• 보험의학회지
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• 제25권
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• pp.9-24
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• 2006

지속적으로 증가 하고 있는 악성 종양 발병률의 증가, 생존률의 향상, 조기발견의 증가 등이 암 기왕자의 보험 수요 상승을 가져오고 있으며, 보험시장에서 더 이상 암 기왕자를 도외시하기 어렵게 만들고 있다. 그러나, 현재 국내에서는 암 기왕자를 인수할 수 있는 상품과 언더라이팅 인수 기법이 부족한 실정이다. 본 논문은 이러한 상황 하에서 기존에 거절체로 인식되었던 암 기왕자의 적극적인 인수를 위해 악성종양에 대한 보험 의학적인 고찰과 사망률, 위험도에 대해 분석하고, 국내에서 암 기왕자의 보험 인수 시 문제점과 그 해결방안을 모색해 보았다. 종양은 종양세포의 성장과 확산의 정도를 나타내는 병기와 조직학적 등급에 의해 그 예후와 경과가 예측 가능하며, 이 병기를 표준화하려는 국제적 시도로 1977년 American Joint Committee on Cancer(AJCC)는 TNM system 을 제시하였다. 병기를 기초로 치료의 결정도 함께 이루어지는데, 주요 치료법을 수술, 방사선치료, 항암치료, 면역요법이 있다. 이러한 치료법들은 후기 부작용을 일으키거나 이차성 암(Secondary malignant neoplasm)의 원인이 되기도 한다. 병기에 따른 암환자의 사망률을 살펴 보면, 암은 일정시기 동안 사망률이 급격히 증가하다가 이후에 점차 사망률이 감소하고, 그 이후에는 사망률에 영향을 미치지 않는다. 이러한 사망률 변화의 특성은 암 기왕자에게 평준식 정액 할증법(Per mille flat extra)의 적용이 적절함을 보여준다. 그러나, 현재 국내에서는 악성 종양 기왕자를 위한 상품이 전무한 상태이며, 암의 병리적 병기와 치료에 관련된 정보를 얻을 수 있는 도구도 부족하고, 명확한 인수 기법이 없다. 또한, 자체의 경험통계의 부족으로 위험에 대한 부담감이 큰 것이 현실이다. 하지만, 병기에 따른 사망률의 변화에서도 알 수 있듯이 평준식 정액 할증법의 도입이나, 악성종양의 병기(Stage)별 정액 할증률을 삭감법으로 전환하는 기준을 개발한다면, 종신보험은 충분히 인수가 가능하다. 또한, CI 보험도 암에 대한 부담보를 하는 선진사의 인수 기법을 도입하거나, 암 기왕자만을 위한 CI 상품을 개발하는 등 새로운 인수 기법을 모색한다면, 암기왕자 인수의 폭은 넓어질 것이다. 이와 같은 노력과 함께, 언더라이팅의 정보 획득을 위한 암 기왕자만의 고지서를 개발하고, 전문 언더라이터의 양성을 위한 노력을 게을리 하지 않는다면, 암기왕자를 적극적으로 인수할 수 있을 것이다. 앞으로 국내 보험사가 위와 같은 노력을 지속적으로 해 나가고, 비교적 예후와 경과가 양호한 0기와 1기 암 기왕자부터 단계적으로 종신보험의 인수를 시도한다면, 비교적 안전하게 경험치를 축적할 수 있을 것이다. 뿐만 아니라 국내 보험업계는 새로운 시장의 확보와 보험에 대한 대외 이미지 개선이라는 효과도 함께 얻게 될 것이다.

• 대한물리치료과학회지
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• 제7권2호
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• pp.711-725
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• 2000

