• Journal of Preventive Medicine and Public Health
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• 제39권1호
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• pp.13-20
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• 2006

Objectives: To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. Methods: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. Results: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test ($x^2=6.92$, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971 patients) and 4 high-volume hospitals (1,087 patients) were identified. Significant differences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. Conclusions: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.

• The Korean Journal of Pain
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• 제32권1호
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• pp.51-52
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• 2019

• Journal of Chest Surgery
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• 제32권10호
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• pp.891-896
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• 1999

Increasing interest in the use of arterial conduites is based on the better patency of the internal thoracic artery(ITA) than the saphenous vein graft and the hope that other arterial conuits will perform similarly over the long term. Material and Method: Between May 1997 and July 1998, 43 patients underwent coronary artery bypass grafting with ITA and the radial artery(RA). There were 28 men and 15 women with a mean age of 61.5 years(range, 35 to 78). In 43 patents, 30 bilateral ITA(including 7 diabetes mellitus, 5 more older 70 years), 8 bilateral ITA only, 2 left ITA and both RA, 11 left ITA and left RA and 22 both ITA and left RA were used. Result: There was 1 hospital mortality. Of the 42 patients alive, 39 patients are asymptomatic. Postoperative complications were postoperative bleeding in 1 patients, and low cardiac output syndrome in 3. Follow-up angiography was performed in 5 patients after the operation(mean 3 months), and all ITA & RA grafts showed excellent results. Conclusion: We conclude that complete arterial revascularization with internal thoracic artery and radial artery is technically feasiale with low mortality and morbidity, and but long term follow-up is needed.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.228-233
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• 2008

Objective : The standard treatment strategy of intracranial aneurysms includes either endovascular coiling or microsurgical clipping. In certain situations such as in giant or dissecting aneurysms, bypass surgery followed by proximal occlusion or trapping of parent artery is required. Methods : The authors assessed the result of extracranial-intracranial (EC-IC) bypass surgery in the treatment of complex intracranial aneurysms in one institute between 2003 and 2007 retrospectively to propose its role as treatment modality. The outcomes of 15 patients with complex aneurysms treated during the last 5 years were reviewed. Six male and 9 female patients, aged 14 to 76 years, presented with symptoms related to hemorrhage in 6 cases, transient ischemic attack (TIA) in 2 un ruptured cases, and permanent infarction in one, and compressive symptoms in 3 cases. Aneurysms were mainly in the internal carotid artery (ICA) in 11 cases, middle cerebral artery (MCA) in 2, posterior cerebral artery (PCA) in one and posterior inferior cerebellar artery (PICA) in one case. Results : The types of aneurysms were 8 cases of large to giant size aneurysms, 5 cases of ICA blood blister-like aneurysms, one dissecting aneurysm, and one pseudoaneurysm related to trauma. High-flow bypass surgery was done in 6 cases with radial artery graft (RAG) in five and saphenous vein graft (SVG) in one. Low-flow bypass was done in nine cases using superficial temporal artery (STA) in eight and occipital artery (OA) in one case. Parent artery occlusion was performed with clipping in 9 patients, with coiling in 4, and with balloon plus coil in 1. Direct aneurysm clip was done in one case. The follow up period ranged from 2 to 48 months (mean 15.0 months). There was no mortality case. The long-term clinical outcome measured by Glasgow outcome scale (GOS) showed good or excellent outcome in 13/15. The overall surgery related morbidity was 20% (3/15) including 2 emergency bypass surgeries due to unexpected parent artery occlusion during direct clipping procedure. The short-term postoperative bypass graft patency rates were 100% but the long-term bypass patency rates were 86.7% (13/15). Nonetheless, there was no bypass surgery related morbidity due to occlusion of the graft. Conclusion : Revascularization technique is a pivotal armament in managing complex aneurysms and scrupulous prior planning is essential to successful outcomes.

• ETRI Journal
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• 제32권2호
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• pp.327-329
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• 2010

A fully integrated small form-factor HBT power amplifier (PA) was developed for UMTS Tx applications. For practical use, the PA was implemented with a well configured bottom dimension, and a CMOS control IC was added to enable/disable the HBT PA. By using helix-on-pad integrated passive device output matching, a chip-stacking technique in the assembly of the CMOS IC, and embedding of the bulky inductive lines in a multilayer substrate, the module size was greatly reduced to 2 mm ${\times}$ 2.2 mm. A stage-bypass technique was used to enhance the efficiency of the PA. The PA showed a low idle current of about 20 mA and a PAE of about15% at an output power of 16 dBm, while showing good linearity over the entire operating power range.

