• Journal of Chest Surgery
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• 제55권1호
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• pp.10-19
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• 2022

Background: According to the eighth TNM (tumor-node-metastasis) staging system, the presence of separate tumor nodules in the same lobe is designated as a T3 descriptor. However, it remains unclear whether adjuvant chemotherapy confers survival advantages in this setting. Methods: We retrospectively identified 142 pathologic T3N0M0 patients with additional pulmonary nodules in the same lobe from a single-institutional database from 2004 to 2019. The main outcomes were overall survival and recurrence-free survival. Multivariable Cox regression was used to identify the benefit of adjuvant chemotherapy while adjusting for other variables. Results: Sixty-one patients received adjuvant chemotherapy (adjuvant group) and 81 patients did not receive adjuvant therapy after surgery (surgery-only group). There were no demonstrable differences between the 2 groups regarding hospital mortality and postoperative complications, indicating that treatment selection had not significantly occurred. However, the use of adjuvant chemotherapy was associated with improved 5-year overall survival (70% vs. 59%, p=0.006) and disease-free survival (60% vs. 46%, p=0.040). A multivariable Cox model demonstrated that adjuvant chemotherapy was associated with a survival advantage (adjusted hazard ratio, 0.54; p<0.001). In exploratory analyses of subgroups, the effect of adjuvant chemotherapy seemed to be insufficient in those with small main tumors (<4 cm). Conclusion: Adjuvant chemotherapy was associated with better survival in T3 cancers with an additional tumor nodule in the same lobe. However, the role of adjuvant chemotherapy in patient subgroups with small tumors or those without risk factors should be determined via large studies.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.346-351
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• 2022

Background Postmastectomy breast reconstruction (PMR) increases patient satisfaction, quality of life, and psychosocial well-being. There is scarce data regarding the safety of PMR in chronic anticoagulated patients. Perioperative complications can reduce patient satisfaction; therefore, it is important to elucidate the safety of PMR in these patients. Methods A retrospective case-control study of patients who underwent PMR with implants and were on chronic anticoagulation was performed at our institution. Inclusion criteria were women ≥ 18 years old. Exclusion criteria included autologous reconstructions, lumpectomy, and oncoplastic procedures. Two controls for every one patient on anticoagulation were matched by age, body mass index, radiotherapy, smoking history, type of reconstruction, time of reconstruction, and laterality. Results From 2009 to 2020, 37 breasts (20 patients) underwent PMR with implant-based reconstruction and were on chronic anticoagulation. A total of 74 breasts (40 patients) who had similar demographic characteristics to the cases were defined as the control group. Mean age for the case group was 53.6 years (standard deviation [SD] = 16.1), mean body mass index was 28.6 kg/m² (SD = 5.1), and 2.7% of breasts had radiotherapy before reconstruction and 5.4% after reconstruction. Nine patients were on long-term warfarin, six on apixaban, three on rivaroxaban, one on low-molecular-weight heparin, and one on dabigatran. The indications for anticoagulation were prior thromboembolic events in 50%. Anticoagulated patients had a higher risk of capsular contracture (10.8% vs. 0%, p = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, p = 0.63), thromboembolism (5% vs. 0%, p = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], p = 0.85). Conclusion Postmastectomy implant-based breast reconstruction can be safely performed in patients on chronic anticoagulation with appropriate perioperative management of anticoagulation. This information can be useful for preoperative counseling on these patients.

• 한국방사선학회논문지
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• 제16권2호
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• pp.123-129
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• 2022

최근 OECD 가입국 중에 MRI 보급률이 평균보다 높게 보급되고 있고, MRI 검사의 횟수도 증가하고 있다. MRI 검사는 다른 의료장비에 비해 검사시간이 길며, 환자의 움직임이 최소화되어야 한다. 그러므로 환자의 불편이 항상 뒤따른다. 이러한 불편한 환경에서 검사 시 정확한 검사가 어려우며 진단적 가치의 영상획득에는 어려움이 따른다. 기존 MRI 검사 시 MRI의 위험성과 협조를 구하기 위해 글로 되어있는 안내문을 제공 하였으나, 전문용어와 이해하기 어려운 문장들로 구성이 되어있어 이해도가 낮아졌다. 본 연구는 이러한 문제점을 보완하고 MRI 검사의 이해도를 높여 진단적 가치가 있는 영상획득에 도움이 되고자 하였다. 그리고 환자의 이해도와 만족도를 평가하여 리플릿 교육의 우수성을 평가하고자 한다. 본 연구의 결과에서 나타났듯이 리플릿 교육 전보다 교육 후의 이해도와 만족도의 점수는 각각 4.44±0.55 점, 4.85±0.37 점으로 높았으며, 학력에 따라 이해도의 차이는 유의함을 알 수 있었다. 그러나 MRI 검사 횟수는 차이가 없었다. 향후 MRI 검사에서 다양하고 이해하기 쉬운 리플릿 교육이 널리 보급되어 환자의 적극적인 검사 협조로 보다 질 좋은 영상을 획득할 수 있기를 기대한다.

