• Archives of Plastic Surgery
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• 제49권2호
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• pp.166-173
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• 2022

The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26-70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1-25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%, n = 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8-32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.385-392
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• 2023

Purpose: This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. Methods: A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Results: Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. Conclusions: DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

• Korean Journal of Acupuncture
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• 제40권4호
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• pp.194-205
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• 2023

Objectives : This study investigated the current utilization status of thermotherapy devices in Korean medicine (KM) institutions and identified areas for improvement and further development, as perceived by KM doctors (KMDs). Methods : An online survey was conducted, targeting KMDs primarily engaged in clinical patient care. The questionnaire included items about respondents' clinical practices, the extent of thermotherapy device usage, their opinions on these devices, and perceived improvement needs. The collected data underwent quantitative analysis. Results : From the 1,025 respondents, data from 862 respondents who provided complete responses were analyzed. On average, respondents utilized thermotherapy treatments for 80% of their patients. Infrared (IR) phototherapy unit, electrical moxibustion apparatus, and heater-based thermotherapy devices were predominantly owned by respondents, with IR being the most frequently used. The average satisfaction score for current thermotherapy devices was 79. A significant concern raised was the necessity for improved health insurance coverage and efficacy evaluation. Conclusions : This research has confirmed that the extensive use of thermotherapy devices by KMDs in treating primarily musculoskeletal and gastrointestinal ailments - common conditions among patients in KM institutions. The main areas identified for improvement encompass safety, cost-effectiveness, and device efficacy. Future enhancements in thermotherapy devices should address these crucial aspects.

• 대한예방한의학회지
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• 제27권3호
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• pp.1-12
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• 2023

Objectives : The aim of this study is to analyze the news articles related to Korean Medicine(KM) and compare trends in news reports from 2018 to 2022. Method : News articles related to KM were collected through the BigKinds, the news bigdata service of the Korea Press Foundation. News reports from 1 January 2018 to 31 December 2022 were searched. 2,950 news articles out of a total of 12,497 met the inclusion criteria. First, quantitative changes in media coverage were analyzed by year, media outlet, and month. For qualitative analysis, two authors independently coded the content of news articles, discussed them until consensus, and consulted with a third researcher to classify them. In addition, keywords extracted by the BigKind's Topic Rank algorithm were compared and analyzed in each year. Results : The number of news articles on KM decreased by 42% in 2022 compared to 2018. Over a fiveyear period, the Naeil Shinmun reported the most on KM among newspapers, while the Hankyoreh did the least. Among broadcasters, YTN reported the most and SBS did the least. When analyzing the reports by category, the most common was 'treatment', followed by 'prevention' and 'scientification'. As a result of extracting keywords with high weight and frequency, 'immunity' and 'immune system' ranked the first and second in 2018, while 'COVID 19' and 'medical law violation' did in 2022. Conclusion : The decrease in media reports on KM during the COVID-19 epidemic period seems to be due to the limited role of KM in responding to infectious diseases, and efforts to expand the scope of KM can induce increased media reports and social interest.

• 한국항만경제학회지
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• 제31권2호
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• pp.41-53
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• 2015

Paracomon Inc. v. Telus Communication사건('Realice호 사건')에서 Realice호의 닻이 항해과정에서 해저광섬유케이블에 얽히는 사고가 발생하자, 선주사의 대표이사이자 선장은 사용 중인 케이블을 절단해 버렸다. 케이블 소유회사는 선주에게 수리비를 청구하였고, 선주는 케이블 소유회사의 청구액을 책임보험자에게 청구하였다. 그런데 캐나다 대법원은, 선주는 1976년 해사채권에 대한 책임제한에 관한 조약('1976년 책임제한조약')에 따라 케이블 소유회사에 대한 손해배상책임을 일정 한도로 제한할 수 있으나, 케이블을 절단한 선주의 비행은 1993년 캐나다 해상보험법(Canada Marine Insurance Act)상 보험자의 면책사유인 피보험자의 고의적 불법행위(wilful misconduct)에 해당되어 책임보험자에게 보험금을 청구할 수 없다고 판결하였다. 결국 이번 판결로 선주는, 케이블소유회사에 대한 책임제한권은 인정받았으나, 책임보험자에 대한 보험금청구권은 상실하게 되었다. Realice호 사건은 국제조약상 선주에게 인정되는 책임제한과 그에 대한 책임보험의 보상 간의 상호 관계를 최초로 다루고 있다는 점에서 우리에게 시사하는 바가 크다. 따라서 본 논문의 목적은 Realice호 사건에서 대법원의 판결 이유를 분석하고, 해운 보험업계 이해와 지금까지 확립된 해상법에 기초하여 판결의 정당성을 평가하는데 있다. 본 논문은 1976년 책임제한조약의 입법 연혁을 고려할 때 선주가 책임제한권을 갖는다는 대법원의 판결은 타당하지만, 해운 및 보험업계의 이해, 제3자의 직접청구권의 도입취지, 책임제한 배제사유의 입법 과정 등을 고려할 때 책임보험자가 면책된다는 대법원의 판결은 적절하지 않다는 결론을 내린다. 끝으로, 본 논문은 이번 대법원 판결에 기초하여 2014년 세월호 사건에서 선주의 책임제한과 책임보험자의 보상 문제를 검토한다.

