• Korean Journal of Radiology
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• v.23 no.10
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• pp.1019-1027
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• 2022

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23-85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion: US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

• Korean Journal of Radiology
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• v.24 no.10
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• pp.983-995
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• 2023

Objective: To compare the diagnostic performance and interobserver agreement between contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CE-MRI) with magnetic resonance cholangiopancreatography (MRCP) for evaluating the resectability in patients with extrahepatic cholangiocarcinoma (eCCA). Materials and Methods: This retrospective study included treatment-naïve patients with pathologically confirmed eCCA, who underwent both CECT and CE-MRI with MRCP using extracellular contrast media between January 2015 and December 2020. Among the 214 patients (146 males; mean age ± standard deviation, 68 ± 9 years) included, 121 (56.5%) had perihilar cholangiocarcinoma. R0 resection was achieved in 108 of the 153 (70.6%) patients who underwent curative-intent surgery. Four fellowship-trained radiologists independently reviewed the findings of both CECT and CE-MRI with MRCP to assess the local tumor extent and distant metastasis for determining resectability. The pooled area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of CECT and CE-MRI with MRCP were compared using clinical, surgical, and pathological findings as reference standards. The interobserver agreement of resectability was evaluated using Fleiss kappa (κ). Results: No significant differences were observed between CECT and CE-MRI with MRCP in the pooled AUC (0.753 vs. 0.767), sensitivity (84.7% [366/432] vs. 90.3% [390/432]), and specificity (52.6% [223/424] vs. 51.4% [218/424]) (P > 0.05 for all). The AUC for determining resectability was higher when CECT and CE-MRI with MRCP were reviewed together than when CECT was reviewed alone in patients with discrepancies between the imaging modalities or with indeterminate resectability (0.798 [0.754-0.841] vs. 0.753 [0.697-0.808], P = 0.014). The interobserver agreement for overall resectability was fair for both CECT (κ = 0.323) and CE-MRI with MRCP (κ = 0.320), without a significant difference (P = 0.884). Conclusion: CECT and CE-MRI with MRCP showed no significant differences in the diagnostic performance and interobserver agreement in determining the resectability in patients with eCCA.

• Korean Journal of Radiology
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• v.20 no.5
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• pp.719-728
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• 2019

Objective: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. Materials and Methods: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAGEPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. Results: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m², and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. Conclusion: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.

• Journal of Environmental Health Sciences
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• v.50 no.2
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• pp.146-156
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• 2024

Background: Children who use playground facilities are exposed to potential risks due to the high concentration of heavy metals contained in the finishing materials of facilities in children's playgrounds. Objectives: The purpose of this study was to investigate the concentration of heavy metals in the finishing materials of outdoor children's playgrounds where harmful heavy metals exist in Gwangju and to conduct human risk assessment for children and adults by age to find the risks and limitations. Methods: The bottom and top layers of double-painted paint were peeled off and collected together from the finishing materials of children's play facilities such as slides, swings, and seesaws in 147 children's parks in Gwangju. Heavy metals were analyzed using ICP-OES, etc., and human risk assessment was performed using the concentrations of heavy metals. Results: Based on 1.0E-04, which requires legal regulation, CTE was found to pose a carcinogenic risk for preschool children and no carcinogenic risk for the rest of the age groups. However, RME showed that both men and women of all ages had a carcinogenic risk. For reference, when the carcinogenic risk was based on 1.0E-06, CTE was found to pose a carcinogenic risk from infants to elementary school students, and RME was found to have a carcinogenic risk in all age groups. It was judged that there is a non-carcinogenic risk if the non-carcinogenic risk exceeds 1 based on the hazard index (HI) 1. In CTE, there was no non-carcinogenic risk, and RME for preschooler males (1.49E+00) and females (1.56E+00) were found to have non-carcinogenic risk. Conclusions: This study was meaningful in that it examines the differences in the current management of heavy metals concentration standards and potential carcinogenic and non-carcinogenic risks to the human body and discusses the relationship between heavy metals and human health effects.

