P-25 Predicting mortality in patients with tuberculous destroyed lung on mechanical ventilation

김원영,조은정,엄중섭,목정하,김미현,김기욱,박혜경,이민기,이광하 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Given the poor prognosis of tuberculous destroyed lung (TDL) necessitating mechanical ventilation, it is important to identify patients who might benefit from such treatment. The aim of this study was to develop a mortality prediction model for patients with TDL requiring mechanical ventilation. Methods: Consecutive TDL patients who received mechanical ventilation and were admitted to the medical ICU of the Pusan National University Hospital were reviewed. Binary logistic regression was used to identify factors predicting ICU mortality. The TDL-Vent score was calculated as the sum of simplified regression weights (SRW), and its predictive ability was compared to Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores. Results: A total of 125 patients were included; 36 (29%) of these died during a stay in the ICU. Multivariate analysis identified age ≥ 65 years (SRW 1), vasopressor use (SRW 1), and PaO2/FiO2 ratio < 180 (SRW 1) for inclusion in the TDL-Vent score. The area under the receiver operating characteristic curve of the TDL-Vent score was 0.72 (95% confidence interval, 0.63-0.80) and was larger than those of APACHE II (0.63; 95% confidence interval, 0.54-0.72) and SOFA (0.62; 95% confidence interval, 0.53-0.71) scores. The cutoff value for predicting ICU mortality based on maximum Youden’s index was ≥ 2. Conclusions: The TDL-Vent score is a simple model that may be useful for predicting ICU mortality among patients with TDL requiring mechanical ventilation.

연구논문초록(’81-’90) : SS41 강의 부식피로균열 성장거동에 미치는 해양환경인자의 영향 ( 2 ) ( 모서리 균열의 형상화와 파괴면적성장속도를 중심으로 )

김원영,박종문,임우조 한국부식학회 1991 Corrosion Science and Technology Vol.20 No.1

Corrosion fatigue test was performed by the use of plane bending fatigue tester in air and marine environment(25 and 500Ω㎝). The purpose of this study is to investigate the effects of marine environmental factor on the corner crick propagation behaviour of SS41 steel by corrosion fatigue. The main resulte obtained are as follows ; 1. The aspect variation of the corner crack growing under each environment can be estimated according to the following equation : b/a=κ-γ· b/t where a : crack length b : crack depth t ; specimen thickness κ-γ : experimental constants 2. The values of aspect ratiom b/a of corner crack in air in air is larger than that in natural sea water. 3. The fracture surface area propagation rate, dA/dN in natural sea water(25Ωcm) is faster than that in air. 4. The propagation rate of fracture surface area is more useful to estimate the corner crack growty rate by corrosion fatigue comparing with hate of suface crack.

지하수 추출에 의한 지반침하 중국의 예

김원영 대한지질공학회 2014 대한지질공학회 학술발표회논문집 Vol.2014 No.-

Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event

김원영,홍상범 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

In 2011, a cluster of peripartum patients were admitted to the intensive care unit of a tertiary hospital in Seoul with signs and symptoms of severe respiratory distress of unknown etiology. Subsequent epidemiological and animal studies suggested that humidifier disinfectant (HD) might represent the source of this pathology. Epidemiological studies, animal studies, and dose-response analysis demonstrated a strong association between HD use and lung injuries. The diagnostic criteria for HD-associated lung injury (HDALI) was defined on the basis of the clinical, pathological, and radiological attributes of the patients. The clinical spectrum of HDALI appears to range from asymptomatic to full-blown acute respiratory failure, and some patients have required actual lung transplantation for survival. The overall mortality of the exposed population was not significant, although peripartum patients and children who were admitted to the intensive care unit did show high mortality rates. Persistent clinical findings such as diffuse ill-defined centrilobular nodules and restrictive lung dysfunction were observed in some of the survivors. The findings of this review emphasize the importance of assessment of the level of toxicity of chemical inhalants utilized in a home setting, as well as the need to identify and monitor afflicted individuals after inhalational injury.

Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study

김원영,박승용,김화정,백문성,정치량,박소희,강병주,오진영,조우현,심윤수,조영재,박성훈,김정현,홍상범 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.3

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/ fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02–0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

효율적 교수학습을 위한 웹 기반 대화형 원격교육시스템

김원영,김치수,김진수 한국컴퓨터교육학회 2002 컴퓨터교육학회 논문지 Vol.5 No.3

본 논문은 학교현장에서 학습자의 창의력 신장을 위해 멀티미디어 교육을 지원하는 웹 기반 실시간 교육 시스템을 제안하였다. 제안된 시스템은 교수·학습자간의 실시간 상호작용과 개별학습, 학습자의 학습일탈을 방지하기 위한 강제화면 분배를 지원할 수 있게 설계되었다. 본 시스템은 UML을 적용하여 다중 사용자 환경에서의 실시간 메시지 교환과 관리를 위한 모듈을 두어 효율적인 상호작용이 가능하게 하였으며, 학습자의 실험·실습을 위한 시뮬레이션이 이루어지고 실험의 방법과 결과분석 등에 대한 질의 응답을 지원한다. 학습자의 학습진행과 지식형성을 위해 시스템의 교육적 기반을 구성주의에 두었다. In this paper a web-based real-time education system, which is able to support education through multimedia, is suggested for the expansion of learner's creative ability in the school. This system is designed so that it can support three things: 1) a real time interaction between instructors and learners, 2) individual learning through such an interaction, and 3) a coercive distribution of display by instructions for preventing the deviation of learners from learning. Also, this system, which UML is applied to, makes efficient interaction possible through the module for the real-time exchange and management of messages even in the multi-user environment. Through this system, not only the simulation by learners can be made for experiments and practices, but also questions and respondence can be supported on the procedure of experiments and the analysis of their results. This system is built on constructivism, and aimed at helping the learning progress and knowledge formation of learners.

Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation

김원영,김미현,조은정,엄중섭,목정하,김기욱,박혜경,이민기,이광하 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.3

Background: Patients with acute respiratory failure secondary to tuberculous destroyed lung (TDL) have a poor prognosis. The aim of the present retrospective study was to develop a mortality prediction model for TDL patients who require mechanical ventilation. Methods: Data from consecutive TDL patients who had received mechanical ventilation at a single university-affiliated tertiary care hospital in Korea were reviewed. Binary logistic regression was used to identify factors predicting intensive care unit (ICU) mortality. A TDL on mechanical Ventilation (TDL-Vent) score was calculated by assigning points to variables according to β coefficient values. Results: Data from 125 patients were reviewed. A total of 36 patients (29%) died during ICU admission. On the basis of multivariate analysis, the following factors were included in the TDL-Vent score: age ≥65 years, vasopressor use, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio <180. In a second regression model, a modified score was then calculated by adding brain natriuretic peptide. For TDL-Vent scores 0 to 3, the 60-day mortality rates were 11%, 27%, 30%, and 77%, respectively (p<0.001). For modified TDL-Vent scores 0 to ≥3, the 60-day mortality rates were 0%, 21%, 33%, and 57%, respectively (p=0.001). For both the TDL-Vent score and the modified TDL-Vent score, the areas under the receiver operating characteristic curve were larger than that of other illness severity scores. Conclusion: The TDL-Vent model identifies TDL patients on mechanical ventilation with a high risk of mortality. Prospective validation studies in larger cohorts are now warranted.

지르코니아 코핑과 전장도재 간의 전단결합강도와 파절양상 비교

김원영,전병욱,정인성 대한치과기공학회 2015 대한치과기공학회지 Vol.37 No.4

Purpose: The aim of this study was to investigate the shear bond strength between various commercial zirconia coping and veneering ceramic, and to observe the failure mode. Methods: For each zirconia block (iJAM Emerald, LUXEN Smile block, ICE Zirkon transluzent), 10 rectangular specimens were layered with Cercon ceram kiss, IPS e.max ceram, ICE Zirkon ceramic according to recommended by the manufacturer. The shear bond strength tests of the veneering porcelain to zirconia were carried out until fracture by a universal testing machine. After the shear bond tests, failure modes were characterized visually, under a stereomicroscope, such as adhesive, cohesive, or mixed. Data were analyzed with One-way ANOVA followed by Scheffe's tests. Results: The shear bond strength (mean±SD) of zirconia-veneer ceramic were JC group 13.9±3.6 ㎫; JE group 17.7±2.4 ㎫; JI group 15.1±2.5 ㎫; LC group 9.5±1.5 ㎫; LE group 16.2±2.3 ㎫; LI group 12.6±0.8 ㎫; ZC group 16.0±2.3 ㎫; ZE group 18.5±3.4 ㎫; and ZI group 15.3±3.2 ㎫. The One-way ANOVA showed a significant difference between groups (p<0.05). The failure mode in most experimental groups was mixed failure, except for the LC group, which showed adhesive failure, and JE group, LE group and ZE group showed cohesive failure. Conclusion: For IPS e.max ceram, the shear bond strength value was highest for all kinds of zirconia blocks. For ICE Zirkon transluzent, the shear bond strength value was highest for all kinds of veneering ceramics. Most of experimental group interfaces revealed mixed failure mode.

