• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.2
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• pp.190-198
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• 2022

Backgrounds/Aims: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience in the management of TPI and assessed patient outcomes according to age group and treatment strategy. Methods: A retrospective analysis of patients diagnosed and treated with TPI at a level-I trauma center from 2000-2019. Patients were divided into two groups: adults and pediatrics. Conservative treatment cases were subjected to subgroup analysis. Level of evidence: IV. Results: Of a total of 77 patients, the mean age was 24.89 ± 15.88 years. Fifty-six (72.7%) patients had blunt trauma with motor vehicle accident. Blunt trauma was the predominant mechanism in 42 (54.5%) patients. Overall, 38 (49.4%) cases had grade I or II injury, 24 (31.2%) had grade III injury, and 15 (19.5%) had grade IV injury. A total of 30 cases had non-operative management (NOM). Successful NOM was observed in 16 (20.8%) cases, including eight (32.0%) pediatric cases and eight (15.4%) adult cases. Higher American association for the surgery of trauma (AAST) grade of injury was associated with NOM failure (16.7% for grade I/II, 100% for grade III, and 66.7% for grade IV injury; p = 0.001). An independent factor for NOM failure was female sex (69.2% in females vs. 29.4% in males; p = 0.03). Conclusions: High AAST grade TPI is associated with a high rate of NOM failure in both pediatric and adults.

• Journal of Korean Philosophical Society
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• v.123
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• pp.379-407
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• 2012

The main purpose of this paper is to make a case for the availability of pragmatist ethics by showing the differences between utilitarianism and pragmatism. In this paper, drawing on Dewey's view, I show that Bentham and Mill were doomed to failure because they both regarded moral conduct not as a process but as a fixed act, the remarkable differences between their views notwithstanding. Besides, I also show that pragmatism distinguishes itself from utilitarianism by its focus on the aspect of the amendment of a conduct rather than its attainment. Pragmatist ethics works on the assumption that moral conduct arises only in conscious experience. What pragmatists mean by consciousness is not an ability just given to haman, but a function emerging from the human interaction with his environment. Therefore, morality is extended from and restricted by experience, because it is grounded in concrete experience, but not in the transcendental nor a priori realm. Since pragmatism suggests the possibility of "ethics without principles" in that it works through the way which successfully rejects the traditional absolutist ethics, while avoiding the downslide to a nihilistic form of skepticism. Thus, it may serve as a third view that overcomes a seriously divergent situation of the current ethical arguments. In other words, starting from the very nature of experience, pragmatist ethics offers a 'bottom-up' ethics, instead of a 'top-down' one. This reconstructive reading of pragmatism away from utilitarianism is expected to offer a more comprehensive account of our moral experience in the pluralistic world of diverged values.

• The Southeast Asian review
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• v.28 no.3
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• pp.111-158
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• 2018

This paper pays attention to the recent increase of young Koreans working in the low-skilled service sector in Singapore. Such rapid increase largely results from the Korean government's initiatives to promote labour migration of young people and the concurrent proliferation of migration agencies, against the background of growing youth unemployment in South Korea. By exploring the motivations and trajectories of young people's labour migration to Singapore, this study examines to what extent they think their expectations have been met and how they interpret their migration and work experiences. There has been little research that examines the actual voices of young migrants as part of migration studies, whilst the majority of previous research focuses on the evaluation of government support programmes based on job matching rates, surveys of participant satisfaction and etc. Young people who went to Singapore to improve their English language skills and qualifications for future employment in Korea have become frustrated due to low-skilled service jobs that consist of low pay and high labour intensity. Their credentials are devalued and they experience deskilling through this migration process. Most of them were discontent with the Korean migration agencies they used and critical about programmes offered by government institutions and universities/colleges. Despite being subject to deskilling, they did try to actively cope or resist this situation. This study focuses on the various ways these migrants attempted to manage the gap between their initial expectations and reality. It also demonstrates how these migrants interpreted their work experiences after returning to Korea: whilst most of them did not cash off their Singapore work experience for a decent job after returning to Korea, they did not define their experience as a complete failure. Adding to cultural, social capital they gained through this experience, they acquired 'mobility capital' which includes confidence, the desire to move, and capacity to control one's own movement.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.21-26
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• 2008

