• Journal of Gastric Cancer
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• v.7 no.1
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• pp.31-37
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• 2007

Purpose: A pancreas-preserving total gastrectomy (PPTG) was introduced to decrease the postoperative complications due to pancreatic resection. However, some complications, such as leakage of pancreatic juice, are still reported. Thus, the purpose of this study was to propose a supplementary procedure based on the results of treatment for gastric cancer at our hospital. Materials and Methods: From Jan. 1997 to Dec. 2004, the cases of 141 patients who underwent a PPTG for gastric cancer were reviewed retrospectively. The patients were divided into Group A (38 cases), patients who were treated using a conventional PPTG, and Group B (103 cases), patients who were treated using a new and improved PPTG. Their postoperative complications were compared. Results: No statistically significant differences in clinicopathologic data were noted between the two groups. The comparison of complications showed for groups A and B, respectively, 4 and 0 cases of pancreatic fistula, 1 and 0 cases of intraabdominal abscess, 2 and 0 cases of intraoperative pancreatic necrosis, and 2 and 2 cases of minor leakage. The difference in the prevalence of complications between the two groups was statistically significant (P=0.0001). Conclusion: In order to reduce the risk of PPTG-related complications, we used vascular clamps to observe the necrosis of the pancreatic tail before dividing the splenic artery, and this method resulted in a significant decrease in postoperative complications. Thus, we conclude that our use of vascular clamps in a PPTG is a simple and useful method for preventing postoperative complications.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.401-408
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• 1997

Background : Pulmonary sequestration is a rare congenital malformation, which is manifested by formation of nonfunctioning lung tissue lacking normal communication with the tracheobronchial tree. The preoperative diagnostic rate has been relatively low, and without consideration of pulmonary sequestration, unexpected bleeding from aberrant vessels may be a serious problem during the operation. The purpose of our study is to describe the clinical features of pulmonary sequestration based on a review of 15 cases treated by operation. Method : Fifteen patients with pulmonary sequestration who had undergone surgical treatment from 1991 through May 1996 at Yongdong Severance Hospital and Severance Hospital were reviewed retrospectively. Results : The mean age of the patients was 22.5 years (range 5~57), and male to female ratio was 9 : 6. Clinical presentations varied from recurrent respiratory infections such as fever, cough, and sputum or chest pain to no symptom. The chest simple X-rays showed multicystic shadow(10/15) and solid mass-like shadow(5/15). The chest CT scans, done in twelve cases, showed multicystic lesion with or without lung infiltration(8/12), solid mass-like lesion(4/12), The chest MRIs, done in three cases, revealed the aberrant arteries originating from descending aorta(2/3). Aortograms, done in four cases, showed the aberrant arteries originating from descending thoracic aorta(2/4), abdominal aorta(I/4), and intercostal artery(1/4). and the venous returns were via the pulmonary veins. Pulmonary sequestration was considered preoperatively in six patients of fifteen. Other preliminary diagnosis were lung tumor(3/15), lung abscess(21/15), bronchiectasis(2/15), and mediastinal tumor(2/15). In the operative findings, twelve cases were of intralobar type and three cases of extralobar type. The left lower lobe was most often affected(9/15) and one extralobar sequestration was in the pericardium. The aberrant arteries originated from descending thoracic aorta(6/15), abdominal aorta(1/15), internal thoracic arteries (2/15), intercostal artery(1/15), pericardiophrenic artery(1/15), but in four cases, the origins could not be defined. There was no mortality or complication postoperatively. Conclusion : In our study, preoperative diagnostic rate was relatively low, and clinical features were similar to previous reports. Preoperative vigorous diagnostic approach including aortography is strongly advocated not only for its diagnostic value, but also for accurate localization of the aberrant vessels, which is major concern to surgical procedure.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.976-986
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• 1996

