• Korean Journal of Radiology
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• 제25권8호
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• pp.756-766
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• 2024

Objective: To evaluate the efficacy and safety of thermal ablation in treating solitary low-risk T2N0M0 papillary thyroid cancer (PTC) and compare the outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA). Materials and Methods: This retrospective, single center study involved 34 patients (age: 40.0 ± 13.9 years; 28 female) who had low-risk T2N0M0 PTC with a maximum diameter >2 cm and ≤4 cm and underwent MWA (n = 15) or RFA (n = 19) from November 2016 to April 2023. The primary outcomes were the cumulative rate of disease progression and delayed surgery rates. In contrast, the secondary outcomes included changes in tumor size, cumulative rate of complete tumor disappearance, and complication rates. Results: The median follow-up period was 18.0 months (interquartile range [IQR]: 9.0-40.0 months). At 12 months, the median volume reduction rate of the ablation zone was 74.2% (IQR: 53.7%-86.0%). Disease progression was noted in two patients within 1 year, including one patient with local tumor progression post-RFA and one with a new tumor post-MWA, resulting in a constant cumulative disease progression rate of 8.8% (95% confidence interval [CI]: 0%-19.8%) throughout the remaining follow-up period. Both patients were subsequently treated with additional ablation and did not require surgery. The cumulative rates of complete tumor disappearance at 1, 3, and 5 years were 4.0% (95% CI: 0%-11.4%), 26.8% (95% CI: 2.7%-44.9%), and 51.2% (95% CI: 0%-79.1%), respectively. No significant differences were observed in the disease progression (P = 0.829) or complete tumor disappearance (P = 0.633) rates between the MWA and RFA groups. Complications occurred in 14.7% (5/34) of patients presenting with transient hoarseness. RFA had a higher but not statistically significant complication rate than MWA did (21.1% [4/19] vs. 6.7% [1/15]; P = 0.355). Conclusion: Both MWA and RFA demonstrated promising short-term outcomes in terms of efficacy and safety in treating solitary low-risk T2N0M0 PTC, with no significant differences.

• 보험의학회지
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• 제27권2호
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• pp.68-74
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• 2008

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

• 대한교통학회지
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• 제17권3호
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• pp.117-130
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• 1999

지진은 교량과 도로 구조물들에 피해를 입혀서 교통시스템 운행전반과 지역경제에 심각한 피해를 초래하도록 한다. 지진위험도 분석방법은 안전도에 문제가 있는 고속도로 교량들에 대하여 구조물 보강공사를 실시하기 위한 우선순위 결정에 사용되어 진다. 지진위험도 분석방법들은 한 교량의 상대적 중요도를 결정하기 위하여 일일 평균교통량을 사용하고 있다. 본 연구는 도로붕괴시 교통시스템에 추가로 부과되는 시스템비용의 관점에서 수많은 교통량분석을 실행하는데 비용-효과적인 교통망 분석방법을 개발하는데 있다. 본 연구에서 개발된 교통망 분석방법의 핵심은 인공지능분야에서 개발된 연상기억모형의 사용이다. 본 연구에서 개발된 교통망 분석방법을 평가하기 위하여 7개의 교통죤으로 구성된 교통망이 구축되었다. 다양한 교통링크 붕괴 시나리오들이 지진으로 붕괴된 교통망에서의 교통량들을 추정하기 위하여 무작위로 선정되었다. 이러한 교통링크 붕괴 시나리오에 대한 교통량의 변화는 여러 연상기억모형들을 이용하여 예측하였고, 그 예측능력을 평가하였다. 다양한 시나리오로부터의 예측결과는 교통량 예측분야에서 연상기억 모형들의 적용 가능성을 보여주고 있다.