• Journal of Chest Surgery
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• 제55권5호
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• pp.388-396
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• 2022

Background: In this study, we present recent trends in heart valve surgery in Korea through analyses of data from the Korea Heart Valve Surgery Registry (KHVSR). Methods: We enrolled 8,981 patients who were registered in the KHVSR from 2017 to 2020. Yearly trends in patients' baseline characteristics, surgical profiles, and early mortality rates were explored. The observed/expected mortality ratio (O/E ratio), calculated from the actual mortality in the KHVSR and the predicted mortality estimated using the EuroSCORE II, was also analyzed. Results: The proportion of aortic valve surgery significantly increased from 56.8% in 2017 to 60.3% in 2020. The proportion of all combined procedures and minimally invasive surgery significantly increased over the 4-year study period. The operative mortality rate was 2.9% in the entire cohort, while mitral valve repair showed the lowest mortality risk (0.9%). The mortality rates of isolated aortic valve replacement (AVR) significantly decreased from 2.1% in 2017 to 0.8% in 2020 (p=0.016). Overall, the O/E ratio was 0.784 (95% confidence interval [CI], 0.677-0.902) demonstrating significantly lower actual mortality risks than expected based on the EuroSCORE II. In particular, the O/E ratios were as low as 0.364 (95% CI, 0.208-0.591) for isolated AVR. Conclusion: The recent data from the KHVSR showed increasing trends for complex procedures and minimally invasive surgery in heart valve surgery in Korea, and demonstrated remarkably low risks of operative mortality.

• 한국임상약학회지
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• 제32권3호
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• pp.215-225
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• 2022

Background: Patients with hematologic cancers have a risk of drug-related problems (DRPs) from medications associated with chemotherapy and supportive care. Although the role of oncology pharmacists has been widely documented in the literature, few studies have reported its impact on cost reduction. This study aimed to describe the activities of oncology pharmacists with respect to hematologic diseases and evaluate the associated cost avoidance. Methods: From January to July 2021, patients admitted to the department of hemato-oncology at Seoul National University, Bundang Hospital were studied. The activities of oncology pharmacists were reported by DRP type following the Pharmaceutical Care Network version 9.1 guidelines, and the acceptance rate was calculated. The avoided cost was estimated based on the cost of the pharmacy intervention, pharmacist manpower, and prescriptions associated with the intervention. Results: Pharmacists intervened in 584 prescriptions from 208 patients during the study period. The most prevalent DRP was "adverse drug event (possibly) occurring" (32.4%), followed by "effect of drug treatment not optimal" (28.6%). "Drug selection" (42.5%) and "dose selection" (30.3%) were the most common causes of DRPs. The acceptance rate of the interventions was 97.1%. The total avoidance cost was KRW 149,468,321; the net profit of the avoidance cost, excluding labor costs, was KRW 121,051,690; and the estimated cost saving was KRW 37,223,748. Conclusion: Oncology pharmacists identified and resolved various types of DRPs from prescriptions for patients with hematologic disease, by reviewing the prescriptions. Their clinical service contributed to enhanced patient safety and the avoidance of associated costs.

• 한국임상약학회지
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• 제32권2호
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• pp.116-124
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• 2022

Background: High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. Methods: We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS). We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. Results: From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. Conclusion: We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.

• 한국환경보건학회지
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• 제48권6호
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• pp.315-323
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• 2022