The purpose of this study was to determine the effects of knee flexor isokinetic training on the mean peak torque of knee muscles and hamstrings-to-quadriceps ratio(H/Q ratio) in hemiplegia able to walk independently for more than 10 meters, to analyze the effect of torque increasing on functional aspects; fatigability and ambulation times, also. Forty-one adult subjects with hemiplegia secondary to a stroke partipated in this study. All participants were in/out patients at the College of Medicine, Pocheon CHA University, Pundang CHA General Hospital. The patients were allocated to two groups: one group exclusively for isokinetic maximal voluntary knee flexor training at $150^{\circ}$/sec(n=20) and the other exclusively for isokinetic maximal voluntary knee flexor training from $30^{\circ}$/sec to $150^{\circ}$/sec (n=21) gradually. The allocation was performed according to patient age, sex, affected side to minimize imbalance between the two training groups. Training was carried out from February 14th, 2000 to April 15th, 2000. Analysis of the data was done by means of t-test, x2-test, paired t-test, ANOVA, and multiple regression analysis. The results of this study were as follows: 1. There were no significant differences between the two groups in mean peak torque of knee muscles and relative decreases in knee extensor mean peak torque with increased knee flexor velocities before training (P<.05). 2.There was no significant differences between the two groups in the H/Q ratio, and no relative increases with increased knee flexor velocities before training. 3. there were significant changes in mean peak torque in group A after training(P<.05), but no significant differences as the velocity increased 4.there were significant changes in mean peak torque in group B after training(P<.05), but no significant differences as the velocity increased 5.there were no significant differences between the two groups, and no significant differences in mean peak torque increase rate between the groups with increased knee flexor velocities after training 6.H/Q ratio increased with increased knee flexor velocities between the two groups, but not statistically And there was no significant differences between the groups with increased knee flexor velocities 7.After training, Ambulation time and its decreasing rate decreased significantly in group B (P<.05) 8Before and after training, there was no significant differences between the groups in the fatiguability 9. In the multiple regression analysis, mean peak torque increase rate of the knee extensor and flexor were higher in group B than A(P<.05), and significantly higher with increased knee flexor velocities (P<.05) Also, training method influenced on Ambulation times decreases significantly(P<.05). Results indicated that knee flexor isokinetic training was effective to knee extensor and flexor mean peak torque increase in the hemiplegia able to walk independently for more than 10 meters. Therefore, we were able to conclude that gradual training from low to high velocity was more effective in the increase of mean peak torque of knee joint and decrease of Ambulation times than training only at high velocity.

• 대한치과의사협회지
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• 제50권12호
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• pp.763-770
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• 2012

The purposes of this work were to assess the cognition of the registered nurse(RN) on oral and maxillofacial emergency treatment and to compare cognition of the RN with that of the 119 emergency medical technician(EMT). 450 RNs who were working at each of secondary hospitals in Jeju province had responded to the questionnaire. Independent sample t-test and chi-square test were used to assess the state of RN on dental emergency treatment and to compare RN with EMT. The question 'education time on dentistry in formal education' that marked '0 hour' and '1-3 hours' were 73.3% and 20.0%, respectively. The question 'refresher training class on dentistry' that marked '0 hour' and '1-3 hours' were 92.9% and 6.7%, aggregately 99.6%. The results showed low score in the question 'reduction of temporo-mandibular joint(TMJ)'($1.67{\pm}0.857$), 'fixation of dislocated TMJ'($1.70{\pm}0.853$) and 'post-avulsed tooth treatment'($1.78{\pm}0.774$) by 5-point Likert scale. Likewise, the scores were $2.02{\pm}0.806$ in the question 'treatment of maxillofacial trauma', $2.76{\pm}1.061$ in the question 'emergent care of avulsed tooth', $2.70{\pm}1.095$ in the question 'treatment time of avulsed tooth' and $2.79{\pm}1.056$ in the question 'mouth guard', respectively. Compared to EMT, results of RN showed a statistically lower figure(p<0.05) in all items compared except the question 'medicine control', and the question 'doctor care in emergency room' was borderline(p=0.069). From this study, it is necessary for RN and student of nursing science to be educated on the oral and maxillofacial emergency treatment for the initial management of injuries. Authors suggest further co-study and nation-wide research with nursing care.

• Journal of Acupuncture Research
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• 제23권1호
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• pp.187-215
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• 2006

Objectives : To determine whether the pragmatic acupuncture treatment provides more effective pain relief than treatment using the same acupuncture point to the all patients. Methods : We randomly allocated participants to treatment group 1 and 2. The group 1 is the pragmatic treatment group and the group 2 is using the same acupuncture point to the all patients. Primary outcomes were measured by the Western Ontario and McMaster Universities Osteoarthritis index(WOMAC) pain and function scores at 4, 8, and 14 weeks. Secondary outcomes were measured by 100mm VAS(Visual Analog Scale), ROM(Range of Motion) using Goniometer, and pain threshold using pressure algometer. Results : When patients were extension of the knee, they were statistically significant in improvement of the ROM in 14 weeks. Whole body condition and pain rate through VAS measurement were improved significantly in 14 weeks. Also pain score and function score of WOMAC were improved significantly in 14 weeks. We could get difference in pain score of two acupuncture groups significantly in 14 weeks. But we could not get difference in whole score of two acupuncture groups significantly. Local temperature using T.C thermometer was changed significantly in 14 weeks. But we could not get difference in whole score of two acupuncture groups significantly. Excluding above item, DITI, pain threshold, and ROM of the knee flexion were no difference in before and after treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.758-770
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• 1996

Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80% to 90% of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy. To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical sits) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows. 1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed. 2. There were thinning of thickness of each zone of articular cartilage except calcified cartilagnous zone was observed in nonsurgical site. 3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group. 4. In both site of experimental group no features of degenerative changes were observed. From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.