• Journal of Trauma and Injury
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• 제33권3호
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• pp.153-161
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• 2020

Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure and extremely time-dependent, and the proficiency of the physician is important. Due to a lack of REBOA education programs in Republic of Korea, few physicians have been trained in the procedure. In this study, we examined how REBOA education affects clinical outcomes in a single center. Methods: A retrospective study conducted from February 2017 to June 2020 at a regional trauma center. We collected data of patients who underwent REBOA and analyzed the factors that influenced the outcome. The patients were divided into the educated and non-educated groups (based on REBOA training received by their physicians), and the success and failure groups. Results: A total of 24 patients underwent REBOA during the study. There were eight patients in the success group and 16 patients in the failure group. There are no significant differences between the educated and non-educated groups in sex, age, ISS, shock, injury-to-REBOA time, injury mechanism, injury sites, arrest, access site, type of catheter, type of REBOA, target Zone, mortality, and the result of REBOA. The non-educated group had a higher risk for failure compared to the educated group in multivariate analysis (odds ratio [OR] 154.64, 95% confidence interval [CI] 1.11-22.60). Conclusions: Failure in REBOA is harmful to patients. The risk of failure is increased in the non-educated group. Physicians working in the trauma center or emergency department need to complete the REBOA education program.

• 대한환경공학회지
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• 제39권12호
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• pp.685-688
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• 2017

장외영향평가의 정량적 위험성평가에 사용되는 ALOHA와 PHAST 프로그램으로 화학물질관리법상 사고대비물질로 지정하고 있는 염소의 누출 사고 시나리오를 가정하여 모델링 하였다. 연평균 기온, 풍속, 습도, 대기안정도를 변화시키면서 ERPG-2 농도에 해당하는 끝점거리를 산출하였으며, 산출된 끝점거리 값을 비교하여 각각의 기상요소와 끝점거리 간의 상관관계와 ALOHA와 PHAST의 장단점 분석하였다. 연구결과 ALOHA는 연평균 기온과 습도와의 상관관계는 없거나 작고, 풍속과 대기안정도와의 상관관계가 큰 것으로 조사되었다. PHAST의 경우 연평균 기온, 풍속, 습도, 대기안정도 모든 기상요소와의 상관관계가 있었으며, 그 중 대기안정도의 영향을 가장 크게 받는 것으로 조사되었다.

• 전산구조공학
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• 제7권2호
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• pp.89-99
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• 1994

본 연구는 국도및 고속도로상에 설치되어 있는 철제 오성방호책인 가아드레일의 동력학적 거동분석을 4개의 설계변수, 즉 보와 지주의 단면형상 충돌시의 차량속도, 충돌각도 및 차량중량에 따라 BARRIER VII프로그램을 사용하여 수행하였다. 컴퓨터 모의해석 프로그램인 BARRIER VII은 비교적 정교한 것으로 실제의 실물충돌시험 결과와 근접한 결과를 보여줄 뿐 아니라 경제적인 이유로 차량과 방호책의 상호작용을 해석하는데 실물충동시험 대신에 많이 사용된다. 본 연구의 주된 관심은 구조적 적합성, 탑승자 위험도와 차량의 궤적이라 할 수 있다. 이 목적을 위해 최대처짐 및 최대충격력이 계신되어 안전노변대 설계와 충격완화 효과를 분석하는데 사용된다. 본 연구의 결과로부터 도로상의 대형참사를 예방하기 위해서는 가아드레일의 설계기순을 보다 강화할 필요가 있다고 판단된다.

• Safety and Health at Work
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• 제7권1호
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• pp.6-11
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• 2016

Background: A permit to work (PTW) is a formal written system to control certain types of work which are identified as potentially hazardous. However, human error in PTW processes can lead to an accident. Methods: This cross-sectional, descriptive study was conducted to estimate the probability of human errors in PTWprocesses in a chemical plant in Iran. In the first stage, through interviewing the personnel and studying the procedure in the plant, the PTW process was analyzed using the hierarchical task analysis technique. In doing so, PTWwas considered as a goal and detailed tasks to achieve the goal were analyzed. In the next step, the standardized plant analysis risk-human (SPAR-H) reliability analysis method was applied for estimation of human error probability. Results: The mean probability of human error in the PTW system was estimated to be 0.11. The highest probability of human error in the PTW process was related to flammable gas testing (50.7%). Conclusion: The SPAR-H method applied in this study could analyze and quantify the potential human errors and extract the required measures for reducing the error probabilities in PTW system. Some suggestions to reduce the likelihood of errors, especially in the field of modifying the performance shaping factors and dependencies among tasks are provided.

