• 한국환경복원기술학회지
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• 제13권2호
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• pp.114-123
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• 2010

The Environmental Conservation Value Assessment Map (ECVAM) is a five grade assessment map created with nationally integrated environmental information and environmental values. The map is made through the evaluation of 67 items, including greenbelt area and bio-diversity. The ECVAM assesses the stability of the community using forest maps. However, the existing assessment method is problematic because the assessment grades are evaluated using higher than practical values; in part because it uses even-valued overlay and minimal indicator methods. This study was performed in order to suggest an integrated assessment method that could complement the stability evaluation based on existing methods. Accordingly, this study added forest type information, including whether the forest was natural or artificial, to the overlay method using forest diameter maps and forest density maps. As a result, the proposed ECVAM indicated a drastic grade change. After applying the method in South Korea, Grade I areas decreased 12.1%, from 52.6% to 40.6%, Grade II areas increased 11.9%, from 17.4% to 29.2%, and Grade III areas increased 0.2%, from 17.1% to 17.4%, respectively. From the results of the field survey, we found differences between natural forest and planted forest with regard to the number of mortality, species of shrubs, and vine cover. This means that natural forests are more stable than planted forests. This study suggests an improved assessment methodology to complement the existing EVCAM method. The results are expected to be used in environmental evaluations and forest conservation value assessments in ecology and environmental fields.

• Tuberculosis and Respiratory Diseases
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• 제46권1호
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• pp.82-88
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• 1999

Herpes simplex virus pneumonia in immunocompromised host is difficult to diagnose with non-invasive method, and has high mortality rate. Because early diagnosis and early treatment can significantly decrease the mortality rate, the enthusiastic efforts for the early diagnosis should be done. A 41-year-old woman who took prednisolone due to mixed connective tissue disease developed gradually increasing dyspnea with radiological features of interstitial lung disease. Initially, we treated her with empirical antibiotics, but failed to improve her dyspnea. So we performed bronchoalveolar lavage and open lung biopsy. Open lung biopsy specimen showed herpes simplex virus pneumonia. Herpes simplex virus was also isolated from bronchoalveolar lavage fluid. There was both clinical and radiological improvement after treatment with acyclovir for 14 days.

• Journal of the Korean Data and Information Science Society
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• 제28권2호
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• pp.271-286
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• 2017

본 논문은 우리나라 생명보험산업의 장수리스크에 대한 자연헤지가 충분히 이루어지고 있는가를 평가해 보았다. 연금보험과 종신보험 준비금 계산 시 사망률 모형으로는 Lee-Carter 모형을 적용하였다. 사망률 개선 시나리오로는 연금보험과 종신보험 사망률이 모두 10%와 20% 개선되는 경우, 50세 이하 저연령 사망률은 10% 개선되고, 50세 이상 고연령 사망률은 20% 개선되는 경우, 마지막으로 연금보험 사망률은 20% 개선되지만 종신보험 사망률은 10% 개선되는 등 네 가지 시나리오를 살펴보았다. 분석결과 연금보험과 종신보험에 동일한 사망률 충격을 가하는 경우와 고연령의 사망률 개선이 저연령에 비해 빠르게 나타나는 경우 모두 연금보험과 종신보험 준비금의 합은 감소하는 것으로 나타났다. 네 번째 시나리오에서만 전체 준비금은 증가하였으나, 이 경우에도 연금보험 준비금 증가의 60% 이상이 자연헤지에 의해 상쇄하는 것으로 나타났다. 따라서 우리나라 생명보험산업의 장수리스크는 자연헤지를 통해 충분히 관리되고 있다고 판단된다.

• Journal of Chest Surgery
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• 제19권1호
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• pp.50-57
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• 1986

Sixty-nine patients with various types of cyanotic congenital heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene [PTFE] prosthesis between 1979 and 1985. Their ages ranged from 2 months to 39 years [mean$\pm$SD: 5.2$\pm$7.4, median: 3.3 years]. Diagnosis included the following: Tetralogy of Fallot, 45: Double outlet right or left ventricle, 11: Single ventricle, .5: Transposition of great vessels, 4: Tricuspid atresia, 3 and Pulmonary atresia with intact ventricular septum, 1. Forty-eight patients had subclavian-pulmonary artery anastomosis, 12 patients aorta-right pulmonary artery anastomosis, 6 patients aorta-main pulmonary artery anastomosis, and 3 patients descending aorta-pulmonary artery anastomosis. The PTEE graft of 3 mm in diameter was used in 1, 4 mm in 29, 5 mm in 35 and 6 mm in 4 patients. Ten patients were died within 30 days after operation [mortality rate: 14.5%]. Among them, 6 patients were operated in urgency due to cardiac arrest or severe anoxic spell after cardiac catheterization, and so surgical mortality of elective operation is 9.5%. The 59 survivors showed improvement of the arterial oxygen saturation [65.4% - 9.8%] and hemoglobin [18.8 gm/dl - 16.0 gm/dl] values [V<0.01]. The follow up period ranged from 1 month to 67 months, [752 patient-months] and during this periods there were 4 late shunt failures after 3 months postoperatively with 4 mm graft, and 2 with 5 mm graft. The over-all patency rate of 4 mm PTFE was 85.9$\pm$9.2% [SEM] in 12 months and 40.9$\pm$22.5% in 24 months. The over-all patency rate of 5 mm PTFE was 87.5$\pm$9.6% in 12 months and 58.3$\pm$24.6% in 36 months. The lowest systolic pressure in death group was 64.9$\pm$15.0 mmHg and in survival group, 86.4$\pm$12.1 mmHg [P<0.001]. We think that the PTFE graft is useful in palliative shunt operation, but the effectiveness of the 4 mm PTFE graft may be limited. The blood pressure also may play an important role in patency of Prosthesis.

