• 한국임상약학회지
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• 제29권3호
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• pp.186-192
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• 2019

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ${\geq}30$ years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31-0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

• Journal of Chest Surgery
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• 제16권4호
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• pp.602-614
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• 1983

Six hundred fourteen consecutive cases of bioprosthetic cardiac valve replacement performed during the period from March 1976 through December 1982 were reviewed. A total of 748 tissue valves [534 Ionescu-Shiley valves, 144 Hancock valves, 46 Angell-Shiley, and 24 Carpentier-Edwards] were implanted in 610 patients. Of these, 477 had single valve replacements [403 mitral, 60 aortic, and 14 tricuspid] including three REDO MVR and one REDO AVR. The remaining 129 had double valve replacements [95 AVR and MVR and 34 MVR and TVR] and 8 had triple valve replacement.592 cases were evaluated. Overall early mortality rate [within 30 days of operation] was 7.1% [6.2% in single valve replacement, 10.2% in double valve replacement, and 16.7% in triple valve replacement]. Leading causes of mortality were low cardiac output or myocardial failure and ventricular arrhythmias. The follow-up period was from one month to 7 years with a cumulative follow-up of 906.6 patient-years [mean 1.53 years]. The late mortality was 1.6%, 3.9%, 0%, 2.6%, 6.6% and 2.0% per patient-year for MVR, AVR, TVR or triple valve replacement, AVR+MVR, MVR+TVR and total, respectively. Actuarial analysis of late results including early mortalities indicates an expected survival rate of 87.6+1.8% at 3 years and 85.92.4% at 7 years for all cases. We also analyzed actuarial survival rate between groups of each valve replacement [AVR, TVR, Double valve, and Triple valve] and the tissue valve groups in MVR. We experienced 7 cases [0.77% per patient-year] of confirmed endocarditis, two of which were fatal. Valve failure-free rates calculated according to the confirmed cases were 97.5% at 4 years, 87.5% at 7 years, and 88.3% at 6 years for Ionescu-Shiley, Hancock and Angell-Shiley valves, respectively. The occurrence rate of thromboembolism was 2.0% per patient-year in total cases, although almost all the patients were given anticoagulant therapy for one year. The occurring rate in MVR was 1.5% and 2.7% per patient-year for Ionescu-Shiley and Hancock valve groups, respectively. The difference in actuarial rate free from thromboemboli between Ionescu-Shiley and Hancock groups was statistically significant [P value less than 0.001]. Thromboembolic events beyond the period of anticoagulation therapy mainly occurred in patients with atrial fibrillation. The actuarial thromboemboli free survival was 95.71.4% at 3 years and 80.17.3% at 7 years. The incidence of hemorrhagic complications was 1.2% per patient-year [fatality 0.55% per patient-year] for anticoagulated patients. Although our clinical data favorably compares with results from other reports, our results suggest that anticoagulant therapy be given on a short-term basis or not at all to hemodynamically stable patients. Long-term therapy with antiplatelet drugs is probably inevitable with patients who have thromboembolic risk factors [such as atrial fibrillation].

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8715-8718
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• 2014

Background: ABVD (doxorubicin, bleomycin, vinblastine (Vb) and dacarbazine) is the standard regimen in Hodgkin's lymphoma (HL).Vincristine (O) is a mitotic spindle agent like Vb. We aimed to evaluate the efficacy and safety of O as a part of ABOD in HL. Materials and Methods: Patients who had ABOD were enrolled. Stage I-II HL were evaluated for unfavorable risk factors according to NCCN. National Cancer Institute Common Toxicity Criteria was used for toxicity. Results: Seventy-nine HL patients in our center between 2003 and 2007 were evaluated retrospectively. Median follow-up was 54 months. Most of the patients were male in their third decade. Median ABOD cycles were 6 (2-8). Primary refractory disease rate was 17.7% whereas it was 5.1% for early relapse and 5.1% for late relapse disease. Response rates were as 82.3% for complete response, 11.4% for partial response, 5.1% for stable disease and 1.3% for progressive disease. Half of relapsed patients had autologous stem cell transplantation. Estimated 5-year failure-free survival was 71% and significantly longer in early stage patients without risk factors, bulky disease or radiotherapy (RT) (p=0.05, p<0.0001, p=0.02; respectively). Estimated 5-year overall survival was 74% and significantly longer in those who had no RT (p=0.001). Dose modification rate was 5.1% and chemotherapy delay rate was 19%. There were no toxicity-related deaths. Conclusions: ABOD seems to be effective with managable toxicity in HL, even in those with poor prognostic factors.

