• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.383-396
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• 2020

Purpose: This study compared the injury mechanism, site, type, initial management approach of orthopedic injury, and outcomes according to the injury severity in moderate-to-severe injured patients. Materials and Methods: During 57-month, excluding the period when the authors' emergency/trauma center was not operating, from 2014 to 2019, a retrospective study was conducted on 778 patients with orthopedic injuries among patients with an Injury Severity Score (ISS)>9 scored. The patients were classified into moderate-injured group (group-1, 679) and severe-injured group (group-2, 99) according to the injury severity based on the ISS and physiologic parameters. The injury mechanism and non-orthopedic injury were evaluated. Orthopedic injuries were assessed according to the injury pattern and the number of anatomical regions and bone sites involved. The management approach for the orthopedic injuries in two groups was compared. Outcomes (hospital stay, systemic complications, and in-hospital mortality) were evaluated, and the risk factors for mortality were analyzed. Results: In group-2, the incidence of younger males, high-energy mechanisms, and accompanying injuries was significantly higher than in group-1. The number of anatomical regions and bone sites involved increased in group-2. The involvement of the pelvis, spine, and upper extremity was significantly higher in group-2, whereas group-1 was involved mainly by the lower extremities. Depending on the patient's condition, definitive or staged management for orthopedic injuries may be used. Group-1 was treated mainly with definite fixation after the physiological stabilization process, and group-2 was treated with staged management using temporary external fixation. The hospital stay was significantly longer in group-2. The overall systematic complications and in-hospital mortality was approximately 4.9% and 4.5%. A higher injury severity was associated with higher in-hospital mortality (2.9%, 15.2%; p<0.0001). Increasing age and high ISS are independent risk factors for mortality. Conclusion: A higher severity of injury was associated with a higher incidence of high-energy mechanism, younger, male, accompanying injuries, and the frequency and severity of orthopedic injuries. Severe polytrauma patients were treated mainly with a staged approach, such as external fixation. The hospital stay, systematic complications, and in-hospital mortality were significantly higher in severe-injured patients. Age and ISS are strong predictors of in-hospital mortality in polytrauma.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.869-875
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• 1997

Perimembranous ventri ular septal defects(PMVSDS) are the most common type of ventricular septal defects(VSDs) and consist morphologically of deficiency of the membranous septum and variable portions of the adjacent muscular septum. Repair of VSD has begun via a right ventriculotomy. Even with this exposure, however, it mght lead to ventricular dysfunction. Transatrial exposure of VSDs is luiown to a versatile approach to PMVSDS and even malaligunent defects can be repaired by this method. Although transatrial exposure can be improved by taking down'the atrioventricular valve at the annulus, surgeons have been hesitant to do so because of concern for valvular competence. Therefore, this study was undertaken to clarity the effects of transamlular approach of tricuspid valve (TATV) at operation of PMVSD. During last 5 years, twenty eight cases from 96 patients of PMVSD were closed by TATV and follow up study was done from 3 months to 33 months and results were obtained as follows. 1. Age at operation was fr m 4 months to 38 years and most patients(17, 62%) were above 5 years. 2. Preoperative pulmonary-systemic flow ratio(QPIQS) was ranged from 1 to 2.8 and 22 patients(79%) were less than 2. 3. Peak systolic pulmonary artery pressure was below 30mmHg in 8, 30-50mmHg in 17, above 50mmHg in 3 patients and 25 patients(89%) were less than 50mmHg. 4. Preoperative tricuspid regurgitation(TR) is none in 12, trivial in 6, mild in 3, moderate in 5, severe in 2 patients but postoperative TR was none in 18, trivial in 6, mild in 4 patients, so TR in most patients had decreased or not. 5. Indications for operation were based on the presence of a significant shunt. However, in patients with small shunts, indications for operation were included additional factors, tricuspid valve pouch, RVOT obstruction(right ventricular outflow tract obstruction), subacute bacterial endocarditis and associated anomalies. 6. There were no hospital deaths and residual shunts in postoperative echocardiography. Therefore TATV is especially a good method in PMVSn where patients have trcuspid valve pouch. And it is a safe and effective technique that improves exposure for PMVSD repair and does not adversely affect tricuspid valvular competence.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.447-453
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• 2001

