Reference Values for Spirometry Derived Using Lambda, Mu, Sigma (LMS) Method in Korean Adults: in Comparison with Previous References

조범식,명준표,이진국,윤형규,구정완,김형렬 대한의학회 2018 Journal of Korean medical science Vol.33 No.3

Background: The present study aimed to update the prediction equations for spirometry and their lower limits of normal (LLN) by using the lambda, mu, sigma (LMS) method and to compare the outcomes with the values of previous spirometric reference equations. Methods: Spirometric data of 10,249 healthy non-smokers (8,776 females) were extracted from the fourth and fifth versions of the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007–2009; V, 2010–2012). Reference equations were derived using the LMS method which allows modeling skewness (lambda [L]), mean (mu [M]), and coefficient of variation (sigma [S]). The outcome equations were compared with previous reference values. Results: Prediction equations were presented in the following form: predicted value = e{a + b × ln(height) + c × ln(age) + M − spline}. The new predicted values for spirometry and their LLN derived using the LMS method were shown to more accurately reflect transitions in pulmonary function in young adults than previous prediction equations derived using conventional regression analysis in 2013. There were partial discrepancies between the new reference values and the reference values from the Global Lung Function Initiative in 2012. Conclusion: The results should be interpreted with caution for young adults and elderly males, particularly in terms of the LLN for forced expiratory volume in one second/forced vital capacity in elderly males. Serial spirometry follow-up, together with correlations with other clinical findings, should be emphasized in evaluating the pulmonary function of individuals. Future studies are needed to improve the accuracy of reference data and to develop continuous reference values for spirometry across all ages.

CA 72-4 참고치 설정에 관한 연구

안재석,김지나,조예지,윤상혁,김윤철,An, Jae-Seok,Kim, Ji-Na,Joe, Ye-Ji,Yoon, Sang-Hyuk,Kim, Yoon-Cheol 대한핵의학기술학회 2021 핵의학 기술 Vol.25 No.2

CA 72-4는 두 종류의 단일클론항체 CC49와 B72.3을 사용하여 혈청 내 종양관련단백인 TAG-72(tumor associated glycoprotein 72)를 측정 하여 결과를 나타내는 종양표지자이다. CA 72-4는 위암, 난소암, 췌장암등의 진단에 사용되고 있으며 특히 위암에 높은 특이도를 나타내는 것으로 알려져 있다. 본 연구는 CA 72-4의 참고치 재검증을 통하여 제조사에서 제공하는 참고치를 재평가 하고, 나아가 임상에서 보다 정확한 진단을 내리는데 유용한 도움을 주고자 진행하였다. 2020년 11월 국립암센터 건강검진센터에서 건강검진을 진행한 환자 271명을 대상으로 하였다. 대상자의 성별은 남자 140명 여자 131명 이었고, 30대부터 60대까지의 환자를 대상으로 진행하였다. 시약은 CA 72-4 IRMA KIT (ISOTOPES, Hungary)를 사용하였고, 감마카운터는 Dream Gamma-10(신진메딕스, Korea)을 사용하여 측정하였다. 종양표지자 참고치 설정 시 주로 사용하는 Hoffmann 법과 Bayesian 법으로 통계처리 하였다. 대상자 271명의 CA72-4를 측정한 결과 평균(Mean, M)값은 4.54 U/mL 이었고 중앙값(Median)은 3.30 U/mL 이었다. 3SD(standard deviation)를 벗어난 24명의 값을 제외하고 측정한 결과 M값은 3.53 U/mL, 중앙값은 3.00 U/mL, SD는 1.89 이었다. 이 값을 토대로 계산한 참고치 값은 7.31 U/mL 이었다. 제조사에서 제공되는 참고치는 4 U/mL 이하이며 이것은 본 연구에서 계산되어진 값인 7.31 U/mL과는 다소 차이가 있어 검사실 환경에 맞게 참고치 재설정이 필요해 보인다. 현재 국립암센터 위암센터에서는 지속적으로 현재 사용하고 있는 참고치에 관하여 문의가 오고 있다. 이번에 진행된 연구와 더불어 추가적인 연구를 진행한다면 보다 정확한 참고치 설정이 가능할 것이다. Purpose CA 72-4 is a tumor marker that uses two monoclonal antibodies, CC49 and B72.3, to measure tumor-related glycoprotein(TAG72) in the serum. CA 72-4 is used to diagnose stomach, ovarian, and pancreatic cancers, and is known to perform high specificity for stomach cancer. The purpose of this study is to re-evaluate the reference value provided by the manufacturer through revalidation of the reference value in CA 72-4. Furthermore this study was conducted to provide useful help when making a clinical diagnosis at gastric cancer center. Materials and Methods We selected 271 patients who had been to health care center in national cancer center for the month of November 2020. The gender of the subjects was 140 males and 131 females, and the age group was from 30s to 60s. The reagent used in the study was a CA 72-4 IRMA KIT (ISOTOPES, Hungary) and the results were measured using a Dream Gamma-10 gamma counter (Shinjin medics, Korea). Results Statistical analysis of the results of this study used Hoffmann's method and Bayesian's method, which are primarily used in setting reference value. As a result of measuring CA 72-4 of 271 patients, the mean value was 4.54 U/mL and the median value was 3.30 U/mL. 24 people who deviated from 3SD were excluded from the measured value, the mean calculated after that was 3.53 U/mL, median was 3.00 U/mL and SD was 1.89. The reference value calculated based on this results was set to 7.31 U/mL. Conclusion The reference value provided by the manufacturer is less than 4 U/mL. It is slightly different from the value calculated in this study, 7.31 U/mL, so it seems necessary to reset the reference value according to the laboratory environment. Currently, we are receiving inquiries about the reference value from the center for gastric cancer at National Cancer Center. If additional research is carried out along with this study, it will be possible to set more accurate reference value.

