• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• 응용통계연구
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• 제30권3호
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• pp.391-401
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• 2017

본 연구는 노인장기요양보험 수급자격을 결정하는 장기요양 등급인정의 지역별 차이를 관리하기 위해 지역별 인정의 차이 관리지표를 개발하고자 수행되었다. 이를 위해 지역별 인정률은 시군구 지역단위별로 설치된 227개 장기요양운영센터의 등급판정자 대비 인정자 비율인 운영센터별 인정률로 정의하고, 등급판정을 받은 자(등급판정자)의 특성에 따라 장기요양 등급인정 여부가 결정되므로, 운영센터별 인정률은 등급판정자의 특성에 의해 영향을 받는다고 가정하였다. 또한 운영센터 인정률에 영향을 미치는 등급판정자 특성 요인을 고려하여 추정된 운영센터별 인정률은 표준인정률이라 정의하였고, 관찰된 인정률 간의 차이(오차)가 클수록 등급판정자의 특성 외의 요인이 인정률에 영향을 끼쳤다고 가정하여 이 지역의 등급인정에 오류가 있다고 판단하였다. 관리지표 개발을 위해 2015년 1월 1일부터 12월 31일까지 장기요양 등급판정이 완료된 433,115명의 인정조사 자료와 등급판정을 실시한 인정조사자 특성을 활용하였다. 운영센터별 관리지표 생산을 위해 분석대상자가 장기요양 등급을 부여 받은 운영센터를 기준으로 자료를 변환하여 회귀분석을 실시하였다. 연구결과, 등급판정자의 인구사회학적 특성과 장기요양 등급 재신청 비율에 영향을 받는 것으로 나타났다. 이를 통해 운영센터 인정의 차이 관리지표를 산출하였고, 인정의 차이 값이 전체 분포의 중앙95% 구간을 벗어난 운영센터를 등급인정에 오류가 있는 지역으로 확인하였다. 본 연구에서 제안한 지역별 인정의 차이 관리지표를 통해 장기요양 등급판정에 대한 국민적 신뢰도 제고와 형평성 향상에 기여할 것으로 기대한다.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.439-445
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• 2008

Purpose: Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. Methods: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision. Results: The average age was 62.8(46 - 73) years old, average follow up period was 7.7(1 - 17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1 - 5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%). Conclusion: The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

• Journal of Chest Surgery
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• 제33권8호
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• pp.662-668
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• 2000

Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

• 스마트미디어저널
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• 제11권10호
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• pp.30-35
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• 2022

의학 전공분야의 학회의 초록이 출판으로 이어지는 비율은 50% 이하라는 이전의 연구들이 있었지만, 소아치과 분야에서는 이에 대한 연구가 거의 없었다. 이번 연구의 목적은 2001년에서 2011년까지의 개최된 대한소아치과 춘추계 학술대회의 초록들 중 어느 정도가 논문으로 출판되는지에 관한 것이다. 구연과 포스터를 위한 초록들을 모두 조사했다. 이 초록들의 제목을 이용해서 학술연구정보서비스에서 논문들을 검색하였다. 총 24번의 학회에서 706개의 초록 (477개의 구연, 229개의 포스터)가 있었고, 이 중 2011년 45.2%(319)에서 2022년 82.9%(585)가 논문으로 출판되었다. 구연은 52.2%(249)에서 86.6%(413), 포스터는 30.6%(70)에서 75.1%(172)의 출판율을 보였다. 우리는 최근 12년 간의 출판율 변화 결과가 전자 문헌검색과 전자 출판 등 디지털화 된 환경에서 기인한다고 생각한다.

• 시큐리티연구
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• 제41호
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• pp.7-36
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• 2014

본 연구는 2015년부터 감시 단속적 근로자들에게 최저임금 100%가 적용되면서 아파트 관리비 인상의 부담으로 인해 경비체계를 유인화 시스템에서 무인화 시스템으로 바꾸거나 경비원의 인력을 대폭 감소시키려는 아파트가 증가하고 있다. 이러한 현 상황에서 아파트 경비의 유 무인화에 대한 경제성 비교 연구를 실시하였다. 이를 위해 비용 편익분석을 통해 2014년부터 2018년까지 5년간 아파트 유 무인 경비시스템의 경제성 비교를 실시하였다. 분석 결과, 무인경비 시스템의 비용 편익 비율은 최소값의 경우 1.66%와 최대값의 경우 1.30%의 편익이 발생된 것을 알 수 있다. 또한 유인경비 시스템의 비용 편익 비율은 최소값의 경우 1.42%와 최대값의 경우 1.66%의 편익이 발생한 점을 미루어 볼 때 아파트 경비시스템 체계를 유인시스템에서 무인시스템으로 변경할 경우 경제적으로 큰 효용성을 얻기가 힘들 뿐만 아니라 특히 최대값의 경우 오히려 무인경비 시스템 보다 유인경비 시스템의 경제적 효용성이 큰 것으로 나타났다.