Background: Socioeconomical disadvantaged communities are more vulnerable to environmental chemical exposure and associated health effects. However, there is limited information on chemical exposure among vulnerable populations in Korea. Objectives: This study investigated chemical exposure among underprivileged populations. We measured urinary metabolites of phthalates in urban disadvantaged communities and investigated their correlations with residential environment factors and relative socioeconomic vulnerability. Methods: Urine samples were collected from 64 residents in a disadvantaged community in Seoul. A total of eight phthalate metabolites were analyzed by liquid chromatography-mass spectroscopy. Analytical method used by the Korean National Environmental Health Survey (KoNEHS) was employed. Covariate variance analysis and general linear regression adjusted with age, sex and smoking were performed. Results: Several phthalate metabolites, namely monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-n-butyl phthalate (MnBP) had higher levels than those reported in the adults of 4th KoNEHS. Notably, the MnBP level was higher in the lower socioeconomic group (geometric mean [GM]=47.3 ㎍/g creatinine) compared to non-recipients (GM=31.9 ㎍/g creatinine) and the national reference level (GM=22.0, 28.2 and 32.2 ㎍/g creatinine for adults, 60's and 70's, respectively.). When age, sex and smoking were adjusted, MEP and MnBP were significantly increased the lower socioeconomic group than non-recipients (p=0.014, p=0.023). The lower socioeconomic group's age of flooring were higher than non-recipients, not statistically significant. Conclusions: These results suggest that a relatively low income and aged flooring could be considered as risk factors for increased levels of phthalate metabolites in socioeconomic vulnerable populations.

• Journal of Chest Surgery
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• 제56권3호
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• pp.155-161
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• 2023

Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m², p=0.025). Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

• 대한토목학회논문집
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• 제43권5호
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• pp.587-599
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• 2023

기후변화로 인해 전 세계 주요 도시에서 홍수의 빈도와 위험성이 증가함에 따라, 도시 침수에 대비한 선제적 대응을 위해 넓은 공간 영역에서 고해상도 2차원 침수 정보를 신속하고 정확하게 해석할 수 있는 모의 기술의 중요성이 대두되고 있다. 기존의 천수 방정식(shallow water equations)에 기반한 물리적 해석 방법은 고해상도 침수 예측을 위해 많은 컴퓨터 자원과 계산 시간이 소요되는 한계가 있다. 본 연구는 전환 규칙과 가중치 기반 시스템을 사용하여 침수의 시공간 변화를 모의하는 셀룰러 오토마타(cellular automata) 기반 2차원 침수 해석 모형 Weighted Cellular Automata 2D (WCA2D)의 이론적 배경을 고찰하고, 부산 온천천 유역의 침수 사상 모의를 통해 재현하여 국내 도시 유역에 대한 적용성을 검토하였다. 또한, Open Computing Language (OpenCL)와 Open Multi-Processing (OpenMP)과 같은 병렬계산(parallel computing)기술을 적용한 버전을 순차계산(sequential computing)결과와 비교하여 연산성능을 평가 하였다. 연구결과, WCA2D 모형에 의한 최대 침수심 분포는 과거침수 피해지도와 유사하게 모의되어, 복잡한 지형특성을 가지는 도시유역 침수의 시공간적 변화를 해석하기에 적절함을 확인하였다. 또한,병렬 계산 적용시 순차 계산 버전에 비해 OpenCL과 OpenMP는 약8배~14배, 5배~6배 연산 효율이 향상되어 효율적인 도시 침수 모의가 가능하였다.

• 한국환경보건학회지
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• 제48권6호
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• pp.298-305
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• 2022

Background: The concentration of air pollutants as measured by the Air Quality Monitoring System (AQMS) is not an accurate population exposure level since actual human activities and temporal and spatial variability need to be considered. Therefore, to increase the accuracy of exposure assessment, the population should be considered. However, it is difficult to obtain population data due to limitations such as personal information. Objectives: The existing population defined in this study is the number of people in each region's grid. The purpose is to provide a methodology for evaluating exposure to PM_2.5 through existing population data provided by the National Geographic Information Institute. Methods: The selected study period was from October 26 to October 28, 2021. Using PM_2.5 concentration data measured at the Sensor-based Air Monitoring Station (SAMS) installed in Guro-gu and Wonju-si, the concentration for each grid was estimated by applying inverse distance weights through QGIS version 3.22. Considering the existing population, population-weighted average concentration (PWAC) was calculated and the exposure level of the population was compared by region. Results: The outdoor PM_2.5 concentration as measured through the SAMS was high in Wonju-si on all three days. Wonju-si showed an average 22% higher PWAC than Guro-gu. As a result of comparing the PWAC and outdoor PM_2.5 concentration by region, the PWAC in Guro-gu was 1~2% higher than the observed value, but it was almost the same. Conversely, observations of Wonju-si were 10.1%, 11.3%, and 8.2% higher than PWAC. Conclusions: It is expected that the Geographic Information System (GIS) method and the existing population will be used to evaluate the exposure level of a population with a narrow activity radius in further research. In addition, based on this study, it is judged that research on exposure to environmental pollutants and risk assessment methods should be expanded.