• Korean Journal of Radiology
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• v.21 no.6
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• pp.695-706
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• 2020

Objective: To investigate the technical and clinical efficacy of the percutaneous insertion of a biliary metallic stent, and to identify the factors associated with biliary stent dysfunction in patients with malignant duodenobiliary obstruction. Materials and Methods: The medical records of 70 patients (39 men and 31 women; mean age, 63 years; range, 38-90 years) who were treated for malignant duodenobiliary obstruction at our institution between April 2007 and December 2018, were retrospectively reviewed. Variables found significant by univariate log-rank analysis (p < 0.2) were considered as suitable candidates for a multiple Cox's proportional hazard model. Results: The biliary stents were successfully placed in all 70 study patients. Biliary stent insertion with subsequent duodenal stent insertion was performed in 33 patients and duodenal stent insertion with subsequent biliary stent insertion was performed in the other 37 study subjects. The median patient survival and stent patency time were 107 days (95% confidence interval [CI], 78-135 days) and 270 days (95% CI, 95-444 days), respectively. Biliary stent dysfunction was observed in 24 (34.3%) cases. Multiple Cox's proportional hazard analysis revealed that the location of the distal biliary stent was the only independent factor affecting biliary stent patency (hazard ratio, 3.771; 95% CI, 1.157-12.283). The median biliary stent patency was significantly longer in patients in whom the distal end of the biliary stent was beyond the distal end of the duodenal stent (median, 327 days; 95% CI, 249-450 days), rather than within the duodenal stent (median, 170 days; 95% CI, 115-225 days). Conclusion: The percutaneous insertion of the biliary metallic stent appears to be a technically feasible, safe, and effective method of treating malignant duodenobiliary obstruction. In addition, a biliary stent system with a distal end located beyond the distal end of the duodenal stent will contribute towards longer stent patency in these patients.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.1
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• pp.84-90
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• 2022

Backgrounds/Aims: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a dreadful complication. Duct-to-mucosa pancreaticojejunostomy (DTMPJ) is a commonly performed anastomosis after PD. This study aims to evaluate whether there is a size limit of pancreatic duct below which POPF rate increases significantly after DTMPJ. Methods: A retrospective study was performed from a database with prospectively collected data on consecutive patients undergoing DTMPJ. Results: Between the years 2003 and 2019, a total of 288 patients with DTMPJ were recruited. POPF occurred in 56.3% of the patients, of which 43.8% were biochemical leak, 8.7% were grade B, and 1.4% were grade C. Overall operative morbidity was 51.4%, of which 19.1% were major complications. Five patients (1.7%) died within 90 days of operation. Patients with grade B/C POPF had significantly soft pancreas (p < 0.001), smaller duct size (p = 0.031), and a diagnosis of carcinoma of the pancreas (p = 0.027). When a clinically significant POPF rate was analysed based on the pancreatic duct diameter, pancreatic duct size ≤ 1 mm had the highest POPF rate (35.7%). There was a significant difference in POPF rate between adjacent ductal diameter ≤ 1 mm and > 1 mm to 2 mm (35.7% vs 13.3%; p = 0.040). Multivariable analysis showed that for the soft pancreas, pancreatic duct diameter ≤ 1 mm was the only significant predictive factor for POPF (p = 0.027). Conclusions: DTMPJ can be safely performed for pancreatic duct > 1 mm without significantly increased POPF risk.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.141-151
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• 2024