• Journal of Chest Surgery
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• 제19권1호
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• pp.75-82
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• 1986

The use of the Angell-Shiley porcine xenograft cardiac valve was limited in number at Seoul National University Hospital chiefly because of the cessation of supply from the manufacturer, Forty-eight Angell-Shiley valves along with the 5 other mechanical or tissue valves were used in 46 patients during the period from 1977 to 1980, and a total of consecutive cases was studied for their early and long-term clinical results. The operative mortality rate was 4.3%; no death after single and 2 deaths after double valve replacement within 30 days of surgery. The 44 early survivors were followed up for a total of 171.6 patient-years and a mean of 46.8$\pm$31.1 months. Four died during the follow-up period with a linealized late mortality rate of 2.33%/patient-year. Four patients had experienced 5 episodes of thromboembolism and one died; a linealized incidence of 2.91% emboli/patient-year. A single case each had a bleeding complication related to the anticoagulants, 0.58% bleeding/patient-year, and prosthetic valve endocarditis, 0.58% endocarditis/patient-year. The clinical improvement was excellent by 70% of the survivors having no cardiac symptoms at the end of the follow-up. The actuarial survival rates were 89.9$\pm$4.9% at 5 years and 69.2$\pm$15.0% at 9 years after surgery. The probabilities of freedom from thromboembolic complication were 92.3$\pm$5.5% and 80.9$\pm$9.0% at 5 and 9 years after surgery. And, the probability of freedom from overall valve failure was 83.4$\pm$6.3% at 5 years and it declined sharply down to 55.9$\pm$22.2% at 9th year of the follow-up. These results are comparable with those in the major reports, except a more accelerated and time-related increases in valve failure after 5 or 6 years after operation with the Angell-Shiley valve. The durability of the xenograft tissue valve remains as the most important debate and the need of more durable tissue valves was also discussed.

• 한국어병학회지
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• 제23권3호
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• pp.409-420
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• 2010

Effects of various concentrations of garlic powder and garlic extract in the diets on growth, serum chemistry and immune response of olive flounder were determined. Thirty-five juvenile fish averaging 5.1 g were randomly distributed into 21 of 180 L flow-through tanks. Seven experimental diets with various concentrations of garlic powder (GP) and garlic extract (GE) were prepared in triplicate: GP-0 without garlic supplementation, GP-0.5, GP-1, GP-2, GP-3 and GP-5 diets containing garlic powder at the concentrations of 0.5, 1, 2, 3 and 5%, respectively at the expense of wheat flour and finally, GE-0.4 diet containing 0.4% garlic extract were prepared. At the end of the 8-week feeding trial, serum chemistry of fish was measured. In addition, twenty fish from each tank were artificially infected with E. tarda for the following 96 h to monitor cumulative mortality. Weight gain of fish fed GP-0 diet was higher than that of fish fed GP-1, GP-2, GP-3 and GP-5 diets. No difference in serum criteria (total protein, glucose, glutamate oxaloacetate transaminase, cholesterol and triglyceride levels) of olive flounder was found among the experimental diets except for glutamate pyruvate transaminase. Lysozyme activity of fish fed GP-0, GP-1, GP-3 and GE-0.4 diets was higher than that of fish fed GP-5 diet. The highest cumulative mortality was 93.3% in fish fed GP-0 diet at 96 h after E. tarda infection, followed by GP-3, GP-1, GP-5, GP-2, GP-0.5 and GE-0.4 diets. In considering these results, dietary inclusion of garlic powder and garlic extract has no distinctive positive effect on improvement in growth, serum chemistry and immune response of olive flounder in this experimental conditions, therefore, its application should be carefully considered.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.173-180
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• 2022

Purpose: The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population-as the highest-risk population-may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States. Methods: The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65-79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy. Results: Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF. Conclusions: By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.

• 한국의료질향상학회지
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• 제10권1호
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• pp.28-41
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• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• 사상체질의학회지
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• 제25권4호
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• pp.432-441
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• 2013

Objectives Despite the treatment with antibiotics, patients with sepsis has a high mortality (80%) in the underlying disease group. The aim of this study was to report the improvement of septic condition of the cholangiocarcinoma patient after the treatment with Handayeolso-tang, Fel Tauri, and antibiotics. Methods We retrospectively reviewed the medical records. The patient's subjective symptoms such as chilling and abdominal pain were evaluated by NRS and the performance status was evaluated by ECOG. This case was literally compared with relevant published studies on prognosis of sepsis. Results Despite poor prognostic factor(MEDS score 18), the patient's symptoms such as fever, chilling, abdominal pain, and diarrhea and ECOG(Eastern Cooperative Oncology Group) improved. The patient was hemodynamically stabilized on 3rd day from the treatment, and her laboratory test results were normalized on 7th day. Conclusions A female patient of metastatic cholangiocarcinoma came to the hospital for cholangitis, later causing septic shock. Both her symptoms and laboratory tests showed significant improvement after the treatment of antibiotics, Handayeolso-tang and Fel Tauri. To our knowledge, this is the first case reporting the synergistic combination of Korean oriental medicine and Western medicine approaching to sepsis.

• Clinical and Experimental Pediatrics
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• 제61권8호
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• pp.239-244
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• 2018

Purpose: Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. Methods: The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above $23.0^{\circ}C$, and a check-list was used for feedback. Results: Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <$36.0^{\circ}C$) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from $35.5^{\circ}C$ to $36.0^{\circ}C$. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from $35.4^{\circ}C$ to $35.9^{\circ}C$ and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. Conclusion: Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.