Background: Although pulmonary resection is the standard approach for the management of pulmonary metastases from soft tissue sarcoma, most of them are unresectable and chemotherapy remains the only option. The effectiveness of the cytotoxic drugs may be limited by the toxicities that occur before the therapeutic dose is reached. The regional administration of doxorubicin using pulmonary arterial perfusion in a rodent model can produce 10 to 25 times higher concentrations in the lung than systemic administration with minimal systemic toxicities. However, it is unclear whether a high concentration of doxorubicin has beneficial effects for killing cancer cells. Material and Method: We studied this to evaluate the dose-dependent cytotoxic and apoptotic effects of doxorubicin on methylcholanthrene-induced rat fibrosarcoma(MCA) cells. This study examined the cytotoxicity and apoptosis-related gene expressions(Fas, FasL, Bax, caspase 1, caspase 2, caspase 8, Bcl-2, Bcl-xL, Bcl-xS) in MCA cells after 24 hours exposure to various concentrations of doxorubicin such as 1, 5, 10, 50, and 100 $\mu$M. Result: Dose-dependent cytotoxicity was observed after 24 hours exposure to doxorubicin. However, peak apoptosis after 24 hours exposure was observed at 5 $\mu$M of doxorubicin. Above 5 $\mu$M, apoptotic activity was decreased with dose-increment. All mRNA levels of apoptosis-related genes after 24 hours exposure were up-regulated above the control level at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment except caspase 8, which showed higher levels than the control level at 5 $\mu$M. Apoptosis-related protein levels were highest at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment. However, Bax and Bcl-xL proteins steadily showed higher levels than the control throughout the different concentrations of doxorubicin. Conclusion: These results suggest that apoptosis is the main cytotoxic mechanism in low concentrations of doxorubicin in MCA cells and apoptosis-related genes, such as Bax, caspase 8, and Bcl-xL, are involved. At high concentrations, doxorubicin still can kill MCA cells, even when apoptosis is inhibited, and have its propriety for achieving much cytotoxicity against MCA cells.

• Fire Science and Engineering
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• v.34 no.2
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• pp.110-119
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• 2020

The National Fire Safety Code (NFSC) sets forth the installation methods and technical standards of firefighting facilities. This information is stipulated in the attached Table 1 of the Enforcement Decree of the Act on Fire Prevention and Installation, Maintenance and Safety Control of Fire-Fighting Systems. The NFSC serves as a foundation for fire prevention and public safety. However, the current version of the NFSC has been under scrutiny due to its delayed enactment and revision process. This is because of its structural inflexibility, time-consuming procedures, and mixed usage of both performance and technical standards. Furthermore, there are difficulties with keeping its unique specialties due to the absence of a specialized, permanent independent entity that enacts, revises, and maintains its standards. Moreover, the NFSC lacks collectivity, openness, and consistency. Therefore, to overcome the aforementioned obstacles, this study investigates the operational and legal status of the NFSC and the problems regarding its enactment and revision process. Further, it presents suggestions for system improvement by analyzing and comparing the information with domestic and foreign counterparts dedicated to managing their similar technical NFSC standards. First, the study recommends that the legal performance and technical standards mixed within the current NFSC should be separated. Second, the enactment and revision of technical standards should be implemented by the private sector and not by the government. Third, technical standards should adopt a user-oriented approach for the code system.

• Fire Science and Engineering
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• v.28 no.4
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• pp.104-111
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• 2014

The purpose of this study is to investigate the CPR within ambulance. The Subjects were 890 emergency medical technicians in fire department in Gyeonggido. After continuing education program, the emergency medical technicians completed the questionnaires from January to February, 2012. Questionnaire consisted of demographic characteristics, method of chest compression (one handed or two handed), chest compression - ventilation ratio, and hands only CPR. Data were analyzed by frequency analysis and Chi-square test, t-test. One-way analysis of variance (ANOVA) was followed by Scheffe post-hoc test to analyze changes in all parameters between all groups. One handed chest compression accounted for 14.0% and two handed chest compression accounted for 86.0%. Hands only CPR accounted for 71.7% and standard CPR (30:2) accounted for 28.3%. In order to perform the high quality CPR, as least three persons must be dispatched in the ambulance. The flexible management of manpower may improve the survival from the cardiac arrest. A systemic approach for educating and training EMT's in CPR is needed.

