충수염 의증 청소년 및 젊은 성인에서 2-mSv CT와 기존 선량 CT의 민감도 및 특이도: LOCAT의 사후 하위그룹 분석

학위논문(박사)--서울대학교 대학원 :융합과학기술대학원 융합과학부,2019. 8. 이경호.Introduction: To explore heterogeneity across patient or hospital characteristics in the diagnostic sensitivity and specificity of 2-mSv CT relative to conventional-dose CT (CDCT) in adolescents and young adults with suspected appendicitis. Methods: We used the per-protocol analysis set of a large randomized controlled noninferiority trial conducted between Dec 2013, and Aug 2016, comparing 2-mSv CT and CDCT (typically 7 mSv). The data included 2,773 patients (median age [interquartile range], 28 [21–35] years) and 160 radiologists from 20 hospitals. We tested for heterogeneity in sensitivity and specificity for the diagnosis of appendicitis across predefined subgroups by patient sex, body size, clinical risk scores for appendicitis, time of CT examination (i.e., working hours [typically 08:00–17:00 of working days] vs. after hours), CT machines, radiologists experience, previous site experience in 2-mSv CT, and site practice volume. We drew forest plots and tested for additive or multiplicative treatment-by-subgroup interaction on sensitivity and specificity. Results: The 95% CIs for the between-group differences, particularly for sensitivity, were wide due to small sizes (< 200) for the subgroups of extreme body sizes, high clinical risk score for appendicitis, newer CT machines, hospital with prior experience in 2-mSv CT, and hospitals with small appendectomy volume. Otherwise, the 95% CIs in most subgroups contained the previously reported overall between-group differences as well as null hypothesis value (i.e., 0). There was no significant additive or multiplicative interaction for either sensitivity or specificity. Conclusions: We found no notable subgroup heterogeneity, which implies that 2-mSv CT can replace CDCT in diverse populations. Further studies are needed for the populations for which our subgroups were small.서론: 본 연구는 충수염 의증 청소년 및 젊은 성인에서 기존 CT와 비교하여 2-mSv CT의 진단 민감도 및 특이도에서 환자 또는 병원의 특성에 따른 이질성이 있는지를 탐색하는 연구임. 방법: 본 연구는 2013년 12월에서 2016년 8월 사이에 15–44세의 환자에서 2-mSv CT와 기존 선량 CT (일반적으로 7 mSv)를 비교한 대규모 비열등성 무작위배정 임상시험의 프로토콜 별 분석세트를 사용함. 본 연구에는 20개 병원에서 2,773명의 환자 (중앙값 연령 [사분위수 범위], 28 [21–35]세)가 포함되었으며, 160명의 판독의가 참여함. 환자의 성별, 신체 크기, 충수염에 대한 임상 위험 점수, CT 검사시간 (일과시간 [근무일 기준 오전 8시부터 오후5시] 또는 일과시간 이후), CT 장비, 판독의의 경험정도, 2-mSv CT에 대한 이전 경험 여부, 그리고 병원의 임상규모 등의 사전 정의된 하위 그룹에서 충수염 진단을 위한 민감도 및 특이도의 이질성을 테스트함. 두 군의 차이를 숲그림으로 제시하고, 민감도와 특이도에 대한 덧셈 및 곱셈 상호작용을 테스트함. 결과: 많이 날씬하거나 뚱뚱한 경우, 충수염 염증 반응 점수가 높은 경우, 최신 CT 기기를 사용한 경우, 2-mSV CT 의 이전 경험이 있는 병원, 그리고 충수절제술 규모가 작은 병원의 경우 등 특정 하위 그룹은 작은 크기 (< 200)로 인해 민감도에 대한 95 % 신뢰구간이 넓었음. 그 외, 대부분의 하위 그룹에서 그룹 간 차이에 대한 95 % 신뢰구간은 이전 보고된 전체 그룹 간 차이 및 귀무 가설 값 (즉, 0)을 포함하였음. 2-mSv CT 군과 기존 선량 CT 군 간에 민감도 및 특이도에서 덧셈 또는 곱셈 상호작용을 보이는 하위 그룹은 없었음. 결론: 충수염 의증 청소년과 젊은 성인에서 2-mSv CT와 기존 선량 CT 간에 민감도와 특이도에서 이질성을 보이는 하위그룹은 없었음. 이는 2-mSv CT가 다양한 집단에서 기존 선량 CT를 대체할 수 있음을 의미함. 다만, 본 연구에서 작은 크기를 가진 일부 하위 그룹에 대해서는 추가적인 연구가 필요함.INTRODUCTION 1 Motivations of LOCAT 1 Purposes of LOCAT 3 Motivations of Dissertation Research 4 Purposes of Dissertation Research 5 BACKGROUND 7 Epidemiology of Appendicitis and CT utilization 7 Imaging Utilization 7 Popularity of CT 8 CT Radiation 9 Radiation Dose Level 10 Typical Radiation Dose for Multi-purpose Abdomen CT 10 Typical Radiation Dose for Appendiceal CT 11 Low Doses Explored in Research Settings 12 Carcinogenic Risk Associated with CT Radiation 12 Controversy 13 ALARA Principle 14 Efficacy and Effectiveness of LDCT