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나성원,이호선,고신옥,Ai Soon Park,한아름 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.3
Background: Nutrition delivery is frequently interrupted or delayed by physicians’ ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients. Methods: After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for ≥ 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician’s recommendation within 48 hours, the patients were classified under the compliant group (Group 1). Results: Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 ± 81 vs 157 ± 77 mg/dl, p =0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p =0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2. Conclusions: Physicians’ compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.
나성원,이우경,김하연,이진애,고신옥,김정민 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.5
Purpose: Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directedtherapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. Materials and Methods: We performed a systematic review that included a meta-analysis. We used electronic search engines includingPubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis. Results: A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observationalstudies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631–0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75–1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found. Conclusion: The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
Traumatic Tricuspid Regurgitation Following Cardiac Massage
나성원,남상범,Yong Kyung Lee,오영준,곽영란 대한의학회 2007 Journal of Korean medical science Vol.22 No.4
We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.
웹 데이터베이스 기반으로 사이버 학습시스템설계 및 구현
나성원,신상민,이순애,조용환 한국콘텐츠학회 2002 한국콘텐츠학회논문지 Vol.2 No.1
컴퓨터의 급속한 보급과 인터넷을 기반으로 웹 서비스가 날로 향상되고 있으며, 웹을 활용한 사이버학습은 웹의 등장과 함께 인터넷의 가장 중요한 교수도구로 자리잡고 일다. 본 연구에서는 수리영역의 특성 학습과 웹에서 구축된 서버와 클라이언트 환경을 통하여 학습 부진아의 학업 성취도를 높이기 위하여 사이버 학습 시스템을 설계 및 구현하였으며, 학습자가 웹 데이터베이스 시스템 환경과 멀티미디어를 활용하여 추상적인 개념보다 직접 참여하는 학습이 되도록 하였다. It is rising to Web service from the rapid supply of the computer, from the basis of Internet, and virtual learning which is the best use of Web is very important teaching instrument. This study was design and embody of the cyber teaming system that teaching of the specific character in mathematical fed and improving to learn-depression-student through driven out sever & client in Web, and the student direct take part in teaming through the Web data base system environment and using multimedia than abstract conception.
딥러닝 기반 CT 스캔 재구성을 통한 조영제 사용 및 신체 부위 분류 성능 향상 연구
나성원,고유선,김경원 한국방송∙미디어공학회 2023 방송공학회논문지 Vol.28 No.3
표준화되지 않은 의료 데이터 수집 및 관리는 여전히 수동으로 진행되고 있어, 이 문제를 해결하기 위해 딥 러닝을 사용해 CT 데이터를 분류하는 연구들이 진행되고 있다. 하지만 대부분 연구에서는 기본적인 CT slice인 axial 평면만을 기반으로 모델을 개발하고있다. CT 영상은 일반 이미지와 다르게 인체 구조만 묘사하기 때문에 CT scan을 재구성하는 것만으로도 더 풍부한 신체적 특징을 나타낼 수 있다. 이 연구는 axial 평면뿐만 아니라 CT 데이터를 2D로 변환하는 여러가지 방법들을 통해 보다 높은 성능을 달성할 수 있는 방법을 찾고자 한다. 훈련은 5가지 부위의 CT 스캔 1042개를 사용했고, 모델 평가를 위해 테스트셋 179개, 외부 데이터셋으로 448개를 수집했다. 딥러닝 모델 개발을 위해 ImageNet으로 사전 학습된 InceptionResNetV2를 백본으로 사용하였으며, 모델의 전체 레이어를 재 학습했다. 실험결과 신체 부위 분류에서는 재구성 데이터 모델이 99.33%를 달성하며 axial 모델보다 1.12% 더 높았고, 조영제 분류에서는 brain과 neck에서만 axial모델이 높았다. 결론적으로 axial slice로만 훈련했을 때 보다 해부학적 특징이 잘 나타나는 데이터로 학습했을 때 더 정확한 성능 달성이 가능했다.