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Kim Joong-Yub,한아람,이하정,하종원,이광웅,서경석,이남준,민상일,홍석균,김용철,Choi YoungRok,임재준,곽낙원 대한의학회 2023 Journal of Korean medical science Vol.38 No.6
Background: Due to impaired cell-mediated immunity, solid organ transplantation (SOT) recipients are at increased risk of developing nontuberculous mycobacterial pulmonary disease (NTM-PD). However, the clinical course of NTM-PD in SOT patients and the impact of SOT on the prognosis of NTM-PD remain unclear. Methods: We analyzed patients who developed NTM-PD after receiving SOT between January 2001 and December 2020, at a tertiary referral hospital in South Korea. Baseline characteristics, clinical course, and prognosis were evaluated. Propensity score-matched analysis was performed to assess the impact of SOT on long-term survival in patients with NTM-PD. Results: Among 4,685 SOT recipients over 20 years, 12 patients (median age, 64 years; interquartile range [IQR], 59–67 years; men, 66.7%) developed NTM-PD. Seven (58.3%) and five (41.7%) patients underwent kidney and liver transplantation, respectively, before the diagnosis of NTM-PD. The incidence of NTM-PD was 35.6 cases per 100,000 person-years among kidney transplant recipients and 28.7 cases per 100,000 person-years among liver transplant recipients. The median time between transplantation and the diagnosis of NTMPD was 3.3 (IQR, 1.5–10.8) years. The most common mycobacterial species was Mycobacterium avium (50.0%). Antibiotic treatment was initiated in five (41.7%) patients, and two patients (40.0%) achieved microbiological cure. Two patients died during a median follow-up of 4.2 (IQR, 2.3–8.8) years and NTM-PD was assumed to be the cause of death in one patient. When matched to patients without a history of SOT, patients with a history of SOT did not show worse survival (P value for log-rank test = 0.62). Conclusion: The clinical course of NTM-PD in SOT recipients was comparable to that of patients without SOT, and SOT did not increase the risk of all-cause mortality in patients with NTM-PD.
( Joong-yub Kim ),( Sun Mi Choi ),( Jayeun Kim ),( Jaeyoung Cho ),( Nakwon Kwak ),( Young Sik Park ),( Chang-hoon Lee ),( Sang-min Lee ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is the leading cause of death in IPF patients. While AE-IPF in-hospital mortality reaches near 50%, what distinguishes non-survivors from survivors is less known. Here, we present an easy-to-use scoring system predicting mortality of AE-IPF patients with six clinical markers that can be quickly acquired at patient’s initial presentation. Methods A retrospective derivation cohort of 769 IPF patients between January 2001 to December 2019 was constructed. Following the latest 2016 AE-IPF diagnostic criteria, we focused on 134 patients who experienced AE for the first-time. Medical history, vital signs, and laboratory Results from emergency department visits or hospital admissions were collected via medical record review. We used beta-coefficients of statistically and/or clinically significant factors from multiple logistic binary regression analysis (Primary outcome: 30-day mortality) to design a scoring system. Its performance was assessed with receiver operating characteristic (ROC) curve analysis. Results Patients with diabetes [adjusted odds ratio (aOR) 2.728, p=0.042], current cigarette use [aOR 4.085, p=0.023], PaO2/FiO2 (PF) ratio above 100 and less than or equal to 200 mmHg [aOR 3.108, p=0.016], and bilirubinemia over 1.2 mg/dL [aOR 2.767, p=0.040] were associated with higher 30-day mortality. Admission within previous 6 months [aOR 2.147, p=0.082], initial systolic blood pressure over 140 mmHg [aOR 2.432, p=0.061], and PF ratio below 100 mmHg [aOR 2.746, p=0.215] were also included in the modeling due to clinical significance. Area under the ROC curve of the scoring system was 0.770 (95% CI 0.679- 0.862, p<0.0001). Derivation cohort patients were divided into quartiles according to their score. Interquartile mortality differed (Q1: 7.69%, Q2: 17.74%, Q3: 54.35%, Q4: 100%) with statistical significance. Conclusion We report a quantitative scoring system predicting 30-day mortality of AE-IPF patients. After validation, this easy-to-use scoring system will serve as a useful aid for clinical decision making.
Pre-Sepsis Length of Hospital Stay and Mortality: A Nationwide Multicenter Cohort Study
Kim Joong-Yub,Lee Hong Yeul,Lee Jinwoo,Oh Dong Kyu,Lee Su Yeon,Park Mi Hyeon,Lim Chae-Man,Lee Sang-Min 대한의학회 2024 Journal of Korean medical science Vol.39 No.9
Background: Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis. Methods: We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between lateonset sepsis and the primary outcome. Results: A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%). The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients. Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69–5.34). The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37–2.50). When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles (P for trend < 0.001). Conclusion: Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days.
