Deep Learning-based Classification of Respiratory Sounds and Its Clinical Value

( Yoonjoo Kim ),( Jeongsuk Koh ),( Seongdae Woo ),( Songi Lee ),( Dahyun Kang ),( Dongil Park ),( Jeongeun Lee ),( Sungsoo Jung ),( Chaeuk Chung ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Introduction Auscultation of respiratory sound is a non-invasive and relatively simple diagnostic method that can be performed anytime, but the information provided is quite useful. Breath sound information markedly improves the accuracy of diagnosis and monitoring of disease status. Despite these advantages, auscultation has a major limitation, subjectivity. Since the interpretation of respiratory sounds requires significant expertise and clinical experience, doctors in training sometimes misidentify respiratory sounds. To overcome such a drawback, we developed an automated classification system of respiratory sounds. Method 2840 respiratory sounds were recorded by a digital stethoscope in a real clinical setting. Three pulmonologists classified them and 1918 sounds including normal sounds, crackles, wheezes, rhonchi were selected. We applied deep learning convolutional neural network (CNN) to identify the classified database. We developed the predictive model for respiratory sound classifcation combining pretrained image feature extractor of series, respiratory sound, and CNN classifer. To evaluate the accuracy of human auscultation ability and compare it with our predictive model, 70 participants were asked to listen to classified sounds and identify them. Result Deep learning-based classification model detected abnormal sounds with an accuracy of 86.5% and the AUC of 0.93. It further classifed abnormal lung sounds into crackles, wheezes, or rhonchi with an overall accuracy of 85.7% and a mean AUC of 0.92. Meanwhile, the accuracy of human auscultation was different depending on the group; 60.3% for medical students, 53.4% for interns, 68.8% for residents, and 80.1% for fellows. Conclusion This respiratory sound classification model using deep learning is expected to complement the limitation of inaccurate auscultation of clinicians and help the rapid diagnosis and appropriate treatment of respiratory diseases. In addition, this model will be useful to meet the current medical demands such as non-face-to-face care due to COVID-19 and telemedicine in hard-to-reach area.

EGFR-TKI Induces Autophagic Flux and Ferritin Accumulation in PC9/GR Cells

( Yoonjoo Kim ),( Jeongsuk Koh ),( Dahyun Kang ),( Dongil Park ),( Jeongeun Lee ),( Heesun Park ),( Chaeuk Chung ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Introduction Despite the development of immunotherapy, EGFR-TKI resistance is one of the most important issues in lung cancer treatment. Autophagy is known to have opposite functions in cancer depending on the situation. Before the establishment of cancer, autophagy acts as suppressor by degrading misfolded proteins. But in the established cancer cells, autophagy functions as survival mechanism. Ferritin is an important member of antioxidant system because it stores iron in nontoxic form. Altered expression of ferritin has been described in many cancers. In this study, we investigated the effect of EGFR-TKI on autophagy and ferritin in EGFR-TKI resistant cells. Method We treated EGFR-TKI resistant lung adenocarcinoma cell line, PC9/GR cells, with EGFR-TKI or control. mCherry-EGFP-LC3B plasmid was transfected by Lipofectamine 2000. Cultured cells were fixed with 4% paraformaldehyde at room temperature, permeabilized with 0.1% Triton X-100 and blocked with 3% FBS in PBS. Following overnight incubation with antibodies, immunofluorescence(IF) was detected using a fluorescence microscope. For an electron microscope(EM), we dehydrated tissues in ethanol and propylene oxide series, embedded in Epon 812 mixture, and polymerized in an oven at 70°C for 24 h. Scanning Transmission Electron Microscpe and Energy Dispersive X-ray spectroscopy was conducted by Monochromated Cs-corrected ARM200F. Result The result of IF study showed PC9/GR cells treated with EGFR-TKI had more autophagic flux than the control. EM scans confirmed PC9/GR cells treated with EGFR-TKI had more double-membrane autophagosomes. And we found PC9/GR cell treated with EGFR-TKI had clusters of high-density particles consisted of Fe atoms. So we concluded PC9/GR cell treated with EGFR-TKI has ferritin accumulation in the cytoplasm. Conclusion We concluded EGFR-TKI significantly induced autophagic flux and ferritin accumulation in PC9/GR cells. Targeting autophagy might be helpful for suppressing the EGFR-TKI resistance and further study about the relationship between ferritin and autophagy in EGFR-TKI resistant cells will be required.

