두 족저압 측정장비의 비교 분석

강호원,변수민,김대유,조윤재,경민규,이동연 대한족부족관절학회 2024 대한족부족관절학회지 Vol.28 No.1

Purpose: Foot pressure measurement devices are used widely in clinical settings for plantar pressure assessments. Despite the availability of various devices, studies evaluating the inter-device reliability are limited. This study compared plantar pressure measurements ob- tained from HR Mat (Tekscan Inc.) and EMED-n50 (Novel GmbH). Materials and Methods: The study involved 38 healthy male volunteers. The participants were categorized into two groups based on the Meary’s angle in standing foot lateral radiographs: those with normal feet (angles ranging from –4° to 4°) and those with mild flatfeet (angles from –8° to –15°). The static and dynamic plantar pressures of the participants were measured using HR Mat and EMED-n50. The reliability of the contact area and mean force was assessed using the interclass correlation coefficient (ICC). Furthermore, the differ- ences in measurements between the two devices were examined, considering the presence of mild flatfoot. Results: The ICC values for the contact area and mean force ranged from 0.703 to 0.947, indicating good-to-excellent reliability across all areas. EMED-n50 tended to record higher contact areas than HR Mat. The mean force was significantly higher in the forefoot region when measured with EMED-n50, whereas, in the hindfoot region, this difference was observed only during static measurements with HR Mat. Participants with mild flatfeet exhibited significantly higher contact areas in the midfoot region for both devices, with no con- sistent differences in the other parameters. Conclusion: The contact area and mean force measurements of the HR Mat and EMED-n50 showed high reliability. On the other hand, EMED-n50 tended to record higher contact areas than HR Mat. In cases of mild flatfoot, an increase in contact area within the midfoot region was observed, but no consistent impact on the differences between the two devices was evident.

A novel urinary mRNA signature using the droplet digital polymerase chain reaction platform improves discrimination between prostate cancer and benign prostatic hyperplasia within the prostate-specific antigen gray zone

강호원,이희윤,변영준,정필두,윤진선,김동호,김원태,김용준,이상철,윤석중,김원재 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.4

Purpose: The aim of this study was to identify a noninvasive urinary marker for prostate cancer (PCa) diagnosis and to validate the clinical performance of this novel urinary mRNA signature using the droplet digital polymerase chain reaction (ddPCR) approach. Materials and Methods: A gene expression microarray (HT-12, Illumina Inc., USA) was used to identify genes differentially expressed between 16 PCa and 8 benign prostatic hyperplasia (BPH) tissues; ddPCR (QX200; Bio-Rad Laboratories, USA) was carried out to quantify the expression of selected genes in urine. The urinary molecular PCa risk score (UMPCaRS) was calculated by using the sum of three upregulated genes as the numerator and the sum of three downregulated genes as the denominator. The diagnostic utility of the UMPCaRS was validated by using a screening set (10 PCa and 10 BPH samples) and a validation set (131 PCa and 105 BPH samples). Results: Three upregulated genes (PDLIM5, GDF-15, THBS4) and three downregulated genes (UPK1A, SSTR3, NPFFR2) were selected from the microarray and subjected to ddPCR. The UMPCaRS for PCa in the screening and validation sets was significantly higher than that for BPH. For the validation set, the diagnostic accuracy of the UMPCaRS was comparable with that of prostate-specific antigen (PSA). Importantly, in the “PSA gray zone” (3–10 ng/mL), the AUC for the UMPCaRS was 0.843 and that for PSA was 0.628 (p<0.001). Conclusions: The data demonstrate that the UMPCaRS is useful for discriminating between PCa and BPH in the “PSA gray zone”.

GRADE (Grading of Recommendations, Assessment, Development and Evalua-tion): “근거수준(Quality of Evidence)” 이란 무엇이며, 임상의사에게 왜 중요한가?

강호원,Jae Hung Jung,Do Kyung Kim,구자윤,정현진,Hong Wook Kim,Eu Chang Hwang 대한요로생식기감염학회 2019 Urogenital Tract Infection Vol.14 No.2

This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evi-dence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation(GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, impre-cision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.

Impact of Young Age at Diagnosis on Survival in Patients with Surgically Treated Renal Cell Carcinoma: a Multicenter Study

강호원,서성필,김원태,윤석중,이상철,김원재,황의창,강석호,홍성후,정진수,권태균,김현회,곽철,변석수,김용준,KOrean Renal Cell Carcinoma (KORCC) Group 대한의학회 2016 Journal of Korean medical science Vol.31 No.12

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.