Compared to CDCT 15 Clinical Outcome 19 Diagnostic Performance 20 Inter-observer Agreement 21 Differentiation between Complicated vs. Uncomplicated Appendicitis 22 Image Quality 24 Visualization of the Appendix 24 Alternative Diagnoses 25 Step-wise Multimodal Diagnostic Approach Incorporating LDCT 27 Patient Subgroups Less Benefited from LDCT 27 Selective Utilization of LDCT 29 Additional Imaging Test(s) Following LDCT 30 Imaging Techniques for LDCT for Suspected Appendicitis 31 Intravenous Contrast Enhancement 31 Contrast-enhancement Phase 31 Enteric Contrast 32 Anatomical Coverage 32 Tube Current 33 Tube Potential 34 Iterative Reconstruction 34 Image Reconstruction Thickness 35 Coronal Reformation 35 Sliding-Slab Averaging Technique 36 Image Interpretation and Reporting for LDCT 37 Diagnostic Criteria for Appendicitis 37 Structured Reporting 38 Other Practical Issues in Implementing LDCT 39 Dedicated Protocol for Appendiceal CT 40 Education for Referring Physicians and Surgeons 41 Education for Radiologists 42 Dose Calibration and Monitoring 43 MATERIALS AND METHODS 47 Study Overview 47 Practice Setting 48 Pre-registration Procedures 48 Study Organization and Site Recruitment 49 Site Activation 50 Patients 51 Eligibility Criteria 54 Clinical Suspicion for Appendicitis 55 The Need for CT Examination 55 Generalizability 56 Representativeness of Study Sample 57 Withdrawal Criteria 58 Randomization 58 Index Test 59 CT Image Acquisition and Archiving 66 Radiation Doses 69 Record of Modulated Radiation Dose 71 Target Median DLP Values for the 2-mSv CT and CDCT groups 71 Calibration of Radiation Doses 72 Estimation of Carcinogenic Risk Associated with CT Examination 74 Image Interpretation 75 Radiologists and CT Reports 76 Radiologist Training 78 Considerations Regarding Technical Advantages over Previous Studies 79 Image Submission 80 Co-intervention 81 Additional Imaging 82 General Treatment Guidelines 82 Follow-up 84 Endpoints in LOCAT 85 Primary Endpoint 86 Secondary Endpoints 86 Considerations for NAR and APR 89 Changes in Endpoints 89 Reference Standards 91 Overview of Reference Standards 91 Definition of Acute Appendicitis 92 Mild or Early Acute Appendicitis 92 Appendiceal Diverticulitis 93 Cases of Delayed Appendectomy 93 Periappendicitis 93 Definition of Appendiceal Perforation 94 Reporting AEs 95 Definition of AE 96 Definition of SAE 97 AE Characteristics 97 Grade 98 Expected/Unexpected AEs 98 Attribution 98 Individual Symptoms vs. Single Diagnosis 99 Who Should Report AEs 99 How to Report AEs 99 Follow-up for AEs 100 Ethical Considerations 100 Ethics and Responsibility 100 Informed Consent Form 101 Data Security and Participant Confidentiality 101 Early Stopping Rules in LOCAT 101 Data Management 102 Case Report Forms 103 Monitoring Participant Accrual 103 Monitoring Data Quality 103 Data and Safety Monitoring Board 105 Statistical Analysis 105 Considerations for Primary Endpoint 105 Analysis Plans 107 Sample Size 108 Sample Size Considerations 108 Final Sample Size 110 Rationale for the Noninferiority Margin 111 Reported NARs Following Preoperative CT 111 Reported NARs in Patients Without Preoperative CT 112 Sample Size Considerations on APR 113 Subgroup Analyses for APR and NAR 114 Subgroup Analyses for Diagnostic Performance 116 RESULTS 119 Patient Characteristics 119 Overall Diagnostic Performance 123 Subgroups of Limited Comparison 123 Between-group Differences for Subgroups 123 Heterogeneity 131 DISCUSSION 132 CONCLUSION 139 REFERENCES 140 APPENDIX 164 Abstract in Korean 176Docto

