• 대한응급의학회지
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• 제29권6호
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• pp.679-686
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• 2018

Objective: The aim of this study was to identify the clinical characteristics and risk factors associated with the admission of patients in the emergency department (ED) within 30 days after discharge. Methods: A retrospective, observational study was conducted on adult patients presenting with abdominal pain to the ED of a single, urban, university hospital, between January 2014 and December 2015, who revisited the ED within 30 days after discharge. Data was collected on the emergency severity index level, time to contact doctors, physical examination, laboratory tests, use of computed tomography (CT), and patient disposition on revisitation. The primary outcome was hospital admission following an ED revisit in the 30-day period after the first visit. Results: During the study period, 19,480 patients visited the ED with the chief complaint of abdominal pain, and 13,577 were discharged. A total of 251 patients (1.29%) revisited the ED within 30 days, of which 89 were eligible for the study. The primary outcome was associated with not performing a CT scan on the initial visit and an increased C-reactive protein (CRP) value. Receiver operating characteristic curve analysis showed that a cut-off baseline CRP value of >0.35 mg/dL can predict the primary outcome with a sensitivity and specificity of 75% and 62.1%, respectively (area under the curve, 0.701; 95% confidence interval, 0.569-0.833; P=0.007). Conclusion: An increased CRP value and not performing abdominal CT were associated with a higher rate of admission following ED revisits of patients with abdominal pain. Future prospective studies on the role of abdominal CT imaging in patients presenting to the ED with abdominal pain will be needed.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• 한국지반환경공학회 논문집
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• 제12권3호
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• pp.47-54
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• 2011

절토비탈면에서 발생되는 낙석에 대한 안정성을 확보하기 위해 설치되는 낙석방지 울타리는 기본적으로 12.5m 높이에서 400kg인 암괴가 낙하될 때 발생되는 50kJ의 충격에너지를 가정하여 설계되고 있다. 그러나 암괴의 크기가 커지거나 높이가 높은 곳에서 낙하하는 경우에는 기존의 낙석방지울타리로는 안정성 확보가 어려운 실정이다. 본 논문은 낙석해석프로그램을 이용하여 암괴중량에 따른 비탈면 높이, 울타리와의 이격거리, 경사각 등의 변화를 주어 낙석에 대한 안정성 분석을 실시하여 보았다. 해석결과 기존의 2.5m 높이의 낙석방지울타리는 설계하중 조건인 400kg 암괴가 낙석 될 때, 비탈면 높이가 20m 이내의 일부를 제외하고 대부분 낙석에 대해 안정성이 확보될 수 있으나, 20m 이상인 경우 낙석의 튀는 높이가 낙석방지울타리를 넘는 경우가 빈번하고 낙석의 충격에너지도 설계충격에너지 이상인 경우가 발생되는 결과를 얻을 수 있었다. 그러므로 낙석방지울타리의 설계 시 표준도에 준하여 설계하는 방식보다 지반조건에 따른 낙석의 안정성 검토를 실시한 후에 낙석 도약높이 및 충격에너지를 평가하여 낙석방지울타리를 설계하는 것이 적절할 것으로 판단된다.

• Journal of Gastric Cancer
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• 제21권4호
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• pp.368-378
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• 2021

Purpose: When patients with early gastric cancer (EGC) undergo non-curative endoscopic submucosal dissection requiring gastrectomy (NC-ESD-RG), additional medical resources and expenses are required for surgery. To reduce this burden, predictive model for NC-ESD-RG is required. Materials and Methods: Data from 2,997 patients undergoing ESD for 3,127 forceps biopsy-proven differentiated-type EGCs (2,345 and 782 in training and validation sets, respectively) were reviewed. Using the training set, the logistic stepwise regression analysis determined the independent predictors of NC-ESD-RG (NC-ESD other than cases with lateral resection margin involvement or piecemeal resection as the only non-curative factor). Using these predictors, a risk-scoring system for predicting NC-ESD-RG was developed. Performance of the predictive model was examined internally with the validation set. Results: Rate of NC-ESD-RG was 17.3%. Independent pre-ESD predictors for NC-ESD-RG included moderately differentiated or papillary EGC, large tumor size, proximal tumor location, lesion at greater curvature, elevated or depressed morphology, and presence of ulcers. A risk-score was assigned to each predictor of NC-ESD-RG. The area under the receiver operating characteristic curve for predicting NC-ESD-RG was 0.672 in both training and validation sets. A risk-score of 5 points was the optimal cut-off value for predicting NC-ESD-RG, and the overall accuracy was 72.7%. As the total risk score increased, the predicted risk for NC-ESD-RG increased from 3.8% to 72.6%. Conclusions: We developed and validated a risk-scoring system for predicting NC-ESD-RG based on pre-ESD variables. Our risk-scoring system can facilitate informed consent and decision-making for preoperative treatment selection between ESD and surgery in patients with EGC.