• 대한지역사회영양학회지
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• 제17권3호
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• 인지과학
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• 제27권1호
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• pp.101-127
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• 2016

본 연구는 미래계획기억(PM) 수행에서 기억전략과 동시과제 처리적절성의 효과를 탐색하기 위해 수행되었다. 먼저 실험 1에서 목표단어 파지를 위한 기억전략 유형이 부호화 단계에서 조작되었다. 먼저 메타 전략을 통해 목표단어를 기억해야했던 참가자들은 PM 과제 수행에 대한 수행 난이도에 대한 주관적 평정과 자신의 수행 예측 정도를 판단해야 했으며, 인지 전략을 통해 목표단어를 기억해야 했던 참가자들은 목표단어에 대한 문장 산출과 주관적 호감도 평정을 해야 했다. 또한 모든 참가자들은 목표단어와의 처리적절성이 높은 동시과제와 낮은 동시과제 두 종류 모두를 수행하면서 PM 과제를 수행해야 했다. 실험 2는 실험 1의 반복검증을 위해 수행되었으며, 처리적절성에 대한 동시과제의 종류를 제외하고 실험 1과 모든 것이 동일하였다. 실험 결과, 두 실험 모두에서 메타 전략 조건의 참가자들이 인지 전략 조건의 참가자들보다 PM 수행 정확률이 더 높았다. 또한 처리적절성이 높은 과제에서 PM 수행 정확률이 더 높았다. 두 조건들 간에 상호작용도 나타났다. 메타 인지 조건에서는 처리적절성이 높은 동시과제를 수행하는 동안 PM 정확율이 좋았던 반면, 인지 전략 조건에서는 처리적절성에 따라 PM 정확율에 차이가 없었다. 동시과제에서는 조건들 간에 아무런 수행의 손실이나 이득이 나타나지 않았다. 본 연구의 결과를 통해 미래계획기억 수행에서 메타 인지처리과정에 의한 수행의 향상은 인지 자원의 영향에 따라 달라질 수 있다고 볼 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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• pp.5077-5081
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• 2014

To clarify whether gastric cancer patients can benefit from laparoscopy-assisted surgery completed by junior surgeons under supervision of expert surgeons, data of 232 patients with gastric cancer underwent operation performed by inexperienced junior surgeons were reviewed. Of the 232 patients, 137 underwent laparoscopy-assisted resection and in 118 cases this approach was successful. All of these 118 patients were assigned to laparoscopic group in this study, 19 patients who were switched to open resection were excluded. All laparoscopic operations were performed under the supervision of expert laparoscopic surgeons. Some 95 patients receiving open resection were assigned to the open group. All open operations were completed independently by the same surgeons. Short-term outcomes including oncologic outcomes, operative time intra-operative blood loss, time to first flatus, time to first defecation, postoperative hospital stay and perioperative complication were compared between the two groups. The numbers of lymph nodes harvested in the laparoscopic and open groups were $21.1{\pm}9.6$ and $18.2{\pm}9.7$ (p=0.029). There was no significant difference in the length of margins. The mean operative time was $215.9{\pm}32.2$ min in laparoscopic group and $220.1{\pm}34.6min$ in the open group (p=0.866), and the mean blood loss in laparoscopic group was obviously less than that in open group ($200.9{\pm}197.0ml$ vs $291.1{\pm}191.4ml$; p=0.001). Time to first flatus in laparoscopic and open groups was $4.0{\pm}1.0$ days and $4.3{\pm}1.2$ days respectively and the difference was not significant (p=0.135). Similarly no statically significant difference was noted for time to first defecation ($4.7{\pm}1.6$ vs $4.8{\pm}1.6$, p=0.586). Eleven patients in the laparoscopic group and 19 in the open group suffered from peri-operative complications and the difference between the two groups was significant (9.3% vs 20.0%, p=0.026). The conversion rate for laparoscopic surgery was 13.9%. Patients with gastric cancer can benefit from laparoscopy-assisted operations completed by inexperienced junior surgeons under supervision of expert laparoscopic surgeons.

• 한국산학기술학회논문지
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• 제13권6호
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• pp.2833-2845
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• 2012

본 연구에서는 자원화 가능한 폐기물의 양이 분석되었으며, 폐기물 자원화시설을 단독 또는 광역시설로 추진할 경우의 설치비 및 운영비를 산정하고, 매립비용과 비교, 분석함으로서 자원화시설의 타당성을 검토하고자 하였다. 자원화시설로는 고형연료화(RDF) 시설과 자원회수시설(소각)에 대한 검토를 수행하였다. 그리고, 강원도 각 시 군별 생활폐기물의 발생량과 가연성 폐기물의 비율을 고려하여 비용분석을 위한 광역권역을 설정하였다. 분석 결과, 단독시설의 경우에는 RDF 및 자원회수시설(소각) 모두 매립방식에 비교하여 경제적 편익이 없는 것으로 나타났다. 광역 시설의 경우, RDF 방식은 매립방식에 비해 많은 비용을 절감하는 것으로 나타났지만, 자소각 방식은 그렇지 않은 것으로 나타났다. 경제적 편익과는 별개로 화석 연료의 고갈, 지구온난화, 환경적 위해성, 그리고 사회적 갈등 등을 고려할 때 폐기물의 자원화는 중요하게 고려되어야 한다. 특히, 향후 CDM 사업이 활성화될 경우 CERs(온실가스 저감인증)에 의한 추가적인 경제적 부가가치도 기대할 수 있을 것으로 나타났다. RDF 시설에 의한 CERs는 약 2,565억원, 자원회수시설에 의한 CERs는 약 540억원(단독시설) 및 774억원(광역시설)으로 분석되었다.