• Tuberculosis and Respiratory Diseases
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• 제72권6호
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• pp.493-500
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• 2012

Background: This study investigated the clinical characteristics and risk factors of the severity of pandemic influenza A (H1N1) 2009 infection in pediatric patients in Busan and Gyeongsangnam-do. Methods: Cases of influenza A (H1N1) 2009 in patients under the age of 18 years, confirmed by reverse transcription polymerase chain reaction, at Pusan National University Hospital and Pusan National University Yangsan Hospital from the last week of August 2009 through the last week of February 2010 were retrospectively analyzed. Results: Of the 3,777 confirmed cases of influenza A (H1N1) 2009, 2,200 (58.2%) were male and 1,577 (41.8%) were female. The average age of the patients was $8.4{\pm}4.8$ years. The total cases peaked during 44th to 46th week. Most of the patients were in the 5- to 9-year-old age group. Oseltamivir was administered to 2,959 (78.3%) of the patients. 221 patients (5.9%) were hospitalized, age an average of $6.7{\pm}4.5$ years. The average duration of hospitalization was $7.4{\pm}5.6$ days. One hundred cases (45.2%) had pneumonia. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. Children with asthma were at very high risk of hospitalization, over 20 times the non-asthmatic children (odds ratio [OR], 21.684; confidence interval [CI], 13.295~39.791). Likewise the children with neurologic deficits faced a 16 times higher risk (OR, 15.738; CI, 7.961~31.111). Ten of the patients (4.5%) were admitted to the intensive care unit, and eight (3.6%) required mechanical ventilation. Conclusion: Of the pediatric patients with pandemic influenza A (H1N1) 2009, most of the patients were in the 5- to 9-year-old age group. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. The most common complication was pneumonia. The very high risk of severe morbidity in children with asthma or neurologic disease shows the critical importance of targeted vaccine coverage, special awareness and swift care by both guardians and primary care providers.

• 대한예방한의학회지
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• 제19권3호
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• pp.29-43
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• 2015

Objective : The purpose of this study was to identify characteristics of patients' self-perceived health in traditional Korean medical facilities. Method : This research was conducted based on the survey on patients whom have visited traditional Korean medical facilities in 2011 by the Ministry of Health and Welfares and Korean Institute for Health and Social Affairs. Using a sample of 3,931 (1,180 male and 2,751 female) outpatients' self-perceived health based on the data from usage and consumption of Korean Medicine. 'Healthy', 'Fair', and 'Poor Health' were used to measure patients' self-perceived health status. The data was analyzed by frequency, t-test, cross correlation analysis and multiple logistics regression analysis using the SPSS program package. Results : Sex(P<0.001), age(P<0.001), marital status(P<0.001), education(P<0.001), employment status(P<0.001), occupation(P<0.001), health insurance(P<0.001) and income level(P<0.0001) showed statistical significance. Main Treatment Facilities(P<0.001), experience of taking Korean medicine(P=0.032), experience of receiving acupuncture treatment(P<0.001), number of visits(P<0.001), medical expense (P=0.005), and subjective health status after the treatments showed statistical significance for Korean herbal medicine(P=0.038), acupuncture (P=0.001), cupping therapy(P=0.006), oriental physiotherapy(P=0.003), and treatment satisfaction(P<0.001). For subjective health status based on suffering disorders in the past three months, the response of poor health was higher in the group suffering recent illnesses. Statistical significance was seen in hypertension (P=0.002), arthritis(P<0.001), lumbar pain(P<0.001), diabetes mellitus(P=0.001), stroke(P<0.001), hwa-byung (P=0.001), gastric disorders(P=0.021), common cold(P<0.001), ankle sprain(P<0.001), muscular injury(P<0.001), lumbar sprain(p=0.009) and fracture(P=0.03). Also the number of diseases during the past three months showed statistical significance(P<0.001). Statistical significance was also seen in Level of knowledge(P<0.001), route of information(P<0.001), reliability of Korean medicine(P=0.003), insurance coverage(P=0.005), medical costs(P<0.001), and future willingness to use Korean medicine(P<0.001). As a result of the multiple logistics regression analysis, risks of subjective poor health statistically increased in female population, elderlies, medicaid beneficiaries, less educated, higher medical expense, and more disorders during the past three months. Conclusion : Patients' self-perceived health status has significant differences with each variables such as sex, age, marital status, education, health insurance, medical expense, number of diseases.

