• Title/Summary/Keyword: Acceptable risk

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Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

  • Kshettry, Varun R.;Lobo, Bjorn;Lim, Joshua;Sade, Burak;Oya, Soichi;Lee, Joung H.
    • Journal of Korean Neurosurgical Society
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    • v.59 no.1
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    • pp.52-57
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    • 2016
  • Objective : Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods : We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results : Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion : When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

Monitoring and Risk Assessment of Carbendazim Residues in Soybean Sprout and Mungbean Sprout from Markets in Western Seoul (서울 강서지역 유통 콩나물 및 숙주나물중 카벤다짐 잔류실태 조사 및 위해성 평가)

  • Hwang, Lae-hong;Park, Sung-kyu
    • Journal of Food Hygiene and Safety
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    • v.34 no.4
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    • pp.348-353
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    • 2019
  • This study was conducted to monitor the carbendazim residues in soybean and mungbean sprouts using LC-MS/MS method. Eighty-two samples were collected from markets in western Seoul. No carbendazim was detected in mungbean sprouts, however, it was detected in 6 among 59 soybean sprout samples showing a 10.2% of detection rate. Among these 6 carbendazim- detected soybean sprout samples, five exceeded the maximum residue limit presenting 83.3% of violation rate. The mean concentration in the detected samples was 0.063 mk/kg (0.012 ~ 0.104 mg/kg) and 5 of the 6 detected samples came from bulk sold products. None of the samples came from domestic products; three were from imported products and 3 were from unidentified sources. Risk assessment for the carbendazim from soybean sprout dietary intake was deemed safe and at less than 1 %Acceptable Daily Intake.

Primary Chest Wall Sarcoma: Surgical Outcomes and Prognostic Factors

  • Park, Ilkun;Shin, Sumin;Kim, Hong Kwan;Choi, Yong Soo;Kim, Jhingook;Zo, Jae Ill;Shim, Young Mog;Cho, Jong Ho
    • Journal of Chest Surgery
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    • v.52 no.5
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    • pp.360-367
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    • 2019
  • Background: Primary chest wall sarcoma is a rare disease with limited reports of surgical resection. Methods: This retrospective review included 41 patients with primary chest wall sarcoma who underwent chest wall resection and reconstruction from 2001 to 2015. The clinical, histologic, and surgical variables were collected and analyzed by univariate and multivariate Cox regression analyses for overall survival (OS) and recurrence-free survival (RFS). Results: The OS rates at 5 and 10 years were 73% and 61%, respectively. The RFS rate at 10 years was 57.1%. Multivariate Cox regression analysis revealed old age (hazard ratio [HR], 5.16; 95% confidence interval [CI], 1.71-15.48) as a significant risk factor for death. A surgical resection margin distance of less than 1.5 cm (HR, 15.759; 95% CI, 1.78-139.46) and histologic grade III (HR, 28.36; 95% CI, 2.76-290.87) were independent risk factors for recurrence. Conclusion: Long-term OS and RFS after the surgical resection of primary chest wall sarcoma were clinically acceptable.

Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock

  • Kim, Younghwan;Cho, Yang-Hyun;Yang, Ji-Hyuk;Sung, Kiick;Lee, Young Tak;Kim, Wook Sung;Lee, Heemoon;Cho, Su Hyun
    • Journal of Chest Surgery
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    • v.52 no.2
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    • pp.70-77
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    • 2019
  • Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

Monitoring and Risk Assessment of Pesticide Residues in Pre-harvest Fresh Ginseng (Panax ginseng C. A. Meyer) in Chungbuk Province in 2019 (충북지역 생산단계 수삼 중 잔류농약 모니터링 및 위해성 평가(2019))

