전신홍반루푸스의 새로운 분류 기준

이연아 ( Yeon-ah Lee ) 대한내과학회 2020 대한내과학회지 Vol.95 No.3

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with highly variable clinical and immunological manifestations. Classification and diagnosis of SLE are complicated by the multi-organ nature of the disease and by our incomplete understanding of its pathophysiology. The 1997 update of the 1982 American College of Rheumatology (ACR) criteria for SLE has been widely used for classification of SLE. In order to improve clinical relevance and early diagnosis, the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) group suggested the 2012 SLICC criteria. These sets of classification criteria have unweighted lists of various serological and clinical findings typical of SLE, can be fulfilled by reaching a sum score of points. The only exception is biopsy-proven lupus nephritis with autoantibodies in the 2012 SLICC criteria. In an attempt to overcome limitations of the previous sets of SLE classification criteria, the new 2019 SLE European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE have been recently published. The 2019 EULAR/ACR criteria include positive ANA at least once as obligatory entry criterion; followed by additive hierarchically clustered and weighted criteria. The structure and weighting of criteria constitute a paradigm shift in the classification of SLE. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%. This review attempts to delineate the history, performance and limitations of the current sets of SLE criteria. (Korean J Med 2020;95:151-161)

소화기 ; 한국인 자가면역성 간염을 진단하기 위한 Simplified Scoring Criteria의 가치 및 유용성

이윤나 ( Yun Nah Lee ),김영석 ( Young Seok Kim ),김상균 ( Sang Gyune Kim ),임재희 ( Jae Hee Lim ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),이세환 ( Se Hwan Lee ),김홍수 ( Hong Soo Kim ),김부성 ( Boo Sung Kim ),김희경 ( 대한내과학회 2011 대한내과학회지 Vol.81 No.3

목적: 자가면역성 간염(AIH)을 진단하기 위한 revised original scoring criteria는 지나치게 번거로워 임상에서의 적용이 쉽지 않았다. 이러한 단점을 보안하기 위해 2008년 Hennes 등 [19]에 의해 simplified scoring criteria가 발표되었다. 이에 저자 등은 이 criteria를 한국인에게 적용하였을 경우, 진단적 가치 및 유용성을 평가하고자 연구를 시행하였다. 방법: Original revised scoring criteria에 의해 AIH이 진단된 22예와 자가면역 간염/원발성담즙 간경변증(autoimmune hepatitis/primary biliary cirrhosis, AIH/PBC) 중복증후군을 진단받은 5예, 그리고 대조군으로 독성간염 50예, 비알코올성 지방간(NAFLD) 18예, 원발성담즙 간경변증(PBC) 11예를 후향적으로 분석하였다. 결과: AIH 중 20명(90.9%)과 AIH/PBC 중복 증후군 5명 모두가 simplified scoring criteria에 의해 AIH로 진단되었다. 그리고 PBC 중 3명인 27.3%에서 새로운 진단기준을 적용하였을 경우 위양성을 보였다. AIH 진단에 대한 simplified scoring criteria의 민감도와 특이도는 각각 90.9%와 96.2%였다. 결론: 한국인에게 simplified scoring criteria는 중복증후군을 포함한 자가면역성 간염을 진단하는 데 유용하게 사용될 수 있을 것으로 생각한다. Background/Aims: The diagnostic criteria for autoimmune hepatitis (AIH) were created and revised by the International Autoimmune Hepatitis Group (IAIHG) in 1999. Simplified scoring criteria based on four clinical components were recently proposed. The aim of this study was to assess the diagnostic value and usefulness of these simplified criteria in Korea. Methods: We applied the simplified scoring criteria to 22 AIH patients diagnosed according to the original revised scoring criteria proposed in 1999. Furthermore, in order to compare the predictive power of these two sets of diagnostic criteria, we included 84 patients with liver diseases [toxic hepatitis (n = 50), nonalcoholic fatty liver disease (n = 18), primary biliary cirrhosis (PBC) (n = 11), and PBC/AIH overlap syndrome (n = 5)] other than AIH. Results: Twenty (90.9%) patients with AIH and five (100%) with PBC/AIH overlap syndrome were diagnosed with AIH according to the simplified scoring criteria. Three (27.3%) patients with PBC were false-positive for AIH according to the simplified scoring criteria. Those patients diagnosed according to the simplified scoring criteria showed an increased frequency of ANA and/or SMA of ≥ 1:80 (p = 0.491) and an increased frequency of serum IgG levels at or above the upper normal limit compared to patients with PBC (p = 0.006). The sensitivity and specificity of the simplified scoring criteria for the diagnosis of AIH were 90.9 and 96.2%, respectively. Conclusions: The simplified scoring criteria offer a reliable and simple method for excluding AIH; however, these criteria may have limitations in the diagnosis of patients with atypical features, especially those with low autoantibody and IgG levels. (Korean J Med 2011;81:340-350)