Objective: Double microcatheter technique (dMC) can be the alternative to Single microcatheter technique (sMC) for challenging cases, but there is lack of studies comparing dMC to sMC especifically for small ruptured aneurysms. Our objective was to compare the safety and efficacy of dMC to sMC in treating small (≤5 mm) and tiny (≤3 mm) ruptured aneurysms. Methods: This study focused on 91 out of 280 patients who had ruptured aneurysms and underwent either single or double microcatheter coil embolization. These patients were treated with either single or double microcatheter coil embolization. We divided the patients into two groups based on the procedural method and evaluated clinical features and outcomes. Subgroup analyses were conducted specifically for tiny aneurysms, comparing the two methods, and within the dMC group, we also examined whether the aneurysm was tiny or not. In addition, univariate logistic regression analysis was performed to assess the impact of coil packing density. Results: The mean values for most outcome measures in the dMC group were higher than those in the sMC group, but these differences did not reach statistical significance (coil packing density, 45.739% vs. 39.943%; procedural complication, 4.17% vs. 11.94%; recanalization, 8.3% vs. 10.45%; discharge discharge modified Rankin Scale (mRS), 1.83 vs. 1.97). The comparison between tiny aneurysms and other sizes within the dMC group did not reveal any significant differences in terms of worse outcomes or increased risk. The only factor that significantly influenced coil packing density in the univariate logistic regression analysis was the size of the aneurysm (OR 0.309, 95% CI 0.169-0.566, p=0.000). Conclusions: The dMC proved to be a safe and viable alternative to the sMC for treating small ruptured aneurysms in challenging cases.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.741-747
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• 2003

Background: Coronary artery bypass graf t (CABG) has been settled as most safe surgery among the open heart surgeries. However, in patients with cardiogenic shock, the emergency CABG has higher mortality than elective CABG. We analyzed thirty four patients who underwent emergency CABG and report the middle and long-term results. Material and Method: From June 1994 to December 2001, 34 patients who underwent emergency CABG at Kang-dong Sacred Heart Hospital were include in this study. On the basis of hospital databases and Out Patient Department (OPD) follow up data, preoperative diagnosis, risk factor, coronary artery anatomy, operation technique, postoperative mortality, complication, recurrence of symptom, and mid and long term mortality were analyzed retrospectively. Result: Indications for emergency CABG were 29 cardiogenic shocks (85.3%), 4 intractable chest pains (11.8%), and 1 polymorphic ventricular tachycardia (2.9%). Preoperative angiographic diagnoses were triple vessel disease in 16 (47.1%) and left main disease in 8 (23.5%) patients. We used saphenous vein grafts in 81 and left internal thoracic artery grafts in 14 anastomosis. The mean number of grafts per patients was 2.8$\pm$0.8. The mean aortic cross clamp time was 91.9$\pm$34.6 minutes and the mean cardiopulmonary bypass time was 262.7$\pm$198.3 minutes. Early mortality was 50% and the most common cause of early mortality was low cardiac output in 7 (20.6%) patients. The mean follow-up period was 30.9$\pm$35.7 months. There were no recurrences of symptom and late mortality. Conclusion: In the case of emergency operation, aggressive and proper management with drugs and IABP should be done for preoperative hemodynamic stability and early surgical intervention is the most important factor for patient salvage.

• Journal of Food Hygiene and Safety
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• v.31 no.2
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• pp.74-84
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• 2016

Literacy on food additives of elementary school teachers (ET) and nutrition teachers (NT) could be influential factor on safe dietary education for school children. Therefore, the perceptions and information needs on food additives were surveyed from 351 elementary school teachers and nutrition teachers in metropolitan area of Korea, and the basic data for the promotion of risk communication on food additives among them were obtained. Compared to ET who consider 'taste' (39.1%) as the most important factor while purchasing food, NT considered 'safety' (68.1%) first (p < 0.001). Among the food labelling items, the level of understanding on food additives was the lowest both in ET (3.53) and NT (4.17), and NT showed better levels of understanding overall on food labels. Both ET and NT regarded hazardous factors of food as environmental pollutants, foodborne pathogens, and food additives in order, and tended to select 'no additives' or 'no artificial color' products while purchasing processed food. Although NT answered that they know all food additives had been passed the evaluation of safety and effectiveness tests (100%) and have standards of use (81.9%), majority of them (87.5%) believed the consumption of food additives are harmful on human health. ET (75.2%) also regarded food additives as dangerous materials. Above results suggested the necessity of proper and enough risk communication for both ET and NT. Both ET and NT wanted to have information on the safety or hazard of food additives. Most preferred media to get the information on food additives was TV (3.80) among ET and lecture (3.65) among NT. ET and NT trusted hospital, research institution/universities or the personnels working in these institutions as the provider of information on food additives. The result that the trust levels of ET and NT on government were relative low suggested the weakness of risk communication in Korean government. Although ET and NT answered that they do not trust mass media, their behaviors were affected by them such as reading food labels in ET (39.4%) and reducing the consumption of food additives in NT (50%). They also indicated mass media's problem of sensitive approach on food additives and asked the urgent reaction of government by providing sound information through experts on food additives. Above results revealed that ET and NT have different perceptions and information needs on food additives, therefore, proper risk communication should be provided for them to serve as dietary educators for elementary school children.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.35-43
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• 2003

