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김중희,이휘재,송성욱,박진식,재환준,이활,신상도,정성구,곽영호,서길준,박재형 대한의학회 2010 Journal of Korean medical science Vol.25 No.3
To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED)from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1,n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6%(negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
김중희,강준원,김규석,최상일,전은주,김여군,김원영,서동우,신종환,이휘재,진광남,안소연,황승식,김광표,정루비,하상욱,최병호,윤창환,서정원,김학령,김주경,장수진,서지선 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.4
Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a lowdose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
Multiple Shock Failures during Resuscitation: Risk Factors and Prognostic Implications
김중희,김태윤,이중의,김규석,조유환,이재혁,김유진,권혁술,정재윤 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.2
Purpose: Electrical shock is not always followed by a perfusing rhythm, and multiple shock failure (MSF) is common during CPR. We sought to investigate its risk factors and prognostic implications. Methods: Adult OHCA patients with emergency department (ED) ACLS attempts were identified from a tertiary hospital OHCA registry extending from 2008 to 2012. Shock failure was defined as any electrical shock attempt not followed by a pulse-generating rhythm. Patients were assigned to one of three groups based on the number of shock failures: 1) MSF: ≥3 electrical shock failures before the first ROSC or CPR termination (if there was no ROSC), 2) early shock success (ESS): pulse-generating rhythm achieved within 3 electrical shock attempts and 3) others: all remaining patients. Baseline characteristics, initial laboratory measurements, and outcomes were compared. Results: A total of 590 patients were included. There was no significant difference in baseline characteristics between the MSF group (n=49) and the early shock success group (n=50) except in its higher proportion of presumed cardiac aetiology. The MSF group showed less severe metabolic acidosis and coagulopathy on ED arrival and better renal function and higher haematocrit and serum albumin levels compared with the ESS group. MSF was associated with less sustained ROSC, but was also associated with more survival discharge and better long-term neurologic outcomes after sustained ROSC. Conclusion: MSF may indicate heart-specific problems rather than severe metabolic derangements. Better longterm outcomes can be expected once sustained ROSC is achieved, therefore, this phenomenon warrants more focused research.
한국군 합동전영역지휘통제(JADC2) 전략: 美 JADC2 전략 분석을 중심으로
김중희,최영찬 육군사관학교 화랑대연구소 2023 한국군사학논집 Vol.79 No.3
미국의 JADC2 전략 분석에 기반하여 한국군 합동전영역지휘통제 중심사고 설정, 구현전략 및 전략구현 방법과 수단의 제시라는 세가지 측면에서 우리 군의 합동전영역지휘통제 전략을 논의했다. 한국군 합동전영역지휘통제의 중심사고는 전 제대간, 영역 간에 언제 어디서나 제 요소들의 연결이 보장되고, AI를 활용하여 OODA Loop 시간을 단축시키며, 분산된 자산과 신속한 결심으로 적에게 혼란을 강요하는 모습으로 설정할 필요성이 있다. 이러한 개념을 구현하기 위한 추진 전략으로 6개 영역과 합동, 연합 및 통합방위의 작전요소 간에 네트워크 통합, AI의 적용을 통한 결심중심전 구현을 목표로 설정하고, 이를 위한 수단 및 방법으로 데이터 표준화, 추진 전담조직 지정, 전략문서 체계 정립, 첨단상용기술 적용 및 진화적 단계화 발전이 요구된다. In this paper, based on the analysis of the U.S. JADC2 Strategy, the ROK Armed Forces JADC2 was studied in three aspects: the core thinking, strategy for implementation, and specifying methods and means. the core thinking guarantees the connection of all elements anytime and anywhere between units and domains, shortens the OODA Loop time by using AI, and forces confusion on the enemy with dispersed assets. The goal is to implement decision-centric warfare through network integration and application of AI between the domains and operation elements of joint, combined, and integrated defense. Five essential tasks were discussed as means and methods: data standardization, designation of a dedicated organization, establishment of a strategic document system, application of advanced commercial technology, and the need for implement evolutionary development.
김중희 대한기계학회 1985 大韓機械學會誌 Vol.25 No.4
경량화와 저연비의 추세에도 불구하고 자동화의 안락감에 대한 고객의 요구 수준은 더욱 높아 가고 있다. 따라서 이와 같은 승차감을 대표하는 요소의 실내소음은 여전히 상품 평가의 중요한 지표가 되고 있으며 최근 이 방면의 기술 역시 요구에 상응하는 속도로 발전하고 있다. 모든 기계 요소의 소음의 수준은 곧 개개의 부품에 대한 완벽성을 총체적으로 평가하는 수단이며 이는 발생원, 전달계, 응답계등 모든 측면에서의 기술 수준을 대변한다. 최근 컴퓨터와 수치 해석법 그리고 실험장치의 발달에 힘입어 이들 각각에 대한 보다 신속하고 정확한 저감대책 수립은 물론 상호간의 연성 문제까지를 포함한 해석이 가능해 지고 있으며 이를 이용한 저소음 차량 개발 노력이 경주되고 있다. 자동차 보유 댓수가 급격히 증가 되고 있는 국내 여건은 물론 자동차 산업이 수출 전략적 측면에서의 위치를 굳히고 있는 현시점에서 생활공간의 일부인 자동차의 실내소음 저감에 더욱 많은 연구발전이 있기를 기대한다.