• Journal of Chest Surgery
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• 제49권3호
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• pp.165-170
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• 2016

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

• 한국수자원학회논문집
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• 제47권10호
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• pp.891-906
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• 2014

본 연구는 수계관리 측면에서 물 공급의 기준이 되는 하류 제어지점에서 발생할 수 있는 물 부족을 최소 허용하면서 저수지군 최적 운영방안을 제공할 수 있도록 위험도 평가기준을 목적함수 및 제약조건에 반영한 hedging rule을 혼합정수계획법(MIP, Mixed Integer Programming)으로 구성하고 이에 대한 이행도를 분석함으로써 기존의 용수공급 신뢰도에 중점을 두었던 저수지군 최적 운영 분석기법을 개선하고자 하였다. 이를 위해 한강수계 5개 저수지(소양강댐, 충주댐, 화천댐, 청평댐, 팔당댐)군을 대상으로 수계관리를 위한 모형을 구축하였으며, 한강수계 내에 총 8개의 가상 제어지점을 구성하여 댐 하류 제어지점에서의 물 부족에 대해 위험도를 평가하였으며, 개발된 hedging rule의 적정성을 검증하기 위하여 2개의 유입량 계열('93. 1월~'97. 12월, '99. 1월~'03. 12월)에 대하여 적용 검토하였다. 팔당댐 하류 제어지점의 월별 최소유량을 비교하면 '93. 1월~'97. 12월의 모의기간에서는 hedging rule 적용 시 $317.5{\times}10^6m^3$으로 단독운영의 $310.6{\times}10^6m^3$, 연계운영의 $56.3{\times}10^6m^3$ 보다 많은 유량을 보였으며, '99. 1월~'03. 12월의모의기간에서도 hedging rule 적용시 $243.7{\times}10^6m^3$ 으로 단독운영의 $204.2{\times}10^6m^3$, 연계운영의 $111.2{\times}10^6m^3$에 비해 최소 유량이 많은 것을 확인하였으며, 이는 제안한 hedging rule에 의해 하류 제어지점에서의 최대 물 부족량이 감소하는 결과를 보여주고 있다.

• 간호행정학회지
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• 제6권3호
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• pp.333-345
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• 2000

The health care environment becomes more competitive every day. It has fallen to nurse managers - from vice presidents of patient care to nurse managers and their assistants - to recruit and develop a workforce that successfully meets the needs of both patients and the organization. This means employees who demonstrate advanced critical thinking skills, creative problem solving, and sound decision making skills combined with clinical skills and patient advocacy. The environment which nurse managers create and the way they relate to their workforce, are pivotal to organizational viability. Especially leadership of first -line nurse managers contributes to the success of their organizations. First-line nurse managers are deserved to be one of the most administrative supervisors through the middle stratum in a hospital organization as being a manager in the field service if assessed from the overall aspects of hospital, as being an interim managers in the nursing department as well as being a supreme supervisor in a unit in terms of an organizational structure in the hospital. Similarly, as a compete leader, the first-line nurse managers have not only a professional which is qualified to perform a role of appropriate coordination with medical staff and key personnel but also hold an important key position a being responsible for performing his or her given role. The first-line nurse manager is expected to manage human and fiscal resources in ways not required before. While an identified need for well-prepared first-line nurse manager continues to plague the profession, first-line nurse managers often have difficulty providing the leadership required. The need leadership training to function effectively in their positions. But we hardly find a useful leadership training program for first-line nurse managers, therefore the purpose of this study was to developed the leadership training program for them. The steps of leadership program development were below: 1st step, 2 studies were done before develop a leadership program. One was done to ask to first-line nurse managers what they want to learn through leadership training, the other one was to ask the staff nurses what their opinions are for their first-line nurse managers leadership. 2nd step was searching other leadership programs contents. The results of this study were below: The total amount of hours is 24. Leadership training program contents are : Future of nursing profession (210min), understanding basic factor's of leadership and leadership theories(310 min), self understanding as first- line nurse managers(320 min), basic principle and practice of interpersonal relationship(210 min), assertiveness training, conflict management (180min), and group study(210min). This is challenging time to be a leader, especially in nursing. As nurse managers look toward the new millennium, it seems as through the same struggles are ahead that are behind. So nurse managers need to embrace change with a positive attitude. They need to demonstrate risk taking and support it in their staffs. All these things are possible that after they participate the leadership training program.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.443-449
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• 2015