• 응용통계연구
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• 제26권6호
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• pp.857-871
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• 2013

한국을 비롯한 많은 국가에서 수출보험은 수출증진을 위한 수단으로 이용되어 왔다. 무역자유화를 위한 세계무역기구의 출범 이후에도 수출보험은 여전히 수출증진을 위한 주요 수단으로 인식된다. 본 논문은 국내 기업의 해외법인이 체결한 단기수출보험의 자료를 이용하여 수출보험과 관련한 위험요소(수입자의 신용등급, 결제기간, 모기업의 크기)의 각 등급에 따른 보험가입금액 대비 보험금 지급비율을 산출한다. 이를 위해 일반화 선형모형을 활용, 모델 선택과정을 거쳐 사고빈도(frequency)와 사고심도(severity)를 각각 음이항분포와 로그노말분포로 적합한다. 그리고 일반화 선형모형의 분석결과를 바탕으로 사고빈도와 사고심도에 미치는 각 위험요소의 등급에 따른 계약건수 대비 평균 사고발생 비율과 보험가입금액 대비 평균 지급비율을 제시한다. 이후 이를 통합함으로써 각 위험요소의 등급별 지급비율의 기댓값을 추정한다. 그리고 이 결과를 이용하여 요율산정에 대한 시사점을 논의한다.

• 한국산학기술학회논문지
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• 제19권6호
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• pp.664-668
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• 2018

특수구조물 중에서 특히 높은 독립적 구조물은 낙뢰에 의한 뇌격을 받을 가능성이 높다. 특수 구조물은 대체적으로 국가 산업시설물에 속하므로 낙뢰로 인한 피해는 사회적 경제적 손실이 막대하다. 이러한 낙뢰 피해 방지를 위해 낙뢰 보호시설을 설치하였으나 2015년도에 서해 대교의 지지케이블에 낙뢰로 인한 화재가 발생하여 많은 경제적 손실을 초래하였다. 이에 낙뢰 보호 시스템의 설계는 구조물에 낙뢰 위험을 분석 한 후 보호 조치를 수립해야한다. 뇌격에 대한 위험도 평가에 대한 국제적 규격은 국제전기기술위원회(IEC) 규격이 전 세계적인 규격의 근간을 이루고 있으며, 특히 해외 국가규격이나 기준은 IEC 기준으로 낙뢰 위험도 평가를 실시하여 낙뢰 보호대책시 적용하고 있다. 국내에서도 KS C IEC 62305 규격을 적용하여 위험성평가와 피뢰보강을 위한 기초자료로 활용하고, 낙뢰 보호 시스템을 설계한다. KSC IEC 측정방법으로 국내 특수교 리스크 평가에 대한 결과로는 물리적 손상 및 전자계시스템 위험 특수교는 평가대상 전체 교량 77개 교량 중 7개 교량에서 허용위험도가 높은 것으로 보고되었다. 본 논문에서는 높고 독립적 구조물의 위치에 따라 낙뢰 수에 대한 실제 정보 수집 시스템을 운영하는 모델링 시스템을 제안하기 위해 실제적인 낙뢰 정보를 분석하고 기상 관측소에서 제공 한 낙뢰수와 높은 구조물에 직접 도달하는 위험한 낙뢰 수를 비교하여 검증하는 방법을 검토하였으며, 지상에 직접적으로 도달한 낙뢰수에 따른 낙뢰위험도 산출시 확률적 보정률을 모니터링하여 적용함으로써 실효적인 낙뢰위험도 평가를 할 수 있도록 제안하고자 한다.

• 대한두경부종양학회지
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• 제37권2호
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• pp.25-31
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• 2021

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC. Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary's Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months. Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092) Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.515-521
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• 2013

Purpose: To evaluate the efficacy and toxicity of induction chemotherapy followed by concurrent chemoradiotherapy (the treatment group) versus concurrent chemoradiotherapy with or without adjuvant chemotherapy (the control group) for locoregionally advanced nasopharyngeal carcinoma. Methods: The search strategy included Pubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, Chinese Biomedical Database and Wanfang Database. We also searched reference lists of articles and the volumes of abstracts of scientific meetings. All randomized controlled trials were included for a meta-analysis performed with RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence. Results: Eleven studies were included. Risk ratios of 0.99 (95%CI 0.72-1.36), 0.37 (95%CI 0.20-0.69), 1.08 (95%CI 0.84-1.38), 0.98 (95%CI 0.75-1.27) were observed for 3 years overall survival, 3 years progression-free survival, 2 years loco-regional failure-free survival and 2 years distant metastasis failure-free survival. There were no treatment-related deaths in either group in the 11 studies. Risk ratios of 1.90 (95%CI 1.24-2.92), 2.67 (95%CI 0.64-11.1), 1.04 (95%CI 0.79-1.37), 0.98 (95%CI 0.27-3.52) were found for grade 3-4 leukopenia, grade 3-4 thrombocytopenia, grade 3-4 mucous membrane, and grade 3-4 hepatic hematologic and gastrointestinal toxicity, the most significant toxicities for patients. Conclusion: Compared with the control group, induction chemotherapy followed by concurrent chemoradiotherapy was well tolerated but could not significantly improve prognosis in terms of overall survival, loco-regional failure-free survival or distant metastasis failure-free survival.

