• Archives of Plastic Surgery
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• 제43권4호
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• pp.328-338
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• 2016

Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4-156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.

• 응용통계연구
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• 제22권3호
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• pp.531-539
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• 2009

로지스틱회귀분석은 고객관계관리를 위한 데이터마이닝 분야에서 많이 사용되는 기법인데, 이 분야의 모형설정 과정에서는 연관성이 매우 높은 설명변수들이 모형에 함께 포함되어 다중공선성의 문제를 유발하며, 더욱이 회귀자료에 이상점들이 포함되면 최우추정량은 심각한 결함을 갖게 된다. 두 가지 문제점을 동시에 해결하기 위하여 로버스트주성분로지스틱회귀를 적용할 수 있는데, 본 논문에서는 주성분의 선정기준을 결정하는 모형을 개발하고, 주성분모형에서의 추정치에 미치는 이상점의 영향을 축소하기 위한 로버스트추정법을 제안하였다. 제안된 추정법은 다중공선성과 이상점이 유발하는 문제들을 적절히 해결해 준다는 사실이 모의실험을 통하여 확인되었다.

• 대한한방내과학회지
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• 제28권2호
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• pp.363-376
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• 2007

Objectives : This study was undertaken to learn what should be considered in a good clinical trial investigating a herbal medicine as an antidepressant. Methods : Five well-designed clinical trials published from 2000 to 2006 investigating SJWE in depressive disorder were selected. The trials were reviewed and compared in terms of methodology such as trial design, patient selection, efficacy & safety evaluation, and so on. On the basis of this review of the trials and the regulations and guidelines of KFDA, we suggest some points to be considered for a good clinical trial of a herb for depression. Results : Although every trial had its own unique design, procedure, objectives and so on, all trials used randomizing and double blinding methods. If there is no ethical problem, a placebo-controlled design should be considered in a herbal antidepressant clinical trial for depression. Conclusions : Some points to be considered in an optimal & good clinical trial for an antidepressive herbal medicine were suggested as follows: 1) randomizing and double blinding manner is essential, 2) if there is no ethical problem, placebo control design should be considered, 3) the trial period should be 6 weeks, 4) out-patients will be recruited as subjects, 5) investigators will be well-trained psychiatrists or medical doctors, 6) the number of subjects should be calculated by statistical methods, 7) subjects should be diagnosed by DSM-IV criteria, 8) subjects who have current risk of committing suicide should be excluded, etc.

• Journal of Chest Surgery
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• 제19권4호
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• Journal of Chest Surgery
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• 제22권6호
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• pp.914-920
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• 1989

Bleomycin and cyclophosphamide are widely used and effective anti-cancer agents for treatment of various forms of cancer. Bleomycin has no myelotoxicity, but because of potential risk of pulmonary complications including interstitial pneumonitis and idiopathic interstitial pulmonary fibrosis, it has been limited in use. Some investigator has also suggested that cyclophosphamide can induce pulmonary toxicity like bleomycin. Recently, The combination chemotherapy including bleomycin and cyclophosphamide has been adopted effectively in some types of cancer. But there are no available literatures for synergistic effect of pulmonary toxicity in combination chemotherapy including these two drugs. We tried this study to observe synergism of pulmonary toxicity using these two drugs in rats. The animals were divided into five groups: group 1 received intra-peritoneal injection of saline, group 2-a received only bleomycin 0.1 mg [0.4 mg/kg] by intra-peritoneal injection twice a week, group 2-b received only bleomycin 0.5 mg [2 mg/kg] by intra-peritoneal injection twice a week, group 3-a received bleomycin 0.1 mg [0.4 mg/kg] twice a week +cyclophosphamide 5 mg [20 mg/kg] two weeks interval by intra-peritoneal injection, group 3-b received bleomycin 0.5 mg [2 mg/kg] twice a week + cyclophosphamide 5 mg[20 mg/kg] two weeks interval by intra-peritoneal injection. The animals were sacrificed at 2 and 4 weeks later. Lung tissues were obtained and observed by light microscope. The results are as follows: 1. The pathologic findings of group 1 were normal without change. 2. There was no difference between group 2-a and group 3-a at 2 weeks later, group 3-a, however, revealed more severe change in lung tissue at 4 weeks later compared with group 2-a. 3. In group 3-b there was more severe pulmonary injury compared with group 2-b at 2 and 4 weeks later. We conclude that the combined administration of bleomycin and cyclophosphamide induce more severe pulmonary toxic effect than bleomycin administration alone and the combination chemotherapy including these two drugs will be require special attention to selection of the dose of each drug.

• 한국산업정보학회논문지
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• 제18권6호
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• pp.113-125
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• 2013

치열한 경쟁환경에서 많은 기업들이 외부의 전문성 활용을 통한 비용절감, 리스크 감소, 경영효율화 추구, 핵심역량의 강화 등을 위해 아웃소싱을 도입하고 있다. 또한, 기업전략 및 기업의 구조적 변혁을 통한 혁신적 활동으로써 아웃소싱을 전략적으로 활용하고 있다. 본 연구의 목적은 우리나라 제조업을 중심으로 아웃소싱 파트너 선정요인과 전략에 따른 아웃소싱 성공도와 BSC 성과간의 영향에 관한 연구를 하였다. 따라서 제조기업의 아웃소싱 전략과 아웃소싱 파트너 선정요인에 따른 성공도를 파악하고 그에 따르는 기업의 성과를 BSC 관점에서 실증분석을 하였다. 본 연구는 제조기업의 아웃소싱 성공도와 기업의 BSC관점에서의 성과에 관한 요인을 파악함으로써 현재 진행 중인 아웃소싱 업체의 평가 및 보상에 관하여 실무적 접근을 가능토록 하였다. 현재 기업의 환경 및 전략 의도에 따라 아웃소싱 파트너 선정과 아웃소싱 전략을 수행함으로써 만족도와 효과에 대한 기대치를 예상할 수 있는데 도움이 될 것이다.

