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      • KCI등재

        Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury

        Soyeoun Lim,임종한,홍영습,김정원,박소영,조준성,권운정,김양호 대한의학회 2020 Journal of Korean medical science Vol.35 No.45

        Background: To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD). Methods: We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment. Results: In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%). Conclusion: Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.

      • KCI등재

        A fatal case report of invasive pulmonary aspergillosis and mucormycosis coinfection in an immunocompetent patient with coronavirus disease 2019 in Korea

        김진형,김미성,Lim Soyeoun,박선영,제갈양진,이태훈,강병주 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.3

        Systemic glucocorticoid treatment is highly recommended in critically ill coronavirus disease 2019 (COVID-19) patients. However, secondary fungal infections are of concern in such patients. Here, we describe the first case of COVID-19-associated invasive pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) coinfection in a COVID-19 positive immunocompetent patient in Korea. A 69-year-old man was admitted to our hospital with COVID-19 pneumonia. He had no underlying comorbidities and was not taking medications. He received remdesivir, dexamethasone, and antibiotic therapy under mechanical ventilation. Although his condition improved temporarily, multiple cavities were observed on chest computed tomography, and Aspergillus fumigatus was cultured from tracheal aspiration culture. He was diagnosed with probable CAPA and received voriconazole therapy. However, his condition was not significantly improved despite having received voriconazole therapy for 4 weeks. After release from COVID-19 quarantine, he underwent bronchoscopy examination and was then finally diagnosed with CAPA and CAM coinfection on bronchoscopic biopsy. Antifungal treatment was changed to liposomal amphotericin B. However, his progress deteriorated, and he died 4 months after admission. This case highlights that clinical suspicion and active checkups are required to diagnose secondary fungal infections in immunocompetent COVID-19 patients who receive concurrent glucocorticoid therapy.

      • 3D-engineered personalized airway stent (“custom GINA stent”): introduction and evaluation in a pig model of tracheal stenosis

        ( Jin Hyoung Kim ),( Soyeoun Lim ),( Jong Joon Ahn ),( Yangjin Jegal ),( Kwang Won Seo ),( Seung Won Ra ),( Byung Ju Kang ),( Soohyun Bae ),( Don Han Kim ),( Taehoon Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.0

        Background: Bronchoscopic treatments of airway stenosis have been evolving. We formerly reported the new silicone airway stent (GINA stent). GINA stent has anti-migration designs, smooth ends for minimalizing granulation tissue, and radio-opaqueness. We herein report “custom GINA stent”, which is a 3D-engineered personalized airway silicone stent made with GINA stent as a backbone. Objectives: To introduce the production process of custom GINA stent, and to know its feasibility by evaluating short term (3 weeks) performance in a pig model of tracheal stenosis. Method: Two female farm pigs (12 weeks old, 40-45kg, 16-20mm of tracheal size) were used. Baseline CT scan was done for stent production, then tracheal stenosis was induced by electrocautery. Using 3D-engineering technology, the mold of stent was fabricated, and the stent was made by injection molding method. When the stent was manufactured, it was inserted through a rigid bronchoscope under general anesthesia. Short term (3 weeks) stent performance was evaluated in terms of migration, granulation (at both ends), and mucostasis. Results: In the first pig, it took 16 days to manufacture the custom GINA stent. In the second pig, the production time was reduced to 7 days. For short term (3 weeks) performance of custom GINA stent, no migration, granulation (at both ends), or mucostasis was occurred in all 2 pigs. Conclusion: In the present study, we developed a personalized airway stent (custom GINA stent) using 3D-engineering within 7 days. In terms of stent performance, it showed perfect results for a short period (3 weeks) in a pig model. Our results should also be demonstrated in clinical trials in humans.