• 한국언론정보학보
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• 제78권
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• pp.177-205
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• 2016

이 연구는 지역신문 기자들의 직업이동을 통해 지역언론의 현실과 기자들의 직업정체성 변화를 살펴보고자 했다. <대전일보>, <중도일보>, <충청투데이>의 대전지역 3개 종이신문에서 퇴직한 기자들이 어떤 이유로, 어디에서 어디로, 어떻게 경력 이동했는지를 알아본 결과, 동종 종이신문과 인터넷신문 같은 저널리즘 영역에서 활동하는 기자들이 있는가 하면 정치 행정 학계 경제 문화예술 등 여러 분야로 이직했다. 이들이 신문을 떠난 이유는 보수 복지 미흡과 미래비전 부재가 가장 많았으며 구조조정, 취재보도 활동제약, 많은 업무량도 영향을 주었다. 1997년 IMF 외환위기 이전 언론노동시장은 공채로 입사해 평기자, 차장, 부장, 국장으로 승진하는 전형적인 내부노동시장이었지만 뉴미디어의 등장과 신문기업의 경영난으로 내부노동시장이 약화되고 있음을 보여줬다. 기자들은 자기 개발을 통해 전문성을 높여 직업을 바꾸기보다는 지연 학연, 출입처 같은 사회자본을 적극적으로 활용함으로써 지역신문 본연의 감시비판 기능을 위축시키는 부작용과 함께 기자들의 직업정체성까지 훼손시키고 있었다.

• 한국산림과학회지
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• 제109권2호
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• pp.124-135
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• 2020

오리나무림은 우리나라를 비롯한 동아시아의 습지림을 구성하는 대표적인 임분으로 예전에는 산지, 하변, 배후습지, 그리고 충적 저지 등 다양한 서식환경에서 비교적 흔하게 분포하고 있었으나, 다양한 토지이용과 서식지의 건조화 등의 영향으로 최근에는 보기 드문 식물군락 중의 하나로 여겨지고 있다. 본 연구는 우리나라 산지습지에 자연적으로 분포하고 있는 오리나무림의 군락생태학적 특성을 파악하여 향후 그 체계적 보전 및 관리를 위한 기초자료를 제공하는 데 있다. 전국 66개 지소의 오리나무림을 대상으로 ZM학파의 식물사회학적 방법과 이원지표종분석(TWINSPAN)을 병용하여 군락 유형을 분류한 결과, 모두 8개 단위 유형 (쪽동백나무형, 들메나무-병꽃나무형, 참조팝나무형, 콩제비꽃형, 꼬리조팝나무-물봉선형, 왕미꾸리광이형, 진퍼리새형, 그리고 상수리나무-생강나무형)이 구분되었으며, 2개 군락, 4개 아군락, 그리고 8개 변군락(variant)의 식생단위 체계로 구성되어 있음을 알 수 있었다. 또한, 군락유형별 생태적 특성(구성종의 총피도(/100㎡), 중요치, 상재도, 생활형 조성, 종다양성 지수, 군락유사도 그리고 지표종 등)을 비교하였다.

• BMB Reports
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• 제51권11호
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• pp.584-589
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• 2018

Secondary prevention via earlier detection would afford the greatest chance for a cure in premalignant lesions. We investigated the exomic profiles of non-malignant and malignant changes in head and neck squamous cell carcinoma (HNSCC) and the genomic blueprint of human papillomavirus (HPV)-driven carcinogenesis in oropharyngeal squamous cell carcinoma (OPSCC). Whole-exome (WES) and whole-genome (WGS) sequencing were performed on peripheral blood and adjacent non-tumor and tumor specimens obtained from eight Korean HNSCC patients from 2013 to 2015. Next-generation sequencing yielded an average coverage of $94.3{\times}$ for WES and $35.3{\times}$ for WGS. In comparative genomic analysis of non-tumor and tumor tissue pairs, we were unable to identify common cancer-associated early mutations and copy number alterations (CNA) except in one pair. Interestingly, in this case, we observed that non-tumor tonsillar crypts adjacent to HPV-positive OPSCC appeared normal under a microscope; however, this tissue also showed weak p16 expression. WGS revealed the infection and integration of high-risk type HPV16 in this tissue as well as in the matched tumor. Furthermore, WES identified shared and tumor-specific genomic alterations for this pair. Clonal analysis enabled us to infer the process by which this transitional crypt epithelium (TrCE) evolved into a tumor; this evolution was accompanied by the subsequent accumulation of genomic alterations, including an ERBB3 mutation and large-scale CNAs, such as 3q27-qter amplification and 9p deletion. We suggest that HPV16-driven OPSCC carcinogenesis is a stepwise evolutionary process that is consistent with a multistep carcinogenesis model. Our results highlight the carcinogenic changes driven by HPV16 infection and provide a basis for the secondary prevention of OPSCC.