Background: Myeloproliferative disorders (MPDs) are clonal hematologic malignancies originating at the level of the pluripotent hematopoietic stem cell. Matrix metalloproteases (MMPs) are proteolytic enzymes that contribute to all stages of malignancy progression. Genetic variants in the MMP genes may influence the biological function of these enzymes and change their role in carcinogenesis and progression. To our knowledge, this is the first investigation of associations between the -735 C/T and -1562 C/T polymorphisms in the MMP2 and MMP9 genes, respectively, and the risk of essential thrombocytosis (ET), and polycythemia vera (PV). Materials and Methods: The case-control study included JAK2V617F mutation positive 102 ET and PV patients and 111 controls. Polymorphisms were determined by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and electrophoresis. Results: No statistically significant differences were detected between patient (ET+PV) and control groups regarding genotype distribution for MMP2 gene-735 C/T and MMP9 gene -1562 C/T polymorphisms and C/T allele frequency (p>0.050). Statistically borderline significance was observed between PV and control groups regarding genotype distribution for the MMP9 gene -1562 C/T polymorphism (p=0.050, OR=2.26, 95%Cl=0.99-5.16). Conclusions: Consequently this study supported that CC genotype of MMP9 gene -1562 C/T polymorphism may be related with PV even if with borderline significance.

• 기본간호학회지
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• 제4권1호
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• pp.43-60
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• 1997

This study was to identify the nursing intervention method in finding out the incidence, risk factor, prevention and treatment of bed sore cilents who received regional home care nursing services. The eleven home care nurse practitioners took the survey on 97 patients who received home care nursing service from Seoul City Nurses Association for one month from September 26 to October 26 1996. A modified version of Braden's bed sore assessment tool for bed sore risks and a tool for assessment of bed sore stage and measurement bed sore sizes by Bergstrom, Braden, Laguzza and Holman(1987) were as research tools for this study and a questionnare with 40 questions and 12 items on nursing activities was used to find out the prevention and treatment of bed sores. Also, two open ended questions were used on current approaches and efforts of the treatment being applied to clients. The finding of the study were summarized as following : 1. The rate of bed sore occurrence was 47.4% 2. The areas of bed sore occurrence were hip(28.9%), sacrum(18.6%), great trochanter(14.4%) and the average number of sore spots were 2.26 3. Two groups-one with bed sores and the other without-were studied to determine prediction factors for bed sore risks. Sensory function, humidity, level of activity, mobility, nutrition, skin friction and chapping and body temperature turned out to be statistically significant factors for bed sores. Also the age of clients turned out to be a individual characteristic variable significantly affecting the rate of bed sore occurrences. 4. The education for clients and family on systematic skin assessment and bed sores and practice of active/passive R.O.M. are mainly used as nursing activities for bed sore care. 5. The treatment method varied by stages of bed sores. Sometimes folk remedies like applying the powders of dried elm tree roots to sores were used. Good nutrition, frequent position change and skin care turned to be the most effective means to fast recovery of sores.

• 대한소아치과학회지
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• 제41권1호
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• pp.40-46
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• 2014

Treacher collins 증후군(TCS)는 25,000명에서 50,000명당 1명의 빈도로 발생하는 상염색체우성의 유전질환이다. 상, 하악의 발육 부전, 부정교합, 양측성 이개 기형, 안검렬의 반몽고증 사면, 구순구개열, 외이도 폐쇄, 중이와 내이의 기형으로 인한 청각 소실등의 구강악안면 부위의 특징을 보여 태생 이후 성인기에 이르기까지 여러 차례에 걸친 외과적 수술을 거치게 된다. 하악골의 형성저하로 하악골이 짧고 후방 위치되며 후방 위치하는 혀와 후비공의 협착과 폐쇄로 인해 상기도가 좁아지게 되는데 이로 인해 기관삽관의 어려움이 따른다. 따라서 치근 발육이 미약한 소아청소년 시기의 TCS 환자의 기관 삽관 시 상악 전치부의 손상 가능성이 매우 높다. 본 증례는 전신마취 유도를 위한 기관 삽관 도중 상악 전치의 완전 탈구가 발생한 TCS 환아의 치험례를 통해 기도 삽관 시사전의 마우스가드 제작의 유용성에 대하여 알리고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제70권6호
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• pp.474-481
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• 2011

