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AI 기반 뇌출혈 진단보조 소프트웨어의 소아 연령별 진단 성능 분석
No full textMasterI 서론 1
A. 배경 및 필요성 1
B. 연구 목적 3
Ⅱ 선행연구 4
Ⅲ 연구 방법 6
A. 연구 데이터 6
1. 연구 설계 및 데이터 6
2. CT 장비 및 기법 9
B. 뇌출혈 진단보조 소프트웨어의 AI 영상 분석 11
C. 통계 분석 14
Ⅳ 연구 결과 16
A. 인구통계학적 분석 결과 16
B. 통계분석 결과 18
1. Cutoff Level 50 에서 진단 성능 분석 18
2. Cutoff Level 30 에서 진단 성능 분석 27
3. Cutoff Level 40 에서 진단 성능 분석 29
Ⅴ 논의 33
Ⅵ 결론 36
참고문헌 37
ABSTRACT 4
근골격계 이환 노인의 신체활동 수준과 주관적 건강인지의 연관성
No full textMasterⅠ. 서론 1
1. 연구의 배경 및 필요성 1
2. 연구 목적 5
3. 용어의 정의 6
Ⅱ. 연구방법 8
1. 연구대상 8
2. 연구모형 10
3. 연구변수 11
Ⅲ. 연구결과 15
1. 연구대상자의 일반적 특성 15
2. 연구대상자의 신체활동 수준 및 주관적 건강인지 17
3. 인구사회학적 특성에 따른 신체활동 수준 19
4. 건강행태학적 특성에 따른 신체활동 수준 21
5. 이환 특성에 따른 신체활동 수준 23
6. 인구사회학적 특성에 따른 주관적 건강인지 25
7. 건강행태학적 특성에 따른 주관적 건강인지 27
8. 이환 특성에 따른 주관적 건강인지 29
9. 신체활동 수준에 따른 주관적 건강인지 31
10. 신체활동 수준과 주관적 건강인지의 연관성 33
Ⅳ. 고찰 37
Ⅴ. 결론 40
참고문헌 42
부록 47
ABSTRACT 5
Standardizing Medical Imaging Data Using Radiology Common Data Model and Analysis of Retinal Thickness in Patients with Chronic Diseases with Standardized Optical Coherence Tomography Databases
No full textDoctorI. Introduction 1
A. Background 1
1. Observational Medical Outcome Partnership Common Data Model 1
2. Efforts to Standardize Unstructured Data Using the OMOP-CDM Framework 3
3. Challenges in Utilizing Multi-Institutional Medical Imaging Data 4
4. The Potential Impact of R-CDM 6
5. Optical Coherence Tomography (OCT) 6
B. Objectives 9
II. Materials and Methods 10
A. Data sources 10
B. Designing a standard structure and terminology system for R-CDM 11
C. Constructing an R-CDM standardized OCT database 18
D. Study Design Using OMOP-CDM: Establishing Chronic Disease and Control Cohorts for OCT Imaging Analysis 21
E. Integration of R-CDM and OMOP-CDM: Extracting Specific OCT Data from Defined Cohorts 26
F. Analyzing Retinal Thickness Measurements from OCT Data Using Mixed-Effects Regression Models 28
III. Results 31
A. Composition of R-CDM Standardized OCT Databases 31
B. Study population 32
C. Clinical Outcomes 40
D. Sensitivity analyses 49
IV. Discussion 50
A. Main findings 50
1. The Global Impact and Application of R-CDM in Medical Imaging Research 51
2. Other Efforts to Standardize Medical Imaging Data 53
3. Retinal Thickness Alterations in Chronic Disease: A Comparative Review of Diabetic and Hypertensive Cohorts 56
4. Application of Large-Scale PSM and Multi-Institutional Analysis for Retinal Thickness Studies 57
B. Limitations 59
V. Conclusion 60
References 62
Appendix 68
국문요약 10
진행성 자궁내막암에서 최소 침습 수술과 개복 수술의 비교
No full textMasterI. Introduction 1
II. Materials and methods 2
III. Results 3
IV. Discussion 5
References 1
Association of Intensive Endoscopic Burden with Esophageal Cancer Detection: A Nationwide Cohort Study
No full textMasterI. INTRODUCTION 1
II. METHODS 3
A. Study population and design 3
B. The KNCSP and screening endoscopy protocol 3
C. Data collection and definitions 4
D. Statistical analysis 5
III. RESULTS 6
A. Study population and baseline characteristics 6
B. Monthly changes in the number of participants and monthly detection rates for EC 6
C. Factors related to endoscopic screening sensitivity for EC detection 7
D. Association between detection rates and calendar month 7
IV. DISCUSSION 9
V. CONCLUSION 14
REFERENCES 21
국문요약 2
Trends in prescribing sodium-glucose cotransporter 2 inhibitors for individuals with type 2 diabetes with and without cardiovascular-renal disease in South Korea, 2015–2021
No full textBACKGROUND: This study evaluates shifts in oral glucose-lowering drug prescription patterns and the adoption of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in South Korea. METHODS: A cross-sectional and retrospective cohort analysis of the Korean National Health Insurance database (2015-2021) assessed the prescription patterns of oral glucose-lowering drugs by therapy level, SGLT2i prescriptions by cardiovascular-renal disease (CVRD) status, and the mean duration for SGLT2i therapy initiation and intensification. RESULTS: From 2015 to 2021, the number of individuals prescribed oral glucose-lowering drugs across all regimen levels increased. However, the proportion of individuals receiving monotherapy or dual combination therapy decreased by 9.2 percentage points, whereas the proportion prescribed triple or more combination therapy increased. SGLT2i prescriptions increased from 2.5% in 2015 to 13.9% in 2021, marking an 11.4 percentage point growth. This trend was consistent among individuals with and without CVRD, with the most significant increase observed in individuals with heart failure-from 2.2% in 2015 to 16.6%. The mean time to SGLT2i initiation post-diagnosis was shortened from 249 days in 2015 to 158 days in 2019. CONCLUSIONS: The adoption of SGLT2i therapy was on the rise, especially among individuals with heart failure, accompanied by a notable decrease in time to treatment initiation. Despite these positive trends, the overall use of SGLT2i among individuals with CVRD remained limited
Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial
No full textBACKGROUND: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain. METHODS: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain. RESULTS: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p < 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group. CONCLUSIONS: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
Association between Exclusive Breastfeeding and the Incidence of Childhood Nephrotic Syndrome
No full textObjective: To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. Study design: This nationwide cohort study utilized data from the National Health Information Database and the National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, 8 years postindex date, death, or December 31, 2022, whichever was first. Results: The study population comprised 1 787 774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612 556 exclusively breastfed and 1 175 218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69-0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70-1.09). Sensitivity analysis confirmed these results. Conclusions: Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age
Improving functional correlation of quantification of interstitial lung disease by reducing the vendor difference of CT using generative adversarial network (GAN) style conversion
No full textObjective: To assess whether CT style conversion between different CT vendors using a routable generative adversarial network (RouteGAN) could minimize variation in ILD quantification, resulting in improved functional correlation of quantitative CT (QCT) measures. Methods: Patients with idiopathic pulmonary fibrosis (IPF) who underwent unenhanced chest CTs with vendor A and a pulmonary function test (PFT) were retrospectively evaluated. As deep-learning based ILD quantification software was mainly developed using vendor B CT, style-converted images from vendor A to B style were generated using RouteGAN. Quantification was performed in both original and converted images. Measurement variability in QCT between original and converted images was evaluated using the concordance correlation coefficient (CCC). Two radiologists visually evaluated quantification accuracy using original and converted images. Correlations between CT parameters and PFT measures were assessed. Results: Total 112 patients (mean age, 61; 82 men) were studied. Measurement variability between original and converted CT was a CCC of 0.20 for reticulation, 0.72 for honeycombing, and 0.59 for ground-glass opacity. The median visual accuracy scores were higher for the quantification using converted compared with the original images (P < 0.001). Correlation between fibrosis score increased significantly after CT conversion for both forced vital capacity (original vs. converted; −0.35 vs. −0.50; P = 0.005) and diffusing capacity of the lung for carbon monoxide (−0.50 vs. −0.66; P < 0.001). Conclusion: The improved accuracy in deep learning based ILD quantification after applying GAN-based CT style conversion can result in the improved functional correlation of QCT measurements in patients with IPF
Long-term outcomes of enzyme replacement therapy from a large cohort of Korean patients with mucopolysaccharidosis IVA (Morquio A syndrome)
No full textMucopolysaccharidosis (MPS) IVA (Morquio A syndrome) is an autosomal recessive lysosomal storage disorder caused by a mutation affecting the enzyme N-acetylgalactosamine-6-sulfatase (EC 3.1.6.4, GALNS). Enzyme replacement therapy (ERT) has been shown to improve physical performance, quality of life, and respiratory function in patients with MPS IVA; however, owing to the rarity of MPS IVA, data on Korean patient characteristics are limited. This retrospective study reports clinical, radiographic, biochemical, and molecular findings, and analyzes long-term clinical outcomes, from the largest cohort of Korean patients with MPS IVA in a single center. The analysis included 17 patients from 14 families (58.8 % females; median [range] age at diagnosis 5.2 [1.8–33.7] years). The majority of patients (64.7 %) were classified as having a severe phenotype, 23 % had an intermediate phenotype, and 11.8 % had an attenuated phenotype. Skeletal manifestations and radiologic abnormalities at initial diagnosis included gait abnormality (35.3 %), short stature (23.5 %), chest deformity (23.5 %), scoliosis (17.6 %), kyphosis (11.8 %), dysmorphic face (6 %), hip pain (6 %), and leg deformity (6 %). Twelve different GALNS mutations were identified. Patients received ERT for a median (range) 7.4 years (3.0–12.1). Twelve patients reached final adult height, and all patients with the severe/intermediate phenotype had short stature (<3rd percentile). Hemiepiphysiodesis was the most common surgical intervention among patients with the severe/intermediate phenotype. Drug-related adverse events (urticaria, rash, and anaphylaxis) were reported in four patients but were managed with antihistamines or desensitization. At follow-up, patients experienced improvements in functional independence measure score, ejection fraction, and the 6-min walk test compared with the pre-treatment baseline. This study provides real-world evidence for long-term stabilization of functional independence, endurance, and respiratory function among patients with MPS IVA treated with ERT, with no new safety concerns identified