• 한국수자원학회:학술대회논문집
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• 한국수자원학회 2011년도 학술발표회
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• pp.14-14
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• 2011

Groundwater in the Waikatoregion is a valuable resource for agriculture, water supply, forestry and industries. The 434,000 ha study area comprises the upper Waikato River catchment from the outflow of Lake Taupo (New Zealand's largest lake) through to Lake Karapiro (a man-made hydro lake with high recreational value) (Figure 1). Water quality in the area is naturally high. However, there are indications that this quality is deteriorating as a result of land use intensification and deforestation. Compounding this concern for decision makers is the lag time between land use changes and the realisation of effects on groundwater and surface water quality. It is expected that the effects of land use changes have not yet fully manifested, and additional intensification may take decadesto fully develop, further compounding the deterioration. Consequently, Environment Waikato (EW) have proposed a programme of work to develop a groundwater model to assist managing water quality and appropriate policy development within the catchment. One of the most important and critical decisions of any modelling exercise is the choice of the modelling platform to be used. It must not inhibit future decision making and scenario exploration and needs to allow as accurate representation of reality as feasible. With this in mind, EW requested that two modelling platforms, MODFLOW/MT3DMS and FEFLOW, be assessed for their ability to deliver the long-term modelling objectives for this project. The two platforms were compared alongside various selection criteria including complexity of model set-up and development, computational burden, ease and accuracy of representing surface water-groundwater interactions, precision in predictive scenarios and ease with which the model input and output files could be interrogated. This latter criteria is essential for the thorough assessment of predictive uncertainty with third-party software, such as PEST. This paper will focus on the attributes of each modelling platform and the comparison of the two approaches against the key criteria in the selection process. Primarily due to the ease of handling and developing input files and interrogating output files, MODFLOW/MT3DMS was selected as the preferred platform. Other advantages and disadvantages of the two modelling platforms were somewhat balanced. A preliminary regional groundwater numerical model of the study area was subsequently constructed. The model simulates steady state groundwater and surface water flows using MODFLOW and transient contaminant transport with MT3DMS, focussing on nitrate nitrogen (as a conservative solute). Geological information for this project was provided by GNS Science. Professional peer review was completed by Dr. Vince Bidwell (of Lincoln Environmental).

• 대한의용생체공학회:의공학회지
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• 제40권5호
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• pp.197-205
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• 2019

The existing Extracorporeal membrane oxygenation(ECMO) and Cardiopulmonary bypass system(CPB) have been developed and applied to various devices according to their respective indications. However, due to the complicated configuration and difficult usage method, it causes inconvenience to users and there is a risk of an accident. Therefore, smart all-in-one cardiopulmonary circulation device is being developed recently. The smart all-in-one cardiopulmonary assist device consists of a blood pump for cardiopulmonary bypass, a blood oxidizer for cardiopulmonary bypass, a blood circuit for cardiopulmonary bypass, and an artificial cardiopulmonary device. It is an integrated cardiopulmonary bypass device that can be used for a variety of purposes such as emergency, intraoperative, post-operative intensive care, and long-term cardiopulmonary assist, combined with CPB used in open heart surgery and ECMO used when patient's cardiopulmonary function does not work normally. The smart all-in-one cardiopulmonary assist device does not exist as a standard and international standard applicable to advanced medical devices. Therefore, in this study, we will refer to the International Standard for Blood Components, the International Standard for Blood, the Guideline for Blood Products, and prepare applicable performance and safety guidelines to help quality control of medical devices, and contribute to the improvement of the health of people. The guideline, which is the result of conducted a survey of the method of safety and performance test, is based on the principle of all-in-one cardiopulmonary aiding device, related domestic foreign standards, the status of domestic and foreign patents, related literature, blood pump(ISO 18242), blood oxygenator (ISO 7199), and blood circuit (ISO 15676) for cardiopulmonary bypass.The items on blood safety are as follows: American Society for Testing and Materials ASTM F1841-97R17), and in the 2010 Food and Drug Administration's Safety Assessment Guidelines for Medical Assisted Circulatory Devices. In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers / importers, testing inspectors, academia, etc. the final guideline was established through revision and supplementation process. Therefore, we propose guidelines for evaluating the safety and performance of smart all-in-one cardiopulmonary assist devices in line with growing technology.