• Journal of Science Education
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• v.41 no.3
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• pp.426-446
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• 2017

The purpose of this study was to analyze undergraduate students' reasoning for solving a problem about a rock and investigate the roles and importance of critical evidence (CE) and critical resource models (CRMs) in abductive reasoning. Participants were 20 senior undergraduate students enrolled in a science major course in a university of education. They were asked to abductively infer geologic processes of sedimentary rocks having a lot of holes and represent them with models. Their reasoning were analyzed according to a scheme for modeling-based abductive reasoning. As a result, successful student reasoning was characterized by using a diversity of grains and lots of holes as CE, activating the sedimentary rock formation and weathering as CRMs, and combining the CRMs into a scientifically sound explanatory model (SSEM). By contrast, in the reasoning unsuccessful in proposing a SSEM, students activated the igneous rock (basalt) formation and deposition as resource models (RMs) based on the evidence of the holes in the rocks and diverse grains, respectively, and used the RMs to construct their own explanatory models (EMs). It was suggested that to construct SSEMs to solve earth scientific problems about rocks, students need to know what could be CE in a particular problem situation, take an integrative or systemic approach to a rock problem, use multiple RMs, and evaluate RMs or EMs in light of evidence.

• Journal of Korea Technology Innovation Society
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• v.20 no.1
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• pp.175-204
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• 2017

The existing innovation policies and strategies mainly focused on the influencing factors for improvement of innovation outcome. However, these strategies were not always successful in driving innovative activities that make technology innovation disseminated. In this regard, innovation ecosystems approach has recently been coming to the force to establish a successful innovation strategy. The innovation ecosystems concept describes that innovation processes are evolved through collaborative networks of economic actors. In an innovation ecosystem, different organizations collaborate for technology development and its use. They interact for value co-creation by sharing mutual resources. The organizational networks are re-organized by dynamic changes of actors' interactions, which drive innovation mechanism of the networks. Recent studies on innovation ecosystems mostly have paid attention on developing theoretical frameworks to describe dynamics of an innovation ecosystem. There have hardly been empirical tests on the theoretical ecosystem models. In this vein, we investigated dynamics of an innovation ecosystem by analyzing structural characteristics of a collaborative network among organizations which are involved in the use of innovative technologies. Particularly, we examined the longitudinal changes of the interaction patterns among the organizations. This test was performed by an analysis of structural equivalence on the network dataset transformed from the organizational interactions. This result provides a guideline for an organization in developing an innovation strategy under a systemic perspective.

• Journal of Oral Medicine and Pain
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• v.37 no.1
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• pp.1-7
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• 2012

Burning mouth syndrome(BMS) refers to a chronic orofacial pain disorder usually unaccompanied by mucosal lesions or other clinical signs. Tongue(anterior and lateral border) is found to be the most common site for the burning sensations in the oral cavity, and various oral sites may be affected including hard palate and lips. The etiology of this disorder remains poorly understood, but the various factors might be related with the pathogenesis of the BMS. These factors have been devided into local, systemic and psychological. Recently, there have been increasing reports that the pain of BMS may be neuropathic in origin. The complex and multifactorial etiology of BMS necessitates multidisciplinary approach for the management of these patients. Recently, several studies have reported that oral parafunctional habits could be related the pathogenesis of BMS, and tried to control the symptom of BMS with various methods. We reported the cases who had the symptom of burning mouth syndrome with removable anti-nociceptive appliance in the lower dentition.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.4119-4123
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• 2012