연구실 점검 및 진단 대가기준에 관한 연구

이종호 ( Jong-ho Lee ) 한국안전학회(구 한국산업안전학회) 2018 한국안전학회지 Vol.33 No.5

Laboratory inspection and diagnosis is a means of investigating and assessing various hazards or the state of research equipment in a laboratory, then taking appropriate safety measures to prevent accidents and injury. In many cases, laboratory inspection and diagnosis carried out by agencies are performed in a perfunctory manner that only barely satisfies the legal requirements. The aim of the present study is to provide clearly established pricing criteria for laboratory inspection and diagnosis, so as to prevent recurrence of laboratory accidents and to establish a safe laboratory environment. In order to clarify previously unclear matters, such as the lower limit for bids submitted by laboratory inspection and diagnosis agencies, technical manpower requirements, and number of laboratories inspected and diagnosed per day, a questionnaire survey was administered to agency personnel. First, when asked what the lower limit for bids submitted by agencies should be in order to improve reliability of inspection and diagnosis results and make up for the shortcomings of the lowest-bidder-wins system, 85.5% of respondents answered that the lower limit for bids should stand at no lower than 90% of the estimated price. The level of technical expertise among the technical personnel committed to laboratory inspection and diagnosis was shown to impact the reliability of results, and questionnaire results indicated a need to vary technical expertise levels depending on the degree of hazard, substances handled, and equipment used in a given laboratory. Level of technical expertise(67.1%) and number of personnel(52.6%) were shown to have a greater impact on reliability of diagnosis than on reliability of inspection. According to the results, it is determined that three persons(specialist, advanced and intermediate) should be committed to inspections, while four persons(professional, specialist, advanced and intermediate) should be committed to diagnoses. The respondents indicated a larger number of laboratories could be inspected than diagnosed per day. This can be attributed to differences in the amount of work each task involves, and the time each task takes. Assuming a six-hour work day not counting transportation, paperwork and rest, it is thought that inspection of up to 36 laboratories will be possible if each laboratory is assigned no more than 10 minutes(34.7%), while up to 24 laboratories could be inspected and diagnosed if each laboratory is assigned 15 to 20 minutes(35.1%).

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

( Jin-ha Kim ),( Hyun-joo Seol ),( Won Joon Seong ),( Hyun-mee Ryu ),( Jin-gon Bae ),( Joon Seok Hong ),( Jeong In Yang ),( Ji-hee Sung ),( Suk-joo Choi ),( Soo-young Oh ),( Cheong-rae ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.2

Objective This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Methods This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Results The median maternal age was 33 years (range, 28-40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Conclusion Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

心病證 진단요건의 표준 설정을 위한 연구

최선미,박경모,정찬길,성현제,안규석 대한동의생리학회,대한동의병리학회 2003 동의생리병리학회지 Vol.17 No.4

The objective is to establish the standard of criteria for differential diagnosis of signs and symptoms. This study selected signs and symptoms related to heart which stands for Fire(火) as a kind of five phase(五行). Eleven experts was asked to evaluate the adequateness of criteria which was developed by Korea Institute of Oriental Medicine(KIOM) and to suggest the amendment of them. To implement the study, we used the questionnaire which asks about the diagnosis criteria for an insufficiency of the heart-qi(心氣虛證), deficiency of the heart blood(心血虛證), deficiency of the heart-yin(心陰虛證), insufficiency of the heart-yang(心陽虛證), exuberant fire due to hyperactivity of the heart(心火亢盛證), stagnation of the heart blood(心血瘀阻證), head disturbed by phlegm-fire(痰火擾心證), attack of the heart by retainedfluid(水氣凌心證). Every criteria consists of primary symptoms, secondary symptoms, tongue findings, and pulse findings. In perspectives of the classiflcation of patterns for signs and symptoms and criteria for diagnosis, the result shows that the previous standard doesn’t have so many problem. So many of experts were agree with the criteria which was suggested but the trend is that they use, in their actual practice, less than the criteria. Additionally, they pointed that every element in a criterion should have the different weight value, criteria for the overlapped pattern should be added, and, in future, criteria which are based on clinical investigation should be established.