『金剛三昧經論』에서 二入說과 一乘

金圓暎 元曉學會 1998 元曉學硏究 Vol.3 No.-

방사선 판독소견서 : 임상의들의 태도, 선호유형 및 의견

김원영,황성수,안명임,정연주,정정임,박영하,박서희,송혜향 대한영상의학회 2001 대한영상의학회지 Vol.45 No.3

목적: 방사선 판독소견서 에 대한 임상의들의 전반적 태도. 선호유형 및 의견을 알아보고자 하였다. 대상과 방법: 400에서 800 병상규모의 4개 대학 부속병원에서 임상 각과의 전공의 및 전문의 315명에게 설문지를 배포하여 총 228명이 응답하였다. 설문지의 내용은 판독소견서를 읽는 임상의의 전반적 인 태도, 선호하는 판독 유형 . 그리고 기타의견 및 건의사항 등을 포함하였다. 설문지 응답을 토대로 판독지에 대한 임상의들의 경향을 분석하고 전공의와 전문의 그리고 내과 계와 외과계 임상의의 응답을 비교하였다. 결과: 임상의들은 판독소견서를 길이에 관계없이 전체를 다 읽는 경우가 가장 많았고. 결론만을 읽은 후 이해가 불분명 할 때만 전체를 읽는 경우가 그 다음으로 많았다. 판독소견서 의 양에 있어서 단순 방사선 사진 판독에 대해서는 적다고. MR 판독에 대해서는 과다하다고 답변하였다 내용의 이해정도는 대부분 이해하지만 간혹 이해가 안된다는 응답이 가장 많았으며 . 이해가 안되는 원인으로는 영어문장이 문법적으로 오류가 많거나 산만하다는 응답이 가장 많았다 판독 소견서가 이해하기 힘든 경우 판독의와 상의하는 경우가, 상의하지 않는 경우보다 많았다. 전문의들이 전공의에 비해 상의하는데 더 적극적이었다. 문장형식에 대해서는 완전하고 복잡한 문장보다는 간결한 단문이나 전보문의 형식을 더 선호하였으며 이러한 경향은 전문의들보다 전공의들에서 더 두드러졌다. 정상 판독 결과, 단순 방사선 촬영 , 그리고 임상소견이 특별히 없는 경우등에서는 대체로 간단한 내용기술을 선호하는데 반하여 . 판독 결과 이상소견이 있거나. 특수 검사들 (특수 방사선 촬영, 초음파 CT MR등) 그리고 임상소견이 있는 경우에서는 보다 자세한 내용 기술을 원하였다. 이 경우 외과계 임상의보다 내과계 임상의가 더 자세한 내용을 원하였다 결론: 위와 같은 결과를 방사선 판독의 질과 이해도를 높이는데 반영하여. 보다 효과적인 판독 정보 전달에 기여하기를 기대하는 바이다 Purpose: To determine referring Physicians'general attitudes, Preferred reporting types, and opinions on radiologic reports. Materials and Methods: A survey questionnaire was distributed to the 315 staff and residents of four university hospitals with 400 to 800 beds, and a total of 228 physicians responded. The questionnaire aimed to determine of the general attitude of referring physicians to radiologic reports, the type of report they preferred, and other opinions and suggestions. The responses elicited, as well as discrepancies among residents, staff, internist, and surgeons, were analyzed. Results: Most referring physicians replied that they read an entire report regardless of its length, and the second majority read the conclusion first and then the remainder of the report only if clarification was required. With regard to report length, physicians answered that reports describing the findings of conventional radiography were often too short, while those dealing with MRI were verbose. The majority experienced occasional confusion when reading a report, the major cause being grammatical errors and incomprehensible sentence structure. When confused, most physicians consulted the radiologist; staff showed a greater inclination than residents to pursue this option. Most physicians preferred brief phrases or telegraphic-style sentences to a style which stressed completeness and detail, a preference which was statistically higher among residents than staff. Whereas physicians favored a brief radiologic report in cases of normal radiologic findings, conventional radiologic studies or no clinical findings, they wished to see a more detailed report in cases of abnormal radiologic findings, specific radiologic studies (special radiographs, US, CT, or MRI) , or positive clinical findings. This need for more detail was expressed more frequently by internists than by surgeons. Conclusion: If implemented, the results of this study can be expected to enhance the quality and comprehensibility of radiologic reports, and may also lead to more efficient communication between radiologists and physicians.