  • Song, Tae Hwa;Lee, Young Wook;Youn, Taek Han;Park, Eun A;Shim, Eun Sun;Lee, Ju Hee;Kyung, Kee Sung
    • Korean Journal of Environmental Agriculture
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    • v.40 no.2
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    • pp.118-126
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    • 2021
  • BACKGROUND: It is very important to monitor the residual characteristics of pesticides in pre-harvest fresh ginseng to ensure consumer safety. METHODS AND RESULTS: Forty-eight fresh ginseng samples were collected from 8 ginseng-growing fields 10 days before harvest and pesticide residues in fresh ginseng with and without rhizome (head of ginseng) and rhizome were analyzed for 320 pesticides by using GC-MS/MS and LC-MS/MS. As a result of the pesticide residue analysis, the number of pesticides detected from the fresh ginseng with rhizome, that without rhizome and rhizome were 26, 25, and 40, respectively, indicating that high number of pesticides found in rhizome, compared with the other parts. Pyraclostrobin was detected with the highest frequency in all samples, reaching to 21.2% in fresh ginseng with rhizome, 16.8% in that without rhizome, and 14.8% in rhizome. CONCLUSION: The residue levels of pesticides detected did not exceed their maximum residue limits, in spite of residual data in fresh ginseng before harvest. The amounts of the estimated daily intakes of all the detected pesticides were found to be from 0.018 to 1.818% of their acceptable daily intakes, indicating that concentrations of pesticides detected from fresh ginseng with and without rhizome collected before harvest do not pose the immediate health risks.

Percutaneous Dilatational Tracheostomy in Patients with COVID-19 Supported by Extracorporeal Membrane Oxygenation

  • JeongA Son;Seungji Hyun;Woo Sik Yu;Joonho Jung;Seokjin Haam
    • Journal of Chest Surgery
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    • v.56 no.2
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    • pp.128-135
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    • 2023
  • Background: Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO. Methods: This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea. Results: Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported. Conclusion: Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.

Long-Term Outcomes of Colon Conduits in Surgery for Primary Esophageal Cancer: A Propensity Score-Matched Comparison to Gastric Conduits

  • Jae Hoon Kim;Jae Kwang Yun;Chan Wook Kim;Hyeong Ryul Kim;Yong-Hee Kim
    • Journal of Chest Surgery
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    • v.57 no.1
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    • pp.53-61
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    • 2024
  • Background: In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis. Methods: A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020. Results: The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in longterm survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m2, neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical nastomosis was the only significant risk factor among those with a colon conduit. Conclusion: Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.

Positive Predictive Values of Abnormality Scores From a Commercial Artificial Intelligence-Based Computer-Aided Diagnosis for Mammography

  • Si Eun Lee;Hanpyo Hong;Eun-Kyung Kim
    • Korean Journal of Radiology
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    • v.25 no.4
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    • pp.343-350
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    • 2024
  • Objective: Artificial intelligence-based computer-aided diagnosis (AI-CAD) is increasingly used in mammography. While the continuous scores of AI-CAD have been related to malignancy risk, the understanding of how to interpret and apply these scores remains limited. We investigated the positive predictive values (PPVs) of the abnormality scores generated by a deep learning-based commercial AI-CAD system and analyzed them in relation to clinical and radiological findings. Materials and Methods: From March 2020 to May 2022, 656 breasts from 599 women (mean age 52.6 ± 11.5 years, including 0.6% [4/599] high-risk women) who underwent mammography and received positive AI-CAD results (Lunit Insight MMG, abnormality score ≥ 10) were retrospectively included in this study. Univariable and multivariable analyses were performed to evaluate the associations between the AI-CAD abnormality scores and clinical and radiological factors. The breasts were subdivided according to the abnormality scores into groups 1 (10-49), 2 (50-69), 3 (70-89), and 4 (90-100) using the optimal binning method. The PPVs were calculated for all breasts and subgroups. Results: Diagnostic indications and positive imaging findings by radiologists were associated with higher abnormality scores in the multivariable regression analysis. The overall PPV of AI-CAD was 32.5% (213/656) for all breasts, including 213 breast cancers, 129 breasts with benign biopsy results, and 314 breasts with benign outcomes in the follow-up or diagnostic studies. In the screening mammography subgroup, the PPVs were 18.6% (58/312) overall and 5.1% (12/235), 29.0% (9/31), 57.9% (11/19), and 96.3% (26/27) for score groups 1, 2, 3, and 4, respectively. The PPVs were significantly higher in women with diagnostic indications (45.1% [155/344]), palpability (51.9% [149/287]), fatty breasts (61.2% [60/98]), and certain imaging findings (masses with or without calcifications and distortion). Conclusion: PPV increased with increasing AI-CAD abnormality scores. The PPVs of AI-CAD satisfied the acceptable PPV range according to Breast Imaging-Reporting and Data System for screening mammography and were higher for diagnostic mammography.