Purpose :To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic billary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor Methods and Materials : A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter Insertion, be)ween December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-lLB, while slx were treated with HDR-lLB only. The 4otal external beam, and brachytherapy radiations dose were 30$\~$61.2 and 9$\~$30 Gy, with median doses of 50 and 15 Gy, respectively. Results : Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8$\%$ (5 patients), respectively. The median survivals for stomach and gailbladder cancers were 7.8 and 10.2 months, respectively, According to the unlvariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (o=0.0200), with all )he patients surviving more than one year had been Irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangltis due to the radiation therapy Conclusion :An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of 4hose patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-lLB, which is a prognostic factor In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and It could be regarded as a safe treatment.

• Journal of Life Science
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• v.26 no.12
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• pp.1376-1382
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• 2016

Xylitol is widely used in the food and medical industry. It is produced by the reduction of xylose (lignocellulosic biomass) in the Saccharomyces cerevisiae strain, which is considered genetically safe. In this study, the expression system of the GRE3 (YHR104W) gene that encodes xylose reductase was constructed to efficiently produce xylitol in the S. cerevisiae strain, and the secretory production of xylose reductase was investigated. To select a suitable promoter for the expression of the GRE3 gene, pGMF-GRE3 and pAMF-GRE3 plasmid with GAL10 promoter and ADH1 promoter, respectively, were constructed. The mating factor ${\alpha}$ ($MF{\alpha}$) signal sequence was also connected to each promoter for secretory production. Each plasmid was transformed into S. cerevisiae $SEY2102{\Delta}trp1$, and $SEY2102{\Delta}trp1$/pGMF- GRE3 and $SEY2102{\Delta}trp1$/pAMF-GRE3 transformants were selected. In the $SEY2102{\Delta}trp1$/pGMF-GRE3 strain, the total activity of xylose reductase reached 0.34 unit/mg-protein when NADPH was used as a cofactor; this activity was 1.5 fold higher than that in $SEY2102{\Delta}trp1$/pAMF-GRE3 with ADH1 as the promoter. The secretion efficiency was 91% in both strains, indicating that most of the recombinant xylose reductase was efficiently secreted in the extracellular fraction. In a baffled flask culture of the $SEY2102{\Delta}trp1$/pGMF-GRE3 strain, 12.1 g/l of xylitol was produced from 20 g/l of xylose, and ~83% of the consumed xylose was reduced to xylitol.

• Korean Journal of Health Education and Promotion
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• v.19 no.1
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• pp.87-107
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• 2002