• 한국농림기상학회지
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• 제3권4호
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• pp.220-237
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• 2001

Over the 20th century global temperature increase has been 0.6$^{\circ}C$. The globally averaged surface temperature is projected to increase by 1.4 to 5.8$^{\circ}C$ over the period 1990 to 2100. Nearly all land areas will have higher maximum temperature and minimum temperature, and fewer cold days and frost days. More intense precipitation events will take plate over many areas. Over most mid-latitude continental interiors will have increased summer continental drying and associated risk of drought. By 2100, if the annual surface temperature increase is 3.5$^{\circ}C$, we will have 15.9$^{\circ}C$ from 12.4$^{\circ}C$ at present. Also the annual precipitation will range 1,118-2,447 mm from 972-1,841 mm at present in Korea. Consequently the average crop periods for summer crops will be 250 days that prolonged 32 days than at present. In the case of gradual increase of global warming, an annual crop can be adapted to the changing climate through the selection of filial generations in breeding process. The perennial crops such as an apple should be shifted the chief producing place to northern or high latitude areas where below 13.5$^{\circ}C$ of the annual surface temperature. If global warming happens suddenly over the threshold atmospheric greenhouse gases, then all ecosystems will have tremendous disturbance. Agricultural land-use plan, which state that farmers decide what to plant, based on their climate-based advantages. Therefore, farmers will mitigate possible negative imparts associated with the climate change. The farmers will have application to use agricultural meteorological information system, and agricultural long-range weather forecast system for their agroecosystems management. The ideal types of crops under $CO_2$ increase and climate change conditions are considered that ecological characteristics need indispensable to accomplish the sustainable agriculture as the diversification of genetic resources from yield-oriented to biomass-oriented characteristics with higher potential of $CO_2$ absorption and primary production. In addition, a heat-and-cold tolerance, a pest resistance, an environmental adaptability, and production stability should be also incorporated collectively into integrated agroecosystem.

• Archives of Reconstructive Microsurgery
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• 제22권1호
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• pp.33-37
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• 2013

Purpose: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery. Materials and Methods: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side. Results: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6). Conclusion: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

• 한국수산과학회지
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• 제41권2호
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• pp.107-112
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• 2008

To evaluate uncertainty and risk in biological reference points, we applied a bootstrapping method and a Bayesian procedure to estimate the related confidence intervals. Here we provide an example of the maximum sustainable yield (MSY) of turban shell, Batillus cornutus, estimated by the Schaefer and Fox models. Fitting the time series of catch and effort from 1968 to 2006 showed that the Fox model performs better than the Schaefer model. The estimated MSY and its bootstrap percentile confidence interval (CI) at ${\alpha}=0.05$ were 1,680 (1,420-1,950) tons for the Fox model and 2,170 (1,860-2,500) tons for the Schaefer model. The CIs estimated by the Bayesian approach gave similar ranges: 1,710 (1,450-2,000) tons for the Fox model and 2,230 (1,760-2,930) tons for the Schaefer model. Because uncertainty in effort and catch data is believed to be greater for earlier years, we evaluated the influence of sequentially excluding old data points by varying the first year of the time series from 1968 to 1992 to run 'backward' bootstrap resampling. The results showed that the means and upper 2.5% confidence limit (CL) of MSY varied greatly depending on the first year chosen whereas the lower 2.5% CL was robust against the arbitrary selection of data, especially for the Schaefer model. We demonstrated that the bootstrap and Bayesian approach could be useful in precautionary fisheries management, and we advise that the lower 2.5% CL derived by the Fox model is robust and a better biological reference point for the turban shells of Jeju Island.

• 융합보안논문지
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• 제20권3호
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• pp.13-20
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• 2020

접근이 어렵거나 지속적인 모니터링이 필요한 서비스에 적용 가능한 WSN(Wireless Sensor Network) 기술은 최근 그 응용 분야의 확대 및 효율성의 증가로 인해 연구 개발의 필요성이 점증하고 있는 분야이다. 특히, 국방 분야에서는 경계 및 감시 정찰 등 인원 투입 시 발생 가능한 위험 요소를 회피하고 효율적인 인원 활용을 위한 대안으로 센서 네트워크를 포함한 최신 IT 기술에 대한 연구가 활발히 진행되는 상황이다. 본 논문에서는 클러스터링(Clustering) 및 위치 기반 기법을 적용하여 센서 네트워크를 구성하는 노드들의 수명을 늘리기 위한 조건을 분석한 후 수명 연장을 위한 요인들을 도출하였다. 도출된 요인들은 CH(Cluster Head) 선출 방안, 각각의 CH에서 BS(Base Station)까지의 경로 선정 방안 등이 포함되며 실험을 통해 검증된 최적의 결과 및 방안을 적용하여 클러스터링 기반의 WSN 구성 방안을 제안하였다.