• Clinical and Experimental Reproductive Medicine
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• 제7권1_2호
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• pp.11-20
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• 1980

Hysterosalpingograms (H.S.G.) have been done for several decades to determine causative factors in female infertility. However, the H.S.G. only reverals uterine cavity and tubal patency or inpatency. The author prefers to find more details in regard to the status and condition of the female reproductive organs and their surrounding tissue as they pertain to infertility. H.S.G. in combination with laparoscopic examination reveals the following results. Preparation and method of performance of H.S.G. during laparoscopy in a healthy reproductive age women are as follows. When laparoscopy is not contraindicated, NPO is ordered with routine bowel preparation. Analgesics administered by injection prior to procedure are valium 10mgs and pethidine 50-100mgs. The radiographic procedure is the same as for any HSG technique. During laparoscopy a solution of 3 to 10 ccs. of 60% hypaque sodium is used. Fluroscopic scout films are obtained A-P and oblique views as well as a delayed check film. 1. Age distribution of primary and secondary infertility in this studies involving tubal factors was as follows: 20-29 age group showed 46% incidence and in the 30-39 age group, 50% incidence. Duration of infertility in this study group was the following: 1-2 years showed 26.7%, 3-5 years 53.8%, and 6-9 years 13.3%. 2. Indications of laparoscopic examination were as follows: Secondary infertility in 35% of the cases, obscure tubal occlusion on previous H.S.G. in 25%, unknown origin in 11.7%, and the remaining cases included pelvic pain, small masses, dysmenorrhea, and uterine anomaly. The laparoscopic examination showed clearly the reproductive organs and the surrounding tissues in the pelvic cavity. The abnormal tubal findings there revealed were tuberculous salpingitis and hydrosalpinx in 10% each, endometriosis and peritubabl adhesions in 6.7% each, biconuate uterus in 3.3%. The remaining 58.3% of the cases showed normal findings. Laparoscopic observation for possible myoma nodules, streak ovary, and peritubal adhesions was also done at this time. 3. Comparative tubal findings in combined H.S.G. and laparoscopic examination revealed the following. Bilateral tubal occlusion was present in 14% (7cases) on laparoscopic examination but on H.S.G. 38% (19 cases) were noted. However, tubal occlusion and peritubal adhesions were found in 26% (13 cases) upon laparoscopy and only 8% (4 cases) on H.S.G. examination alone. Normal pelvic findings were present in 60% (27 cases).

• 약학회지
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• 제42권1호
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• pp.25-30
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• 1998

This study was designed to compare the absorption fraction and extent of ketoprofen gels and a matrix typed ketoprofen plaster patch. 3g (90mg as ketoprofen) of the two gels whi ch has oleohydrogel or hydrogel as a base, respectively, and 3 pieces of plaster patches (90mg as ketoprofen) were, applied in the area of 210$cm^2$ on forearm in 12 volunteers by cross over design. Blood samples were collected serially up to 24 hours and the plasma concentrations of ketoprofen were analyzed by HPLC using flurbiprofen as an internal standard. The detection limit of the assay was 1ng/ml of ketoprofen in plasma. The pharmacokinetic parameters (e.g. $AUC_{24hr}$, $AUMC_{24hr}$, MRT, Fraction Absorbed) were calculated from the plasma concentrations time data of each volunteer. The oleo-hydrogel showed significantly higher absorption fraction and extent of ketoprofen than the current hydrogel. The mean plasma concentrations of the oleo-hydrogel were increased to 98.46${\pm}$23.15ng/ml by 6 hour after application, and increased futher to 100.61${\pm}$18.65ng/ml at 24 hour. On the other hand, those of the hydrogel were increased 17.61${\pm}$18.65ng/ml at 5 hour to 34.68${\pm}$9.65ng/ml at 24 hour gradually. Therefore the plasma concentrations of oleo-hydrogel at each measured time were 3~7 times greater than those of the hydrogel with statistical significance. The $AUC_{24hr}$ (1797.26${\pm}$52.09ng.h/ml) of the oleo-hydrogel was 3.5 times greater (P<0.05) than that (516.17${\pm}$104.52ng.h/ml) of the hydrogel. The plaster patches showed higher bioavailability ($AUC_{24hr}$ 2877.37${\pm}$578.27ng.h/ml) than the olea-hydrogel ($AUC_{24hr}$ 1797.26${\pm}$52.09ng.h/ml) without statistical significance. But the absorption fraction of the oleo-hydrogel was rather higher than that of the plaster patches during the first 6 hours after administration. These results suggest that newly developed ketoprofen gel which is used oleo-hydrogel as a base would show excellent skin permeation on topical application for the corresponding clinical indications and could be absorbed as well as plaster patches.