There is significant morbidity and mortality associated with the combination of esophageal atresia (EA) and duodenal atresia (DA). Nevertheless, the management protocol for the combined anomalies is not well defined. The aim of this study is to review our experience with the combined anomalies of EA and DA. From May 1989 to August 2006, seven neonates were diagnosed as EA with DA at Asan Medical Center. In all cases, the type of EA was proximal EA and distal tracheoesophageal fistula (TEF). The diagnosis of DA was made in theprenatal period in 1, at birth in 4, 4 days after birth in 1 (2 days after EA repair) and at postmortem autopsy in 1. Except the one case where DA was missed initially, primary simultaneous repair was attempted. DA repair with gastrostomy followed by EA repair in 2, EA repair followed by DA repair without gastrostomy in 2, and TEF ligation followed by DA repair with gastrostomy in 1. There were two deaths. One baby had a large posterolateral diaphragmatic hernia, and operative repair was not attempted. The other infant who had a TEF ligation and DA repair with gastrostomy expired from cardiac failure due to a large patent ductus arteriosus. Simultaneous repair of EA and DA appears to be an acceptable management approach for the combined anomalies, but more experience would be required for the selection of the primary repair of both anomalies.

• Nuclear Engineering and Technology
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• v.39 no.3
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• pp.215-220
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• 2007

The existing flooding Probabilistic Safety Analysis(PSA) was updated to reflect the Korean plant specific operating experience data into the flooding frequency to improve the PSA quality. Both the Nuclear Power Experience(NPE) database and the Korea Nuclear Pipe Failure Database(NuPIPE) databases were used in this study, and from these databases, only the Pressurized Water Reactor(PWR) data were used for the flooding frequencies of the flooding areas in the primary auxiliary building. With these databases and a Bayesian method, the flooding frequencies for the flooding areas were estimated. Subsequently, the Core Damage Frequency(CDF) for the flooding PSA of the Ulchin(UCN) unit 3 and 4 plants based on the Korean Standard Nuclear Power Plant(KSNP) internal full-power PSA model was recalculated. The evaluation results showed that sixteen flooding events are potentially significant according to the screening criterion, while there were two flooding events exceeding the screening criterion of the existing UCN 3 and 4 flooding PSA. The result was compared with two kinds of cases: (1) the flooding frequency and CDF from the method of the existing flooding PSA with the PWR and Boiled Water Reactor(BWR) data of the NPE database and the Maximum Likelihood Estimate(MLE) method and (2) the flooding frequency and CDF with the NPE database(PWR and BWR data), NuPIPE database, and a Bayesian method. From the comparison, a difference in CDF results was revealed more clearly between the CDF from this study and case (2) than between case (1) and case (2). That is, the number of flooding events exceeding the screen criterion further increased when only the PWR data were used for the primary auxiliary building than when the Korean specific data were used.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.426-432
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• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

• Journal of Advanced Marine Engineering and Technology
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• v.41 no.1
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• pp.118-124
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• 2017

To investigate and analyze the cause of the failure of the connecting rod bolt and the crank pin bearing bolt of the diesel engine of this study, the following results were obtained through site surveying, the investigation of literature referring to similar failures, testing and inspection of the fracture surface, and the experience of the researchers. The fractured crank pin bearing bolt of the diesel engine is estimated to be damaged later than the connecting rod bolt. From the shape of fracture surface, it is evident that the failed connecting rod bolt is fractured by fatigue failure due to abnormally repeated loads (e.g. loosening of the connecting bolt, etc.), and is not failed by brittle fractures due to the impact load. The surface of the U-nut on the fractured connecting rod bolt has been worsening due to the improper use of lubricant (agent for prevention of thread fixing) and no usage of separating the each connecting rod on each cylinder. Moreover, there is the possibility that those poor surface conditions of the fractured connecting rod bolt have affected the failure of the connecting rod bolt of the main engine. And it could be assumed that the mechanical characteristic and manufacturing process of the failed connecting rod bolt and crank pin bearing bolt, which were made by a domestic company, conform to the design requirements for those bolts.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.397-405
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• 2020

