• Journal of Cardiovascular Imaging
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• 제31권1호
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• pp.51-61
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• 2023

BACKGROUND: Valvular heart disease (VHD) is a common cause of cardiovascular morbidity and mortality worldwide; however, its epidemiological profile in Korea requires elucidation. METHODS: In this nationwide retrospective cohort study from the Korean valve survey, which collected clinical and echocardiographic data on VHD from 45 medical centers, we identified 4,089 patients with VHD between September and October 2019. RESULTS: The aortic valve was the most commonly affected valve (n = 1,956 [47.8%]), followed by the mitral valve (n = 1,598 [39.1%]) and tricuspid valve (n = 1,172 [28.6%]). There were 1,188 cases of aortic stenosis (AS) and 926 cases of aortic regurgitation. The most common etiology of AS was degenerative disease (78.9%). The proportion of AS increased with age and accounted for the largest proportion of VHD in patients aged 80-89 years. There were 1,384 cases of mitral regurgitation (MR) and 244 cases of mitral stenosis (MS). The most common etiologies for primary and secondary MR were degenerative disease (44.3%) and non-ischemic heart disease (63.0%), respectively, whereas rheumatic disease (74.6%) was the predominant cause of MS. There were 1,172 tricuspid regurgitation (TR) cases, of which 46.9% were isolated and 53.1% were associated with other valvular diseases, most commonly with MR. The most common type of TR was secondary (90.2%), while primary accounted for 6.1%. CONCLUSIONS: This report demonstrates the current epidemiological status of VHD in Korea. The results of this study can be used as fundamental data for developing Korean guidelines for VHD.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.20-27
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• 2024

Purpose: Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy. Methods: We reviewed the data recorded in our center's trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately. Results: From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14-59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88-151 minutes; P<0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries. Conclusions: Although ED laparotomy was associated with a higher mortality rate, the time between admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.60-66
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• 2024

Purpose: This study investigated changes in interpersonal violence and utilization of trauma recovery services during the COVID-19 pandemic. At an urban level I trauma center, trauma recovery services (TRS) provide education, counseling, peer support, and coordination of rehabilitation and recovery to address social and mental health needs. The COVID-19 pandemic prompted considerable changes in hospital services and increases in interpersonal victimization. Methods: A retrospective analysis was conducted between September 6, 2018 and December 20, 2020 for 1,908 victim-of-crime patients, including 574 victims of interpersonal violence. Outcomes included length of stay associated with initial TRS presentation, number of subsequent emergency department visits, number of outpatient appointments, and utilization of specific specialties within the year following the initial traumatic event. Results: Patients were primarily female (59.4%), single (80.1%), non-Hispanic (86.7%), and Black (59.2%). The mean age was 33.0 years, and 247 patients (49.2%) presented due to physical assault, 132 (26.3%) due to gunshot wounds, and 76 (15.1%) due to sexual assault. The perpetrators were primarily partners (27.9%) or strangers (23.3%). During the study period, 266 patients (mean, 14.9 patients per month) presented before the declaration of COVID-19 as a national emergency on March 13, 2020, while 236 patients (mean, 25.9 patients per month) presented afterward, representing a 74.6% increase in victim-of-crime patients treated. Interactions with TRS decreased during the COVID-19 period, with an average of 3.0 interactions per patient before COVID-19 versus 1.9 after emergency declaration (P<0.01). Similarly, reductions in length of stay were noted; the pre-COVID-19 average was 3.6 days, compared to 2.1 days post-COVID-19 (P=0.01). Conclusions: While interpersonal violence increased, TRS interactions decreased during the COVID-19 pandemic, reflecting interruption of services, COVID-19 precautions, and postponement/cancellation of elective visits. Future direction of hospital policy to enable resource and service delivery to this population, despite internal and external challenges, appears warranted.

• 스마트미디어저널
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• 제13권4호
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• pp.33-48
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• 2024

향상된 모바일 광대역(eMBB), 초저지연 및 고신뢰 통신(URLLC), 대규모 기계형 통신(mMTC) 등의 특징을 가진 5G의 등장으로 인해 효율적인 네트워크 관리와 서비스 제공을 위해 증가하는 네트워크 트래픽과 복잡성 해결이 시급한 상황이다.본 논문에서는 기계학습(Machine Learning, ML) 및 딥러닝(Deep Learning, DL)기술을 활용하여 5G 네트워크의 초고속, 초저지연, 초연결성이라는 주요 과제를 해결하면서 네트워크 슬라이싱 및 자원 할당을 동적으로 최적화하는 새로운 접근 방식을 제시한다. 제안된 기법에서는 네트워크 트래픽 및 자원 할당에 대한 예측 모델, 네트워크 대역폭 및 지연 시간을 최적화하면서 동시에 개인 정보와 보안을 향상시키기 위한 연합 학습(FL) 기법을 사용한다. 특히, 본 논문에서는 랜덤 포레스트와 LSTM 등 다양한 알고리듬과 모델의 구현 방법에 대해 자세히 다루며, 이를 통해 5G 네트워크 운영의 자동화와 지능화를 위한 방법론을 제시한다. 마지막으로 제안된 기법을 통해 5G 네트워크에 ML 및 DL을 적용하여 얻을 수 있는 성능향상 효과를 성능평가 및 분석을 통해 검증하고 다양한 산업 응용 분야에서 네트워크 슬라이싱 및 자원 관리 최적화를 위한 솔루션을 제시한다.