대학도서관에서 인터넷을 통한 정부정보 제공에 관한 연구

본 연구는 현재 인터넷 상에서 제공하고 있는 국내외 정부정보 제공의 특징과 형태를 파악하고, 이용자의 정부정보에 대한 요구분석을 통하여 대학도서관에서 효율적인 정부정보 제공을 위한 방안을 제시하는데 그 목적을 두었다. 이를 위하여 문헌연구와 설문조사, 사례연구를 실시하였다. 문헌연구에서는 정부정보의 개념과 특성, 유형, 전자환경에서의 특성에 관한 연구들을 고찰하였다. 설문조사는 서울대, 연세대, 고려대, 서강대, 이화여대 등 5개 대학의 정치학 전공, 경제학 전공, 사회학 전공 대학원생 각각 30명씩 150명을 대상으로 하여, 그들의 정부정보 이용현황과 요구사항을 분석하였다. 사례연구에서는 이용자 요구분석 설문결과를 토대로 국내 대학 도서관에서 제공하고 있는 정부정보의 현황과 서비스 정도를 파악하였다. 또한 정부정보를 제공하고 있는 미국의 4개 대학도서관 사이트를 방문하여 구축현황과 정부정보 제공 정도 등을 살펴보았다. 정부정보 요구분석을 위한 설문조사는 이용자의 이용현황과 그들의 정보요구 두가지 측면에서 조사 분석되었다. 조사결과는 다음과 같다. 첫째, 정치학 전공, 경제학 전공, 사회학 전공 대학원생들은 정부정보의 이용률이 높았으며, 인터넷으로 제공되는 정보를 더 선호하는 경향을 보였다. 둘째, 이용자들은 정부정보를 얻기 위해 주로 이용하는 기관은 재학중인 대학도서관 홈페이지, 국회도서관, 정부기관 홈페이지의 순으로 나타났다. 셋째, 이용자들이 가장 많이 이용하는 정부정보는 통계자료, 정기간행물, 조사연구보고서, 보도자료, 홍보자료의 순으로 나타났다. 넷째, 이용자들은 정부정보를 획득하기까지 어려움을 많이 느끼고 있었고, 그 이유로는 정보의 소재를 알지 못했거나, 검색도구 사용의 미숙을 들었다. 다섯째, 이용자들이 도서관에서 가장 필요로 하는 정부정보서비스에 대한 응답으로 필요한 정보를 직접 찾아주는 서비스가 가장 많았고, 그 다음으로는 정부정보를 위한 별도의 사이트 운영, 관련기관에 대한 소재안내, 추천사이트의 제공, e-mail서비스의 순으로 나타났다. 여섯째, 이용자들은 도서관에서 정부정보원의 원활한 사용을 위해 인터넷 상의 이용지침을 마련하여 개인적으로 이용하거나, 개별적인 정보이용 교육을 원했다. 이와 같은 이용자들의 정부정보 이용현황과 요구에 따라 대학도서관에서 효율적인 정부정보 제공을 위한 방안을 내용적 측면과 디자인 측면, 정부정보의 접근 측면에서 다음과 같이 제시하였다. 내용적 측면에서의 정부정보 제공방안은 다음과 같다. 첫째, 단순히 정부기관을 링크시키는 것이 아니라, 정부정보의 유형별로 선별하여 해제와 함께 이용자에게 제공해야 한다. 또한 이용자가 특히 필요로 하는 정부정보 유형을 파악하여 구축하는 것도 중요한 일이다. 둘째, 정부정보의 범위와 최신성을 제공함으로써 이용자가 정부정보를 이용하는데 편의를 도모하여야 한다. 정부정보의 수록 범위를 제시함으로써 이용자가 원하는 정보를 보다 분명하게 판단하여 정보를 취사선택하는데 도움이 되어야 한다. 또한 정보가치의 노후속도가 빠른 정부정보는 최신의 자료로 갱신하여 정보의 신뢰도를 높여야 한다. 셋째, 정부정보의 원문을 제공해야 한다. 원문들만 따로 분류하여 제공하거나, 원문이 있는 사이트를 안내하는 등의 원문정보를 구체적으로 제시함으로 이용자가 원문을 입수하는데 어려움이 없도록 해야 한다. 디자인 측면에서의 정부정보 제공방안은 다음과 같다. 첫째, 검색기능을 제공함으로써 다양한 각도에서 정부정보로의 접근을 유도해야 한다. 이러한 검색기능은 대학교 자체내의 검색기능을 제공하거나, 정부정보를 전문으로 검색하는 상용검색엔진을 이용하는 것이다. 둘째, 이용자와 사서와의 관계를 위한 피드백 메커니즘의 개발이다. 정부정보를 별도로 다루고 있지 않는 경우가 많기 때문에, 문의사항이나 정부정보 검색에 대한 질문사항을 실시간으로 이용할 수 있는 방법을 개발하여 대학도서관 홈페이지상에서 제공하여야 한다. 셋째, 인터넷상에 정부정보원에 대한 전체적인 이용지침과 검색전략 등을 체계적으로 구성해 놓아 이용자 스스로가 정보원에 접근할 수 있도록 제시해야 한다. 정부정보 접근 측면에서 정부정보 제공방안은 다음과 같다. 첫째, 정부정보를 위한 별도의 사이트를 운영하는 것이다. 다양한 정부정보의 유형을 최대한 반영하며, 단순한 정보원의 링크가 아닌 검색기능까지 제공되는 사이트를 형성하는 것이다. 또한 다른 외부 서버의 정보원도 자유롭게 이용할 수 있도록 설계하도록 한다. 둘째, 정부정보의 소재를 안내하는 것이다. 국가에서 운영하고 있는 행정정보소재안내서비스(GILS)를 효과적으로 이용할 수 있도록 하며, 대학 도서관과의 연계를 통해 이용자의 편의를 도모하여야 한다. 셋째, 추천사이트의 제공이다. 여기서는 정부정보에 대한 충분한 정보원을 포괄적으로 제공하고, 각각의 정보원에 대한 소개, 수록 내용, 범위, 정보원에 대한 평가까지 함께 수록하여, 이용자가 정부정보에 접근하는데 도움을 주어야 한다. ; The purpose of this research is to analyze characteristics and forms of national and international internet governmental information services, and is to provide better services in academic libraries by analyzing users information requests through internet. This study is performed with literature review, survey, and case study. In literature review, definition, character, forms, and characteristics under the electronic environment for the governmental information service are reviewed using the studies on the information services. This survey is performed by analyzing responses from 150 social science graduate students about their uses and requests for the governmental information service. 30 students from each Seoul National University, Yonsei University, Korea University, Sogang University, and Ewha Womans University are participated in the survey. In case study, the status of governmental information services and the actual application and uses of governmental information service system, which are supplied by national academic libraries, are studied by analyzing the survey responses. Indeed, four different university library websites in United States, which provide United States governmental information service, are visited to make observations of their current information service system structure, and the status and