      • The Relation between Occupational Metal Exposure and Interstitial Lung Disease in Shipyard Workers

        ( Hwa Sik Jung ),( Soyeoun Lim ),( Jin Hyoung Kim ),( Byung Ju Kang ),( Hyeon Hui Kang ),( Jong Joon Ahn ),( Jiho Lee ),( Yangjin Jegal ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

        Background Occupational exposure to metal dust has been known as a risk factor for interstitial lung disease (ILD) in previous studies. However, most studies relied on patients' recall for metal exposure, and there was no study exclusively for shipyard workers. We investigated the association with occupational metal exposure and ILD prevalence and lung function changes in shipyard workers according to official record of the company. Method A total of 4,943 workers who performed chest CT during regular company medical checkups at Ulsan University Hospital from December 2014 to March 2020 were enrolled. The workers were employees of the shipbuilding industry in Ulsan and they were classified as metal-exposure or non-exposure groups depending on the company’s official policy of hazardous factor exposure. Medical records, chest CT, and pulmonary function tests were reviewed to diagnose ILD including interstitial lung abnormalities and analyze risk factors. Result ILD prevalence of shipyard workers was significantly higher in metal-exposure group than that of non-exposure group [1.7% (n=53) vs. 0.7% (n=13); p=0.002)]. However, metal-exposure was not associated with the annual decline in lung function. ILD were associated with older age (57.50 vs. 53.86, p<0.001), metal-exposure (80.3% vs. 61.5%, p=0.002), working-years more than 30years (72.7% vs. 39.0%, p=0.001), ever-smoker (87.9% vs. 78.6%, p=0.021), and higher number of pack-years (20.81 vs. 13.50, p<0.001). In logistic regression analysis, metal-exposure (OR=1.98; 95% CI, 1.07-3.66), working-years more than 30years (OR=2.35; 95% CI 1.23-4.43), age (OR=1.14; 95% CI, 1.07-1.21), and pack-years (OR=1.03; 95% CI, 1.01-1.04) were significantly increased the risk of ILD. On adjusted analysis using 1:4 propensity-score matched for all-covariables, metal-exposure was associated with ILD {[80.0% (n=52) vs. 67.3% (n=175), p=0.046], and [OR=1.01; 95% CI, 1.00-1.01, p=0.014]}. Conclusion Occupational metal-exposure was associated with ILD in shipyard workers, but not associated with the change in lung function.

      • Significance of histopathologic features suggesting connective tissue disease in idiopathic pulmonary fibrosis

        ( Sojung Park ),( Joon Seon Song ),( Soyeoun Lim ),( Eun Jin Chae ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

        Background: Idiopathic interstitial pneumonia (IIP) with rheumatologic flavor as supported by specific autoantibodies or histopathologic features has been termed as lung dominant connective tissue disease (LD-CTD). In Idiopathic pulmonary fibrosis (IPF), the significance of histopathologic features suggesting CTD remain unclear. Methods: Clinical data and histopathologic findings were reviewed in 114 subjects with IPF diagnosed by surgical lung biopsy. Key histologic features suggesting CTD (lymphoid aggregates, plasmacytic infiltration, germinal centers, perivascular collagen, pleuritis) were semiquantitatively graded with fibroblastic foci, honeycombing and stromal fibrosis. CTD score was calculated by adding scores of lymphoid aggregates, plasmacytic infiltration, germinal centers and subjects with high (≥ 4) CTD score were classifed as LD-CTD group. Results: The median follow-up period was 23 months and 35% was LD-CTD group. LD-CTD group included more women and non-smokers, and showed better survival and lesser decline of lung function than those with low CTD score (<4). They also had smaller honeycombing spaces and lesser stromal fibrosis. The germinal centers score (hazard ratio [HR], 0.615; p=0.003) was a significant predictor of survival with diffusing capacity (DLco) (HR, 0.968; p<0.001). After adjustment for age, sex, forced vital capacity (FVC), DLco, LD-CTD group showed a lower mortality (HR, 0.450; p=0.004). Conclusions: The germinal centers score was a significant prognostic factor and LD-CTD group showed a favorable outcome in IPF.