건강검진 자료를 통한 성인의 골다공증 진단을 위한 정상 참고치

최승화,박일중,주남석,김범택 대한골대사학회 2008 대한골대사학회지 Vol.15 No.1

Background: Osteoporosis is defined based on T-scores (<-2.5), which are calculated from mean value and standard deviation (SD) of bone mineral density (BMD) of young adults. Therefore the diagnosis of osteoporosis is race and population specific. We investigated new reference young population and establish the prevalence of osteoporosis. Methods: 3,435 males and 10,231 females are enrolled for this study, from 2003 to 2004. There BMD were taken at health promotion center, Ajou university hospital, Suwon, Korea by Dual energy X-ray Absorptiometry. Osteoporosis is defined by T-score less than -2.5 SD of 20~29 years old young adults in men. In women, T-score less than -2.5 SD of 30~39 years old adults. Results: In men, osteoporosis prevalence is twelve percent by previous reference value, but, eight percent by new reference value. In women, osteoporosis prevalence is twelve percent by previous reference value and eleven percent by new reference value. Conclusion: This result showed that different reference values leads to different prevalence of osteoporosis. So, for the accurate diagnosis of osteoporosis, reference populations of young adults depend on each machines should be representative of the population of each country.

Functional Reference Limits: Describing Physiological Relationships and Determination of Physiological Limits for Enhanced Interpretation of Laboratory Results

Chuah Tyng Yu,Lim Chun Yee,Tan Rui Zhen,Pratumvinit Busadee,Loh Tze Ping,Vasikaran Samuel,Markus Corey,APFCB Harmonization of Reference Intervals Working Group 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.5

Functional reference limits describe key changes in the physiological relationship between a pair of physiologically related components. Statistically, this can be represented by a significant change in the curvature of a mathematical function or curve (e.g., an observed plateau). The point at which the statistical relationship changes significantly is the point of curvature inflection and can be mathematically modeled from the relationship between the interrelated biomarkers. Conceptually, they reside between reference intervals, which describe the statistical boundaries of a single biomarker within the reference population, and clinical decision limits that are often linked to the risk of morbidity or mortality and set as thresholds. Functional reference limits provide important physiological and pathophysiological insights that can aid laboratory result interpretation. Laboratory professionals are in a unique position to harness data from laboratory information systems to derive clinically relevant values. Increasing research on and reporting of functional reference limits in the literature will enhance their contribution to laboratory medicine and widen the evidence base used in clinical decision limits, which are currently almost exclusively contributed to by clinical trials. Their inclusion in laboratory reports will enhance the intellectual value of laboratory professionals in clinical care beyond the statistical boundaries of a healthy reference population and pave the way to them being considered in shaping clinical decision limits. This review provides an overview of the concepts related to functional reference limits, clinical examples of their use, and the impetus to include them in laboratory reports.