• 대한족부족관절학회지
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• 제24권4호
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• pp.129-134
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• 2020

Purpose: This study compared the results of proximal and distal chevron osteotomy in patients with severe hallux valgus. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include severe hallux valgus. Materials and Methods: This study analyzed 127 severe hallux valgus surgeries. Of these, 76 patients (76 feet) were excluded for lack of adequate follow-up and additional procedures (Akin procedure), leaving 51 patients (51 feet) in the study. The mean age of the patients was 58 years (21~83 years), and the mean follow-up duration was 18 months (12~32 months). The patients were divided into two groups. Group 1 underwent distal chevron osteotomy, and group 2 underwent proximal chevron osteotomy performed sequentially by a single surgeon. The patients were interviewed for the American Orthopaedic Foot and Ankle Society (AOFAS) score before and one year after surgery. The anteroposterior weight-bearing radiography of the foot was taken before and one year after surgery. Results: There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and an increase in the AOFAS score. Significant improvement of the hallux valgus and intermetatarsal angle corrections was observed in both groups, and the sesamoid position was similar in each group. More improvement in radiographic correction of intermetatarsal angle was noted in group 2. Both procedures gave similar good clinical and radiological outcomes. Conclusion: This study suggests that a distal chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting severe hallux valgus as a proximal chevron osteotomy with a distal soft-tissue procedure.

• 한국방사선학회논문지
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• 제12권7호
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• pp.869-877
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• 2018

본 연구는 MRI 건강보험 급여기준 적용 연혁과 건강보험 청구 자료를 바탕으로 MRI 진료 현황(검사 수, 진료금액)을 분석하여 추후 MRI 급여기준 확대 시 참고할 수 있는 기초자료를 제공하기 위해 시행되었다. MRI 검사가 급여로 적용되기 시작한 것은 2005년으로 초기에는 일부 질환에 대해서만 적응증이 제한되었으나, 2010년, 2013년, 2016년, 2018년 급여 대상이 확대되었으며, 보건복지부는 2021년에는 모든 MRI 검사에 대해 건강보험을 적용키로 하였다. 2010년부터 2017년까지 MRI 검사수와 진료금액 변화는 검사수는 2010년 대비 2017년도에 86.7% 증가하였고, 진료금액은 53.5% 증가하였다. 일반적 특성에 따른 MRI 진료현황은 여성이 남성보다 검사수가 많았고, 연령별로는 70-79세 연령대가 검사수가 가장 많았다. 진료 형태는 외래 검사가 입원검사 보다 많았으며, 의료기관 형태에 따라서는 상급종합병원의 검사수가 가장 많았다. 검사 부위별로는 뇌 MRI 검사수가 가장 높은 비율을 차지하였다. 2013년 12월 심장질환과 크론병에 급여 확대에 따른 진료 현황 변화를 분석한 결과 심장 MRI와 복부 MRI 검사수가 2013년 대비 2014년에 증가하였다. 하지만 전체 대비 검사수가 차지하는 비율이 낮고 질병명과 연계하지 못한 제한점으로 전체 MRI 검사수 증가에 영향을 주었다고 보기는 어려울 것이다. 우리나라는 건강보험 보장성 강화를 위하여 MRI 급여기준을 지속적으로 확대하고 있다. 건강보험 지속가능성과 정책 효과 평가를 위해 추후 지속적인 모니터링이 필요할 것이다.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.248-253
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• 2018