Bronchitis Mimicking Squamous Cell Carcinoma: A Case Report

( Yoonjoo Kim ),( Jeongsuk Koh ),( Dahyun Kang ),( Dongil Park ),( Jeongeun Lee ),( Heesun Park ),( Chaeuk Chung ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Introduction Chronic inflammation can increase cancer risk and various types of inflammatory cells are present within cancer. Inflammation recruits inflammatory cells around epithelial cells, and severe inflammation can cause epithelial cell detachment and cell shape alteration. Thus, the differential diagnosis is sometimes difficult when the pathology specimen contains serious inflammation. Case A 60-year-old male was referred with 2-week history of hemoptysis, cough, and sputum without fever, chill. He was a 30 pack-year ex-smoker. On initial examination, Chest CT revealed diffuse lobar and segmental bronchial wall thickening and luminal narrowing of left lung, suggesting endobronchial tumor spread. 1L, 7, and 9R lymph nodes were enlarged, suggesting metastasis. Bronchoscopy indicated tumorous lesion mixed with mucosal ulceration in lingular segment. Pathology demonstrated high possibility of squamous cell cancer with mucosal inflammation. Immunohistochemistry revealed that epithelial cells were positive for p63 and CK5/6 and had Ki-67 index of 50%. He was treated with antibiotics for 7-day, and symptoms were improved. In follow-up bronchoscopy after 3-week, tumorous lesion of lingular segment was markedly improved and pathology showed mild chronic inflammation without cancer cells. Follow-up CT also showed that diffuse bronchial wall thickenings were significantly improved and the size and extent of LNs enlargement returned. PET-CT showed no evidence of malignancy. For 3-years follow-up, bronchoscopy and CT showed no manifestation of cancer. Discussion In this case, clinical data and initial examinations suggested the diagnosis of lung cancer. However, based on 3-year clinical course and pathologic reviews, we concluded the initial lesion was more likely bronchitis mimicking lung cancer. Also, it is difficult to completely rule out the possibility of early cancer lesions being eliminated by severe inflammation of bronchial walls. In such a case, it might be difficult to make an accurate diagnosis with only initial examinations. Therefore, careful pathology review and follow-up studies are required.

Tri-iodothyronine (T3) as a Prognostic Factor for Patients with Advanced NSCLC Receiving Immune Checkpoint Inhibitors

( Yoonjoo Kim ),( Jeongsuk Koh ),( Seongdae Woo ),( Songi Lee ),( Dahyun Kang ),( Dongil Park ),( Chaeuk Chung ),( Jeongeun Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Introduction Endocrine hormones such as thyroxine and estrogen are known to influence the tumor progression and response to treatment. Despite the importance of ICIs (immune checkpoint inhibitors) in the treatment of advanced NSCLC, few studies have explored the effects of endocrine hormones on NSCLC receiving ICI therapy. Biomarkers like PD-L1 expression in the tumor have been developed to predict the treatment response to ICI. However, only several markers have been clinically verified using standard measurement techniques. We investigated the effects of baseline endocrine hormones in advanced NSCLC on ICI treatment and discovered an easily measurable and useful predictor. Method 156 patients with advanced NSCLC who received PD-1/PD-L1 inhibitors, excluding those with positive driver mutations, were retrospectively analyzed. We collected their clinical information and baseline laboratory findings including endocrine hormones, cytokines, CBC parameters, blood chemistry panels from peripheral blood. We identified the relationship between endocrine hormones and clinical outcomes (OS, PFS, best response), liver metastasis, and other blood markers. Result Shorter PFS was independently associated with liver metastasis, higher cortisol, lower Hb, while shorter OS was associated with liver metastasis, lower T3, higher LDH, lower albumin. According to T3 level, a newly found predictor, patients were divided into two groups, and patients with low T3 levels exhibited shorter PFS, OS, and worse best response. And we confirmed a significant association between the low T3 level and liver metastasis, a negative predictive marker for the treatment response of ICI in NSCLC. Conclusion This study shows that the baseline T3 level, relatively underrated in its clinical importance, is associated with the prognosis and response to ICIs in advanced NSCLC. The specific mechanism is probably related to the decreased function of the liver and the systemic inflammation induced by the interaction with other biomarkers such as IL-6, ACTH, cortisol, C-peptide, Hb, LDH, albumin.

Asperities on the Surface of Plate-like Alumina and their Effect on Nacre-inspired Alumina-PMMA Composites

Kim, Bo-Yeon,Lee, Yoonjoo,Kim, Soo-Ryong,Shin, Dong-Geun,Kwon, Woo-Teck,Choi, Duck-Kyun,Kim, Younghee The Korean Ceramic Society 2015 한국세라믹학회지 Vol.52 No.4

Natural materials often have unique mechanical properties, such as the hierarchical structure of nacre formed through mineral bridges or asperities created between an inorganic particle and a natural-layer surface. As these asperities produce an exceptional shear resistance, in this study, we aimed to emulate the natural structure of nacre by synthesizing inorganic asperities and mineral bridges with different temperatures in the range of $1100-1300^{\circ}C$ and clay contents from 10 - 50 wt%. Following the infiltration of methyl methacrylate, we measured the mechanical properties to assess whether they were improved by the asperities. It was confirmed that the asperities improved the bending strength by 10%, and the anchoring effect was observed on the fracture surface.

