Value of image subtraction for the identification of hepatocellular carcinoma capsule on gadoxetic acid-enhanced MR images

김현중,안지현,문진실,차승환 대한영상의학회 2018 대한영상의학회지 Vol.79 No.6

Purpose To evaluate value of image subtraction for identifying hepatocellular carcinoma (HCC) capsule on gadoxetic acid-enhanced MR images. Materials and Methods This study involved 108 patients at risk of HCC preoperatively examined using gadoxetic acid-enhanced MRI with hepatic resection between May 2015 and February 2017. We evaluated qualities of subtraction images and presence of capsular appearance on portal venous or transitional phases conventional and subtraction images. We assessed effect of capsular appearance on subtraction images on HCC. Results After excluding 1 patient who had treated by transarterial chemoembolization prior to surgery and 33 patients with unsatisfactory subtraction image qualities, 82 focal hepatic lesions (73 HCC, 5 non-HCC malignancies, and 4 benign) from 74 patients were analyzed. Regarding detection of capsules, sensitivity, accuracy, and area under the receiver operating characteristic curve (AUC) on subtraction images were significantly higher than those on conventional images (95.4%, 89.0%, and 0.80, respectively; P<0.001), though specificities were same (64.7%). For diagnosis of HCC, sensitivity, accuracy, and AUC on subtraction images were significantly higher than on conventional images (82.2%, 79.3%, and 0.69, respectively; P=0.011), though specificities were identical (55.6%). Conclusion Portal venous or transitional phase gadoxetic acid-enhanced MRI subtraction images could improve detection of HCC capsule.

Metabolic Syndrome Severity Score in Korean Adults: Analysis of the 2010–2015 Korea National Health and Nutrition Examination Survey

허지혜,이준혁,문진실,성기철,김장영,강대룡 대한의학회 2019 Journal of Korean medical science Vol.34 No.6

Background: Continuous metabolic syndrome (MS) severity scores that can track metabolic risk in individuals over time have been developed for Western populations. The present study aimed to develop gender- and age-specific equations for MS severity scores in Korean adults. Methods: Using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) IV (2010–2012) and VI (2013–2015), we performed a confirmatory factor analysis of single MS factor that allowed for differential loadings across groups to generate gender- and age-specific, continuous MS severity scores. Then, we validated this equation in a different dataset of Korean adults. Results: In confirmatory analysis, waist circumference had the highest factor loading, indicating that waist circumference had the strongest correlation with MS among Korean adults. Lower factor loadings (< 0.4) among Korean adults aged 40–59 years were noted for systolic blood pressure and fasting glucose. MS severity score values were significantly correlated with metabolic parameters, including high-sensitivity C-reactive-protein, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Furthermore, MS severity scores well predicted traditional MS according to receiver operating characteristic analysis in a validation dataset (KNHANES VII). In a longitudinal cohort dataset, participants diagnosed with Adult Treatment Program III (ATP-III) MS after an initial assessment had progressively higher baseline MS severity scores in relationship to their time until ATP-III MS diagnosis. Conclusion: The new MS severity score equations for Korean adults proposed in this study provide a clinically-accessible continuous measure of MS for potential use in identifying adults at higher risk for MS-related diseases and following changes within individuals over time.

Metabolic Syndrome Severity Score for Predicting Cardiovascular Events: A Nationwide Population-Based Study from Korea

장요남,이준혁,문진실,강대룡,박성용,조재림,Kim Jang Young,허지혜 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.4

Background Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population. Methods From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve. Results Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III. Conclusion The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Effectiveness of a multidisciplinary team for nutrition support in a trauma intensive care unit

오은석,심홍진,연현주,문진실,Kang Dae Ryong,장지영 대한중환자의학회 2020 Acute and Critical Care Vol.35 No.3

Background: We evaluated clinical and nutritional outcomes according to multidisciplinary team involvement in nutrition support in a regional trauma intensive care unit (TICU). Methods: We retrospectively compared the outcomes for 339 patients admitted to the TICU for >5 days depending on nutrition support team (NST) involvement (n=176) and non-NST involvement (n=163). Results: The mean age and injury severity score (ISS) were 57.3±16.7 years and 18.6±9.7, respectively. Fifty-three patients (15.6%) had shock on admission and 182 (53.7%) underwent surgery during TICU admission. Some patients were admitted to neurosurgery (46%), general surgery (35.4%), and other (18.6%) departments. There were significant differences in the ISS, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock on TICU admission, and initial laboratory results. After propensity score matching, the total delivered/required caloric ratio and total delivered/required protein ratio were significantly higher in the NST group than in the non-NST group (calorie: 80.4% vs. 66.7%, P=0.007; protein: 93.1% vs. 68.3%, P<0.001). The NST group had an adequate protein supply more frequently than the non-NST group (protein: 48.0% vs. 25.8%, P=0.002). There was no significant difference in survival, even after adjustment for risk factors using Cox proportional hazard analysis. Conclusions: The results of our study suggest that multidisciplinary team involvement in nutrition support in TICU patients may improve nutritional, but not clinical, outcomes.

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study

이주연,박상만,차승환,문진실,김명순 대한영상의학회 2020 대한영상의학회지 Vol.81 No.6

Purpose This study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis. Materials and Methods This study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4. Results Intersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201). Conclusion Although nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.