Chronological Trends in Clinical and Urinary Metabolic Features over 20 Years in Korean Urolithiasis Patients

강호원,서성필,하윤석,김원태,김용준,윤석중,김원재,이상철 대한의학회 2017 Journal of Korean medical science Vol.32 No.9

Urolithiasis is common and is becoming more prevalent worldwide. This study assessed the chronological trends in clinical and urinary metabolic features over 20 years in Korean urolithiasis patients. We performed a retrospective analysis of 4,076 patients treated at our clinic from 1996 to 2015. Urinary metabolic data and stone analysis data were available for 1,421 and 723 patients (34.9% and 17.7%), respectively. Patients were categorized into 4 groups according to the date of initial diagnosis: group 1 (1996–2000, n = 897), group 2 (2001–2005, n = 1,018), group 3 (2006–2010, n = 1,043), and group 4 (2011–2015, n = 1,118). Incidental detection of uric acid renal stones has become more prevalent in the past 10 years, accompanied by an increase in body mass index and age at diagnosis. Similarly, the prevalence of diabetes mellitus and of hypertension increased from one group to the next throughout the study period. Levels of 24-hour urinary excretion of sodium, calcium, uric acid, and oxalate have decreased significantly over the study period. The incidence of urinary metabolic abnormalities also showed an identical tendency. The proportion of stones composed of uric acid increased over the study period. In conclusion, incidental detection of uric acid renal stones has become more prevalent in Korea in the past 20 years. Urinary excretion of lithogenic constituents and the incidence of urinary metabolic abnormalities have decreased significantly over this period.

근대 건축문화유산 보존·재생에 관련한 법제도의 한일 비교연구

강호원,홍규선,이성재 한국문화공간건축학회 2016 한국문화공간건축학회논문집 Vol.- No.53

More than 100 years have been passed since importation of Western and/or Modern Architecture into Korea and Japan. Many of those have been kept demolishing due to economical, political and other reasons without considering their cultural meaning. In order to preserve and regenerate Architecture in Modern Era, it is necessary to rearrange the given conditions, as a first step. Related regulations are one of the most essential conditions for the preservation and regeneration. Their system and vocabularies are very similar comparing other countries like the West, but showing differences in their way of revising regulations and operating systems. The analysis suggests three remedies as follows. Registration system of cultural property is the most effective way to preserve and regenerate Architecture in modern era. Those regulations have to be keep revising according to the situation that keeps changing day by day, while the standard, that judges importance of an architecture, stays still. Also cooperation of government, academy and citizen is an critical requirement, too.

Trends in clinical, operative, and pathologic characteristics of surgically treated renal mass in a Korean center: A surgical series from 1988 through 2015

강호원,서성필,김원태,윤석중,이상철,김원재,황의창,강석호,홍성후,정진수,권태균,김현회,곽철,변석수,김용준 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.3

Purpose: To analyze trends over a period of 28 years in the clinical, operative, and pathologic characteristics of patients with a renal mass who underwent surgical resection in Korea. Materials and Methods: Consecutive patients (n=6,231) with a renal mass who underwent surgical resection at eight Korean institutions between 1988 and 2015 were reviewed. Patients were assigned to one of three groups according to the date of surgery: group 1, 1988–1999; group 2, 2000–2009; and group 3, 2010–2015. Results: Age at the time of surgery, body mass index, smoking status, incidence of diabetes and hypertension, and the number of incidentally identified renal masses increased significantly over time. The proportion of patients undergoing partial nephrectomy (PN) or minimally invasive surgery (MIS) increased sharply during the last two time periods. From 2010, the rate of robot-assisted nephrectomy rose sharply, occurring in 37.8% of MIS cases. Benign pathology was identified in 1.8% and 5.2% of cases in the middle and last periods, respectively; angiomyolipoma was the most common pathology. In later years, tumors were more often localized, although tumor grade increased. Sub-group analysis of small renal masses ≤4 cm revealed similar trends in operative and pathologic characteristics over time. Conclusions: Between 1988 and 2015, there was a substantial change in the clinical, operative, and histological characteristics of patients who underwent resection of a renal mass in Korea. The most notable changes were stage migration towards localized disease and widespread use of PN and MIS.