• Journal of Gastric Cancer
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• 제21권4호
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• pp.379-391
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• 2021

Purpose: Promoter DNA methylation of various genes has been associated with metachronous gastric cancer (MGC). The cancer-specific methylation gene, cysteine dioxygenase type 1 (CDO1), has been implicated in the occurrence of residual gastric cancer. We evaluated whether DNA methylation of CDO1 could be a predictive biomarker of MGC using specimens of MGC developing on scars after endoscopic submucosal dissection (ESD). Materials and Methods: CDO1 methylation values (TaqMeth values) were compared between 33 patients with early gastric cancer (EGC) with no confirmed metachronous lesions at >3 years after ESD (non-MGC: nMGC group) and 11 patients with MGC developing on scars after ESD (MGCSE groups: EGC at the first ESD [MGCSE-1 group], EGC at the second ESD for treating MGC developing on scars after ESD [MGCSE-2 group]). Each EGC specimen was measured at five locations (at tumor [T] and the 4-point tumor-adjacent noncancerous mucosa [TAM]). Results: In the nMGC group, the TaqMeth values for T were significantly higher than that for TAM (P=0.0006). In the MGCSE groups, TAM (MGCSE-1) exhibited significantly higher TaqMeth values than TAM (nMGC) (P<0.0001) and TAM (MGCSE-2) (P=0.0041), suggesting that TAM (MGCSE-1) exhibited CDO1 hypermethylation similar to T (P=0.3638). The area under the curve for discriminating the highest TaqMeth value of TAM (MGCSE-1) from that of TAM (nMGC) was 0.81, and using the cut-off value of 43.4, CDO1 hypermethylation effectively enriched the MGCSE groups (P<0.0001). Conclusions: CDO1 hypermethylation has been implicated in the occurrence of MGC, suggesting its potential as a promising MGC predictor.

• 대순사상논총
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• 제34집
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• pp.323-351
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• 2020

此论文的目的是通过横向比较 《圣经》 和 《典经》 中的道成肉身思想, 揭示基督教最终走向神本主义道路, 大巡真理会最终走向人文主义道路的根本原因。基督教和大巡真理会都承认人的世界之上另有一个人的感官触及不到的世界。而且他们都主张上面的世界有一个至高者, 而且这位至高者通过女人的身体来到了人的世界。但不同的是, 基督教认为2000多年前在伯利恒出生的耶稣就是那位至高者, 而大巡真理会认为100多年前出生在朝鲜客望里的姜一淳才是那位至高者。基督教的神来到人间是为了替人类赎罪, 为此道成肉身者被钉在了十字架上流干了血, 成了赎罪的羔羊。大巡真理会的上帝降诞人间是为了帮人类解冤, 为此道成肉身者大巡天地人三界, 探索偏斜的度数并将其调正。基督教所谓的"罪"本质上是对至高神的"背叛", 这意味着神的世界不能容忍罪, 所以当第一个人 (亚当) 背叛神以后被赶出了圣洁的伊甸园。从此人的世界与神的世界之间就产生了不能逾越的鸿沟。相反, 大巡真理会所谓"偏斜的度数"并非是对至高者的背叛, 而只是一种自然的结果而已。也就是说, 度数偏斜的现象不仅能发生在人的世界里, 也能发生在神明的世界之中, 而且两个世界还可以相互作用, 相互影响。因此可以说, 基督教思想中的两个世界是两个完全不同秩序和不同系统的世界, 而大巡真理会思想中的两个世界是同一个秩序和同一个系统下运转的世界。大多数将某一事物分割成两个部分的思想主要是为了强调一边比另一边更重要或更关键。基督教以神的世界为人世界的最终根源和终极关怀, 以人对神的绝对信仰和绝对崇拜为人生最高的价值。相反大巡真理会则认为人的世界决定了神明界的存在意义, 主张人与人之间, 人与自然之间的互利相生是人尊时代的核心价值。由此可以得出本论文的最终结论 : 导致基督教踏上神本主义道路的根本原因是他们相信在完全相隔绝的两个世界中, 神的世界是人世界的最终根源和终极关怀 ; 导致大巡真理会走向人文主义的根本原因是他们相信在可以相互作用且可以相互影响的神明界与人世界中, 人世界决定神明界的存在意义。

