome components among adults)

  • 김태희
    • 산업융합연구
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    • 제19권5호
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    • pp.69-77
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    • 2021
  • 본 연구는 19세 이상 성인에서 비타민E와 대사증후군 및 대사증후군 요인과의 관계를 알아보기 위한 연구로 제7기 국민건강영양조사 원시자료를 활용한 단면조사 연구이다. 자료는 IBM SPSS Statistics 24.0을 이용하여 가중치를 적용한 복합표본설계로 Chi-sqaure, t-test, ANOVA, 로지스틱회귀분석을 실시하였다. 자료분석에 포함된 전체 대상자는 6,425명으로 ABIM (American Bord of Internal Medicine) laboratory reference range에 따라 비타민E 수준을 높음, 정상, 낮음으로 구분하였다. 비타민E가 높은 그룹 882명, 정상 그룹 5,498명, 낮은 그룹 45명이었다. 로지스틱회귀분석 결과 비타민E 수준이 정상인 그룹에 비하여 높은 그룹이 대사증후군(Adjusted Odds Ratio [AOR]: 1.889, 95% Confidence Interval [CI]: 1.550-2.303, p<.001), 복부비만(AOR: 1.444, CI: 1.205-1.730, p<.001), 고중성지방(AOR: 3.182, CI: 2.641-3.835, p<.001), 수축기혈압(AOR: 1.711, CI: 1.446-2.026, p<.001), 이완기기혈압(AOR: 1.806, CI: 1.521-2.144, p<.001), 저고밀도지단백콜레스테롤(AOR: 1.558, CI: 1.060-2.290, p=.024)의 오즈비가 증가함을 보였다. 본 연구 결과는 비타민E와 대사증후군 및 대사증후군 요인과 연관성이 있음을 나타내므로 대사증후군 대상자 간호중재 시 비타민E에 대한 교육이 적극적으로 포함되어야 할 것으로 생각된다.

Angioembolization performed by trauma surgeons for trauma patients: is it feasible in Korea? A retrospective study

  • Soonseong Kwon;Kyounghwan Kim;Soon Tak Jeong;Joongsuck Kim;Kwanghee Yeo;Ohsang Kwon;Sung Jin Park;Jihun Gwak;Wu Seong Kang
    • Journal of Trauma and Injury
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    • 제37권1호
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    • pp.28-36
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    • 2024
  • Purpose: Recent advancements in interventional radiology have made angioembolization an invaluable modality in trauma care. Angioembolization is typically performed by interventional radiologists. In this study, we aimed to investigate the safety and efficacy of emergency angioembolization performed by trauma surgeons. Methods: We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at Jeju Regional Trauma Center. Until May 2022, two dedicated interventional radiologists performed emergency angiography at our center. However, since June 2022, a trauma surgeon with a background and experience in vascular surgery has performed emergency angiography for trauma-related bleeding. The indications for trauma surgeon-performed angiography included significant hemorrhage from liver injury, pelvic injury, splenic injury, or kidney injury. We assessed the angiography results according to the operator of the initial angiographic procedure. The term "failure of the first angioembolization" was defined as rebleeding from any cause, encompassing patients who underwent either re-embolization due to rebleeding or surgery due to rebleeding. Results: No significant differences were found between the interventional radiologists and the trauma surgeon in terms of re-embolization due to rebleeding, surgery due to rebleeding, or the overall failure rate of the first angioembolization. Mortality and morbidity rates were also similar between the two groups. In a multivariable logistic regression analysis evaluating failure after the first angioembolization, pelvic embolization emerged as the sole significant risk factor (adjusted odds ratio, 3.29; 95% confidence interval, 1.05-10.33; P=0.041). Trauma surgeon-performed angioembolization was not deemed a significant risk factor in the multivariable logistic regression model. Conclusions: Trauma surgeons, when equipped with the necessary endovascular skills and experience, can safely perform angioembolization. To further improve quality control, an enhanced training curriculum for trauma surgeons is warranted.

노인의 아침식사에 따른 건강관련 삶의 질 (Health-related quality of life according to breakfast in elderly)

  • 김지연
    • 한국산학기술학회논문지
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    • 제16권7호
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    • pp.4668-4678
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    • 2015
  • 본 연구는 노인의 아침식사와 건강관련 삶의 질의 관련성을 파악하기 위해 시행되었다. 2010년부터 2012년까지 국민건강영양조사 자료를 분석하였으며 65세 이상 4035명의 자료를 분석하였고 SAS 9.3 version을 이용하여 복합표본설계를 고려한 SAS SURVEY procedure로 t-test, 카이스퀘어, 로지스틱회귀분석으로 분석하였다. 노인의 아침 결식률은 4.7%였고 여성, 혼자 사는 노인에게서 아침결식률이 높았으며 음주, BMI에서 유의한 차이를 보였다. 아침식사를 하는 노인의 건강관련 삶의 질은 0.85, 아침을 결식하는 노인의 건강관련 삶의 질은 0.81이었다. 식사의 횟수가 증가할수록 건강관련 삶의 질은 높은 것으로 나타났고 아침식사를 하는 노인들이 건강관련 삶의 질 중 통증/불편감, 불안/우울 영역에서 삶의 질이 높은 것으로 나타났다. 아침식사는 노인의 건강관련 삶의 질과 관련이 있는 것으로 나타나 노인을 대상으로 아침식사의 중요성에 대한 인식과 개선이 필요하며 식습관을 개선하기 위한 프로그램 개발과 적용을 통한 건강관련 삶의 질 향상을 도모해야 한다.

Comparative Analysis of Endovascular Stroke Therapy Using Urokinase, Penumbra System and Retrievable (Solitare) Stent

  • Choi, Jae-Hyung;Park, Hyun-Seok;Kim, Dae-Hyun;Cha, Jae-Kwan;Huh, Jae-Taeck;Kang, Myongjin
    • Journal of Korean Neurosurgical Society
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    • 제57권5호
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    • pp.342-349
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    • 2015
  • Background : Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. Method : A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes ($mRS{\leq}2$) at 3 month were compared across the three method. Results : Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). Conclusion : Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.