• Journal of Bio-Environment Control
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• v.33 no.1
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• pp.37-44
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• 2024

This study was conducted to validate the growth and productivity of cucumber hydroponics using coir as the medium, different types of nutrient solutions and formal methods, in order to select the most efficient cultivation method. The nutrient solutions consisted of culture solution (S) and raw water (W), the planting methods were rockwool cube seedlings (RC), rockwool plug seedlings (RP), and slab directly seedlings (DS). The reference date was set the sowing date. The initial growth showed a significant increase in the culture solution treatment, the differences among treatments decreased as the growth period lengthened. There was no apparent correlation between the planting methods and growth, but different results were observed among the same planting methods depending on nutrient solution used. Similarly, productivity followed a similar trend, with significantly higher harvest in the culture solution treatment during the initial harvest period of 6-8 weeks after sowing, but the harvest gap among treatments were diminished in the after period. The cumulative harvest was significantly higher in the culture solution treatment due to the initial difference in harvest quantity. Plant growth and fruit productivity exhibited a similar trend, showing a linear relationship. There was no correlation among the planting methods, but direct seedling with the culture solution showed the highest initial growth and harvests due to stable nutrient and moisture supply in the initial root zone. Therefore, it is believed that direct seeding method on the culture solution medium would be most advantageous for plant growth and productivity. Additionally, it is expected to contribute to cost effectiveness from an economic perspective through simplification of the cultivation process, labor costs and production cost reduction

• The Korean Journal of Air & Space Law and Policy
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• v.35 no.2
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• pp.3-40
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• 2020

The term "accident" in the Warsaw Convention of 1929 and the Montreal Convention of 1999, which govern carrier liability in international air transport, is an important criterion for determining carrier liability. However, because there is no explicit definition of the term in the treaty provisions, the term is largely subjected to the judgment and interpretation of the courts. Although there have been numerous changes in purpose and circumstance in the transition from the Warsaw regime to the conclusion of the Montreal Convention, there was no discussion on the concept of "accident" therefore, even after the adoption of the Montreal Convention, there is no doubt that the term is to be interpreted in the same manner as before. On this point, the United States Supreme Court's Air France v. Saks clarified the concept of "accident" and is still cited as an important precedent. Recently, the CJEU, in GN v. ZU, presented a new concept of "accident" introduced in the Montreal Convention: that "reference must be made to the ordinary meaning" in interpreting "accident" and that the term "covers all situations occurring on aboard an aircraft." Furthermore, the CJEU ruled that the term does not include the applicability of "hazards typically associated with aviation," which was controversial in previous cases. Such an interpretation can be reasonably seen as the court's expansion of the concept of "accident," with a focus on "protecting consumer interests," a core tenet of both the Montreal convention and the European Union Regulations(EC: No 889/2002). The CJEU's independent interpretation of "accident" is a departure from the Warsaw Convention and the Saks case, with their focus on "carrier protection," and instead focuses on the "passenger protection" standard of the Montreal Convention. Consequently, this expands both the court's discretion and the carrier's risk management liability. Such an interpretation by the CJEU can be said to be in line with the purpose of the Montreal Convention in terms of "passenger protection." However, there are problems to be considered in tandem with an expanded interpretation of "accident." First, there may be controversy concerning "balance" in that it focused on "passenger protection" in relation to the "equitable balance of interests" between air carriers and passengers, which is the basic purpose of the agreement. Second, huge losses are expected as many airlines fly to countries within the European Union. Third, there is now a gap in the interpretation of "accident" in Europe and the United States, which raises a question on the "unity of rules," another basic tenet of the Convention. Fourth, this interpretation of "accident" by the CJEU raises questions regarding its scope of application, as it only refers to the "hazards typically associated with aviation" and "situations occurring aboard an aircraft." In this case, the CJEU newly proposed a novel criterion for the interpretation of "accident" under the Montreal Convention. As this presents food for thought on the interpretation of "accident," it is necessary to pay close attention to any changes in court rulings in the future. In addition, it suggests that active measures be taken for passenger safety by recognizing air carriers' unlimited liability and conducting systematic reforms.