• 한국환경보건학회지
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• 제39권4호
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• pp.312-321
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• 2013

Objective: In May 2011, an interview with three United States Forces Korea veterans revealed that chemicals believed to be 'Agent Orange' were buried at Camp Carroll (situated in Waegwan, Chilgok-gun, Gyeongsangbuk-do, Korea) in 1978. Many hazardous chemicals, such as perchloroethylene (PCE), trichloroethylene (TCE), and organochlorines were subsequently found in a joint US-ROK environmental investigation, although dioxins or burial evidence related to 'Agent Orange' have been not uncovered. This study was carried out to investigate the relevance of hazardous chemical exposure and health effects of the residents around Camp Carroll. Methods: The authors conducted a health questionnaire survey among residents around Camp Carroll regarding Waegwan groundwater ingestion, length of residence in Waegwan, and physician-diagnosed disease history (such as cancer, hypertension, diabetes and etc.). Logistic regression was performed to identify the associations between hazardous chemical exposure and physician-diagnosed diseases. Results: Among the 5,320 residents, excluding those living outside the Waegwan area, 3,430 subjects age 30 and over were analyzed. Among females, upon correction of age, smoking history and Camp Carroll working history, a higher distribution in the Waegwan groundwater ingestion group was demonstrated for patients with physician-diagnosed cancer and hypertension. The odds ratios have a tendency to increase with increased length of Waegwan groundwater ingestion. Conclusions: This study may be limited by not adopting a cohort study for the evaluation of factors that may confound environmental exposure. Yet it is meaningful that the correlation between Waegwan groundwater ingestion and chronic diseases were found through regression analysis in female; and further, this outcome may be used as a sampling basis for a secondary epidemiologic study.

• Asian-Australasian Journal of Animal Sciences
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• 제24권2호
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• pp.285-294
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• 2011

The abatement of methane emission from ruminants is an important global issue due to its contribution to greenhouse gas with carbon dioxide. Methane is generated in the rumen by methanogens (archaea) that utilize metabolic hydrogen ($H_2$) to reduce carbon dioxide, and is a significant electron sink in the rumen ecosystem. Therefore, the competition for hydrogen used for methanogenesis with alternative reductions of rumen microbes should be an effective option to reduce rumen methanogenesis. Some methanogens parasitically survive on the surface of ciliate protozoa, so that defaunation or decrease in protozoa number might contribute to abate methanogenesis. The most important issue for mitigation of rumen methanogenesis with manipulators is to secure safety for animals and their products and the environment. In this respect, prophylactic effects of probiotics, prebiotics and miscellaneous compounds to mitigate rumen methanogenesis have been developed instead of antibiotics, ionophores such as monensin, and lasalocid in Japan. Nitrate suppresses rumen methanogenesis by its reducing reaction in the rumen. However, excess intake of nitrate causes intoxication due to nitrite accumulation, which induces methemoglobinemia. The nitrite accumulation is attributed to a relatively higher rate of nitrate reduction to nitrite than nitrite to ammonia via nitroxyl and hydroxylamine. The in vitro and in vivo trials have been conducted to clarify the prophylactic effects of L-cysteine, some strains of lactic acid bacteria and yeast and/or ${\beta}$1-4 galactooligosaccharide on nitrate-nitrite intoxication and methanogenesis. The administration of nitrate with ${\beta}$1-4 galacto-oligosaccharide, Candida kefyr, and Lactococcus lactis subsp. lactis were suggested to possibly control rumen methanogenesis and prevent nitrite formation in the rumen. For prebiotics, nisin which is a bacteriocin produced by Lactococcus lactis subsp. lactis has been demonstrated to abate rumen methanogenesis in the same manner as monensin. A protein resistant anti-microbe (PRA) has been isolated from Lactobacillus plantarum as a manipulator to mitigate rumen methanogenesis. Recently, hydrogen peroxide was identified as a part of the manipulating effect of PRA on rumen methanogenesis. The suppressing effects of secondary metabolites from plants such as saponin and tannin on rumen methanogenesis have been examined. Especially, yucca schidigera extract, sarsaponin (steroidal glycosides), can suppress rumen methanogenesis thereby improving protein utilization efficiency. The cashew nutshell liquid (CNSL), or cashew shell oil, which is a natural resin found in the honeycomb structure of the cashew nutshell has been found to mitigate rumen methanogenesis. In an attempt to seek manipulators in the section on methane belching from ruminants, the arrangement of an inventory of mitigation technologies available for the Clean Development Mechanism (CDM) and Joint Implementation (JI) in the Kyoto mechanism has been advancing to target ruminant livestock in Asian and Pacific regions.