표준지공시지가 기준 토지보상액 산정의 공법적 쟁점 ― 헌법재판소 2009. 11. 26. 2009헌바141 전원재판부 결정 ―

한국토지보상법연구회 한국토지보상법연구회 2015 土地補償法硏究 Vol.15 No.-

The calculation of the compensation amount in the case of expropriation of land is a very important and difficult issue. The land value comprises of 80% or more of the total compensation amount, but it is difficult to calculate because of the lack of comparable sales. Article 23(3) of the Constitution stipulates that “expropriation, use or restriction of private property from public necessity and compensation therefor shall be governed by Act: Provided, That in such a case, just compensation shall be paid.” Based on the premise that land may only be assessed by its objective value due to its nature by undergoing a reasonable adjustment which comprehensively takes into consideration of all of the elements affecting the formation of the price of the land based on the market price of a similar neighboring land, the Constitutional Court held that the calculation of compensation damages resulting from expropriation of land based on “officially announced price of reference land” does not violate the principle of just compensation under the Constitution. However, the argument that just compensation is not being made due to issues such as the officially announced value of land falls short of the market value has been constantly brought up. The Public Notice of Values and Appraisal of Real Estate Act provides that, where the value of land appraised by the certified public appraiser based on the officially announced price of reference land does not meet a just compensation amount, the project implementer may add, subtract or adjust the appraised value. However, the Act on Acquisition of Land and Compensation for Land, Etc. for Public Works does not provide for a provision which allows the project implementer to add, subtract or adjust the land value appraised by a certified public appraiser in calculating the compensation amount. Even if it is possible to find a valid cause for adjustment based on other factors through the interpretation of relevant laws and cases as it is done now, it is a limited alternative as the Act on Acquisition of Land and Compensation for Land, Etc. for Public Works does not expressly stipulate a relevant provision and it is determined that it can be reasonably resolved by legislating such provision. This study annotates public law issues surrounding the calculation of compensation amounts based on officially announced price for reference land from a critical point of view based on the full bench decision of the Constitutional Court in November 26, 2009, 2009HunBa141. The main issues include the meaning of “addition, subtraction or adjustment” of the officially announced price of reference land under the Public Notice of Values and Appraisal of Real Estate Act, the constitutionality of the calculation of compensation amounts based on appraised value of land, issues concerning officially assessed individual land prices and just compensation and the nature of the standard comparison table of land price.

Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

( Francesco Cresi ),( Elena Andrea Cester ),( Silvia Salvatore ),( Domenico Umberto De Rose ),( Antonio Ripepi ),( Anna Maria Magist ),( Claudia Fontana ),( Elena Maggiora ),( Alessandra Coscia ),( Ru 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.3

Background/Aims Combined multichannel intraluminal impedance and pH monitoring (MII/pH) is considered the most accurate test to detect gastroesophageal reflux (GER), however lacking reference values. We aim to determine reference values for the pediatric population and to correlate these values with age and postprandial/fasting period. Methods We evaluated MII/pH traces from patients (newborns, infants, and children) admitted to 3 Italian hospitals and who underwent MII/ pH for suspected GER disease. Patients with MII/pH traces that showed significant symptom-reflux associations and/or a pathological reflux index (> 6% for newborns and infants, > 3% for children) were excluded. Traces were analysed in their entirety, and in the postprandial period (first hour after a meal) and the fasting period (the following hours before the next meal) separately. Results A total of 195 patients (46 newborns, 83 infants, and 66 children) were included. Age positively correlated with frequency of acidic GER events (r = 0.37, P < 0.05) and negatively associated with weakly acidic GER events (r = 0.46, P < 0.05). Conclusions This study describes the distribution of MII/pH values in a pediatric population with normally acidic GER exposure and no significant association between GER events and symptoms. These MII/pH values may be used as reference values in clinical practice for a corrected GER disease diagnosis in the pediatric population. (J Neurogastroenterol Motil 2020;26:370-377)