levels of information service supply. Then, suggestions for more effective governmental information service, which can be applied by national academic libraries, are provided by observing and comparing governmental information services in United States university libraries. The survey to analyze the requests on governmental information services is performed by asking responses for both the current status of the participants governmental information services uses, and their requests for better information service system. The result is like this: First, graduate students in politics, economics, and sociology have higher frequency in using governmental information, and tend to prefer information supplied by internet information services. Second, users prefer to use their own university library homepage most frequently to get the governmental information, and then they use National library homepage, and government offices homepage in the order of preference. Third, the governmental information most frequently used by the information service users is statistics research, and then periodicals, research reports, broadcasting reports, and governmental advertisement histories in the order of frequency. As fourth response, users indicate that they find difficulties in researching governmental information through the internet sites due to the lack of information in the location for the information, or due to the lack of experiences in utilizing the internet search services. Lastly, most of users for governmental information services respond that they are in need of service, which does the search for the wanted information directly for them. Then the rest of the users respond that they want a separate site only for governmental information, and then the information on each government departments site locations, links to websites for more help, and e-mail response services. The suggestions for more effective supply of governmental information in university library websites are provided by analyzing the survey on governmental information use status and users requests to improve services: First, it needs to run a separate website only for the purpose of providing governmental information. The site should contain various forms of information. It should not only contain the help links, but provide search engine for more information. It is also need to be designed for all possible internet users searching for the information. Second, the internet site can direct the users to various links for governmental information. It can direct users to use GILS (Governmental information location service) more efficiently, and it can link other university library websites, which supply governmental information. Third, the library site can provide helpful links for governmental information. The site can inclusively provide enough sources for the information. Then it can induce more effective use of the website to get the information by introducing each of the information sources, providing contents, explaining the range of the information, analyzing the sources of information. Lastly, academic library site can develop a feedback mechanism between users and librarians. Since it is more common that most library sites do not contain governmental information separately, library homepage should provide a method to exchange questions or requests on the information search with librarians.논문개요 = vi I. 서론 = 1 A. 연구목적 = 1 B. 연구방법과 범위 = 2 C. 선행연구 = 4 II. 정부정보의 특성 = 10 A. 정부정보의 개념과 유형 = 10 B. 전자환경에서의 정부정보의 특성 = 14 III. 정부정보 제공 현황 분석 = 19 A. 이용자 요구분석 = 19 B. 미국의 대학도서관 사례분석 = 32 C. 국내 대학도서관 사례분석 = 52 IV. 정부정보의 서비스 제공 방안 = 64 A. 정부정보 내용측면 = 64 B. 정부정보 디자인 측면 = 69 C. 정부정보 접근 측면 = 72 V. 결론 = 79 참고문헌 = 83 &amp;lt;부록 1&amp;gt; = 86 &amp;lt;부록 2&amp;gt; = 93 영문초록 = 9