BACKGROUND : Dyspnea is common among patients with cardiopulmonary disease, and "daily disability" is defined as a functional impairment resulting from exercise intolerance. The maximal oxygen uptake(VO2max) during exhausting work is not only the best single physical indicator of the capacity of a man for sustaining hard muscular work, but also the most objective method by which one can determine the physical fitness of an individual as reflected by his cardiovascular system. However, the expense, time and personnel requirements make this procedure prohibitive for testing large group. The walking test is well-known type of exercise and it cost nothing to perform and have good reproducibility. Thus we performed the walking test and investigated correlations with spirometry, ABG and exercise test. METHOD: We observed the walking test and exercise test by cycle ergometer in 37 patients who visited our hospital because of dyspnea. Arterial blood gas analysis and spiromety, dyspnea index were performed, too. RESULT : (1) The VO2max was significantly lower in patients with COPD and cardiovascular disease than asthma and dyspnea on exertion group(p<0.05). The walking test distance was also lower in former. (2) The 12 minute walking test was significantly correlated with VO2max, PaCO2, FVC(%), FEV1(%) in all patients(p<0.05), and the walking test was only conelated with VO2max in patients with COPD(p<0.05). (3) In COPD patients, the VO2max was best correlated with FEV1(%) and FVC(%) and significantly correlated with walking test. But there was no correlation between walking test and FEV1(%) & FVC(%). (4) The 6 minute walking test was well correlated with 12 minute walking test(r=0.92. p<0.01). CONCLUSION : The walking test is the simple method for assessing exercise performance in patient with cardiopulmonary disease and a reliable indicator for VO2max. And the walking test is practical method for assessing on everyday disability rather than maximal exercise capacity. The 6 minute walking test is highly correlated with 12 minute walking test and a less exhausting for the patients and a time-saving for the investigator.

• The Korean Journal of Emergency Medical Services
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• v.22 no.1
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• pp.7-19
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• 2018

Purpose: With the purpose of educating and producing outstanding paramedics by enhancing their competencies, this study aimed to make policy suggestions to re-establish the education system and improve the national examination and the certification scheme. Methods: This study used focus group interviews and questionnaires to collect data. Totally, there were 277 subjects, including experts from the education and field. Data were collected from September 9 to 20, 2016, and analyzed using SPSS 22.0. Results: To strengthen the curriculum of paramedics, this study suggested 27 courses with 94 credits as the standardized curriculum and derived 9 core competencies of paramedics. For the national examination, this study suggested consolidating written test subjects, adding scenario questions to practical tests, and applying critical criteria to simple practical tests that performs a procedure, grading these tests on a pass/fail basis. In addition, this study suggested converting certification into license, reflecting paramedics' healthcare job characteristics. Conclusion: The quality of emergency medical services in Korea will improve when those with core competencies that originated from the standardized curriculum based on the results of this study acquire their certification through the national test scheme, and the certification management system creates a virtuous cycle to further enhance paramedics' professionalism.

• Journal of Intelligence and Information Systems
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• v.21 no.1
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• pp.99-118
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• 2015

Object-oriented programming languages have been widely selected for developing modern information systems. The use of concepts relating to object-oriented (OO, in short) programming has reduced efforts of reusing pre-existing codes, and the OO concepts have been proved to be a useful in interpreting system requirements. In line with this, we have witnessed that a modern conceptual modeling approach supports features of object-oriented programming. Unified Modeling Language or UML becomes one of de-facto standards for information system designers since the language provides a set of visual diagrams, comprehensive frameworks and flexible expressions. In a modeling process, UML users need to consider relationships between classes. Based on an explicit and clear representation of classes, the conceptual model from UML garners necessarily attributes and methods for guiding software engineers. Especially, identifying an association between a class of part and a class of whole is included in the standard grammar of UML. The representation of part-whole relationship is natural in a real world domain since many physical objects are perceived as part-whole relationship. In addition, even abstract concepts such as roles are easily identified by part-whole perception. It seems that a representation of part-whole in UML is reasonable and useful. However, it should be admitted that the use of UML is limited due to the lack of practical guidelines on how to identify a part-whole relationship and how to classify it into an aggregate- or a composite-association. Research efforts on developing the procedure knowledge is meaningful and timely in that misleading perception to part-whole relationship is hard to be filtered out in an initial conceptual modeling thus resulting in deterioration of system usability. The current method on identifying and classifying part-whole relationships is mainly counting on linguistic expression. This simple approach is rooted in the idea that a phrase of representing has-a constructs a par-whole perception between objects. If the relationship is strong, the association is classified as a composite association of part-whole relationship. In other cases, the relationship is an aggregate association. Admittedly, linguistic expressions contain clues for part-whole relationships; therefore, the approach is reasonable and cost-effective in general. Nevertheless, it does not cover concerns on accuracy and theoretical legitimacy. Research efforts on developing guidelines for part-whole identification and classification has not been accumulated sufficient achievements to solve this issue. The purpose of this study is to provide step-by-step guidelines for identifying and classifying part-whole relationships in the context of UML use. Based on the theoretical work on Meta-model Formalization, self-check forms that help conceptual modelers work on part-whole classes are developed. To evaluate the performance of suggested idea, an experiment approach was adopted. The findings show that UML users obtain better results with the guidelines based on Meta-model Formalization compared to a natural language classification scheme conventionally recommended by UML theorists. This study contributed to the stream of research effort about part-whole relationships by extending applicability of Meta-model Formalization. Compared to traditional approaches that target to establish criterion for evaluating a result of conceptual modeling, this study expands the scope to a process of modeling. Traditional theories on evaluation of part-whole relationship in the context of conceptual modeling aim to rule out incomplete or wrong representations. It is posed that qualification is still important; but, the lack of consideration on providing a practical alternative may reduce appropriateness of posterior inspection for modelers who want to reduce errors or misperceptions about part-whole identification and classification. The findings of this study can be further developed by introducing more comprehensive variables and real-world settings. In addition, it is highly recommended to replicate and extend the suggested idea of utilizing Meta-model formalization by creating different alternative forms of guidelines including plugins for integrated development environments.