• 대한관절경학회지
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• 제15권1호
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• pp.13-18
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• 2011

목 적: $TightRope^{(R)}$ (Arthrex, Inc, Naples, FL)를 이용한 급성 견봉쇄골 관절 탈구의 관절경적 오구쇄골 관절 고정술의 방사선학적 및 임상적 결과를 평가하고자 한다. 대상 및 방법: 2009년 2월부터 2010년 2월까지 Rockwood 3형 또는 5형의 급성 견봉쇄골 관절 탈구 환자 20명에 대해 $TightRope^{(R)}$를 이용하여 관절경적 오구쇄골 관절 고정술을 시행하였다. 추시 기간은 평균 13.4(10~22)개월이었다. 방사선학적 평가는 쇄골 관절 부하 사진을 통해 쇄골과 오구돌기 사이 거리를 건측과 비교하였고, 임상적 평가는 KSS(Korean Shoulder Scoring System)를 이용하였으며, 환자들의 미용적 만족도도 평가하였다. 결 과: 방사선학적 평가에서 18예는 매우 우수, 1예는 우수, 1예는 양호의 결과를 보였다. KSS는 평균 98.5(92~100)점이었으며, 전 예에서 만족할 만한 미용적 결과를 보였다. 1예에서 매듭에 의한 피부 압통 및 촉진되는 불편감을 호소하여 시행한 매듭 봉합술 후 국소 감염이 발생하여 국소 마취 하 배농술 및 2주간 항생제 사용으로 치유하였다. 결 론: Rockwood 3형 또는 5형의 급성 견봉쇄골관절 탈구의 치료에 있어 $TightRope^{(R)}$를 이용한 관절경적 오구쇄골 관절 고정술은 만족스러운 방사선학적 및 임상적 결과를 보이며, 술후 합병증이 거의 없고, 조기 재활이 가능하며, 뛰어난 미용적 결과를 보이고, 금속 고정물 제거를 위한 이차적 수술이 필요없는 훌륭한 치료 방법이 될 것으로 생각된다.

• Composites Research
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• 제16권5호
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• pp.45-53
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• 2003

본 논문에서는 이차 본딩으로 접착된 복합재료-복합재료 Single-Lap 조인트 시편에 대해 인장 시험 및 수치해석을 통해 그 파손 특성을 조사하였다. 시편시험에서는 시험 중에 CCD 카메라 및 AE 센서를 이용해 초기 균열의 발생 및 진전양상에 대한 시험적인 관찰을 수행하였다. 시편에 대해 기하비선형 유한요소해석 및 VCCT(Virtual Crack Closure Technique)기법을 이용해 시편의 거동 및 변형율에너지방출률을 계산하고 세 가지 관찰된 초기 균열 모드에 대해 파손강도를 계산하였다. 인장시험에서 초기 균열은 모서리 계면 균열, 측면 계면 균열 및 층간 분리 균열의 세 가지 형태로 최종 파손의 60∼90% 하중에서 발생하였다. 주된 파손 모드는 접착제 계면 파손(adhesive failure) 및 적층판의 첫 번째 및 두 번째의 층간 분리 파손이었다. 두꺼운 접착제 층을 갖는 시편들은 초기균열이 낮은 하중에서 발생하였지만 균열진전에 대한 저항성 및 파손하중은 높게 나타났다. 층간분리파손은 주로 두꺼운 접착제의 경우에 발생하였다. 세 가지 초기 균열 모드에 대해 변형률에너지방출률은 Mode I의 G값이 Mode II의 G값보다 크게 계산되었다. Mode I 및 전체 G값은 측면 계면 균열, 모서리 계면 균열, 층간분리 균열의 순서로 크게 계산되었다.

• 한국임상수의학회지
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• 제22권1호
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• pp.56-59
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• 2005

5개월령의 암컷 토끼가 소양증, 탈모 및 점액화농성 안루로 내원하였다. 전신에서 경미에서 중등도 인설이 관찰되었다. 안면부, 이개내측, 사지 중수골과 중족골의 내측, 좌측슬관절 앞쪽의 탈모, 발적, 구진, 농포와 가피등의 다양한 피부병변이 나타났다. 채취된 인설의 현미경 검사에서 다수의 Cheyletiella spp가 관찰되었다. 다수의 이염색성 백혈구, 호산구 및 림프구가 세포학적 검사에서 나타났으며 곰팡이 배양검사는 음성이었다. 세균배양결과 Pasteurella spp가 검출되었다. 검사결과에 따라 Cheyletiella 피부염으로 진단하였다. 치료는 selamectin 6mg/kg을 2주 간격으로 2회 국소 적용하였으며 치료 1개월 후에 임상증상이 현저하게 경감되었고 피부병변은 대부분 정상으로 회복하였다. 따라서 selamectin의 국소적용은 토끼의 Cheyletiellosis의 치료에 효과적인 것으로 판단되었다.