Background: Chronic obstructive pulmonary disease (COPD) is characterized by air low limitation, which is one of the leading causes of mortality worldwide. There have been many studies on survival rates in the world literature, but there have been few reports regarding the survival rate in Korean patients with COPD. Acute exacerbation is regarded as a risk factor for mortality in patients with COPD. The purpose of this study was to investigate the survival rate and the effect of acute exacerbations on the survival rate of Korean patients with COPD. Methods: A total of 502 COPD patients who were diagnosed on the basis of history and lung function tests were enrolled in this study. The frequency of acute exacerbations, body mass index (BMI), C-reactive protein (CRP) and pulmonary hypertension were analyzed. Results: The 3- and 5-year survival rates were 98% and 83%, respectively. The median survival time was 78 months. The median survival time was 55 months in 322 patients with one or more acute exacerbations. The 3- and 5-year survival rates were significantly lower in the 322 patients with one or more acute exacerbations than in those without any. The mortality rate was significantly higher in patients with CRP>3 mg/L than in those with CRP ${\leq}3$ mg/L (p<0.005); it was significantly higher in patients with pulmonary hypertension than in those without it (p<0.01). Conclusion: Because the 5-year survival rate is 83% in Korean patients with COPD, the management of stable patients with COPD should focus on the prevention of acute exacerbations.

• 기업가정신과 벤처연구
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• 제19권3호
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• pp.1-16
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• 2016

한국 정부는 효과적인 경기대응 수단으로 공적보증을 이용해 왔다. 그러나 공적보증과 같은 중소기업에 대한 정책금융의 효과성에 대해서는 아직 논란이 해소되지 않았다. 비판적인 견지에서 보면 정책금융이 오히려 중소기업의 정부에 대한 의존도만 증가시켜 기업 스스로의 경쟁과 혁신을 방해하고 한계기업의 퇴출을 지연시킨다는 논리이다. 따라서 이 논문은 공적보증시스템의 운영은 어떻게 자리 잡아야 하며, 동시에 시장기반 중소기업 금융시스템과 어떻게 공존해 나가야 하는지에 대해 구체적 의견을 제시하고 있다. 첫째, 공적보증은 민간금융시장의 경기 순응적 행태가 초래하는 시장실패를 보완하기 위한 경기대응수단으로 이용되어야 하며, 정부, 국회, 납세자를 포함하는 이해관계자들과 이에 대한 인식을 공유해야 한다. 공적보증기관의 목적은 이윤추구가 아니라 성장 가능성이 높은 중소기업을 선별하여 지원하는 공공성의 확보에 있음을 명확히 할 필요가 있다. 둘째, 공적보증은 자금을 필요로 하는 중소기업에게 직접적으로 유동성을 공급해 줌으로써 단기간에 경기를 회복시킬 수 있는 대증적 처방이라는 점에서 한국은행의 이자율정책의 효과가 낮을 때 사용할 수 있는 중요한 정책대안이다. 특히 공적보증은 자본금에 근거한 운용배수 범위 내에서 공급이 이루어지므로 정부재정 정책 시 우려되는 재정적자의 위험으로부터 상대적으로 자유롭다는 장점을 지닌다. 셋째, 공적보증의 존재는 창업기업, 성장기업, 생산성 향상, 수출향상, 장기시설투자, 고용창출 사업, 그리고 혁신기업 지원과 같이 민간은행으로부터 기대하기 어려운 서비스의 제공에서 찾아야 한다.

• Journal of Periodontal and Implant Science
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• 제33권2호
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• pp.159-166
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• 2003

The purpose of this study was to investigate and compare the frequence of 4 periodontal pathogens in the supra- and subgingival plaque in periodontally healthy subjects. Twenty adult individuals aged 22 to 28 years (mean age 23.65 years) participated in this study. All subjects had no pocket sites more than 3 mm deep, and the sites selected for sampling were all negative for bleeding. After drying and isolation of the sites with cotton rolls, supragingival plaque was sampled using sterile periodontal curette. Each plaque sample was placed in individual tubes containing 500 ml of 1X PBS. After removal of the supragingival sample and any remaining supragingival plaque, subgingival plaque samples were taken from the same sites using sterile curette and placed in similar individual tubes. Identification of 4 putative periodontal pathogens from the samples was performed by polymerase chain reaction based on 16S rDNA. Chi-square test was employed to identify significant explanatory variables for the presence of the 4 periodontal pathogens. The data show that Actinobacillus actinmycetemcomitans, Porphyromonanas gingivalis, Bacteroides forsythus, and Fusobacterium nucleatum occurred in 16.9%, 14.4%, 52.5%, and 80.6%, respectively. No significant differences were noted in the periodontal pathogens between supra- and subgingival plaques according to the kind of teeth. However, the incisors were at higher risk for harboring F. nucleatum (p <0.05). Conclusion: These results reveal that anaerobic periodontal pathogens can be detected in supragingival plaques. Supragingival plaque may function as a reservoir of peri-odotopathogens.

• Tuberculosis and Respiratory Diseases
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• 제49권1호
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• pp.93-98
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• 2000

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/$mm^3$, $PaO_2$ was 42.5 mm Hg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ARDS by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of A TRA. And so, we present this case with a review of related literatures.