Caregiving Distress and Inflammatory Response among Family Caregivers of Cancer Patients

Yoonjoo Kim,Hyangkyu Lee,Heejung Kim,Sangyeon Suh,Hyun-Ki Park 한국간호과학회 2018 한국간호과학회 학술대회 Vol.2018 No.1

Purpose: Caregivers of cancer patients suffer from a wide range of problems, including fatigue, care burden, burnout and depression. Researches on cancer caregivers have demonstrated that the caregiving distress is related not only to mental but also to physical health such as dysregulation of inflammatory function. This study aimed to investigate the relationship between caregiving distress and serum IL-6 and TNF-α, which are implicated in immune function of caregivers of cancer patients. Methods: Total 63 family caregivers of cancer patients participated in this study. Caregiving distress (fatigue, caring burden, burnout, and depression) was measured by using structured self-report questionnaires. Two inflammatory cytokines, IL-6 and TNF-α levels were obtained using a high-sensitivity enzyme-linked immunosorbent assay (ELISA). Data were analyzed using descriptive statistics, t-test, ANOVA, Spearman correlation coefficient analysis, and Hierarchical multiple regression analyses. Results: There was a significant correlation between fatigue, caring burden, burnout, depression. Caregiving distress was associated with the increased serum IL-6 and TNF-α levels. Gender, experience in radiotherapy, length of caregiving, and fatigue are associating factors for the levels of cytokines. Conclusions: Caregiving distress is a negative experience that affects mental health and inflammatory response to family caregivers. It is necessary to develop practical nursing intervention that supports caregivers and manages caregiving distress.

Isobutanol Production from Empty Fruit Bunches Using Engineered Escherichia coli

Yoonjoo KIM,Kyoung Heon KIM 한국생물공학회 2023 한국생물공학회 학술대회 Vol.2023 No.10

Hepcidin Level Is a Prognostic Factor for Patients with Advanced NSCLC Receiving Immune Checkpoint Inhibitors

( Yoonjoo Kim ),( Jeong Eun Lee ),( Eunso Lee ),( Ock-hwa Kim ),( Jae Young Moon ),( Sun-young Yoon ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Effects of asperities and organic-inorganic interactions on the strength of nacre-mimetic composites

Lee, Yoonjoo,Kim, Bo-Yeon,Shin, Dong-Geun,Kim, Soo-Ryong,Kwon, Woo-Teck,Kim, Younghee Elsevier 2017 Materials Science and Engineering C Vol.71 No.-

<P>Nacre is a natural organic-inorganic hybrid composite, whose hierarchical structure has a complex influence on its high strength. Many structural features have been discovered, which influence the mechanical properties of nacre, and the authors have a particular interest in the role of the asperities and organic-inorganic interactions. In this study, a composite was prepared which mimics the asperity structure using clay minerals. Organic-inorganic bonding was induced with silane treatment. Both factors increased the yield strength of the composites; however, different deformation behavior was exhibited. It was found that asperities improved the strength of the composite, and that composition influences the stiffness of the composite. The organic-inorganic interaction between the resin and the other components of the composite reduced the deformation of the composite and consequently improved strength. (C) 2016 Published by Elsevier B.V.</P>

「2012 한국어 교육과정」과 「2017 개정 한국어 교육과정」 비교 분석 및 시사점

김윤주 ( Yoonjoo Kim ) 사단법인 아시아문화학술원 2021 인문사회 21 Vol.12 No.2

이 논문의 연구 목적은 「2012 한국어 교육과정」과 「2017 개정 한국어 교육과정」을 비교분석하는 것이고 이를 위해 교육과정에 명시된 교육 목표, 대상, 내용 체계, 등급, 성취기준 등을 살펴보았다. 분석 결과, KSL 교육 대상 학습자의 언어적 특성 강조, 학습 한국어의 개념 재정립 및 하위 구성 요소 정교화, 문화 영역 강조, 언어 재료의 추가 확대 등의 변화를 확인할 수 있었다. 앞으로 초ㆍ중ㆍ고등학교 KSL 교육의 발전을 위해 한국어 교육과 타교과와의 연계 방안, 등급별 언어능력 기술을 위한 성취기준 문장 형식의 정교화 방안, 교육과정의 학년별 세분화 방안, 교수학습 방안 및 평가 방안 제시, 교사 역량 강화 방안 등을 위한 연구가 더욱 필요할 것이다. 본 연구의 결과는 향후 KSL 한국어 교육과정 개발에 방향성 제시를 위한 지침으로서 의의를 지닌다. The objects of this study is comparative analysis of 2012 and 2017 KSL Curriculum for students who have multi-cultural backgrounds. The author focuses on the educational goals, target students, educational contents, and achievement standards of each curriculum. The analysis confirms that there have been some changes from 2012 curriculum to 2017 curriculum; putting more emphasis on linguistic characteristics of KSL students, redefinition of academic Korean language, elaboration of educational components of the programs, emphasizing cultural areas of KSL education, and expansion of linguistic materials. With this analysis, the author suggests that there is a need to study for finding alternatives of connecting KSL subjects and other academic subjects, elaborating achievement standards for linguistic capabilities levels, suggesting teaching methods, evaluation methods, and measures for enhancing teachers capacity.