• 대한안전경영과학회지
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• 제17권4호
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• pp.23-33
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• 2015

Recently, the Ministry of Employment and Labor Management is a trend to strengthen all men death rate than the accident rate. Points reduction in the accident rate change orders related to credit rating score to +2 points in his plans as part of +1 point. In addition, according to the fancy linger RISK treatment in the event of a disaster site and fiction treatment to achieve accident-free during processing the scene interspersed with equity issues have been raised. In general disaster for the problem in the first two cases occurs when abnormal process according to the disaster site manager positions dismissal policy, each division headquarters itself, interspersed disasters performance compared to processing in accordance with the refrain, processing expenses in accordance with the composition of untreated industrial accident, costs and burdens partners FTC, there is a possibility that the issues raised, such as the Ministry of Employment and Labor. In response to domestic social practices focused on the construction site practices and prevention measures should be evaluated with respect to what.

• Radiation Oncology Journal
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• 제15권4호
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• pp.357-367
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• 1997

목적 : 근치적 절제술과 골반림프절 절제술을 시행한 자궁경부암 환자 중에서 치료실패의 위험인자가 있어서 술후 방사선치료를 시행한 환자를 대상으로 치료성적, 예후인자, 실패양상을 알아보기 위하여 후향적 분석을 시행하였다. 대상 및 방법 : FIGO 병기 IB, IIA와 IIB 환자 중에서 근치적 수술과 방사선치료를 시행하고 추적조사가 가능하였던 124명을 대상으로 하였다. 환자들은 1985년 3월부터 1994년 3원까지 수술후 방사선치료를 시행하였으며 최소 추적기간은 24개월이었다. 모든 환자는 4-MV 선형가속기를 이용한 외부방사선치료를 전골반에 50-6OGy를 조사하였고 일부 환자는 코발트를 이용한 고선량율 강내치료를 추가하였다. 결과 : 전체 환자의 5년 생존율과 5년 무병 생존율은 각각 $75.4\%,\;73.5\%$였고, 단변수 분석상 5년 무병 생존율에 영향을 미치는 인자는 림프절 전이 유무, 개수와 위치, 종양의 크기, 자궁체부 침운, 자궁주위조직 침윤, 병기, 자궁경부벽 침윤정도, 질 절제면 양성, 그리고 치료 관계 인자로 방사선량, 강내치료, 항암제 등이 통계상 유의하였으며, 다변량 분석상 림프절 전이와 종양의 크기, 질 절제면 양성이 유의하였다. 치료 실패는 33명이었고 2명은 다른 원인으로 사망하였고 부위별로는 국소재발이 13명, 원격전이 13명 국소-원격 동시 실패가 7명이었고 추적 종료시점까지 5명이 생존하였다. 국소재발은 병기 IB, 림프절 전이 양성 또는 질 절제면 양성 환자에서 많이 발생하였으며 림프절 전이 음성환자에서는 빈도는 낮았으나 원격전이가 상대적으로 더 많았다. 그리고 병기 lIB에서 5년 생존율 은 $56\%$ 였고 22명 중에서 9명이 재발하였다. 결론 : 수술후 방사선치료는 비교적 효과적인 방법이지만 다수의 재발 위험인자들을 가진 환자에게 술후 방사선치료만으로는 재발을 막기가 충분하지 않으므로 방사선감작제의 추가나 동시방사선-항암치료 등의 보다 효과적인 방법이 필요할 것으로 성각되며, 술혹 방사선치료의 효율을 정하기 위하여 무작위 표본 추출에 의한 전향적 연구가 필오하다. 그리고 병기 IIB는 항암치료와 수술후 방사선치료를 시행해도 치료 성적이 나쁘므로 일차적으로 근치적 방사선치료를 시행해야한다.

• 대한두경부종양학회지
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• 제26권2호
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• pp.212-215
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• 2010

Objectives：There are various reports for incidence and risk factors of hypothyroidism after hemithyroidectomy for benign thyroid disease. The reported incidence rate varies from 5.0 to 41.9%. Moreover, there are few reports about this in Korea. So, our objective is to identify the incidence and possible factors contributing to hypothyroidism after hemithyroidectomy in Korea. Subjectives and Methods：We reviewed medical records of patients who underwent hemithyroidectomy between 1999 and 2007 years. We enrolled 80 patients. The incidence of postoperative hypothyroidism was based on thyrotropin values and clinical symptoms. And all patients were evaluated for age, gender, serum thyrotropin(TSH) levels, serum free T4, weight of resected thyroid tissue and associated thyroiditis. Results：Nine of 80 patients(11.3%) became biochemically hypothyroid postoperatively. Six of 9 hypothyroid patients were diagnosed within 2 months of operation. The mean preoperative TSH level was $2.12{\pm}0.96mIU/L$ in hypothyroid and significantly different from $1.33{\pm}0.77mIU/L$ in euthyroid patients(p<0.05). There were no significant differences in age, gender, weight of resected thyroid tissue, preoperative free T4 and associated thyroiditis. Conclusion：A minority of patients became hypothyroid after hemithyroidectomy. Hypothyroidism following hemithyroidectomy occurred in patients with higher preoperative TSH levels.. The screening test for postoperative hypothyroidism should be performed from month to year after operation.