• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• Journal of Korean Elementary Science Education
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• v.29 no.4
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• pp.552-566
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• 2010

This paper is an in-depth case study to analyze integrated elementary science lesson planning and practical teaching by two teachers at an urban elementary schools. One is an experienced teacher and the other is a beginning teacher. For this study, researchers asked teachers to design 5 stages of lesson planning after sharing basic theories about the integrated science education. The first of the 5 lesson planning stages is curriculum analysis and choice of integrated science topic. The second stage is constructing the frame of integrated science lesson contents, and the third is drawing a diagram of the integrated science lesson development. The fourth stage is making a table of lesson plans, and the last stage is writing integrated science lesson plans. Then, the teachers implemented the lessons they created. They taught students one unit of science which is composed of 8 lessons. Difficulties that teachers meet during designing plans and integrated science class were analyzed. 5 staged lesson planning, video transcriptions, teacher interview about lesson planning and teaching, researchers' checklists, reports of inspection classes, teachers' self evaluation, and students interviews were used for this study. One of the significant results of this study is that both experienced and beginning teachers had many difficulties in deciding on time to teach and contents of science and other subjects, as well as selection and organization of whole topics of integrated science teaching. The beginning teacher especially had greater issues with developing definite teaching-learning strategy to conduct thoughts and views for integrated science at the whole unit and each lesson. However, the experienced teacher was using various teaching-learning strategies by utilizing integrated science teaching professionalism to develop students' integrated thinking ability during the instruction of other subjects. The outcomes of this study are that both teachers could deeply understand the need and value of integrated science education at the elementary school through planning and teaching 8 lessons, and that they could have self-confidence with development of teaching professionalism for integrated science teaching. It may be possible that this study could help the development of pre- and in-service program for improvement of integrated science teaching professionalism for elementary school teacher.

• Journal of Gastric Cancer
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• v.6 no.2
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• pp.114-119
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• 2006

Purpose: The purpose of this study is to determine whether it is possible to evaluate patients with pN2 or pN3 early gastric cancer (EGC) as being in an advanced stage before and during the operation. Materials and Methods: 4,430 patients underwent a gastrectomy for cancer from 1990 to 2003. Eight of the 552 patients with EGC included pN2 or pN3. The estimated clinical and surgical stage before and during the operation were compared to the pathological results, and a follow-up of progression was done. Results: The patients were evenly distributed among all age groups with seven men and one woman. The pre-operative estimate of T1 by CT was 25% (2/8). In the main, the cT stage was over estimated. The estimate of over N2 was 50% (4/8). One patient was preoperatively staged as la sT1 during operation was 57.1% (4/7), and the estimate of over N2 was 67% (4/6). Two patients were intraoperatively evaluated as Ia. Only one patient survived over 5 years, and the mean survival of these patients was 15 months $(95%\;Cl:\;0{\sim}35.5)$. Conclusion: It was generally possible to evaluate patients with EGC of over pN2 as being in an advanced stage before and during the operation. Although very rare (2/552, 0.04%), there were EGC patients whose stages were not predictable at all. Therefore, more precise preoperative and intraoperative staging methods are warranted.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.76-84
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• 2005

Immediate breast reconstruction in breast cancer patients is universalized and now with a wide variety of methods to choose from, we can select a breast reconstruction method according to the patient's condition. Among these methods, immediate breast reconstruction with TRAM free flap is the most commonly used. Nipple reconstruction is usually performed as a secondary procedure, reconstructed. Nipple is reconstructed with contralateral nipple composite graft or with local flap. Areola is reconstructed with skin graft and tattooing. Therefore, to reconstruct complete breast, two or more staged operations are needed and are troublesome to both the surgeon and the patient. If we could reconstruct breast mound and nipple at same time, we would reduce the operative stages and heighten the patient's satisfaction. The author performed delayed or immediate breast reconstruction with TRAM free flap and nipple reconstruction at the same time. If the TRAM flap was to situate in the whole of the breast or at the center of the breast mound, nipple was reconstructed with a local flap from the TRAM flap. If the TRAM flap was not situated in center of breast mound, nipple was reconstructed with a local flap from remnant breast skin. Immediate nipple reconstructions in breast reconstruction consisted total of 22 cases. Among these, delayed breast reconstruction were 5 cases and immediate breast reconstruction were 17 cases. According to patient's condition and mastectomy method, nipple reconstruction method was selected; nipple reconstruction with contralateral nipple composite graft(3 cases); nipple reconstruction with remnant breast skin(6 cases); nipple reconstruction from flap margin(10 cases); nipple reconstruction with prefabricated nipple on flap(3 cases). Malposition of the reconstructed nipple was the most common and serious complication(6 cases). The other complications were atrophy of the nipple(1 case), and necrosis(1 case). Reconstruction of the breast and nipple at the same time can reduce the need of a secondary operation and use remnant skin or redundant flap tissue maximally. On the other hand, it must be considered that position and shape of nipple could be deformed, because the nipple reconstruction is performed before the shape of reconstructed breast settles completely. Prudent attention is needed, because the danger of complication is higher than delayed nipple reconstruction.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.62-66
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• 2009