표준지공시지가제도 개선방향에 관한 법정책적 고찰

김지석(Kim, Ji-Seok),김성록(Kim, Sung-Rok) 한국부동산법학회 2018 不動産法學 Vol.22 No.1

표준지공시지가의 선정과 산정 등에 관해서는 부동산공시법에서 규정하고 있다. 그런데 동법상의 표준지공시지가제도와 관련해서는 몇 가지 문제가 있다. 즉, 대규모 개발사업 등에 따라 현재의 표준지 수와 분포기준에 대한 조정이 필요하고, 공시지가와 시장가치의 불일치를 개선해야 하며, 보상평가를 함에 있어서 개발이익을 배제하는 경우에 공시지가 상승분의 어느 정도가 개발이익에 의한 것인지 등을 판단하는 구체적인 기준을 마련할 필요가 있다. 그리고 표준지공시지가제도의 개선과 관련하여 토지특성조사의 객관화 방안에 관한 논의가 필요하다. 이에 본 논문에서는 이러한 문제점에 대한 개선방향에 관하여 다음과 같이 살펴보았다. 첫째, 상업지역과 계획관리지역에 대해서는 표준지 수를 늘리고, 그 밖의 지역에 대해서는 표준지 수를 줄이는 방향을 고려할 수 있다. 또한 변화가 없는 대도시의 기성시가지는 표준지 수를 줄이고 그 주변과 지방의 개발예정지에 대해서는 표준지 수를 늘릴 필요가 있다. 그리고 전체 표준지 수의 5~10% 정도는 별도로 관리하면서 필요한 때에 표준지로 지정하는 것도 고려할 수 있다. 둘째, 가장 바람직한 것은 표준지공시지가가 그 시장가치와 일치하는 것이며, 장기적으로 이를 위한 논의의 축적과 그에 따른 법제 개선이 필요하다. 다만, 공시지가의 급격한 상승은 납세자들의 조세 저항 등을 야기할 수 있으므로 점진적인 조정이 필요할것으로 본다. 셋째, 보상평가를 함에 있어서 개발이익을 배제해야 할 필요가 있다. 다만, 토지보상액산정에서 제외되어야 하는 개발이익은 당해 공익사업으로 인한 개발이익에 한정되는 것이 타당하고, 개발이익의 배제는 특정 개인에게 불편부당함이 없이 형평에 맞아야 하며, 그 부담을 하는 자가 이를 감수할 수 있을 정도가 되어야 하는 것이 바람직한 정책방향일 것이다. 넷째, 토지특성조사에 있어 GIS, 항공사진 등을 적극적으로 활용하여 공간분포 분석과 토지특성자료 분석을 정교하게 할수 있는 방안을 모색하고, 그 데이터베이스를 지속적으로 축적․관리할 필요가 있다. The selection and calculation of the officially announced price of reference land are defined in the ACT ON THE PUBLIC ANNOUNCEMENT OF REAL ESTATE VALUES. However, there are some problems related to the officially announced price of reference land system in this law. Thus, this paper examined the improvement direction for these problems as follows. First, it is possible to consider increasing the number of reference land for commercial areas and planned control areas, and reducing the number of reference land for other areas. In addition, there is a need to reduce the number of reference land in the existing urban areas of large cities, and to increase the number of reference land parcels in the surrounding area and local development areas. It is also possible to consider designing 5~10% of the total number of reference land when necessary. Second, the most desirable state is to set the officially announced price of reference land in line with the market value, and it requires accumulation of discussion and improvement of legal system accordingly in the long term. However, gradual adjustment is necessary because the sharp increase in official land price may cause taxpayer resistance. Third, it is necessary to exclude the development gains in the evaluation for compensation. However, since the exclusion of development gains may violate just(legitimate) compensation, discussion regarding this issue must be continued. Also, the exclusion of development gains should be equitable. And it would be a desirable policy direction that the burden should be enough to take over. Finally, it is necessary to find ways to positively utilize GIS and aerial photographs in the survey of land characteristics, and to accumulate and manage the database continuously.