Methylation Signature for Prediction of Progression Free Survival in Surgically Treated Clear Cell Renal Cell Carcinoma

강호원,박홍용,서성필,변영준,Xuan-Mei Piao,김성민,김원태,윤석중,장우영,손호선,류근호,이상철,김운재,김용준 대한의학회 2019 Journal of Korean medical science Vol.34 No.19

Background: Little is known about epigenetic silencing of genes by promoter hypermethylation in renal cell carcinoma (RCC). The aim of this study was to identify prognostic methylation markers in surgically treated clear cell RCC (ccRCC). Methods: Methylation patterns were assayed using the Infinium HumanMethylation450 BeadChip array on pairs of ccRCC and normal tissue from 12 patients. Using quantitative PSQ analysis, tumor-specific hypermethylated genes were validated in 25 independent cohorts and their clinical relevance was also verified in 152 independent cohorts. Results: Using genome-wide methylation array, Zinc finger protein 278 (ZNF278), Family with sequence similarity 155 member A (FAM155A) and Dipeptidyl peptidase 6 (DPP6) were selected for tumor-specific hypermethylated genes in primary ccRCC. The promoter methylation of these genes occurred more frequently in ccRCC than normal kidney in independent validation cohort. The hypermethylation of three genes were associated with advanced tumor stage and high grade tumor in ccRCC. During median follow-up of 39.2 (interquartile range, 15.4–79.1) months, 22 (14.5%) patients experienced distant metastasis. Multivariate analysis identified the methylation status of these three genes, either alone, or in a combined risk score as an independent predictor of distant metastasis. Conclusion: The promoter methylation of ZNF278, FAM155A and DPP6 genes are associated with aggressive tumor phenotype and early development of distant metastasis in patients with surgically treated ccRCC. These potential methylation markers, either alone, or in combination, could provide novel targets for development of individualized therapeutic and prevention regimens

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

강호원,서성필,김원태,김용준,윤석중,이상철,최영득,하윤석,김태환,권태균,변석수,제성욱,김원재 대한의학회 2017 Journal of Korean medical science Vol.32 No.2

The aim of the present multi-institutional study was to assess the influence of the American Society of Anesthesiologists Physical Status (ASA-PS) classification on adjuvant chemotherapy eligibility and survival in a multi-institutional cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We retrospectively reviewed data from 416 patients who underwent RNU for UTUC at four Korean institutions between 2001 and 2013. The ASA-PS classification was obtained from the anesthesia chart. Locally advanced UTUC was defined as ≥ pT3 and/or pN1 disease. The influence of ASA-PS score on survival was evaluated by Kaplan-Meier analyses and a multivariate Cox regression model. Patients with a higher ASA-PS class were less likely to be eligible for adjuvant chemotherapy in locally advanced UTUC (P = 0.016). Kaplan-Meier estimates showed that the high-risk ASA-PS group has a poorer overallsurvival (OS) and cancer-specific survival (CSS) compared to low risk ASA-PS groups in both the total and locally advanced UTUC cohorts. Based on multivariate Cox regression analysis, the high-risk ASA-PS category was an independent predictor for overall mortality (OM) (hazard ratio [HR], 1.919; 95% confidence interval [CI], 1.017–3.619; P = 0.044) and cancer-specific mortality (CSM) (HR, 2.120; 95% CI, 1.023–4.394; P = 0.043). In conclusion, high-risk ASA-PS score was independently associated with a lower survival rate in patients with UTUC after RNU. However, the influence of ASA-PS classification on survival was limited to locally advanced UTUC. The lower eligibility of patients in the high-risk ASA category for adjuvant chemotherapy may contribute to the lower survival rate in this group.

Diagnostic Role of Prostate Resection in the Elderly Patients Who Experience Significant Co-Morbidity with a High Clinical Suspicion of Prostate Cancer

강호원,양진박,권휘안,이영숙,김원태,김용준,윤석중,이상철,Isaac Yi Kim,김원재 대한의학회 2013 Journal of Korean medical science Vol.28 No.12

The necessity of routine prostate biopsy prior to transurethral resection of the prostate (TURP) in elderly comorbid patients with a high prostate specific antigen (PSA) level remains controversial. We assessed the role of TURP in prostate cancer diagnosis in these individuals. A total of 197 patients underwent TURP in conjunction with prostatic needle biopsy. Pathologic reviews of specimens of TUR chips and biopsy cores were analyzed. Overall, prostate cancer (CaP) was detected in 114 patients (57.6%). Ninety-eight cancers (86%) were detected with TURP and biopsy, and seven cancers (6.1%) with only TURP. The Gleason score of a TUR-specimen was identical to that of the biopsy-core in 43.9% of cases. Variables associated with diagnostic accuracy in the TUR-specimens included the prebiopsy PSA level, prostate specific antigen density (PSAD), and the Gleason score in biopsy cores. In patients with a PSA level and a PSAD that was greater than 15.4 ng/mL and 0.69 ng/mL/g, respectively, 100% of the cancers were detected in the TUR-specimens. Our results suggest that a prostatic biopsy might be omitted prior to TURP in elderly patients with significant co-morbidity and levels for PSA of >15.4 ng/mL.