Education curriculum development and application using robot to improve computational thinking for non-professional

소프트웨어 중심사회에서 중요한 소프트웨어 인재 양성을 위해 과학기술정보통신부는 2019년까지 소프트웨어 중심대학 총 35개를 선정하여 산업 현장의 요구를 반영 및 국가·기업·학생들의 경쟁력을 높이고 소프트웨어 교육 가치 확산을 선도하는 대학으로 소프트웨어 교육을 혁신하고자 하였다. 국내 대학에서 실행하고 있는 소프트웨어 교육은 컴퓨터 전공자들을 위한 프로그래밍 중심의 기초 코스가 있고, 컴퓨터 비전공자를 위한 교양교육 측면의 프로그래밍 코스가 있다. 이런 프로그래밍 코스가 확대되고 있지만, 컴퓨터 비전공자들은 프로그래밍 기초 개념과 문법에 대한 이해의 어려움으로 소프트웨어 과목을 어려운 과목으로 인식하여, 소프트웨어 과목 수강 자체를 피하고 싶은 과목으로 생각하는 경우가 대다수이다. 이러한 어려운 과목에 대한 인식을 극복하기 위하여 소프트웨어 교육에 대한 다양한 교수·학습 방법이 연구되고 있는데, 그 중 초보 학습자들에게는 Scratch, Entry, Alice 교육용 프로그래밍 언어로 소프트웨어 교육을 하는 것이 간결하고 쉬운 문법으로 구성되어 보다 쉽게 프로그래밍을 할 수 있는점에서 긍정적으로 평가되고 있다. 또한, 교육용 프로그래밍 언어로 학습하는 방법 외에도 최근 로봇을 활용한 피지컬 컴퓨팅 시스템의 개념이 주목을 받고 있다. 이에 본 연구에서는 교육용 프로그래밍 언어 교육과정과 로봇을 활용한 피지컬 컴퓨팅 교육과정을 개발하고 프로그래밍 경험이 없는 컴퓨터 비전공자들에게 적용한 후 컴퓨팅 사고력 검사와 수업만족도 설문을 실시하여 컴퓨팅 사고력 증진에 어떤 효과가 있는지 알아보았다. 그 결과 아래와 같은 결론을 내릴 수 있었다. 첫째, 로봇 활용 교육과정은 컴퓨팅 사고력 증진에 긍정적인 효과가 있다고 볼 수 있었다. 특히, 컴퓨팅 사고력 영역 중 설계능력과 실현능력에서 효과성이 크다고 볼 수 있었다. 둘째, 로봇 활용 교육과정은 교육용 프로그래밍 활용 교육과정보다 컴퓨팅 사고력 증진에 더 영향을 미친다. 셋째, 로봇 활용 교육과정은 교육용 프로그래밍 활용 교육과정보다 수업만족도에 더 기여하는 것으로 나타났다.;In order to cultivate important software talents in the software-oriented society, the Ministry of Science, Technology and Information (MIC) plan to select 35 software-oriented universities by 2019 to reflect the needs of industrial sites and increase the competitiveness of countries, companies and students. Thereby they also want to innovate software education as a leading university in spreading software education value. Software training at domestic universities provides a basic curriculum for computer majors and a liberal arts education for computer non-professionals. Although these programming courses are expanding, beginners in compute science have difficulty to understand programming fundamentals and grammar. Therefore, it is recognized that programming is difficult subjects, and they are regarded as subjects