목적: 변형-내초점 핀 고정술을 통한 골성 망치 수지의 해부학적인 직접 정복에 대한 임상적 결과를 알아보고자 한다. 방법: 2014년 3월부터 2017년 10월까지 18명의 골성 망치 수지 환자를 대상으로 K-강선을 이용하여 골편을 직접 정복하는 방법인 변형-내초점 핀 고정술을 시행하였다. 수술 후 통증, 관절 운동 범위, 방사선적인 평가를 시행하였다. 또한 골유합 시기, 기능 회복 정도, 합병증 발생률을 평가하였고, 수술 후 기능적 예후를 판정하기 위해 Crawford의 평가 기준을 이용하였다. 결과: 평균 6주(5-7주)에 방사선적 골유합을 얻었다. 전체 환자에서 평균 $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$)의 신전 소실(extension loss)이 발생하였다. 모든 환자에서 관절면의 일치와 만족스러운 관절면의 재형성이 관찰되었으며, 최종 외래 추시에서 원위지간 관절의 평균 굴곡각은 $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$)였다. Crawford의 평가 기준으로 아주 만족이 12명(66.7%), 만족이 6명(33.3%)이었다. 결론: 변형-내초점 핀 고정술은 골편을 직접 정복 후 고정하여 해부학적 정복을 얻는 방법으로 기존의 다른 경피적 핀 고정술들과 결합하여 적절한 적응증에 적용한다면 좋은 결과를 얻을 수 있을 것으로 기대한다.

• 한국임상약학회지
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• 제28권4호
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• pp.333-341
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• 2018

Objective: Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used as a treatment in various immune-mediated inflammatory diseases (IMIDs). Tuberculosis (TB) risk is reported in several meta-analyses in patients treated with TNF-alpha inhibitors. The purpose of this study is to collect, review, and evaluate the TB risk in TNF-alpha inhibitors according to IMIDs indications and between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors. Methods: A systematic literature search on systematic reviews and meta-analyses was performed in PubMed, MEDLINE, Cochrane library, and EMBASE. We identified meta-analyses that evaluated TB infection risk of TNF-alpha inhibitors in IMIDs patients. Results: Thirteen meta-analyses including 41 study results were included in this umbrella review. IMIDs patients treated with TNF-alpha inhibitors had an increased risk of TB than control group (placebo with or without standard therapy patients) (relative risk ratio (RR) 2.057, 95% confidence interval (CI) 1.697 to 2.495). Among them, RA patients with TNF-alpha inhibitors had a higher risk of TB than control group (RR 1.847, 95% CI 1.385 to 2.464), and non-RA patients with TNF-alpha inhibitors had an increased risk of TB (RR 2.236, 95% CI 1.284 to 3.894). In subgroup analysis on TB risk between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors in RA patients, the analysis indicated that monoclonal-antibody TNF-alpha inhibitors had higher risk of TB than soluble-receptor TNF-alpha inhibitor (RR 2.880, 95% CI 1.730 to 4.792). Conclusion: This umbrella review confirms that the risk of TB is significantly increased in TNF-alpha inhibitor treated patients compared to control group.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.251-260
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• 2019

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

• 한국산림과학회지
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• 제110권2호
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• pp.266-279
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• 2021

본 연구는 대학 산림교육 발전을 목적으로 S 대학교 산림과학과 4학년 "도시림관리학 및 실습" 전공과목에 e-PBL (e-Project-based learning) 학습법을 적용한 사례를 소개한다. 특히 2020년 코로나-19 확산으로 비대면 학사 운영 상황에서 학습자들은 온라인 매체를 주로 활용하여 학교숲을 대상으로 프로젝트를 수행하고 결과물을 발표하였다. 학습자 중심의 e-PBL 학습법은 학습자들이 프로젝트 주제를 직접 선정하고 수행함으로써 자기주도학습, 문제해결능력과 의사소통능력 및 책임감 등을 향상시킬 수 있다. 학습자들의 e-PBL 학습성과에 대해 5점 리커트 척도를 이용하여 조사한 결과, 학습자들은 e-PBL 학습법을 통해 동기부여 및 흥미를 유발할 수 있었으며(4.17점), 전공지식에 대한 이해도를 높일 수 있었다(4.17점). 또한, 학습자들은 의사소통능력(4.33점), 문제해결능력(4.25점), 의사결정능력(4.21점)을 향상시킬 수 있었다고 응답하는 등 전반적으로 e-PBL 학습법에 대해 만족하였다. 특히 학습자들은 팀원들과 밀접한 의사소통과 상호협력이 문제 및 전공지식에 대한 이해력 향상에 효과적이었다고 응답하였다. 향후 산림교육에 적합한 e-PBL 학습모델을 개발이 필요하며, 효율적 수업시간의 운영과 e-PBL 학습법 지침 및 제도적 지원이 마련됨으로써 보다 효율적이고 성공적인 산림교육의 발전을 기대한다.