• Archives of Plastic Surgery
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• 제48권2호
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• pp.165-174
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• 2021

Background In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness. Methods The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed. Results The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation. Conclusions In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.

• Advances in concrete construction
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• 제14권3호
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• pp.153-167
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• 2022

The interaction between blast load and structures, as well as the interaction among structural members may well affect the structural response and damages. Therefore, it is necessary to analyse more realistic reinforced concrete structures in order to gain an extensive knowledge on the possible structural response under blast load effect. Among all the civilian structures, columns are considered to be the most vulnerable to terrorist threat and hence detailed investigation in the dynamic response of these structures is essential. Therefore, current research examines the effect of blast loads on the reinforced concrete columns via development of Pressure- Impulse (P-I) diagrams. In the finite element analysis, the level of damage on each of the aforementioned RC column will be assessed and the response of the RC columns when subjected to explosive loads will also be identified. Numerical models carried out using LS-DYNA were compared with experimental results. It was shown that the model yields a reliable prediction of damage on all RC columns. Validation study is conducted based on the experimental test to investigate the accuracy of finite element models to represent the behaviour of the models. The blast load application in the current research is determined based on the Lagrangian approach. To develop the designated P-I curves, damage assessment criteria are used based on the residual capacity of column. Intensive investigations are implemented to assess the effect of column dimension, concrete and steel properties and reinforcement ratio on the P-I diagram of RC columns. The produced P-I models can be applied by designers to predict the damage of new columns and to assess existing columns subjected to different blast load conditions.

• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1173-1179
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• 2007

The diagnosis of juvenile rheumatoid arthritis (JRA) is based on patient's age at disease onset, symptom duration, gender, and clinical manifestations. JRA is of unknown origin, begins under the age of 16, and persists for a minimum of 6 weeks. JRA is categorized into three principal types, systemic, oligoarticular and polyarticular. Infection, other connective tissue diseases, malignancy, trauma, and immunodeficiency are discussed as differential diagnoses for JRA. Because of joint damage, focusing on early diagnosis and intervention, a vigorous initial therapeutic approach must be taken in patients who have poor prognostic factors. A multidisciplinary team approach is also important for the care of patients with JRA.

• Journal of Preventive Medicine and Public Health
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• 제40권6호
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• pp.447-453
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• 2007

Although the New National Health Promotion Plan 2010 target to reduce health inequalities, whether the program will be effective for reducing the health inequalities in Korea remains quite unclear. More and more developed countries have been started to concentrate on comprehensive policies for reducing health inequalities. The health policies of the UK, Netherlands, and Sweden are the most wellknown. I propose that a comprehensive blueprint for tackling health inequalities in Korea should be made and that it must contain five domains: a target, structure and process, life-course approach, area-based approach, and reorganization of health care resources. The target should be based on determinants of health and more attention should be paid to socioeconmic factors. The structure and process require changes from the national health care policy based on medical services to the national health policy that involves the establishment of a Social Deputy?Prime Minister and the strengthening multidisciplinary action. A life-course approach especially focused on the early childhood years. Area-based approach such as the establishment of healthy communities, healthy schools, or healthy work-places which are focused on deprived areas or places is also required. Finally, health care resources should be a greater investment on public resources and strengthening primary care to reduce health inequalities. The policy or intervention studies for tackling health inequalities should be implemented much more in Korea. In addition, it is essential to have political will to encoruage policy action.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.652-655
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• 2022

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

• Korean Journal of Radiology
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• 제23권7호
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• pp.732-741
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• 2022

Objective: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. Materials and Methods: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician's initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT's consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. Results: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (odds ratio, 4.48; p = 0.017). Conclusion: MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

• Journal of Ecology and Environment
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• 제47권4호
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• pp.228-240
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• 2023