Objective : We retrospectively evaluated the efficacy of Gamma Knife radiosurgery (GKS) for recurrent nasopharyngeal carcinoma (NPC) in patients who previously underwent radiotherapy, and analyzed the treatment outcomes over 14 years. Methods : Ten patients with recurrent NPC who had previously received radiotherapy underwent stereotactic radiosurgery using a Gamma Knife^® (Elekta Inc, Atlanta, GA, USA) between 2005 and 2018. The median target volume was 8.2 ㎤ (range, 1.7-17.8), and the median radiation dose to the target was 18 Gy (range, 12-30). The median follow-up period was 18 months (range, 6-76 months). Overall and local failure-free survival rates were determined using the Kaplan-Meier method. Results : The NPCs recurred at the primary cancer site in seven patients (70%), as distant brain metastasis in two (20%), and as an extension into brain in one (10%). The recurrent tumors in seven of the 10 patients (70%) were found on the routine follow-up imaging studies. Two patients presented with headache and one with facial pain. Local failure after GKS occurred in five patients (50%) : two of whom died eight and 6 months after GKS, respectively. No adverse radiation effects were noted after GKS. The 1- and 3-year overall survival rates after GKS were 90% and 77%, respectively. The local failure-free survival rates at 6 months, 1 year, and 3 years after GKS were 80%, 48%, and 32%, respectively. The median interval from GKS to local failure was 8 months (range, 6-12). Univariate analysis revealed that using co-registration with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) was associated with a lower local failure rate of recurrent NPC (p=0.027). Conclusion : GKS is an acceptable salvage treatment option for patients with recurrent NPC who previously received radiation therapy. PET-CT and MRI co-registration for dose planning can help achieve local control of recurrent NPC.

• Journal of Korean Society of Steel Construction
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• v.13 no.5
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• pp.567-575
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• 2001

In order to consider statistical properties of probability variables used in the structural analysis the conventional approach using the safety factor based on past experience usually estimated the safety of a structure Also the real structures could only be analyzed with the error in estimation of loads material characters and the dimensions of the members. But the errors should be considered systematically in the structural analysis Safety of structure could not precisely be appraised by the traditional structural design concept Recently new aproach based on the probability concept has been applied to the assessment of structural safety using the reliability concept Thus the computer program by the Probabilitstic FEM is developed by incorporating the probabilistic concept into the conventional FEM method. This paper estimated for the reliability of a plane stress structure by Advanced First-Order Second Moment method using von Mises, Tresca and Mohr-Coulomb failure criterions. Verification of the reliability index and failure probability of attained by the Monte Carlo Simulation method with the von Mises criterion were same as PFEM, but the Monte Carlo Simulation were very time-consuming. The variance of member thickness and load could influence the reliability and failure probability most sensitively among the design variables from the results of the parameter analysis. The proper failure criterion according to characteristic of materials must be used for safe design.

• Journal of Chest Surgery
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• v.53 no.3
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• pp.132-139
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• 2020

Background: The double-lumen cannula (DLC) has begun to be used worldwide for venovenous (VV) extracorporeal membrane oxygenation (ECMO). We aimed to examine whether the DLC could be an effective tool in the treatment of pediatric respiratory failure in Korea. Methods: We reviewed the records of patients weighing under 15 kg who underwent ECMO due to respiratory failure between January 2017 and December 2018. Outcomes of ECMO using a DLC and conventional ECMO using central method or 2 peripheral cannulas were compared. Results: Twelve patients were treated with ECMO for respiratory failure. Among them, a DLC was used in 5 patients, the median age of whom was 3.8 months (interquartile range, 0.1-49.7 months). In these patients, the median values of pH, partial pressure of carbon dioxide, and partial pressure of oxygen were 7.09, 74 mm Hg, and 37 mm Hg before ECMO and corrected to 7.31, 44 mm Hg, and 85 mm Hg, respectively, after ECMO cannulation. Median blood flow rate in the patients treated with ECMO using a DLC was slightly higher than that in the conventional ECMO group, but this difference was not statistically significant (86.1 mL/kg/min and 74.3 mL/kg/min, respectively; p=1.00). One patient from the DLC group and 3 patients from the conventional group were weaned off ECMO. Conclusion: VV ECMO using a DLC provided adequate oxygenation, ventilation, and blood flow rate in Korean pediatric patients with respiratory failure. Further prospective and randomized studies are warranted.