• 품질경영학회지
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• 제51권4호
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• pp.531-550
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• 2023

Purpose: The unique nature of life-and-death healthcare services sets them apart from other service industries. While many studies exist on the relationship between healthcare services and customer satisfaction, most of them focus on mildly ill patients, ignoring the differences between critically ill and non-seriously ill patients. This study discusses the actual quality of healthcare services for patients who are facing life-threatening illnesses and are on life support, as well as their right to protection and dignity. Methods: The survey conducted to 149 patients with the four major illnesses: cancer, heart disease, brain disease and rare and incurable disease, those who have experiences with senior general hospitals. Results: The basic statistics of this study are adequate to represent the four major critical illnesses, and the reliability and validity of this study's hypotheses, which were measured by multiple items, were analyzed, and the internal consistency was judged to be high. In addition, it was found that the convergent validity was good and the discriminant validity was also secured. When examining the goodness of fit of the hypotheses, the SRMR, which is the standardized root mean square of residuals that measures the difference between the covariance matrix of the data variables and the theoretical covariance matrix structure of the model, met the optimal criteria. Conclusion: The academic implications of this study are differentiated from other studies by moving away from evaluating the quality of healthcare services for mildly ill patients and focusing on the rights and dignity of patients with life-threatening illnesses in four senior general hospitals. In terms of academic implications, this study enriches the depth of related studies by demonstrating the right to protection and dignity as a factor of patient-centeredness based on physical environment quality, interaction quality, and outcome quality, which are presented as sub-factors of healthcare quality. We found that the three quality factors classified by Brady and Cronin (2001) are optimized for healthcare quality assessment and management, and that the results of patients' interaction quality assessment can be used to provide a comprehensive quality rating for hospitals. Health and human rights are inextricably linked, so assessing the degree to which rights and dignity are protected can be a superior and more comprehensive measurement tool than traditional health level measures for healthcare organizations. Practical implications: Improving the quality of the physical environment and the quality of outcomes is an important challenge for hospital managers who attract patients with life and death conditions, but given the scale and economics of time, money, and human inputs, improving the quality of interactions and defining them as performance indicators in hospital quality management is an efficient way to create maximum value in the short term.

• Journal of Veterinary Science
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• 제25권2호
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• pp.20.1-20.15
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• 2024

Background: Avian influenza (AI) is a contagious disease that causes illness and death in poultry and humans. High pathogenicity AI (HPAI) H5N6 outbreaks commonly occur in Quang Ninh province bordering China. In June 2021, the first HPAI H5N8 outbreak occurred at a Quang Ninh chicken farm. Objectives: This study examined the risk factors associated with HPAI H5N6 and H5N8 outbreaks in Quang Ninh. Methods: A retrospective case-control study was conducted in Quang Ninh from Nov 2021 to Jan 2022. The cases were households with susceptible poultry with two or more clinical signs and tested positive by real-time reverse transcription polymerase chain reaction. The controls were households in the same village as the cases but did not show clinical symptoms of the disease. Logistic regression models were constructed to assess the risk factors associated with HPAI outbreaks at the household level. Results: There were 38 cases with H5N6 clade 2.3.4.4h viruses (n = 35) and H5N8 clade 2.3.4.4b viruses (n = 3). Compared to the 112 controls, raising poultry in uncovered or partially covered ponds (odds ratio [OR], 7.52; 95% confidence interval [CI], 1.44-39.27), poultry traders visiting the farm (OR, 8.66; 95% CI, 2.7-27.69), farms with 50-2,000 birds (OR, 3.00; 95% CI, 1.06-8-51), and farms with ≥ 2,000 birds (OR, 11.35; 95% CI, 3.07-41.94) were significantly associated with HPAI outbreaks. Conclusions: Combining biosecurity measures, such as restricting visitor entry and vaccination in farms with more than 50 birds, can enhance the control and prevention of HPAI in Quang Ninh and its spread across borders.