Diagnostic Performance of Three-Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

Kwon, Hyun-Woo,Paeng, Jin-Chul,Nahm, Francis Sahn-Gun,Kim, Seog-Gyun,Zehra, Tanzeel,Oh, So-Won,Lee, Hyo-Sang,Kang, Keon-Wook,Chung, June-Key,Lee, Myung-Chul,Lee, Dong-Soo The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.4

Purpose Although the three-phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type I (CRPS-1), there is some controversy regarding the TPBS image criteria for CRPS-1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. Materials and Methods The study included 140 patients with suspected CRPS-1 (CRPS-1, n=79; non-CRPS, n=61; mean age $39{\pm}15$ years) who underwent TPBS. The clinical diagnostic criteria for CRPS-1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS ($TI_{event-scan}$). Quantitative analysis for lesion-to-contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Results Both increased and decreased periarticular DU were significant image findings for CRPS-1 (CRPS-1 positive-rate=73% in the increased DU group, 75% in the decreased DU group). The $TI_{event-scan}$ did not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS-1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS-1 were 80% and 72%, respectively. Conclusions Optimally modified TPBS image criteria for CRPS-1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS-1 even with the most recent consensus clinical diagnostic criteria.

실무자 관점에서의 건축물 정밀안전점검 및 정밀안전진단 실행대가 현황분석

이종필,임남기 한국구조물진단유지관리공학회 2018 한국구조물진단유지관리공학회 논문집 Vol.22 No.4

Recently, interest in the safety and maintenance of the structures is growing. However, due to the low-cost order placed by the ordering organization, the safety diagnosis specialized institution becomes insolvent and many problems have arisen due to insufficient inspection and diagnosis. Therefore, in this study, the current status of bid cost was examined through the survey of the practitioners and case analysis. As a result, Precision safety inspection is deemed that it is necessary to increase the efficiency of the criteria cost and to strengthen the rigidity of the criteria cost rather than adjusting the criteria cost. Precision safety diagnosis, the criteria cost for structures with a floor area of less than 10,000 ㎡ is lowered to 80 % from the current standard. For structures larger than that, the current criteria cost are applied, but it is deemed necessary to strengthen the rigidity of the criteria cost. 최근 시설물의 안전 및 유지관리에 관심이 증대되고 있으나, 발주처의 저가발주로 인해 안전진단전문기관은 부실화 되고 부실 점검 및 진단으로 인한 많은 문제점들이 야기되고 있다. 따라서 본 연구에서는 실무자들의 인식조사와 사례분석을 통해 실행대가 현황을 고찰하였으며, 그 결과 정밀안전점검은 대가기준 조정보다는 대가기준의 효율성 증대 및 강제성 강화가 필요한 것으로 판단된다. 또한 정밀안전진단은 연면적 10,000㎡미만 시설물에 대한 대가기준 설계금액을 현재 기준에서 80%로 하향조정하고, 그 이상의 시설물에 대해서는 현행 대가기준을 적용하되, 대가기준의 강제성 강화가 필요할 것으로 판단된다.

Noninvasive Diagnosis of Hepatocellular Carcinoma: Elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guidelines Compared with Other Guidelines and Remaining Issues

윤정희,박중원,이정민 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.1

Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed “washout” in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis.

1형 자가면역췌장염의 진단기준에서 논란이 되는 쟁점

류지곤 ( Ji Kon Ryu ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1

The diagnosis of autoimmune pancreatitis (AIP) is clinically challenging because it is a rare disease, which closely mimics more common pancreaticobiliary malignancies in its presentation such as obstructive jaundice and pancreatic mass. The price of misdiagnosis is high because AIP diagnosed as pancreatic cancer can lead to unnecessary surgery for the benign disease, and cancer diagnosed as AIP can delay potentially curative surgery. There is no single ideal diagnostic test for AIP; hence one has to use a set of diagnostic criteria to distinguish it from other diseases. International consensus diagnostic criteria (ICDC) and algorithm for AIP have been proposed by a consensus of expert opinion in 2011. The concept of the Japan pancreas society (JPS) 2011 criteria took basic concepts of both the Japanese previous criteria and type 1 in the ICDC as much as possible. However, the ICDC are very complex to remember and definition of level 1 and 2 are not evidence based in some criteria. The revised JPS criteria are simpler than ICDC but further evaluation is necessary in other than Japan. So, further research is required to establish easy, ideal and practical diagnostic criteria. Korean J Pancreatobiliary 2014;19(1):1-6

Noninvasive Diagnosis of Hepatocellular Carcinoma: Elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guidelines Compared with Other Guidelines and Remaining Issues

Yoon, Jeong Hee,Park, Joong-Won,Lee, Jeong Min The Korean Society of Radiology 2016 KOREAN JOURNAL OF RADIOLOGY Vol.17 No.1

<P>Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed 'washout' in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis.</P>