• Journal of Veterinary Clinics
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• v.28 no.5
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• pp.497-505
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• 2011

Natural orifice transluminal endoscopic surgery is a newly emerging technique recently, with its many potential advantages in clinical practice. Cholecystectomy by Hybrid NOTES in this work, performed with single working channel endoscope in conjunction with a laparoscopic grasping forceps in dogs, is a "bridge" between laparoscopic procedure and pure NOTES. Three different approaches for cholecystectomy were carried out; transgastric, transcolonic and transvaginal. In all three approaches, abdominal opening was made by a 5 mm trocar, followed by making pneumoperitoneum of 4 mmHg with $CO_2$ insufflator. Transgastric cholecystectomy, single working channel endoscope was advanced to the peritoneal cavity through gastric incision in antral region made by endoscopic needle knife. Endoscope was retroflexed to visualize the gall bladder. Transcolonic access, incision for endoscopic entry was done at right ventral wall of descending colon, 15 cm inside from the anus. Incision in transvaginal access was made at right-ventral region, just caudal to the caudal tubercle. With the simple traction by the laparoscopic grasping forceps, good visualization of surgical field was obtained in all three groups. Cystic duct and artery were ligated with endoclips; for complete gall bladder dissection from liver, L-knife was used. Closure of incision sites were done in transgastric and transcolonic cholecystectomy by endoclips, not in transvaginal approach.

• The Korean Journal of Nuclear Medicine
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• v.39 no.3
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• pp.200-208
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• 2005

Purpose: Tc-99m labeled diethylenetriaminepentaacctic acid (DTPA)-coupled galactosylated human serum albumin (GSA) is a currently used imaging agent for asialoglycoprotein receptor (ASGPR) of the liver, but, it has several shortcomings. Recently a new ASGPR imaging agent, $^{99m}Tc$-lactosylated human serum albumin (LSA), with simple labeling procedure, high labeling efficiency, high stability was developed. In order to assess the feasibility of the $^{99m}Tc$-LSA as a ASGPR imaging radiopharmaceuticals, we performed biodistribution study of the tracer in liver injured mice model and the results were compared with histolgic data. Materals and Methods: To induce hepatic damage in ICR mice, diethylnitrosamine (DEN) ($60mg/kg/week{\times}5time$, low dose or $180mg/kg/week{\times}2times$, high dose) and thioacetamide (TAA) ($50mg/kg{\times}1time$) were administrated intraperitoneally. Degree of liver damage was evaluated by tissue hematoxilin-eosin stain, and expression of asialoglycoprotein receptor (ASGPR) was assessed by immunohistochemistry using ASGPR antibody. $^{99m}Tc$-LSA was intravenously administrated via tail vein in DEN or TAA treated mice, and biodistribution study of the tracer was also performed. Results: DEN treated mice showed ballooning of hepatocyte and inflammatory cell infiltration in low dose group and severe hapatocyte necrosis in high dose group, and low dose group showed higher ASGPR staining than control mice in immunohistochemical staining. TAA treated mice showed severe hepatic necrosis. $^{99m}Tc$-LSA Biodistribution study showed that mice with hepatic necrosis induced by high dose DEN or TAA revealed higher blood activity and lower liver activity than control mice, due to slow clearance of the tracer by the liver. The degree of liver uptake was inversely correlated with the degree of histologic liver damage. But low dose DEN treated mice with mild hepatic injury showed normal blood clearance and hepatic activity, partly due to overexpression of ASGPR in mice with mild degree hepatic injury. Conclusion: Liver uptake of $^{99m}Tc$-LSA was inversely correlated with degree of histologic hepatic injury in DEN and TAA treated mice. These results support that $^{99m}Tc$-LSA can be used to evaluate the liver status in liver disease patients.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.379-388
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• 2000

Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

• Geophysics and Geophysical Exploration
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• v.8 no.1
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• pp.7-17
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• 2005

The determination of seismic velocities in refractors for near-surface seismic refraction investigations is an ill-posed problem. Small variations in the computed time parameters can result in quite large lateral variations in the derived velocities, which are often artefacts of the inversion algorithms. Such artefacts are usually not recognized or corrected with forward modelling. Therefore, if detailed refractor models are sought with model based inversion, then detailed starting models are required. The usual source of artefacts in seismic velocities is irregular refractors. Under most circumstances, the variable migration of the generalized reciprocal method (GRM) is able to accommodate irregular interfaces and generate detailed starting models of the refractor. However, where the very-near-surface environment of the Earth is also irregular, the efficacy of the GRM is reduced, and weathering corrections can be necessary. Standard methods for correcting for surface irregularities are usually not practical where the very-near-surface irregularities are of limited lateral extent. In such circumstances, the GRM smoothing statics method (SSM) is a simple and robust approach, which can facilitate more-accurate estimates of refractor velocities. The GRM SSM generates a smoothing 'statics' correction by subtracting an average of the time-depths computed with a range of XY values from the time-depths computed with a zero XY value (where the XY value is the separation between the receivers used to compute the time-depth). The time-depths to the deeper target refractors do not vary greatly with varying XY values, and therefore an average is much the same as the optimum value. However, the time-depths for the very-near-surface irregularities migrate laterally with increasing XY values and they are substantially reduced with the averaging process. As a result, the time-depth profile averaged over a range of XY values is effectively corrected for the near-surface irregularities. In addition, the time-depths computed with a Bero XY value are the sum of both the near-surface effects and the time-depths to the target refractor. Therefore, their subtraction generates an approximate 'statics' correction, which in turn, is subtracted from the traveltimes The GRM SSM is essentially a smoothing procedure, rather than a deterministic weathering correction approach, and it is most effective with near-surface irregularities of quite limited lateral extent. Model and case studies demonstrate that the GRM SSM substantially improves the reliability in determining detailed seismic velocities in irregular refractors.

• Korean Journal of Environment and Ecology
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• v.34 no.6
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• pp.558-572
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• 2020

The purpose of this study was to classify the types of degraded areas of Mt. Jirisan section in Baekdudaegan and survey the actual condition of each damage type to use it as basic data for the direction of the restoration of damaged areas according to damage type based on the vegetation information of reference ecosystem. The analysis of the Mt. Jirisan section's actual degraded conditions showed that the total number of patches of degraded areas was 57, and the number of patches and size of degraded areas was higher at the low average altitude and gentle slope. Grasslands (deserted lands) and cultivated areas accounted for a high portion of the damage types, indicating that agricultural land use was a major damage factor. The survey on the conditions of 14 degraded areas showed that the types of damage were classified into the grassland, cultivated area, restoration area, logged-off land, and bare ground. The analysis of the degree of disturbance (the ratio of annual and biennial herb, urbanized index, and disturbance index) by each type showed that the simple single-layer vegetation structure mostly composed of the herbaceous and the degree of disturbance were high in the grassland and cultivated land. The double-layer vegetation structure appeared in the restoration area where the pine seedlings were planted, and the inflow of naturalized plants was especially high compared to other degraded areas due to disturbances caused by the restoration project and the nearby hiking trails. Although the inflow of naturalized plants was low because of high altitude in bare ground, the proportion of annual and biennial herb was high, indicating that all surveyed degraded areas were in early succession stages. The stand ordination by type of damage showed the restoration area on the I-axis, cultivated area, grassland, logged-off land, and bare ground in that order, indicating the arrangement by the damage type. Moreover, the stand ordination of the degraded areas and reference ecosystem based on floristic variation showed a clear difference in species composition. This study diagnosed the status of each damage type based on the reference ecosystem information according to the ecological restoration procedure and confirmed the difference in species composition between the diagnosis result and the reference ecosystem. These findings can be useful basic data for establishing the restoration goal and direction in the future.