표준지공시지가 기준 토지보상액 산정의 공법적 쟁점

허강무(Heo, Kang-Moo) 행정법이론실무학회 2013 행정법연구 Vol.- No.36

토지수용에서 보상액 산정은 매우 중요하고 어려운 문제이다. 토지는 전체 보상액 중 80% 이상을 차지하고 있으나, 객관적 가치를 산정하는 데 어려움이 있다. 헌법 제23조 제3항은 “공공필요에 의한 재산권의 수용·사용 또는 제한 및 그에 대한 보상은 법률로써 하되, 정당한 보상을 지급하여야 한다”고 규정하고 있다. 헌법재판소는 토지의 경우에는 그 특성상 인근 유사토지의 거래가격을 기준으로 하여 토지의 가격형성에 미치는 제 요소를 종합적으로 고려한 합리적 조정을 거쳐서 객관적인 가치를 평가할 수밖에 없음을 전제로, 토지수용으로 인한 손실보상액의 산정을 ‘표준지공시지가’를 기준으로 한 것이 헌법상의 정당보상의 원칙에 위배되는 것이 아니라고 판단하고 있다. 그러나 공시지가가 시가(market value)에 미달되는 등의 문제로 정당보상이 이루어지고 있지 않다는 논란이 지속적으로 제기되고 있다. 「부동산 가격공시 및 감정평가에 관한 법률」에서는 감정평가사가 표준지공시지가를 기준으로 평가한 평가금액이 정당보상액에 미치지 못할 경우 사업시행자가 이를 ‘가감조정’하도록 규정하고 있다. 그러나 「공익사업을 위한 토지 등의 취득 및 보상에 관한 법률」에서는 사업시행자가 보상금액을 산정함에 있어 감정평가사가 평가한 금액을 가감 조정할 수 있도록 하는 조항이 없다. 현재와 같이 판례 또는 법률의 해석을 통하여 기타요인보정의 타당성을 찾을 수는 있다고 하더라도, 「공익사업을 위한 토지 등의 취득 및 보상에 관한 법률」에서 명시적으로 규정하고 있지 않고 있어 한계가 있으므로 이를 법제화하는 것이 합리적인 해결책이라고 판단된다. 이 논문은 표준지공시지가 기준 보상액 산정의 공법적 쟁점을 헌법재판소 2009. 11. 26. 2009헌바141 전원재판부 결정을 중심으로 비판적 관점에서 평석한 것이다. 주요 쟁점은 「부동산 가격공시 및 감정평가에 관한 법률」상 표준지공시지가의 ‘가감조정’ 의미, 공시지가 기준 보상액 산정의 위헌성, 개별공시지가와 정당보상 문제, 토지가격비준표의 성격 등이다. The calculation of the compensation amount in the case of expropriation of land is a very important and difficult issue. The land value comprises of 80% or more of the total compensation amount, but it is difficult to calculate because of the lack of comparable sales. Article 23(3) of the Constitution stipulates that "expropriation, use or restriction of private property from public necessity and compensation therefor shall be governed by Act: Provided, That in such a case, just compensation shall be paid." Based on the premise that land may only be assessed by its objective value due to its nature by undergoing a reasonable adjustment which comprehensively takes into consideration of all of the elements affecting the formation of the price of the land based on the market price of a similar neighboring land, the Constitutional Court held that the calculation of compensation damages resulting from expropriation of land based on "officially announced price of reference land" does not violate the principle of just compensation under the Constitution. However, the argument that just compensation is not being made due to issues such as the officially announced value of land falls short of the market value has been constantly brought up. The Public Notice of Values and Appraisal of Real Estate Act provides that, where the value of land appraised by the certified public appraiser based on the officially announced price of reference land does not meet a just compensation amount, the project implementer may add, subtract or adjust the appraised value. However, the Act on Acquisition of Land and Compensation for Land, Etc. for Public Works does not provide for a provision which allows the project implementer to add, subtract or adjust the land value appraised by a certified public appraiser in calculating the compensation amount. Even if it is possible to find a valid cause for adjustment based on other factors through the interpretation of relevant laws and cases as it is done now, it is a limited alternative as the Act on Acquisition of Land and Compensation for Land, Etc. for Public Works does not expressly stipulate a relevant provision and it is determined that it can be reasonably resolved by legislating such provision. This study annotates public law issues surrounding the calculation of compensation amounts based on officially announced price for reference land from a critical point of view based on the full bench decision of the Constitutional Court in November 26, 2009, 2009HunBa141. The main issues include the meaning of "addition, subtraction or adjustment" of the officially announced price of reference land under the Public Notice of Values and Appraisal of Real Estate Act, the constitutionality of the calculation of compensation amounts based on appraised value of land, issues concerning officially assessed individual land prices and just compensation and the nature of the standard comparison table of land price.