( Joong-yub Kim ),( Nakwon Kwak ),( Jae-joon Yim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0
Background While treatment compliance and effectiveness in patients with nontuberculous mycobacterial pulmonary disease (NTMPD) are suspected to vary by age, they are largely undocumented and current guideline recommendations are congruent regardless of age. We compared clinical characteristics and outcomes of patients with pulmonary disease caused by Mycobacterium avium complex (MAC), most common NTM species globally, across different age groups. Methods MAC-PD patients treated at Seoul National University Hospital between 2009 and 2019 were divided into five age groups; <50, 50-59, 60-69, 70-79, and ≥80 years. Baseline characteristics and treatment success rate across age groups were elucidated retrospectively. Treatment success connoted at least 12 months of sustained culture negativity while on therapy. To assess the difference in the trend of the proportion and the distribution of variables in the age groups, Mantel-Haenszel chi-squared test was applied for categorical variables, Analysis of Variance for normal distributed continuous variables and Kruskal-Wallis test for non-parametric continuous variables, respectively. Results Among 665 patients included for analysis, 62 patients (9.3%) aged under 50 years, 162 patients (24.4%) aged 50-59 years, 202 patients (30.4%) aged 60-69 years, 193 patients (29.0%) aged 70-79 years, and 46 patients (6.9%) aged 80 years or more. Proportion of patients with interstitial lung disease (3.2% vs. 1.9% vs. 1.0% vs. 4.1% vs. 8.7%, P=0.041), cerebrovascular disease (0.0% vs. 2.5% vs. 4.5% vs. 9.8% vs. 8.7%, P=0.005), dementia (0.0% vs. 0.0% vs. 1.0% vs. 3.6% vs. 6.5%, P=0.006) and male proportion (22.6% vs. 19.1% vs. 34.7% vs. 48.2% vs 54.3%, P<0.001) increased in older groups. Treatment success rate decreased gradually from younger groups to older groups (45.2% vs. 43.2% vs. 39.1% vs. 37.8% vs. 17.4%, P=0.023). Conclusions MAC-PD patients aged 80 years or more have drastically lower treatment success rate than younger patients. Age-related factors should be considered when initiating or maintaining treatment.
항공이동통신에서의 지연 시간 감소를 위한 MAC 프로토콜에 대한 연구
김용중,강석엽,임형렬,박효달 한국항행학회 2002 韓國航行學會論文誌 Vol.6 No.1
본 논문은 현재 무선 LAN 환경에서 적용되고 있는 매체접근제어 프로토콜인 IEEE 802.11 CSMA/CA를 이용함으로써, 음성 위주의 항공이동통신에서 음성과 데이터 채널을 통합하여 사용하도록 하고 있다. 또한, 표준으로 제정되어 있는 기존의 CSMA/CA 매체접근제어 프로토콜에 대한 이해를 바탕으로 성능 개선 방안을 제안하였으며, 이를 바탕으로 채널 효율을 향상시켰다. IEEE 802.11 매체접근제어(MAC, Medium Access Control) 프로토콜은 데이터 유형에 따라 채널을 두 개의 구간(PCF와 DCF 구간)으로 나누어 전송하도록 하고 있다. 본 논문에서는, 데이터 유형별로 적용되는 구간 중, DCF 구간에서의 패킷간의 충돌 가능성을 줄임으로써 데이터 전송 효율을 높이는데 주안점을 두고 있다. 제안 방안으로는 경쟁 구간에서의 전송에서 충돌에 따른 손실을 보완할 수 있도록 Wireless Window Protocol(이하, WWP)을 적용한 후 전송 과정을 제어하였다. Hidden 처미널의 영향이 적으므로 가시권내 통신에 적합한 기존의 2-Way CSMA/CA 프로토콜을 항공통신에 적용하여 상태 천이 과정을 5개에서 6개로 세분화하였고, 주어진 확률에 의하여 나누어진 두 개의 그룹별로 상태 천이 과정을 다르게 적용하였다. 따라서, 채널이 한 항공기에 의해 점유되는 PCF를 제외한, DCF 구간에서의 데이터 전송 효율을 높일 수 있었다. 시뮬레이션은 채널 대여폭과 패킷 크기 등을 파라미터 값으로 하여 수행하였으며, 시뮬레이션 결과 CSMA/CA에 비해 새로 제안한 알고리즘이 데이터 전송 과정에서 발생하는 충돌 가능성을 감소시킴으로써 성능이 향상됨을 알 수 있었다.