• 대한영상의학회지
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• 제83권1호
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• pp.138-148
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• 2022

목적 본 연구는 전국 인구 기반 데이터베이스를 이용하여 국내 소아 전산화단층촬영의 비율과 연간 추세를 평가하였다. 대상과 방법 2012년부터 2017년까지 국내에서 촬영된 소아 전산화단층촬영에 대한 건강보험심사평가원의 데이터를 사용하였다. 연령, 성별, 진단명 및 해부학적 위치에 대한 데이터를 같이 추출하여 분석하였다. 결과 18세 미만 어린이 58527528명을 대상으로 총 576376건의 전산화단층촬영이 시행되었다(1000명당 9.8회). 어린이 1000명당 전산화단층촬영 횟수는 9.0회에서 11.0회로 23.2% 증가했다. 전산화단층촬영 건수는 6-12세 그룹에서 32.9%(1000명당 7.4회에서 9.8회로 증가), 13-18세 그룹에서 34.0% 증가했다(1000명당 11.4회에서 15.3회로 증가). 부위별 전산화단층촬영의 비율은 두부(39.1%), 사지(32.5%), 복부(13.7%) 순서로 확인되었다. 사지 전산화단층촬영 횟수는 83.6% 증가했으며(1000명당 2.3회에서 4.2회로 증가) 사지 전산화단층촬영의 비율은 25.3%에서 37.7%로 증가했다. 결론 소아 환자의 전산화단층촬영은 2012년부터 2017년까지 매년 4.4%의 속도로 지속적으로 증가했다. 따라서 의사는 소아 환자에서 전산화단층촬영으로 인한 이득과 방사선 노출로 인한 잠재적인 피해를 적절히 고려하여 신중하게 촬영을 결정해야 한다.

• 한방비만학회지
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• 제24권1호
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• pp.87-93
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• 2024

Objectives: Obesity is a globally prevalent public health issue. Hence, there is a need for the development of safer and more effective anti-obesity drugs. Lythrum salicaria, a traditional medicinal herb used for centuries, has been reported to improve lipid metabolism and fat accumulation. It also has a low toxicity profile. Therefore, its potential as a functional ingredient in health functional foods needs to be evaluated. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 90 participants will be randomly assigned to either the experimental or control group. Each subject will orally receive L. salicaria extract (1,350 mg/day) (500 mg L. salicaria+850 mg lactose as vehicle) or lactose (1,350 mg/day) as a hard capsule formula for 84 days (12 weeks). The primary outcome will be body fat mass (kg), which will be assessed using dual-energy x-ray absorptiometry (DXA) (performed only at visits 2 and 4). Secondary outcomes include body mass index, body weight, waist-to-hip ratio, body fat percentage (%) measured using DXA, lean body mass (kg) measured using DXA (assessed only at visits 2 and 4), lipids (total cholesterol, triglyceride, high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol), free fatty acid, high sensitivity C-reactive protein, adiponectin, and leptin. Conclusions: This protocol will be implemented after approval of Institutional Review Board of Pusan National University Korean Medicine Hospital (approval number: PNUKHIRB-2022-08-002) and registration with the Korean National Clinical Research Information Service (CRIS) (CRIS-KCT0008060). The results of this trial will provide potential of L. salicaria as a new anti-obesity functional food with fat-reducing effects and low toxicity.

• Korean Circulation Journal
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• 제54권5호
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• pp.256-267
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• 2024

Background and Objectives: Accumulating evidence shows that sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce adverse cardiovascular outcomes. However, whether SGLT2i, compared with other antidiabetic drugs, reduce the new development of atrial fibrillation (AF) is unclear. In this study, we compared SGLT2i with dipeptidyl peptidase-4 inhibitors (DPP-4is) in terms of reduction in the risk of AF in individuals with type 2 diabetes. Methods: We included 42,786 propensity score-matched pairs of SGLT2i and DPP-4i users without previous AF diagnosis using the Korean National Health Insurance Service database between May 1, 2016, and December 31, 2018. Results: During a median follow-up of 1.3 years, SGLT2i users had a lower incidence of AF than DPP-4i users (1.95 vs. 2.65 per 1,000 person-years; hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.97; p=0.028]). In individuals without heart failure, SGLT2i users was associated with a decreased risk of AF incidence (HR, 0.70; 95% CI, 0.52-0.94; p=0.019) compared to DPP-4i users. However, individuals with heart failure, SGLT2i users was not significantly associated with a change in risk (HR, 1.04; 95% CI, 0.44-2.44; p=0.936). Conclusions: In this nationwide cohort study of individuals with type 2 diabetes, treatment with SGLT2i was associated with a lower risk of AF compared with treatment with DPP-4i.

• Korean Circulation Journal
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• 제52권11호
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• pp.814-825
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• 2022

Background and Objectives: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. Methods: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018. Results: Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001). Conclusions: Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.