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A Legal Analysis on the Absence of Provisions Regarding Non-relative Patients in the Act of Decisions-Making in Life-Sustaining Medicine (연명의료결정법에서 무연고자 규정미비 등에 관한 법적 고찰)

  • Moon, Sang Hyuk
    • The Korean Society of Law and Medicine
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    • v.24 no.4
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    • pp.103-128
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    • 2023
  • According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

Multi-classification of Osteoporosis Grading Stages Using Abdominal Computed Tomography with Clinical Variables : Application of Deep Learning with a Convolutional Neural Network (멀티 모달리티 데이터 활용을 통한 골다공증 단계 다중 분류 시스템 개발: 합성곱 신경망 기반의 딥러닝 적용)

  • Tae Jun Ha;Hee Sang Kim;Seong Uk Kang;DooHee Lee;Woo Jin Kim;Ki Won Moon;Hyun-Soo Choi;Jeong Hyun Kim;Yoon Kim;So Hyeon Bak;Sang Won Park
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.187-201
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    • 2024
  • Osteoporosis is a major health issue globally, often remaining undetected until a fracture occurs. To facilitate early detection, deep learning (DL) models were developed to classify osteoporosis using abdominal computed tomography (CT) scans. This study was conducted using retrospectively collected data from 3,012 contrast-enhanced abdominal CT scans. The DL models developed in this study were constructed for using image data, demographic/clinical information, and multi-modality data, respectively. Patients were categorized into the normal, osteopenia, and osteoporosis groups based on their T-scores, obtained from dual-energy X-ray absorptiometry, into normal, osteopenia, and osteoporosis groups. The models showed high accuracy and effectiveness, with the combined data model performing the best, achieving an area under the receiver operating characteristic curve of 0.94 and an accuracy of 0.80. The image-based model also performed well, while the demographic data model had lower accuracy and effectiveness. In addition, the DL model was interpreted by gradient-weighted class activation mapping (Grad-CAM) to highlight clinically relevant features in the images, revealing the femoral neck as a common site for fractures. The study shows that DL can accurately identify osteoporosis stages from clinical data, indicating the potential of abdominal CT scans in early osteoporosis detection and reducing fracture risks with prompt treatment.

Skin Permeability Study of Flavonoids Derived from Smilax china: Utilizing the Franz Diffusion Cell Assay

  • Sun-Beom Kwon;Ji-Hui Kim;Mi-Su Kim;Su-Hong Kim;Seong-Min Lee;Moo-Sung Kim;Jun-Sub Kim;Gi-Seong Moon;Hyang-Yeol Lee
    • Journal of the Korean Applied Science and Technology
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    • v.41 no.1
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    • pp.9-18
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    • 2024
  • Smilax china is known for its excellent antimicrobial, antioxidant, and anti-inflammatory properties. As a foundational study for applying the functionality of Smilax china extracts to cosmetics, it is necessory to investigate the concentration-dependent skin permation characteristics of the flavonoids in the extract, namely quercetin, catechin, and naringenin. Therefore, it serves as a crucial method for conducting this basic research on the functional aspects fo Smilax china extracts for cosmetic applications. This investigation focused on examining the percutaneous permeability characteristics of flavonoids originating from Smilax china. Applying Marzulli's definition, the Kp value of quercetin was categorized as "fast" at 0.1 mg/mL and "moderate" at 0.2 and 0.4 mg/mL. Notably, the permeation rate exhibited a decline with increasing concentration. For naringenin, Flux values were 0.69, 1.07, and 1.42 ㎍/hr/cm2 at concentrations of 0.1, 0.2, and 0.4 mg/mL, respectively, with corresponding Kp values of 6.95, 5.34, and 3.56. Naringenin's Kp value fell into the "moderate" category across all concentrations, and as observed with quercetin, the permeation rate decreased with higher concentrations. Likewise, for catechin, Flux values were 0.75, 1.09, and 1.66 ㎍/hr/cm2, and corresponding Kp values were 7.55, 5.46, and 4.16. Catechin's Kp value was consistently classified as "moderate" across all concentrations. The efficacy of quercetin, catechin, and naringenin, active ingredients in high-performance and anti-inflammatory Smilax china extracts, was found to exhibit skin penetration properties above the average. This confirms their suitability as excellent natural materials for use in functional cosmetics, given their outstanding capabilities in preventing acne and reducing inflammation.