Acute and Chronic Exposure Assessment of Organophosphate Pesticides through the Consumption of Fruit Vegetables (과채류 섭취를 통한 유기인계 농약의 급성 및 만성노출평가)

  • Park, Byung-Jun;Gil, Keun-Hwan;Son, Kyeong-Ae;Im, Geon-Jae;Yoon, Hyunjoo;Park, Kyung-Hun;Kim, Doo-Ho;Ihm, Yangbin;Paik, Min-Kyoung
    • The Korean Journal of Pesticide Science
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    • v.18 no.2
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    • pp.95-103
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    • 2014
  • In this study, we monitored the residues of organophosphate pesticides (OP) in eight fruit vegetables grown in Korea, and assessed risk levels of acute and chronic exposure of OP through the consumption of fruit vegetables. Chlorpyrifos, EPN, methidathion and phosphamidon in eight fruit vegetables were detected in this study. The results of cumulative assessment of national estimated short term intake for acute exposure of OP were due to the following order; eggplant, tomato, squash and cucumber. Total theoretical maximum daily intake calculated at first step of chronic exposure assessment for registered OP in Korea was 76.14%, compared with acceptable daily intake ADI) based on chlorpyrifos. In addition, total national estimated maximum daily intake calculated at second step of chronic exposure assessment was 13.949%, compared with ADI. Third chronic assessment was conducted by probabilistic approach using OP residues detected in eight fruit vegetables and showed that total exposure risk was very low, corresponding to 0.0001% compared to ADI. Based on those finding, the risk of organophosphate pesticides in fruit vegetables was considered quantitatively negligible. In future, further investigation to expand the target should be followed to do more accurate and detailed risk assessment.

Skipping breakfast is associated with diet quality and metabolic syndrome risk factors of adults

  • Min, Chan-Yang;Noh, Hwa-Young;Kang, Yun-Sook;Sim, Hea-Jin;Baik, Hyun-Wook;Song, Won-O.;Yoon, Ji-Hyun;Park, Young-Hee;Joung, Hyo-Jee
    • Nutrition Research and Practice
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    • v.5 no.5
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    • pp.455-463
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    • 2011
  • The aim of the present study was to assess the effects of skipping breakfast on diet quality and metabolic disease risk factors in healthy Korean adults. Subjects included 415 employees (118 men, 297 women; 30-50 years old) of Jaesang Hospital in Korea and their acquaintances. Data collected from each subject included anthropometric measurements, 3-day dietary intake, blood pressure, and blood analyses. The subjects were classified into three groups based on the number of days they skipped breakfast: 'Regular breakfast eater', 'Often breakfast eater', or 'Rare breakfast eater'. Participants in the 'Rare breakfast eater' group consumed less rice, potatoes, kimchi, vegetables, fish and shellfish, milk and dairy products, and sweets than did participants in the other two groups (P for trend <0.05) and ate more cookies, cakes, and meat for dinner (P for trend <0.05). Participants in the 'Rare breakfast eater' group consumed less daily energy, fat, dietary fiber, calcium, and potassium than did participants in the other groups (P for trend <0.05). The percent energy from carbohydrates was lower and fat intake was higher in the 'Rare breakfast eater' group than in the other groups (P for trend <0.01). When diets were compared using the Acceptable Macronutrient Distribution Range for Koreans, 59.1% of subjects in the 'Rare breakfast eater' group consumed more energy from fat compared with the other two groups (P <0.005). According to the Estimated Average Requirements for Koreans, intake of selected nutrients was lower in the 'Rare breakfast eater' group than in the other two groups (P <0.05). The risk of elevated serum triglycerides was decreased in the 'Rare breakfast eater' group (OR, 0.3 [0.1-1.0], P for trend=0.0232). We conclude that eating breakfast regularly enhances diet quality, but may increase the risk of elevated serum triglycerides.