in which software courses should be avoided. In order to overcome the recognition of these difficult subjects, various teaching and learning methods for software education are being studied. And it is evaluated positively in terms of easy programming for beginner when they use a Scratch, Entry, Alice that is program language for education because it is composed of simple and easy program grammar. Furthermore, In addition to learning in educational programming languages, the concept of a physical computing system using a robot has recently attracted attention. In this research, It has been examined the effect of improving the computational thinking ability through test and class evaluation survey. Program language class for education and physical computing class using robot were used to check the computer non-professional who has no experience in computer science. Examined result are listed as below. First, the robot-based curriculum has a positive effect on the improvement of computational thinking ability. Especially, it was effective in design ability and realization ability in the area of computational thinking skills. Second, robotic education curriculum teaches educational programming skills more effectively. Third, it was found that robot - based curriculum contributes more to class satisfaction than curriculum using educational programming.Ⅰ. 서론 1 A. 연구의 배경과 필요성 1 B. 연구 문제 3 C. 용어의 정의 4 D. 연구의 제한점 5 Ⅱ. 이론적 배경 6 A. 컴퓨팅 사고력의 정의 및 구성요소 6 B. 교육용 프로그래밍 언어 : 스크래치, 엔트리 8 C. 피지컬 컴퓨팅 : 완성형, 조립형, 개방형 로봇 17 Ⅲ. 로봇 활용 교육과정 개발 21 A. 교육도구 선정 : 프로그래밍 언어(엔트리), 로봇(햄스터) 21 B. 설계 방향 : 시연중심모델(DMM 모델) 28 C. 교육과정 개발 : 교육용 프로그래밍 언어 활용 vs 로봇 활용 31 Ⅳ. 연구 방법 42 A. 연구 대상 : 실험집단 vs 비교집단 42 B. 소프트웨어 교육 프로그램 실험 설계 42 C. 소프트웨어 교육 프로그램 실험 절차 43 D. 컴퓨팅 사고력 및 수업만족도 측정 도구 46 E. R프로그래밍 활용 자료처리 도구 51 Ⅴ. 연구결과 52 A. 연구 대상자의 일반적 특성 52 B. 실험집단과 비교집단의 동질성 검사 53 C. 컴퓨팅 사고력 검사 결과 분석 56 D. 수업만족도 설문 결과 분석 64 Ⅵ. 결론 및 제언 67 A. 요약 및 결론 67 B. 제언 69 참고문헌 70 부록1. 수업만족도 설문 74 ABSTRACT 7