The association between COVID-19 and changes in food consumption in Korea: analyzing the microdata of household income and expenditure from Statistics Korea 2019-2022 (코로나19와 한국 식품 소비 변화의 관계: 2019-2022년 통계청 소비자 가계동향조사를 활용하여)

  • Haram Eom;Kyounghee Kim;Seonghwan Cho;Junghoon Moon
    • Journal of Nutrition and Health
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    • v.57 no.1
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    • pp.153-169
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    • 2024
  • Purpose: The main goal of this study was to identify the impact of coronavirus disease 2019 (COVID-19) on grocery purchases (i.e., fresh and processed foods by grain, vegetable, fruit, seafood, and meat categories) in Korea. To understand the specific impact of COVID-19, the study period was divided into 3 segments: PRE-COVID-19, INTER-COVID-19, and POST-COVID-19. Methods: We used the microdata of household income and expenditure from Statistics Korea (KOSTAT), representing households across the country. The data comprised monthly grocery expenditure data from January 2019 to September 2022. First, we compared the PRE-COVID-19 period to INTER-COVID-19 and then INTER-COVID-19 to POST-COVID-19 and used multiple regression analysis. The covariates used were the gender and age of the head of the household, the household's monthly income, the number of family members, the price index, and the month (dummy variable). Results: The expenditures on all grocery categories except fresh fruit increased from PRE-COVID-19 to INTER-COVID-19. From INTER-COVID-19 to POST-COVID-19, almost all grocery category spending declined, with processed meat being the only exception. Most purchases of protein sources, increased during INTER-COVID-19 compared to PRE-COVID-19, while ham/sausage/bacon for meat protein, fish cakes and canned seafood for seafood protein, and soy milk for plant-based protein did not decrease during POST-COVID-19 compared to INTER-COVID-19. Conclusion: These results show an overall increase in in-home grocery expenditure during COVID-19 due to an increase in eating at home, followed by a decrease in this expenditure in the POST-COVID-19 period. Among the trends, the protein and highly processed convenience food categories did not see a decline in spending during the POST-COVID-19 period, which is a reflection of the preferences of consumers in the post-COVID-19 period.

Effects of Compounds Isolated from an Ethanol Extract of the Sclerotium of Wolfiporia hoelen on Osteoblast Differentiation and Osteoclast Formation (복령 균핵의 에탄올 추출물에서 분리한 화합물의 조골세포 분화 촉진 및 파골세포 생성 억제 효과)

  • Sora Lee;Seokju Kim;Bowook Moon;Sik-Won Choi;Rhim Ryoo;Hyung Won Lee
    • Journal of Korean Society of Forest Science
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    • v.113 no.1
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    • pp.73-87
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    • 2024
  • Wolfiporia hoelen (Fr.) Y.C.Dai & V. Papp, commonly known as Poria cocos, is a significant traditional herb used for medicinal and culinary purposes Asian and European countries. Many studies have confirmed that the main components of W. hoelen have pharmacological activities and thatits extract has been shown to affect bone metabolism. This study aimed to the potential of a 50% ethanol extract of the sclerotium of W. hoelen for preventing and treating bone diseases. The ethanol extract was systematically fractionated using n-hexane, dichloromethane, and ethyl acetate. The dichloromethane fraction caused an approximately 29% increase in alkaline phosphatase (ALP) differentiation activity in C2C12 cells compared to the control. Four compounds isolated from this active dichloromethane fraction were identified through instrumental analysis and literature references as 3α-dehydrotrametenolic acid, ergosterol, pachymic acid, and dehydrotumulosic acid. All four compounds were evaluated at increasing concentrations (1, 3, 10, 30, and 100 μM) to determine their effects on ALP differentiation activity in C2C12 cells and RANKL-induced inhibition activity in bone marrow macrophages (BMMs), with a concurrent assessment of cytotoxicity at these concentrations. At a concentration of 3 μM, dehydrotumulosic acid caused a 160% increase in ALP activity, 24% higher than in the BMP-2 control. BMMs treated with dehydrotumulosic acid at concentrations between 10 and 100 μM showed a substantial 15-86% decrease in RANKL-induced inhibition activity compared to the control, with distinct patterns of RANKL inhibition and cytotoxicity observed at 10 μM. These findings suggest that the ethanol extract from the sclerotium of W. hoelen has potential to modulate bone-cell differentiation, while highlighting the possible benefits of dehydrotumulosic acid isolated from the dichloromethane fraction of W. hoelen for preventing and treating osteoporosis.