Growing complexity in ecosystem structure and functions, under impacts of climate and land-use changes, requires interdisciplinary understandings of processes and the whole-system, and accurate estimates of the changing functions. In the last three decades, observation networks for biodiversity, ecosystems, and ecosystem functions under climate change, have been developed by interested scientists, research institutions and universities. In this paper we will review (1) the development and on-going activities of those observation networks, (2) some outcomes from forest carbon cycle studies at our super-site "Takayama site" in Japan, and (3) a few ideas how we connect in-situ and satellite observations as well as fill observation gaps in the Asia-Oceania region. There have been many intensive research and networking efforts to promote investigations for ecosystem change and functions (e.g., Long-Term Ecological Research Network), measurements of greenhouse gas, heat, and water fluxes (flux network), and biodiversity from genetic to ecosystem level (Biodiversity Observation Network). Combining those in-situ field research data with modeling analysis and satellite remote sensing allows the research communities to up-scale spatially from local to global, and temporally from the past to future. These observation networks oftern use different methodologies and target different scientific disciplines. However growing needs for comprehensive observations to understand the response of biodiversity and ecosystem functions to climate and societal changes at local, national, regional, and global scales are providing opportunities and expectations to network these networks. Among the challenges to produce and share integrated knowledge on climate, ecosystem functions and biodiversity, filling scale-gaps in space and time among the phenomena is crucial. To showcase such efforts, interdisciplinary research at 'Takayama super-site' was reviewed by focusing on studies on forest carbon cycle and phenology. A key approach to respond to multidisciplinary questions is to integrate in-situ field research, ecosystem modeling, and satellite remote sensing by developing cross-scale methodologies at long-term observation field sites called "super-sites". The research approach at 'Takayama site' in Japan showcases this response to the needs of multidisciplinary questions and further development of terrestrial ecosystem research to address environmental change issues from local to national, regional and global scales.

• 한국컴퓨터정보학회논문지
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• 제17권11호
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• pp.197-206
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• 2012

본 연구는 21세기에 필요한 핵심적인 학습 능력을 연구하고 미래사회 국가 발전에 필요한 핵심 인력을 양성하는데 있다. '21세기 학습 능력 프로젝트'는 학습자의 학습 능력과 개인 사회적으로 가치 있는 주제를 중심으로 기존 지식과 학문을 다학문적, 통합적으로 접근하는 것이다. 국내에서도 학습 능력 배양을 위한 다양한 교과 간 통합 교육과정의 시도가 있었으나 각 교과의 내용과 특성의 차이를 충분히 이해하여 효과적으로 교수할 수 있는 교사가 부족하고 현장에서 쉽게 적용하는데 어려움이 있다. 이에 본 연구는 21세기에 필요한 학습 능력 신장을 위해 학문의 지식을 통합하는 다학문적 맞춤형 교육과정을 개발하고 이를 효율적으로 지원하기 위해 교육과정 실태를 분석 연구하고 그 결과로 초 중등학교에 적용할 수 있는 다학문 맞춤형 학문 통합 모형을 제안한다.

• 한국콘텐츠학회논문지
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• 제10권1호
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• pp.286-294
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• 2010

복합부위통증증후군은 외상, 신경 손상, 골절, 뇌졸중, 척수 손상과 수술 등에 의해 부적합하게 발생하는 만성 신경병성 통증증후군으로, 질환의 경과, 치료법 등 모든 면에서 생물심리사회적 요인의 영향을 받는다. 작업치료에서는 생물학적, 심리적, 사회적 요소를 고려한 다학제적인 치료적 접근이 유용할 것이다. 생물학적 치료는 모든 영역에서의 독립성을 향상시키기 위해 사지의 기능적 사용을 증가시키는 것이다. 심리적 치료는 이완/바이오피드백 훈련과 인지행동치료를 제공하고, 사회적 치료는 레크리에이션 치료와 직업 재활을 실시할 수 있다. 복합부위통증증후군에 대한 작업치료는 다양한 전문 분야의 협조적인 치료과정을 통해 기능 회복과 통증 관리, 심리적 요인들의 회복을 이끌어 내야 할 것이다.

• 대한청각학회지
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• 제25권1호
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• pp.49-54
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• 2021

Type II mucopolysaccharidosis (MPS II) commonly known as Hunter syndrome, is a rare X-linked lysosomal storage disorder caused by iduronate-2-sulfatase deficiency, which in turn causes otorhinolaryngological manifestations, including sensorineural hearing loss (SNHL). Previously, the median survival age of patients with MPS was approximately 13.4 years. However, in the era of enzyme replacement therapy and other multidisciplinary care modalities, the life expectancy has increased. Herein, we report a rare case of an adolescent with MPS II who underwent SNHL treatment with cochlear implantation (CI). Based on unexpected findings of mastoid emissary veins and overgrowth of the vessels around the temporal bone, CI was performed using the transmeatal approach instead of the conventional transmastoid method, to avoid damage to the vessels. The average hearing threshold after CI was 35 dB and no surgical complications were encountered. Adolescent MPS II may present vessel abnormalities, which can reduce the success rate of surgery. In patients with MPS II with SNHL, CI should be performed under careful monitoring of vessel overgrowth. Moreover, with regard to feasibility of CI in adolescent patients with MPS II with SNHL, surgical techniques such as the transmeatal approach should be selected based on adequate assessment of the case.