Subcutaneous fat area at the upper thigh level is a useful prognostic marker in the elderly with femur fracture

Background The aim of this study was to evaluate prognostic value of body tissue composition at the upper thigh level for 1 year mortality in elderly patients with proximal femur fracture. Methods This retrospective cohort study included consecutive elderly (aged &gt;= 65) patients diagnosed with proximal femur fracture based on the findings of pelvic bone computed tomography (CT) performed at the emergency department of a tertiary care hospital and treated with surgery between 2010 and 2017. The cross-sectional area of subcutaneous fat and skeletal muscle at the upper thigh level was measured using CT. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 1 year mortality were estimated using a Cox proportional hazards model. Survival based on the SFA quartiles was assessed using nonparametric Kaplan-Meier survival analysis and compared used log-rank tests. Results Among 876 elderly patients included in this study, the median age was 79.0 years, and 646 (73.7%) patients were female. A total of 93 (10.6%) died within 1 year after admission to the emergency department. Survivors had a significantly higher median subcutaneous fat area (SFA) than non-survivors (170.2 vs. 133.0 cm(2), P &lt; 0.001), but no significant difference was observed between the skeletal muscle area (median, 156.7 vs. 160.3 cm(2), P = 0.504) and muscle density (median, 19.0 vs. 19.1 HU, P = 0.861) of both groups. After adjustment of other clinical characteristics and body compositions, the multivariate Cox proportional hazard analysis showed that SFA (adjusted HR, 0.987; 95% CI, 0.982-0.992; P &lt; 0.001) was independently associated with 1 year mortality. With 384 deaths during 51 322 person-months of follow-up, the median estimated survival duration of all the patients was 92.8 months (95% CI, 80.8-104.7 months). The patients with SFA in the third (165.6-195.0 cm(2)) and fourth (&gt;195.0 cm(2)) quartiles showed significantly longer survival duration than those with SFA in the first (&lt;131.4 cm(2); median survival time, 51.3 months) and second (131.4-165.5 cm(2); median survival time, 88.7 months) quartiles (P &lt; 0.001 by log-rank test). Conclusions The SFAs measured at the upper thigh level and 1 year mortality are positively associated in elderly patients with proximal femur fracture. SFA may be an independent prognostic biomarker for 1 year mortality of femur fracture

Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis

Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p &lt; 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan-Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p &lt; 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation

Incidence of Immune-Mediated Pseudoprogression of Lymphoma Treated with Immune Checkpoint Inhibitors: Systematic Review and Meta-Analysis

We evaluated the incidence of pseudoprogression and indeterminate response (IR) in patients with lymphoma treated with immune checkpoint inhibitors (ICIs). A systematic search of PubMed and EMBASE was performed up to 6 February 2021, using the keywords "lymphoma," "immunotherapy," and "pseudoprogression." Random-effects models were used to calculate both pooled incidence of pseudoprogression patients with lymphoma and an IR according to LYRIC criteria, while the Higgins inconsistency index (I2) test and Cochran's Q test were used for heterogeneity. Eight original articles were included, in which the number of patients ranged from 7 to 243. Among the lymphoma patients with ICIs, the pooled incidence of pseudoprogression was 10% (95% confidence interval [CI]: 0.06-0.17). There was no publication bias in Begg's test (p = 0.14). Three articles were analyzed to determine the pooled incidence of pseudoprogression in patients with IR according to LYRIC criteria in a subgroup analysis, which was shown to be 19% (95% CI: 0.08-0.40). A significant proportion (10%) of patients with lymphoma treated with ICIs showed pseudoprogression, and 19% of patients with an IR response showed pseudoprogression and a delayed response. Immune-related response criteria such as LYRIC may be used for patients with lymphoma treated with ICIs

Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia

Myosteatosis, which is excessive fat infiltration in the skeletal muscle, is now considered a distinct disease from sarcopenia. Advances in imaging technique have made muscle parameters an evaluable biomarker, and many studies have proved association between myosteatosis and aging or disease process. However, the diagnosis and clinical impact of myosteatosis have not been well established. Thus, we aim to provide a systematic summary with a qualitive review of 73 eligible studies regarding these issues. First, the most widely used modality to diagnose myosteatosis is abdominal computed tomography, based on evaluation of the muscle radiodensity of the total abdominal muscle area predominantly at the L3 vertebral level. However, there was significant het-erogeneity in the diagnostic methods and cutoff values used to diagnose myosteatosis (32 different cutoff values among 73 studies). Second, the clinical impact of myosteatosis on prognosis was very straightforward, and most studies have shown a negative impact of myosteatosis on overall survival and complications related to underlying diseases. However, the mechanism of the myosteatosis on mortality has not been explored well, and metabolic dysfunction (i.e. insulin resistance, systemic inflammation) would be a possible explanation. Providing systemic review of current issues can elucidate future directions for developing standardized diagnosis and management of myosteatosis

Combined radiomics-clinical model to predict malignancy of vertebral compression fractures on CT

Objectives To develop and validate a combined radiomics-clinical model to predict malignancy of vertebral compression fractures on CT. Methods One hundred sixty-five patients with vertebral compression fractures were allocated to training (n = 110 [62 acute benign and 48 malignant fractures]) and validation (n = 55 [30 acute benign and 25 malignant fractures]) cohorts. Radiomics features (n = 144) were extracted from non-contrast-enhanced CT images. Radiomics score was constructed by applying least absolute shrinkage and selection operator regression to reproducible features. A combined radiomics-clinical model was constructed by integrating significant clinical parameters with radiomics score using multivariate logistic regression analysis. Model performance was quantified in terms of discrimination and calibration. The model was internally validated on the independent data set. Results The combined radiomics-clinical model, composed of two significant clinical predictors (age and history of malignancy) and the radiomics score, showed good calibration (Hosmer-Lemeshow test, p &gt; 0.05) and discrimination in both training (AUC, 0.970) and validation (AUC, 0.948) cohorts. Discrimination performance of the combined model was higher than that of either the radiomics score (AUC, 0.941 in training cohort and 0.852 in validation cohort) or the clinical predictor model (AUC, 0.924 in training cohort and 0.849 in validation cohort). The model stratified patients into groups with low and high risk of malignant fracture with an accuracy of 98.2% in the training cohort and 90.9% in the validation cohort. Conclusions The combined radiomics-clinical model integrating clinical parameters with radiomics score could predict malignancy in vertebral compression fractures on CT with high discriminatory ability

CDISC-compliant clinical trial imaging management system with automatic verification and data Transformation: Focusing on tumor response assessment data in clinical trials

Objective: Major issues in imaging data management of tumor response assessment in clinical trials include high human errors in data input and unstandardized data structures, warranting a new breakthrough IT solution. Thus, we aim to develop a Clinical Data Interchange Standards Consortium (CDISC)-compliant clinical trial imaging management system (CTIMS) with automatic verification and transformation modules for implementing the CDISC Study Data Tabulation Model (SDTM) in the tumor response assessment dataset of clinical trials. Materials and methods: In accordance with various CDISC standards guides and Response Evaluation Criteria in Solid Tumors (RECIST) guidelines, the overall system architecture of CDISC-compliant CTIMS was designed. Modules for standard-compliant electronic case report form (eCRF) to verify data conformance and transform into SDTM data format were developed by experts in diverse fields such as medical informatics, medical, and clinical trial. External validation of the CDISC-compliant CTIMS was performed by comparing it with our previous CTIMS based on real-world data and CDISC validation rules by Pinnacle 21 Community Software. Results: The architecture of CDISC-compliant CTIMS included the standard-compliant eCRF module of RECIST, the automatic verification module of the input data, and the SDTM transformation module from the eCRF input data to the SDTM datasets based on CDISC Define-XML. This new system was incorporated into our previous CTIMS. External validation demonstrated that all 176 human input errors occurred in the previous CTIMS filtered by a new system yielding zero error and CDISC-compliant dataset. The verified eCRF input data were automatically transformed into the SDTM dataset, which satisfied the CDISC validation rules by Pinnacle 21 Community Software. Conclusions: To assure data consistency and high quality of the tumor response assessment data, our new CTIMS can minimize human input error by using standard-compliant eCRF with an automatic verification module and automatically transform the datasets into CDISC SDTM format