Reference values of lead in blood and related factors among Korean adolescents: the Korean National Health and Nutrition Examination Survey 2010-2013

Choi, Min-Gyu,Park, Mi-Jung,Kim, Shin-Hye The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.3

Purpose: This study aimed to assess the reference values and factors influencing blood lead levels among Korean adolescents. Methods: The study population consisted of 1,585 adolescents (801 males, 784 females; aged 10-19 years) who participated in the Korea National Health and Nutrition Examination Survey 2010-2013. We analyzed blood lead concentrations in relation to demographic/lifestyle characteristics for all participants. "Reference values" of blood lead levels were calculated as the upper limit of the 95% confidence interval of the 95th percentile. Results: The average "reference value" for blood lead concentrations among Korean adolescents was $2.25{\mu}g/dL$ ($2.49{\mu}g/dL$ for males, $2.07{\mu}g/dL$ for females), and the geometric mean of the blood lead concentrations was $1.34{\mu}g/dL$. Males had higher blood lead concentrations than females (male, $1.48{\mu}g/dL$; female, $1.19{\mu}g/dL$; P<0.001). Elementary school students had higher blood lead concentrations than junior and senior high school students ($1.44{\mu}g/dL$ vs. $1.31{\mu}g/dL$, P<0.001). Participants living in detached houses had higher blood lead concentrations than those living in apartments (P<0.001) and current smokers had higher concentrations than nonsmokers or participants with secondhand smoke exposure (P<0.05). Additionally, participants with excessive alcohol consumption had higher levels than non-drinkers (P<0.001). Conclusion: This study provides national reference data on blood lead concentrations stratified by demographic and lifestyle factors among Korean adolescents. Further studies are needed to elucidate the relationship between increased lead exposure and demographic factors including type of housing.

Ultrasound Dimensions of the Rotator Cuff and Other Associated Structures in Korean Healthy Adults

김경원,김홍근,송대헌,윤정윤,정명은 대한의학회 2016 Journal of Korean medical science Vol.31 No.9

In evaluating patients complaining of shoulder pain, ultrasonography is an emerging imaging tool due to convenience, low cost, high sensitivity and specificity. However, normative values of ultrasound dimensions of the shoulder to be compared with pathologic findings in Korean adults are not provided yet. We evaluated the ultrasound dimensions of the rotator cuff, long head of biceps tendon, deltoid muscle and acromioclavicular joint in Korean healthy adults. Shoulder ultrasonography was performed on 200 shoulders from 100 healthy adults. The dimensions of the thickness of rotator cuff (supraspinatus, infraspinatus, subscapularis tendon), deltoid muscle, long head of biceps tendon, subacromial subdeltoid bursa, and acromioclavicular joint interval were measured in a standardized manner. Differences in measurements among sex, age, and dominant arms were compared. The thickness of rotator cuff tendons (supraspinatus, infraspinatus, subscapularis) and deltoid muscle were significantly different between men and women. The thickness of subacromial subdeltoid bursa was significantly different between men and women for non-dominant side. In rotator cuff tendon measurements, the differences between dominant and non-dominant shoulders were not significant, which means the asymptomatic contralateral shoulder can be used to estimate the normal reference values. When stratified by age divided by 10 years, the measurements of supraspinatus, subscapularis and deltoid thickness showed tendency of increase with the age. The acromioclavicular joint interval, on the other hand, revealed decreasing tendency. This report suggests normative values of ultrasound dimensions of healthy Korean population with varying age, and can be useful as reference values in evaluating shoulder pathology, especially in rotator cuff tendon pathology.