• Journal of Bio-Environment Control
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• v.29 no.2
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• pp.141-152
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• 2020

The rapid on-site measurement of hydroponic nutrients allows for the more efficient use of crop fertilizers. This paper reports on the development of an embedded on-site system consisting of multiple ion-selective electrodes (ISEs) for the real-time measurement of the concentrations of macronutrients in hydroponic solutions. The system included a combination of PVC ISEs for the detection of NO₃, K, and Ca ions, a cobalt-electrode for the detection of H₂PO₄, a double-junction reference electrode, a solution container, and a sampling system consisting of pumps and valves. An Arduino Due board was used to collect data and to control the volume of the sample. Prior to the measurement of each sample, a two-point normalization method was employed to adjust the sensitivity followed by an offset to minimize potential drift that might occur during continuous measurement. The predictive capabilities of the NO₃ and K ISEs based on PVC membranes were satisfactory, producing results that were in close agreement with the results of standard analyzers (R² = 0.99). Though the Ca ISE fabricated with Ca ionophore II underestimated the Ca concentration by an average of 55%, the strong linear relationship (R² > 0.84) makes it possible for the embedded system to be used in hydroponic NO₃, K, and Ca sensing. The cobalt-rod-based phosphate electrodes exhibited a relatively high error of 24.7±9.26% in the phosphate concentration range of 45 to 155 mg/L compared to standard methods due to inconsistent signal readings between replicates, illustrating the need for further research on the signal conditioning of cobalt electrodes to improve their predictive ability in hydroponic P sensing.

• Tuberculosis and Respiratory Diseases
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• v.38 no.2
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• pp.155-163
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• 1991

Bronchoalveolar lavage had been done as the treatment of some diseases such as alveolar proteinsois, bronchiectasis, and severe asthma to remove excessive secretion or mucus. But in the recent decade it has been done as a diagnostic method and a tool to understand and evaluate the pathophysiology of diffuse interstitial lung diseases such as sarcoidosis, pneumoconiosis and hypersensitivity pneumonitis. To analyse the bronchoalveolar fluid, it might be useful to have a standard reference (especially cell counts and differetial count of the cells from bronchoalveolar lavage fluid) of normal person. But it is difficult to study the normal volunteers. We investgated the bronchoalveolar lavage fluid of 48 patients (28 nonsmokers, 20 smokers) who visited Severance Hospital because of minor pulmonary symptoms such as cough and sputum. They did neither complain of dyspnea nor cyanosis, and had normal or unilateral minor lesion on physical examination and chest X-ray. We analysed the recovery rate, viability, total cell count and differential count of the cells in fluid obtained by bronchoalveolar lavage. The following results were obtained: 1) Age ranged from 17 to 72 years-old with the mean age of 36.7; there was no difference of age between the nonsmoker and the smoker gorup. Male to female ratio was 2.43:1 for total group, 1.15:1 for nonsmokers, and 19:1 for smokers. 2) The diagnoses of the patients were undetermined in 41.9%, healed pulmonary tuberculosis in 37.5%, laryngitis or pharyngitis in 10.4% and others in 10.4%. 3) Total cell number of the recovered fluid by bronchoalveolar lavage was significantly higher in male[$9.6{\pm}6.2({\times}10^6)$] than in female[$5.1{\pm}3.0({\times}10^6)$](p<0.05), and there was no significant difference in the total cell number between the smokers and nonsmokers [$9.3{\pm}5.8({\times}10^6)$ vs $7.5{\pm}5.8({\times}10^6)$]. 4) The differential count of the cells from bronchoalveolar lavage fluid had no difference between the nonsmokers and the smokers. 5) There was no correlation between the total cell count and smoking or age. 6) In the smoker group, there was no correlation between the amount of smoking and the total cell count of the bronchoalveolar fluid. In conclusion, it should be careful to regard the patients with symptoms or minor radiologic abnormalities as a control group in bronchoalveolar lavage study and further study of cell analysis in bronchoalveolar lavage will be needed between smoker and nonsmoker in the male and female healthy people.

• The Journal of Korean Academy of Prosthodontics
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• v.40 no.1
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• pp.1-17
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• 2002