Presenteeism in Agricultural, Forestry and Fishing Workers: Based on the 6th Korean Working Conditions Survey (농업, 임업 및 어업 종사자에서의 프리젠티즘: 제6차 근로환경조사를 바탕으로)

  • Sang-Hee Hong;Eun-Chul Jang;Soon-Chan Kwon;Hwa-Young Lee;Myoung-Je Song;Jong-Sun Kim;Mid-Eum Moon;Sang-Hyeon Kim;Ji-Suk Yun;Young-Sun Min
    • Journal of agricultural medicine and community health
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    • v.49 no.1
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    • pp.1-12
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    • 2024
  • Objectives: Presenteeism is known to be a much more economically damaging social cost than disease rest while going to work despite physical pain. Since COVID-19, social discussions on the sickness benefit have been taking place as a countermeasure against presenteeism, and in particular, farmers and fishermen do not have an institutional mechanism for livelihood support when a disease other than work occurs. This study attempted to examine the relationship between agricultural, fishing, and forestry workers and presenteeism using the 6th Korean Work Conditions Survey. Methods: From October 2020 to January 2021, data from the 6th working conditions survey conducted on 17 cities and provinces in Korea were used, and a total of 34,981 people were studied. Control variables were gender, age, self-health assessment, education level, night work, shift work, monthly income, occupation, working hours per week, and employment status. Results: As a result of the analysis, farmers and fishermen showed the characteristics of the self-employed and the elderly, and as a result of the regression analysis, when farmers and fishermen analyzed the relationship with presenteeism tendency compared to other industry workers, farmers and fishermen increased by 23% compared to other industry groups. Conclusion: This study is significant in that it has representation by utilizing the 6th working conditions survey and objectively suggests the need for a sickness benefit for farmers and fishermen who may be overlooked in the sickness benefit.

Establishing Optimal Conditions for LED-Based Speed Breeding System in Soybean [Glycine max (L.) Merr.] (LED 기반 콩[Glycine max (L.) Merr.] 세대단축 시스템 구축을 위한 조건 설정)

  • Gyu Tae Park;Ji-Hyun Bae;Ju Seok Lee;Soo-Kwon Park;Dool-Yi Kim;Jung-Kyung Moon;Mi-Suk Seo
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.68 no.4
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    • pp.304-312
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    • 2023
  • Plant breeding is a time-consuming process, mainly due to the limited annual generational advancement. A speed breeding system, using LED light sources, has been applied to accelerate generational progression in various crops. However, detailed protocols applicable to soybeans are still insufficient. In this study, we report the optimized protocols for a speed breeding system comprising 12 soybean varieties with various maturity ecotypes. We investigated the effects of two light qualities (RGB ratio), three levels of light intensity (PPFD), and two soil conditions on the flowering time and development of soybeans. Our results showed that an increase in the red wavelength of the light spectrum led to a delay in flowering time. Furthermore, as light intensity increased, flowering time, average internode length, and plant height decreased, while the number of nodes, branches, and pods increased. When compared to agronomic soil, horticultural soil resulted in an increase of more than 50% in the number of nodes, branches, and pods. Consequently, the optimal conditions were determined as follows: a 10-hour short-day photoperiod, an equal RGB ratio (1:1:1), light intensity exceeding 1,300 PPFD, and the use of horticultural soil. Under these conditions, the average flowering time was found to be 27.3±2.48 days, with an average seed yield of 7.9±2.67. Thus, the speed breeding systems reduced the flowering time by more than 40 days, compared to the average flowering time of Korean soybean resources (approximately 70 days). By using a controlled growth chamber that is unaffected by external environmental conditions, up to 6 generations can be achieved per year. The use of LED illumination and streamlined facilities further contributes to cost savings. This study highlights the substantial potential of integrating modern crop breeding techniques, such as digital breeding and genetic editing, with generational shortening systems to accelerate crop improvement.

Effect of the Ayres Sensory Integration Intervention on the Motor Skills and Occupation Participation of Preschool Children with Attention-Deficit/Hyperactivity Disorder (Ayres의 감각통합중재가 학령전기 주의력결핍 과잉행동장애(ADHD) 성향 아동의 운동기능 및 작업참여에 미치는 영향)

  • Jung, Yun-Jin;Kang, Je-wook;Chang, Moon-young;Kim, Kyeong-Mi
    • The Journal of Korean Academy of Sensory Integration
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    • v.22 no.1
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    • pp.1-14
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    • 2024
  • Objective : This study aimed to investigate the impact of Ayres' sensory integration (ASI) intervention on motor skills and occupational participation of preschool children with attention-deficit/hyperactivity disorder (ADHD). Method : Children with ADHD aged between 4 and 6 years who met the inclusion and exclusion criteria were randomly recruited through screening tests. The subjects were divided into an experimental group (10 subjects) and a control group (8 subjects). The instruments used were the Bruininks-Oseretsky test of motor proficiency-2 (BOT-2), Pediatric Evaluation of Disability Inventory (PEDI), and Goal Attainment Scale (GAS) to evaluate occupational participation. The subjects in the experimental group underwent individual sensory integration therapy according to the ASI principles for 40 minutes twice a week in a total of 16 sessions over eight weeks. The control group did not receive the ASI intervention. Data analysis was performed using the Mann-Whitney U test, chi-squared test, Wilcoxon signed-rank test, and Cohen's d test in SPSS 20.0. Results : The ASI experimental group had significantly higher scores in total motor composite, manual coordination, body coordination, strength, and agility in motor function than the control group (p<.05). The two groups did not differ significantly in terms of occupational participation (PEDI), but GAS scores for individual target activities were significantly higher in the experimental group than in the control group (p<.05). Conclusion : This study shows that the ASI intervention has positive effects on motor skills and occupation participation among preschool children with ADHD.

Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study

  • Young Choi;Byounghyun Lim;Song-Yi Yang;So-Hyun Yang;Oh-Seok Kwon;Daehoon Kim;Yun Gi Kim;Je-Wook Park;Hee Tae Yu;Tae-Hoon Kim;Pil-Sung Yang;Jae-Sun Uhm;Jamin Shim;Sung Hwan Kim;Jung-Hoon Sung;Jong-il Choi;Boyoung Joung;Moon-Hyoung Lee;Young-Hoon Kim;Yong-Seog Oh;Hui-Nam Pak;CUVIA-REGAB Investigators
    • Korean Circulation Journal
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    • v.52 no.9
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    • pp.699-711
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    • 2022
  • Background and Objectives: We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation. Methods: In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax maps were generated by computational modeling based on atrial substrate maps acquired during clinical procedures in sinus rhythm. Smax maps were generated during the clinical PV isolation (PVI). The V-Smax group underwent an additional extra-PV ablation after PVI targeting the virtual high Smax sites. Results: After a mean follow-up period of 12.3±5.2 months, the clinical recurrence rates (25.6% vs. 23.9% in the V-Smax and the E-ABL group, p=0.880) or recurrence appearing as atrial tachycardia (11.1% vs. 5.7%, p=0.169) did not differ between the 2 groups. The post-ablation cardioversion rate was higher in the V-Smax group than E-ABL group (14.4% vs. 5.7%, p=0.027). Among antiarrhythmic drug-free patients (n=129), the AF freedom rate was 78.7% in the V-Smax group and 80.9% in the E-ABL group (p=0.776). The total procedure time was longer in the V-Smax group (p=0.008), but no significant difference was found in the major complication rates (p=0.497) between the groups. Conclusions: Unlike a dominant frequency ablation, the computational modeling-guided V-Smax ablation did not improve the rhythm outcome of the PeAF ablation and had a longer procedure time.

Growth Characteristics and Yield According to Differential Storage Temperature of Southern Ecotype Allium sativum var. 'Namdo' for Crop Model Development (작물모형개선을 위한 저장온도별 '남도' 마늘의 생장 및 수량 특성)

  • Byung-Hyuk Kim;Min-Seon Choi;Minji Shin;Seong Eun Lee;Kyung Hwan Moon;Chun Hwan Kim;Hyun-Hee Han
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.26 no.3
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    • pp.141-150
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    • 2024
  • Garlic (Allium sativum L.) is considered as one of the most important vegetables with various uses throughout the many countries. Also, it is one of the most economically important Allium species, and has been widely cultivated for more than 5,000 years. In Korea, garlic is planted in late summer and is grown from autumn and spring of the next year. Bulb starts to form when temperature rises under longer photoperiods. Garlic growth is affected by various factors such as storage conditions, humidity, duration of minimum temperature, and photoperiod. Also, the storage conditions for propagation seed are known to potentially affect future vegetative stages. In this study, we evaluated to effect of the inter-bud growth and growth of the southern-type cultivar 'Namdo' according to storage temperatures. The inter-bud growth, emergence & sprouting rate, and initial growth of stored garlic at low temperatures (5~15℃) exhibited robust growth, while garlic stored at high temperatures (30℃) was investigated to be sluggish compared to another treatments. However, the bulb diameter of stored garlic at 10 ℃ and 15℃ increased to 148.7% and 154.0 % compared to untreated garlic, respectively. Also, the bulb weight of stored garlic increased to 285.7% and 294.4% compared to control, respectively. In contrast, garlic stored at 5℃ showed a decrease of 70 .5% in bulb dimeter and 70 .6% in bulb weight compared to the control. As a results, it was confirmed that the storage temperature of garlic affects the inter-bud growth, emergence & sprouting rate, growth, bulb diameter, and bulb weight. These results will be to the possibility that is possible to estimate the growth cycle of garlic using the growth index for the improvement of crop modeling.