Recently, the industrialized world is suffering from accidents referring from the lack of safety consciousness. According to Korean Safety Regulation Department(1996), students at junior high schools are mostly involved in safety accidents, and this is due to lack of safety consciousness. To prevent these accidents, we need to have safety consciousness and attitude. To make junior high school students who are mostly affected in these accidents act safely, they need to know their level of safety consciousness. The purpose of this study is to develop a guideline of measuring the scale of safety consciousness and analyze the relationship between safety education, accident experiences and safety consciousness. This study is based on a survey of 708 junior high students in Seoul, which was carried out from 12 November, 2001 to 21 November, 2001. 1. The main fields of safety consciousness are home safety, school safety, fire safety, emergency management based on documents. Home safety is again divided into facility safety and livelihood safety, school safety is divided into facility safety, livelihood safety and laboratory safety, traffic safety is divided into pedestrian safety, bicycling safety and public transportation safety, fire safety divided into prevention and escaping during fire breakouts, emergency management safety is divided into general principles and escaping during emergency situations. 2. The primary safety consciousness scale was made according to every field of safety consciousness. A preliminary examination based on the scale and a study of reliance and the factors was held. Based on these results, 27 questions which were concerned to be impairing reliability or lacking in factor were deleted on the secondary safety consciousness scale development The secondary safety consciousness scale which constituted of 73 questions was put into another preliminary study and after analyzing reliability and the factors, 12 questions of low reliabilities were deleted and with these results, the third scale were made consisting of 61 questions. 3. A study based on the third safety scale which is made of 61 questions, were held and with a analysis of the reliability and factors made, the relationship between safety education, accident experience and safety mind were examined. (1) The study of reliability and factors show that Cronbach's coefficient in home safety fields is .7598, in school safety .7924, in traffic safety .8306, in emergency treatment .7775, in fire safety .7247. The questions indicating low reliability were deleted. The factor analysis revealed that home safety is converged on facility safety and livelihood safety. But one question was deleted because it showed incongruence of validity. School safety was converged on facility safety, livelihood safety and laboratory safety. But 2 questions showed incongruence of validity and these were deleted. Traffic safety fields were converged on pedestrian safety, bicycle safety and public transportation safety. One question showing incongruence of validity was deleted. Emergency treatment fields converged on general principles and acting in emergency situations and three questions showing incongruence of validity were deleted. Fire safety was converged on prevention and acting in fire breakouts. Totally, eight questions were removed and the final scale were consisted of 53 questions (2) The 3/sup rd/ grade students scored higher average safety mind scales than 1st graders(p〈.05). And students who had high scores at school tend to have a higher scale than those who do not(p〈.001). (3) Average scale of students who had experience in safety education were higher(p〈.001). Students who had previously been involved in home safety accidents had a low score(p〈.001). This was same to students with experience in school safety accidents(p〈.001). Students with traffic safety accidents and fire safety accidents tend to have a lower scale too(p〈.05, p〈.001).

• Journal of Korean Society of Transportation
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• v.22 no.6
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• pp.133-144
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• 2004

A model and a measure which can evaluate the risk of rear end collision are developed. Most traffic accidents involve multiple causes such as the human factor, the vehicle factor, and the highway element at any given time. Thus, these factors should be considered in analyzing the risk of an accident and in developing safety models. Although most risky situations and accidents on the roads result from the poor response of a driver to various stimuli, many researchers have modeled the risk or accident by analyzing only the stimuli without considering the response of a driver. Hence, the reliabilities of those models turned out to be low. Thus in developing the model behaviors of a driver, such as reaction time and deceleration rate, are considered. In the past, most studies tried to analyze the relationships between a risk and an accident directly but they, due to the difficulty of finding out the directional relationships between these factors, developed a model by considering these factors, developed a model by considering indirect factors such as volume, speed, etc. However, if the relationships between risk and accidents are looked into in detail, it can be seen that they are linked by the behaviors of a driver, and depending on drivers the risk as it is on the road-vehicle system may be ignored or call drivers' attention. Therefore, an accident depends on how a driver handles risk, so that the more related risk to and accident occurrence is not the risk itself but the risk responded by a driver. Thus, in this study, the behaviors of a driver are considered in the model and to reflect these behaviors three concepts related to accidents are introduced. And safe stopping distance and accident occurrence probability were used for better understanding and for more reliable modeling of the risk. The index which can represent the risk is also developed based on measures used in evaluating noise level, and for the risk comparison between various situations, the equivalent risk level, considering the intensity and duration time, is developed by means of the weighted average. Validation is performed with field surveys on the expressway of Seoul, and the test vehicle was made to collect the traffic flow data, such as deceleration rate, speed and spacing. Based on this data, the risk by section, lane and traffic flow conditions are evaluated and compared with the accident data and traffic conditions. The evaluated risk level corresponds closely to the patterns of actual traffic conditions and counts of accident. The model and the method developed in this study can be applied to various fields, such as safety test of traffic flow, establishment of operation & management strategy for reliable traffic flow, and the safety test for the control algorithm in the advanced safety vehicles and many others.