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

• Journal of Chest Surgery
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• v.52 no.4
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• pp.221-226
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• 2019

Background: Accurate mediastinal lymph node staging is vital for the optimal therapy and prognostication of patients with lung cancer. This study aimed to determine the preoperative risk factors for pN2 disease, as well as its incidence and long-term outcomes, in patients with clinical N0-1 non-small cell lung cancer. Methods: We retrospectively analyzed patients who were treated surgically for primary non-small cell lung cancer from November 2005 to December 2014. Patients staged as clinical N0-1 via chest computed tomography (CT) and positron emission tomography (PET)-CT were divided into two groups (pN0-1 and pN2) and compared. Results: In a univariate analysis, the significant preoperative risk factors for pN2 included a large tumor size (p=0.083), high maximum standard uptake value on PET (p<0.001), and central location of the tumor (p<0.001). In a multivariate analysis, central location of the tumor (p<0.001) remained a significant preoperative risk factor for pN2 status. The 5-year overall survival rates were 75% and 22.9% in the pN0-1 and pN2 groups, respectively, and 50% and 78.2% in the patients with centrally located and peripherally located tumors, respectively. In a Cox proportional hazard model, central location of the tumor increased the risk of death by 3.4-fold (p<0.001). Conclusion: More invasive procedures should be considered when preoperative risk factors are identified in order to improve the efficacy of diagnostic and therapeutic plans and, consequently, the patient's prognosis.

• Journal of Veterinary Science
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• v.25 no.1
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• pp.15.1-15.15
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• 2024

Background: The anti-programmed death 1 (PD-1) antibody has led to durable clinical responses in a wide variety of human tumors. We have previously developed the caninized anti-canine PD-1 antibody (ca-4F12-E6) and evaluated its therapeutic properties in dogs with advance-staged oral malignant melanoma (OMM), however, their therapeutic effects on other types of canine tumors remain unclear. Objective: The present clinical study was carried out to evaluate the safety profile and clinical efficacy of ca-4F12-E6 in dogs with advanced solid tumors except for OMM. Methods: Thirty-eight dogs with non-OMM solid tumors were enrolled prospectively and treated with ca-4F12-E6 at 3 mg/kg every 2 weeks of each 10-week treatment cycle. Adverse events (AEs) and treatment efficacy were graded based on the criteria established by the Veterinary Cooperative Oncology Group. Results: One dog was withdrawn, and thirty-seven dogs were evaluated for the safety and efficacy of ca-4F12-E6. Treatment-related AEs of any grade occurred in 13 out of 37 cases (35.1%). Two dogs with sterile nodular panniculitis and one with myasthenia gravis and hypothyroidism were suspected of immune-related AEs. In 30 out of 37 dogs that had target tumor lesions, the overall response and clinical benefit rates were 6.9% and 27.6%, respectively. The median progression-free survival and overall survival time were 70 days and 215 days, respectively. Conclusions: The present study demonstrated that ca-4F12-E6 was well-tolerated in non-OMM dogs, with a small number of cases showing objective responses. This provides evidence supporting large-scale clinical trials of anti-PD-1 antibody therapy in dogs.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.862-868
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• 1997

Shone's syndrome is a congenital cardiac malformation that consists of multiple levels of left heart obstruction including supravalvular mitral ring, congenital mitral stenosis(parachute mitral valve), subaortic stenosis, and coarctation of aorta. This syndrome is a very rare congenital anomaly and its prognosis is poor. We experienced 9 patients with Shone's syndrome between 1985 and 1994. There were 8 male and 1 female patients, and mean age was 33.0$\pm$31.0 months ranged from 2 months to 1 1 years. The congenital mitral, stenosis and coarctation of aorta existed in all patients and the supravalvular mitral ring and subaortic stenosis in 4 patients. Two patients had all four anatomic lesions. 3 patients underwent one stage total correction and the other 6 patients underwent two staged operation that was initial coarctoplasty with thoracotomy and later correction of intracardiac anomalies with median sternotomy. A third operation was performed in 2 patients. These procedures included reoperation for coarctation and replacement of mitral valve for persistent mitral stenosis. There was no operative death at the first operation but two operative deaths at the second operation. The cause of death in two cases was severe heart failure secondary to left ventricular hypoplasia. There was no operative death at the third operation. The seven survivors have beeli followed from 11 months to 12 years(mean follow-up 6.7 $\pm$ 3.6 years). There was no late death and the New York HeArt Association activity level was class I for all patients. We conclude that a food lone-term outcome can be expected by proper surgical treatment tailred to each individual's anatomy and pathophysiology although the operative mortality and morbidity of Shone's syndrome are high.