• 한국분무공학회지
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• 제24권2호
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• pp.66-72
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• 2019

Diesel vehicles suffer from poor starting and running problems at cold temperatures. Diesel vehicles have the characteristic that CO and PM are reduced or similarly discharged when going from low temperature to high temperature. In this study, a bypass type piezo injector for electronic control based common rail injection system was used. Numerical analysis using injector drive analysis model was performed to analyze injector drive and internal fuel flow characteristics according to fuel temperature change. The results show that the rate of density change due to the fuel temperature is proportional, and that the effect of the kinematic viscosity is relatively large between $-20^{\circ}C$ and $0^{\circ}C$. Comparing the results of temperature condition at $0^{\circ}C$ and $20^{\circ}C$, it is considered that the viscosity is more correlated with the needle displacement than the pressure chamber of the delivery chamber.

• 대한기계학회논문집B
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• 제27권10호
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• pp.1427-1434
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• 2003

Turbo- or Super-charging has been used to boost engine power for Gasoline- and Diesel Engine since beginning of 20th century. So far turbo-charger has enjoyed a high reputation in the charging field for its technical advantages such as no demand of operation power from engine and an excellent charging effect in a static operation at mid- and high engine speed. A mechanically driven super-charger, however, is now popular due to the high engine power at quick change of the driving mode - high engine torque even at low engine speed. Since super-charger needs operation power from engine, it is difficult to improve its relatively higher fuel consumption than that of turbo-charger. This negative point is still an obstacle to the wide use of supercharger. Super-charger using screw-type compressor will fulfill the purpose to reduce fuel consumption by minimizing operation power owing to no charge at idling or part load driving condition. This study aims to develop power control concept to achieve the minimization of operation power. A screw type super-charger was modified in design partially and installed with an internal bypass valve and a bypass tube to control charging pressure at part load. The various control concepts show a possibility to reduce operation power of super-charger.

• 한국자동차공학회논문집
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• 제11권6호
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• pp.21-29
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• 2003

Boosting of engine power by using Turbo- or Super-charger is a solution to comply with $CO_2$-regulation in Europe. Turbo-charger is now playing a major role in the field of charging system thank to its technical advantages such as no demand of operation power from engine. A mechanically driven Super-charger, however, is now popular due to quick speed response to change of the driving mode-high engine torque even at low engine speed. Since Super-charger needs operation power from engine, it is difficult to improve its relatively higher fuel consumption than that of Turbo-charger. This negative point is still an obstacle to the wide use of Super-charger. This study aims to develop power control concept to achieve the minimization of operation power when it is not necessary to charge at idling or part load driving condition. A screw type Super-charger was modified in design partially and adapted an internal bypass valve and a bypass tube to control charging pressure at part load. The various control concepts show a possibility to reduce operation power of Super-charger and result in improvement of fuel consumption.

• 대한의생명과학회지
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• 제10권3호
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• pp.237-243
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• 2004

In recent, many cardiac centers have preferred off-pump coronary artery bypass grafting (CABG) to on-pump CABG to prevent the adverse effects of cardiopulmonary bypass. The present study was performed to prove beneficial effects of off-pump CABG. Sixty adult patients scheduled for elective CABG were randomly assigned to On-pump group (n=30) or Off-pump group (n=30). Arterial blood samples were drawn before and after the operation (Pre-OP and Post-OP, respectively) for measuring CBC, prothrombin time, activated thromboplastine time, blood gas analysis, creatine kinase-MB (CK-MB) level, and lactate dehydrogenase (LDH) level. Perioperative parameters including heparin and protamine usages, complications, blood components usages, blood loss, ventilation and ICU-staying time, and hospitalization were also evaluated. Platelet count at Post-OP was high in Off-pump group whereas CK-MB and LDH levels were low compared with On-pump group. Off-pump group had significantly lower heparin and protamine usages, lower total leukocyte count, higher hematocrit and hemoglobin levels, less blood loss, lower usages of blood components, shorter ventilation and ICU-staying time, and lower incidence of pleural effusion than On-pump group. Other variables did not significantly differ between two groups. These results showed that Off-pump CABG was a satisfactory technique with less inflammatory reaction, less cardiac damage, less postoperative complications, and less cost.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2001년도 춘계학술대회논문집B
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• pp.253-258
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• 2001

This paper introduces a simple nonlinear adaptive control method for pipeline inspection gauge (PIG) flow in natural gas pipeline. The dynamic behavior of the PIG depends on the different pressure across its body and the bypass flow through it. The system dynamics includes: dynamics of driving gas flow behind the PIG, dynamics of expelled gas in front of the PIG, and dynamics of the PIG. The method of characteristics (MOC) and Runger-Kuta method are used to solve the dynamics of flow. The PIG velocity is controlled through the amount of bypass flow across its body. A simple nonlinear adaptive controller based on the backstepping method is introduced. To derive the controller, three system parameters should be measured: the PIG position, its velocity and the velocity of bypass flow across the PIG body. The simulation has been done with a pipeline segment in the KOGAS low pressure system, Ueijungboo-Sangye line to verify the effectiveness of the proposed controller. Three cases of interest are considered: the PIG starts to move at its launcher, the PIG arrives at its receiver and the PIG restarts after stopping in the pipeline by obstruction. The simulation results show that the proposed nonlinear adaptive controller attained good performance and can be used for controlling the PIG velocity.