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of Chest Surgery
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• 제55권2호
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• pp.143-150
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• 2022

Background: The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO. Methods: We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups. Results: Patients' mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064-1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56-0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008). Conclusion: A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.

• 한국건설관리학회논문집
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• 제23권6호
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• pp.111-118
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• 2022

최근에 우리나라의 도로 하부에 매설된 지하시설물이 노후화되면서, 지하시설물 유지보수 공사 물량이 급증하고 있다. 이러한 도로지하 시설물의 유지관리를 위해서는 도로포장의 절단작업이 선행되어야 한다. 그런데 우리나라에서 사용되는 기존 도로절단기는 친환경적이지 못하며 소음과 절단슬러지(비산먼지)가 많이 발생하는 것이 현실이다. 이에 본 연구에서는 절단슬러지 회수장치의 개념을 도출하고, 이 기능을 포함하는 친환경 도로절단기를 설계·제작하였다. 개발된 장비는 1m를 100~150mm 깊이로 절단하는 데에 20~30초 가량 소요되었다. 또 대부분의 구간에서 슬러지 흡입 성능은 양호하였으며, 2m 거리에서 약식 측정한 장비의 소음도는 평균 82.7dB 수준이었다. 다만 개발된 장비가 1차 프로토타입 수준이라는 한계로 인하여 구동안정성이 다소 낮았고, 시동꺼짐, 슬러지 회수성능 저하 등의 이상현상이 발생하는 경우가 있었다. 향후 개발된 프로토타입의 튜닝 및 개선을 통해 절단성능과 슬러지 회수 기능을 보다 안정시킬 예정이다. 그리고 개선된 프로토타입을 실제 현장 상황에 적용하여, 생산성 등을 정량적으로 비교·분석할 계획이다.

• 한국결정성장학회지
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• 제32권2호
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• pp.55-60
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• 2022

본 연구에서는 SiC 단결정의 TSSG 공정중 결정 품질을 저하시키지 않으면서도 의도하지 않은 질소 도핑(N-UID)을 쉽게 제어하기 위해 지금까지 Co 또는 Sc 전이금속을 첨가한 신규 용융조성을 제안한다. Co 또는 Sc의 특성을 파악하기 위해 Ar 분위기에서 1900℃ 온도에서 약 2시간 동안 열처리 실험을 수행했다. 용융조성은 Si-Ti 10 at% 또는 Si-Cr 30 at%를 비롯하여, 탄소 용해도에 효과적이라고 알려진 Co 또는 Sc을 각각 3 at% 첨가하였다. 열처리 후 도가니 단면을 가공하여 도가니-용융물 계면에서 발생한 Si-C 반응층을 관찰하고, 탄소황분석을 통해 조성에 따른 탄소 용해도를 간접적으로 분석하였다. 그 결과, Si-Sc 기반 용융조성이 TSSG 공정에 적합한 특성을 갖는 Si-C반응층을 형성하고 있었다. 또한 탄소황분석 결과에서도 Cr 다음으로 높은 탄소량이 갖는 것으로 분석되었다. Sc는 Cr에 비해 질소와의 반응성이 낮은 이점을 가지므로 TSSG 공정에 Si-Sc 용융조성을 적용하면, 본 연구에서 의도한 대로 SiC 단결정 성장속도와 질소 UID를 모두 제어할 수 있는 것으로 고려된다.