• Journal of the Korea Organic Resources Recycling Association
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• v.11 no.3
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• pp.75-86
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• 2003

In the near future, the capacity of conventional anaerobic digester is thought to be insufficient because of the increase of the total solids from expansion of intercepting sewer, sewage quantity and direct input of night soil from near apartment districts. The objectives of this study was to investigate the improvement of digestion efficiency using microbial agent(Bio-dh). The system was a pilot-scale, two-staged, anaerobic sludge digestion system. The first-stage digester was heated and mixed. The agitation velocity of the first-stage digester was 120rpm. The second-stage digester was neither heated nor mixed. The Digestion temperature was kept at $35{\pm}1^{\circ}C$ The detention time of digester was 19 days. The dosage of sewage sludge and microbial agent were $0.65m^3/day$ and $0.5{\ell}/day$, respectively. The experiments was run for 25days. Three times a week, $COD_{Mn}$ and SS of effluent, TS, VS, and biogas production rate were measured. Temperature, pH, and alkalinity were measured daily. The results were as follows ; Without microbial agent, digestion efficiencies ranged 46.0%~50.9%(mean=48.6%), with microbial agent(Bio-dh), digestion efficiencies ranged 52.8%~57.3%(mean=54.2%). Consequently, microbial agent(Bio-dh) increased the sludge digestion efficiency about 12%. Also, Without microbial agent, the mean concentration of $COD_{Mn}$ and SS of second-stage digester effluent were 1,639mg/L, 4,888mg/L respectively. With microbial agent, the mean concentration of $COD_{Mn}$ and SS of second-stage digester effluent were 859mg/L, 2,405mg/L respectively. Consequently, microbial agent(Bio-dh) increased the removal efficiency of $COD_{Mn}$ and SS about 47.6% and 50.8%, respectively.

• Journal of Agricultural Extension & Community Development
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• v.21 no.1
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• pp.35-82
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• 2014

It was main objectives to find the learners characteristics and educational effects of cyber agricultural technology courses in RDA. For the research, it was followed by literature reviews and internet based survey methods. In internet based survey, two staged stratified sampling method was adopted from cyber training members database in RDA along with some key word as open course or certificate course, and enrollment years. Instrument was composed through literature reviews about cyber education effects and educational effect factors. And learner characteristics items were added in survey documents. It was sent to sampled persons by e-mail and 316 data was returned via google survey systems. Through the data cleaning, 303 data were analysed by chi-square, t-test and F-test. It's significance level was .05. The results of the research were as followed; First, the respondent was composed of mainly man(77.9%), and monthly income group was mainly 2,000,000 or 3,000,000 won(24%), bachelor degree(48%), fifty or forty age group was shared to 75%, and their job was changed after learning(12.2%). So major respondents' job was not changed. Their major was not mainly agriculture. Learners' learning style were composed of two or more types as concrete-sequential, mixing, abstract-random, so e-learning course should be developed for the students' type. Second, it was attended at 3.2 days a week, 53.53 minutes a class, totally 172.63 minutes a week. They were very eager or generally eager to study, and attended two or more subjects. The cyber education motives was for farming knowledge, personal competency development, job performance enlarging. They selected subjects along with their interest. A subject person couldn't choose more subjects for little time, others, non interesting subject, but more subject persons were for job performance benefits and previous subjects effectiveness. Most learner was finished their subject, but a fourth was not finished for busy (26.7%). And their entrying behavior was not enough to learn e-course and computer or internet using ability was middle level as software using. And they thought RDA cyber course was comfort in non time or space limit, knowledge acquisition, and personal competency development. Cyber learning group was composed of open course only (12.5%), certificate only(25.7%), both(36.3%). Third, satisfaction and academic achievement of e-learning learners were good, and educational service offering for doing job in learning application category was good, but effect of cyber education was not good, especially, agricultural income increasing was not good because major learner group was not farmer, so they couldn't apply their knowledge to farming. And content structure and design, content comprehension, content amount were good. The more learning subject group responded to good in effects, and both open course and certificate course group satisfied more than open course only group. Based on the results, recommendation was offered as cyber course specialization before main course in RDA training system, support staff and faculty enlargement, building blended learning system with local RDA office, introducing cyber tutor system.