      • The Effectiveness of the Use of Regdanvimab in Addition to Remdesivir in Patients with Severe COVID-19: A Single Center Retrospective Study

        ( Aram Choi ),( Woon-jung Kwon ),( Soyeoun Lim ),( Hyeon Hui Kang ),( Jin Hyoung Kim ),( Byung Ju Kang ),( Yangjin Jegal ),( Jong Joon Ahn ),( Eun Ji Park ),( Jae-bum Jun ),( Taehoon Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0

        Background Although the use of remdesivir and systemic corticosteroids has reduced the number of deaths due to coronavirus disease 2019 (COVID-19), this disease still has a high mortality rate when it is severe. Regdanvimab (CT-P59), a neutralizing monoclonal antibody that has been proven effective against mild COVID-19, may be effective against severe COVID-19. This study was conducted to determine the effectiveness of the combined use of remdesivir and regdanvimab in patients with severe COVID-19 Methods From March to early May 2021, 124 patients with severe COVID-19 were admitted to Ulsan University Hospital (Ulsan, Korea) and received oxygen therapy and remdesivir. Among them, 25 were also administered regdanvimab before remdesivir. We retrospectively compared the clinical outcomes between the remdesivir alone group [n = 99 (79.8%)] and the regdanvimab/ remdesivir group [n = 25 (20.2%)]. Results The oxygen-free days on day 28 (primary outcome), defined as the number of days a patient was alive and oxygen-free for 28 days from the beginning of remdesivir administration, were significantly higher in the regdanvimab/remdesivir group [mean ± SD (standard deviation): 19.36 ± 7.87 vs. 22.72 ± 3.66, P = 0.003]. The association between the regdanvimab/remdesivir group and oxygen-free days was also significant in the multivariate analysis (logistic regression), after adjusting for the initial SpO2/FiO2 ratio (severity index). Further, in the regdanvimab/remdesivir group, the lowest SpO2/FiO2 ratio during treatment was significantly higher (mean ± SD: 237.05 ± 89.68 vs. 295.63 ± 72.74, P = 0.003), and the Kaplan-Meier estimates of oxygen supplementation days in surviving patients (on day 28) were significantly shorter [mean ± SD: 8.24 ± 7.43 vs. 5.28 ± 3.66, P (logrank test) = 0.024] (Figure). Conclusions In patients with severe COVID-19, clinical outcomes can be improved by administering regdanvimab, in addition to remdesivir. This abstract was also submitted to APSR 2021.

      • Quantitative computed tomography features associated with the prolonged infectiousness of cavitary pulmonary tuberculosis

        ( Soohyun Bae ),( Kwang Won Seo ),( Soyeoun Lim ),( Jong Joon Ahn ),( Yangjin Jegal ),( Seung Won Ra ),( Taehoon Lee ),( Byung Ju Kang ),( Jin Hyoung Kim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

        Background: Cavitary pulmonary tuberculosis (TB) is known to remain infectious for longer periods than non-cavitary pulmonary TB, which is nearly non-infectious with two weeks anti-TB medication. However, there is verly little studies about this, so it is not known whether there is a correlation between the persistence of infectiousness and the number of cavities or volume of cavities. Objectives: The purpose of this study was to identify the quantitative computed tomography features and clinical values to predict the presistence of infectiousness in cavitary TB patients. Method: A total of 304 TB patients were selected from the cohort of TB in Ulsan university hospital. The study subjects were classified into two groups according to the Acid-fast bacilli Ziehl-Neelsen staining in sputum. The two groups were compared with respect to demographic data, clinical characteristics, sputum AFB stain, mycobacterial culture and quantitative CT values. Results: Among 304 patients, 80 were enrolled for analysis. 43 patients (54%) were positive sputum AFB stains. Compared to negative sputum AFB stain group, the positive sputum AFB stain group had more systemic symptom and larger maximal size of cavity. Treatment duration for last culture positive was 37.9 ± 64.7 days (p = 0.01), which is significantly longer in AFB positive group. Conclusion: Cavitary lesion was associated with a infectiousness, more systemic symptom, longer duration of culture conversion. Quantitative analysis of CT showed that volume and size of cavities were associated with persistent infectiousness in TB patients.