Background: Neoadjuvant systemic chemotherapy is the accepted approach for women with locally advanced breast cancer. Anthracycline- and taxane-based regimens have been extensively studied in clinical trials and consequently are widely used. In this study aimed to research the complete response (pCR) rates in different regimens for neoadjuvant setting and determine associated clinical and biological factors. Methods: This study included 63 patients diagnosed with breast carcinoma among 95 patients that had been treated with neoadjuvant chemotherapy between 2007 and 2010. TNM staging system was used for staging. The histologic response to neoadjuvant chemotherapy was characterized as a pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Luminal A was defined as ER+, PR+, HER2-; Luminal B tumor was defined as ER+, PR-, HER2-; ER+, PR-, HER2+; ER-, PR+, HER2-; ER+, PR+, HER2+; HER2 like tumor ER-, PR+, HER2+; and triple negative tumor ER, PR, HER2 negative. Results: Patients median age was 54.14 (min-max: 30-75). Thirty-two patients (50.8%) were premenapousal and 31 (49.2%) were postmenapousal. Staging was performed postoperatively based on the pathology report and appropriated imaging modalities The TNM (tumor, lymph node, metastasis) system was used for clinical and pathological staging. Fifty-seven (90.5%) were invasive ductal carcinomas, 6 (9.5%) were other subtypes. Thirty nine (61.9%) were grade II and 24 (38.1%) were grade III. Seven (11.1%) patients were stage II and 56 (88.9) patients were stage III. The patients were classified for ER, PR receptor and HER2 positivity. Seventeen patients had complete response to chemotherapy. Forty patients (63.5%) were treated with dose dense regimen (cyclophosphamide 600 mg/m2 and doxorubicine 60 mg/m every two weeks than paclitaxel 175 mg/m2 every two weeks with filgrastim support) 40 patients (48%) were treated anthracycline and taxane containing regimens. Thirteen patients (76%) from 17 patients with pCR were treated with the dose dense regimen but without statistical significance (p=0.06). pCR was higher in HER2(-), ER(-), grade III, premenopausal patients. Conclusion: pCR rate was higher in the group that treated with dose dense regimen, which should thus be the selected regimen in neoadjuvant setting. Some other factors can predict pCR in Turkish patients, like grade, menopausal status, triple negativity, percentage of ER positivity, and HER2 expression.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.19 no.4
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• pp.381-389
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• 2009

Confined spaces are inherently dangerous workplace and many fatal and nonfatal accidents have been reported. Even though these accidents occur in various kinds of confined spaces, there has rarely been reported on the health hazard agent, i.e., the types of gases and their concentration ranges. Therefore in this study, we evaluated several toxic and asphyxiating gas concentrations in various confined spaces. We surveyed 57 manholes, 3 sewage treatment plants, 2 yellow radish manufacturing companies and 7 barges to measure the concentrations of oxygen($O_2$), hydrogen sulfide($H_2S$), carbon monoxide(CO), ammonia($NH_3$). Lower Explosion Limits(LEL) and Volatile Organic Compounds (VOCs). Those four types of confined spaces occupies 56% of accidents during last 9 years in Korea. In 57 manholes, the concentration varied according to the types of manholes; rainfall and sewage, and by location; residential and industrial areas. Sewage manhole in industrial area was evaluated as the most hazardous than other types of manhole like rainfall manholes, residential sewage manholes. The highest $H_2S$ concentration and the lowest $O_2$ concentration at sewage manhole in industrial area were 300 ppm, 8.7% respectively. In 3 sewage treatment plants, $H_2S$ and $NH_3$ concentrations were reached up to the 500 ppm and 200 ppm respectively. Two yellow radish manufacturing companies showed the concentrations of 316 ppm, 505.2 ppm, 90 ppm and 15.7% for $H_2S$, CO, VOCs and $O_2$, respectively. Seven barges showed 15.9%~20.9% oxygen concentration. Gas species and concentration ranges varied by the types and location of confined spaces; CO, $H_2S$, $O_2$ could be hazardous in manhole, especially manhole connected to sewage plants. CO, $H_2S$, LEL, $O_2$, $NH_3$ should be controlled in sludge silo and sluge pumping confined spaces in sewage treatment plant. The activity of lifting out radish from the storage tank was evaluated more hazardous rather than the other activities in yellow radish manufacturing industry. The employers must conduct the survey to identify all possible confined spaces in their local workplace prior to performing the tasks. At the national level to reduce the accidents in the confined spaces, we suggest that systemic approach and active education program including possible hazards, standard operation procedures, ventilation plan, and personal protective equipment in confined spaces should be implemented.