The purpose of this study is to examine the possibility of thermal injury to bone tissues during an implant site preparation under the same condition as a typical clinical practice of $Br{\aa}nemark$ implant system. All the burs for $Br{\aa}nemark$ implant system were studied except the round bur The experiments involved 880 drilling cases : 50 cases for each of the 5 steps of NP, 5 steps of RP, and 7 steps of WP, all including srew tap, and 30 cases of 2mm twist drill. For precision drilling, a precision handpiece restraining system was developed (Eungyong Machinery Co., Korea). The system kept the drill parallel to the drilling path and allowed horizontal adjustment of the drill with as little as $1{\mu}m$ increment. The thermocouple insertion hole. that is 0.9mm in diameter and 8mm in depth, was prepared 0.2mm away from the tapping bur the last drilling step. The temperatures due to countersink, pilot drill, and other drills were measured at the surface of the bone, at the depths of 4mm and 8mm respectively. Countersink drilling temperature was measured by attaching the tip of a thermocouple at the rim of the countersink. To assure temperature measurement at the desired depths, 'bent-thermocouples' with their tips of 4 and 8mm bent at $120^{\circ}$ were used. The profiles of temperature variation were recorded continuously at one second interval using a thermometer with memory function (Fluke Co. U.S.A.) and 0.7mm thermocouples (Omega Co., U.S.A.). To simulate typical clinical conditions, 35mm square samples of bovine scapular bone were utilized. The samples were approximately 20mm thick with the cortical thickness on the drilling side ranging from 1 to 2mm. A sample was placed in a container of saline solution so that its lower half is submerged into the solution and the upper half exposed to the room air, which averaged $24.9^{\circ}C$. The temperature of the saline solution was maintained at $36.5^{\circ}C$ using an electric heater (J. O Tech Co., Korea). This experimental condition was similar to that of a patient s opened mouth. The study revealed that a 2mm twist drill required greatest attention. As a guide drill, a twist drill is required to bore through a 'virgin bone,' rather than merely enlarging an already drilled hole as is the case with other drills. This typically generates greater amount of heat. Furthermore, one tends to apply a greater pressure to overcome drilling difficulty, thus producing even greater amount heat. 150 experiments were conducted for 2mm twist drill. For 140 cases, drill pressure of 750g was sufficient, and 10 cases required additional 500 or 100g of drilling pressure. In case of the former. 3 of the 140 cases produced the temperature greater than $47^{\circ}C$, the threshold temperature of degeneration of bone tissue (1983. Eriksson et al.) which is also the reference temperature in this study. In each of the 10 cases requiring extra pressure, the temperature exceeded the reference temperature. More significantly, a surge of heat was observed in each of these cases This observations led to addtional 20 drilling experiments on dense bones. For 10 of these cases, the pressure of 1,250g was applied. For the other 10, 1.750g were applied. In each of these cases, it was also observed that the temperature rose abruptly far above the thresh old temperature of $47^{\circ}C$, sometimes even to 70 or $80^{\circ}C$. It was also observed that the increased drilling pressure influenced the shortening of drilling time more than the rise of drilling temperature. This suggests the desirability of clinically reconsidering application of extra pressures to prevent possible injury to bone tissues. An analysis of these two extra pressure groups of 1,250g and 1,750g revealed that the t-statistics for reduced amount of drilling time due to extra pressure and increased peak temperature due to the same were 10.80 and 2.08 respectively suggesting that drilling time was more influenced than temperature. All the subsequent drillings after the drilling with a 2mm twist drill did not produce excessive heat, i.e. the heat generation is at the same or below the body temperature level. Some of screw tap, pilot, and countersink showed negative correlation coefficients between the generated heat and the drilling time. indicating the more the drilling time, the lower the temperature. The study also revealed that the drilling time was increased as a function of frequency of the use of the drill. Under the drilling pressure of 750g, it was revealed that the drilling time for an old twist drill that has already drilled 40 times was 4.5 times longer than a new drill The measurement was taken for the first 10 drillings of a new drill and 10 drillings of an old drill that has already been used for 40 drillings. 'Test Statistics' of small samples t-test was 3.49, confirming that the used twist drills require longer drilling time than new ones. On the other hand, it was revealed that there was no significant difference in drilling temperature between the new drill and the old twist drill. Finally, the following conclusions were reached from this study : 1 Used drilling bur causes almost no change in drilling temperature but increase in drilling time through 50 drillings under the manufacturer-recommended cooling conditions and the drilling pressure of 750g. 2. The heat that is generated through drilling mattered only in the case of 2mm twist drills, the first drill to be used in bone drilling process for all the other drills there is no significant problem. 3. If the drilling pressure is increased when a 2mm twist drill reaches a dense bone, the temperature rises abruptly even under the manufacturer-recommended cooling conditions. 4. Drilling heat was the highest at the final moment of the drilling process.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.79-86
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• 2009

Background: Background: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. Material and Method: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20~39 years old, 40~59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. Result: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. Conclusion: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population.