      • KCI등재

        Circulating Tumor Cell Number Is Associated with Primary Tumor Volume in Patients with Lung Adenocarcinoma

        ( Byung Ju Kang ),( Seung Won Ra ),( Kyusang Lee ),( Soyeoun Lim ),( So Hee Son ),( Jong-joon Ahn ),( Byung Chul Kim ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.1

        Background: Circulating tumor cells (CTCs) are frequently detected in patients with advanced-stage malignant tumors and could act as a predictor of poor prognosis. However, there is a paucity of data on the relationship between CTC number and primary tumor volume in patients with lung cancer. Therefore, our study aimed to evaluate the relationship between CTC number and primary tumor volume in patients with lung adenocarcinoma. Methods: We collected blood samples from 21 patients with treatment-naive lung adenocarcinoma and 73 healthy individuals. To count CTCs, we used a CTC enrichment method based on fluid-assisted separation technology. We compared CTC numbers between lung adenocarcinoma patients and healthy individuals using propensity score matching, and performed linear regression analysis to analyze the relationship between CTC number and primary tumor volume in lung adenocarcinoma patients. Results: CTC positivity was significantly more common in lung adenocarcinoma patients than in healthy individuals (p<0.001). The median primary tumor volume in CTC-negative and CTC-positive patients was 10.0 cm<sup>3</sup> and 64.8 cm<sup>3</sup>, respectively. Multiple linear regression analysis showed that the number of CTCs correlated with primary tumor volume in lung adenocarcinoma patients (β=0.903, p=0.002). Further subgroup analysis showed a correlation between CTC number and primary tumor volume in patients with distant (p=0.024) and extra-thoracic (p=0.033) metastasis (not in patients with distant metastasis). Conclusion: Our study showed that CTC numbers may be associated with primary tumor volume in lung adenocarcinomas patients, especially in those with distant metastasis.

      • Retrospective analysis of transbronchial cryobiopsy: the first report in Korea

        ( Woori Jo ),( Chuiyong Pak ),( Jin Hyoung Kim ),( Soohyun Bae ),( Byung Ju Kang ),( Seung Won Ra ),( Kwang Won Seo ),( Jong Joon Ahn ),( Soyeoun Lim ),( Hee Jeong Cha ),( Taehoon Lee ),( Yangjin Jega 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

        Background: Interstitial lung diseases(ILD) are heterogeneous group of lung diseases that require a multidisciplinary approach through discussion with clinicians, radiologists, and pathologists. Surgical lung biopsy is the gold standard for pathologic diagnosis of ILD. Recently, the usefulness of transbronchial cryobiopsy (TBC) has increased in the assessment of ILD. As far as we know, there is no study in Korea on the role of TBC in ILD diagnosis, yet. This study first evaluated the significance of TBC in suspected cases of ILD in Korea. Methods: The medical records of 17 patients suspected of ILD who were performed TBC at Ulsan University Hospital from August 2016 to June 2019 were retrospectively evaluated. Results: Seventeen patients with a mean age of 67 years were included in this analysis and there were 47%(eight patients) of women. The 1.9 mm sized probe was used for three patients and 2.4 mm sized probe was used for 14 patients. The median number of specimens per procedure was four (range; 1-9). The mean diameter of the specimens was 0.5 cm(range; 0.2-1.2cm). The diagnostic yield of TBC was 47.1%(eight patients). The frequent histopathologic results included usual interstitial pneumonia(two patients), organizing pneumonia(two patients) and adenocarcinoma(two patients). In the multidisciplinary diagnosis, they were diagnosed with idiopathic pulmonary fibrosis(two patients), cryptogenic organizing pneumonia(two patients) and adenocarcinoma(two patients). Four of the nine patients with non-diagnostic histopathologic patterns were able to be diagnosed after a multidisciplinary review. As a result, the number of patients who could be diagnosed by TBC increased to 12 patients(70.6%). The complication occurred in eight patients including mild bleeding (three patients) and pneumothorax(four patients). Conclusions: The diagnostic yield of TBC in this study was 47.1% and increased to 70.6% after a multidisciplinary diagnosis. The value of TBC as the alternative methods of surgical lung biopsy should be evaluated through further study.

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