• 한국방재안전학회논문집
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• 제15권4호
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• pp.71-78
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• 2022

최근 산사태나 토석류와 같은 산지재해가 계류를 따라 흘러와 주거지 및 도로를 덮치는 피해가 증가하고 있으며 본 연구에서는 산지재해의 피해 저감 및 원인 분석을 위하여 토석류 발생지역을 대상으로 현장 조사 및 지상 LiDAR 지형 분석을 수행하고 토석류 수치 모형인 FLO-2D 와 RAMM 모형을 이용하여 토석류 유동 과정을 시뮬레이션하였다. 그리고 토석류 퇴적 면적을 산정하고 실제 발생 구간과 비교 분석하였다. 지상 LiDAR 스캔 자료의 토석류 발생 구간 퇴적 면적은 대략 21,336 m²로 산정되었으며 FLO-2D 모의 결과 20,425 m², RAMMS 모형의 경우 19,275 m²로 분석되었다. 두 모형 모두 실제 발생 구간과 유사한 형태를 보였다. 구축된 지형자료는 재해 발생 위험지역의 안전성 확보를 위한 기초자료로 활용 가능할 것이다.

• 대한기관식도과학회지
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• 제16권2호
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• pp.121-125
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• 2010

Background: Penetrating neck injuries are potentially dangerous and require emergency management because of the presence of vital structures in the neck. The risk of airway, vascular, neurological, and pharyngoesophageal injuries leads to many difficult diagnostic decisions. The purpose of this retrospective study is to evaluate our experience with management of penetrating neck injuries, and to assess treatment outcome. Material and Method: Forty-two consecutive patients were identified (26 patients from Korea university Ansan hospital, 16 patients from Guro hospital) as having penetrating neck injuries from 2003 to 2009. With review of medical records, variables were collected and evaluated including the location of injury, mechanism of injury, number of significant injuries, diagnostic modalities, duration of hospital stay and outcome. Results: The location of injury was zone I (lower neck) in 13 cases (31%), zone II (midportion of the neck) in 22 (52%), and zone III (upper neck) in 7 (17%). Injuries were caused by stab wounds in 23 patients, penetrating foreign bodies in 12. Among 35 patients who had deep injuries that violated the platysma, significant injuries, including major vascular (20), trachea (5) Pharyngoesophageal injuries (5) were identified in 24 patients. The mean hospital stay was 9.5 days. Conclusion: The penetrating trauma in the neck may show various degrees of severity. However, Cervical penetrating injury should not be underestimated in spite of the minimal width of the lesion.

• Nutrition Research and Practice
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• 제15권sup1호
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• pp.32-40
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• 2021

BACKGROUND/OBJECTIVES: Considering the high number of deaths from coronavirus disease 2019 (COVID-19) in Latin American countries, together with multiple factors that increase the prevalence of vitamin D deficiency, we aimed to determine 25-hydroxyvitamin D (25[OH]D) levels and its association with mortality in patients with critical COVID-19. SUBJECTS/METHODS: This was a prospective observational study including adult patients with critical COVID-19. Data, including clinical characteristics and 25(OH)D levels measured at the time of intensive care unit admission, were collected. All patients were followed until hospital discharge or in-hospital death. The patients were divided into those surviving and deceased patient groups, and univariate and multivariate logistic regression analyses were performed to determine independent predictors of in hospital mortality. RESULTS: The entire cohort comprised 94 patients with critical COVID-19 (males, 59.6%; median age, 61.5 years). The median 25(OH)D level was 12.7 ng/mL, and 15 (16%) and 79 (84%) patients had vitamin D insufficiency and vitamin D deficiency, respectively. The median serum 25(OH)D level was significantly lower in deceased patients compared with surviving (12.1 vs. 18.7 ng/mL, P < 0.001). Vitamin D deficiency was present in 100% of the deceased patients. Multivariate logistic regression analysis revealed that age, body mass index, other risk factors, and 25(OH)D level were independent predictors of mortality. CONCLUSIONS: Vitamin D deficiency was present in 84% of critical COVID-19 patients. Serum 25(OH)D was independently associated with mortality in critical patients with COVID-19.