The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

Lee, Kyeong Soo,Kim, Chang Suk,Park, Jong Heon,Hwang, Tae Yoon,Kim, Sang Won,Sim, Sung Bo,Lee, Kun Sei The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.sup

Background: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. Methods: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. Results: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. Conclusion: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

국내 정형외과 의료소송 현황 파악

이원(Won Lee),이미진(Mi Jin Lee),김용민(Yong Min Kim),우찬명(Chan Myung Woo),김소윤(So Yoon Kim),김양수(Yang-Soo Kim) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 국내 정형외과 관련 의료소송 판결문의 분석을 통하여 정형외과 의료소송의 현황과 원인이 된 과정을 파악하고자 함이다. 대상 및 방법: 소송시작이 2005년부터 2010년인 정형외과 의료소송 판결문 341건을 대상으로 하여 빈도분석을 실시하였다. 결과: 사건 발생 시점에서 소송 종결 시점까지의 평균 소요기간은 4.22년이었다. 의료소송의 원인이 된 과정은 수술이 46.3%였고, 수술의 종류는 척추 수술이 가장 많았다. 사고의 결과는 장애가 가장 많았고, 최종심 결과는 원고일부승이 40.5%, 원고패(기각)가 34.3%였다. 감염은 전체 중 26.1%에서 발생하였고, 손해배상 청구금액은 평균 181,998,036원이었으며 인용금액은 평균 58,897,161원이었다. 결론: 정형외과 의료소송으로 이어진 의료사고의 주요 원인 과정은 수술이 가장 많았고, 그 중에서도 척추 수술이 가장 많았다. 추후 의료사고의 근본 원인분석을 통해 의료사고를 줄이고 재발을 방지하기 위한 후속 연구가 이루어져야 할 것이다. Purpose: Through the analysis of orthopedics lawsuit rulings, the purpose of this study is to understand the current trends of medical lawsuits in orthopedics in Korea. Materials and Methods: An analysis of medical lawsuits in orthopedics was conducted. As the study method, a quantitative analysis was performed on 341 cases. Results: The average period of lawsuits, from the occurrence of the medical accident to end of the ruling, took an average of 4.22 years. The most frequent procedure that was the main cause of the medical accidents was surgery, at 46.3%. When surgery is the main procedure that caused the medical accidents, the result of examining the types of surgeries showed that spine surgery had the highest percentage. For the outcome of the accident, the highest number of cases resulted in disability and for the final court outcome, 40.5% ruled partially in favor of the plaintiff (the patient) with acknowledgement of only the damage incurred due to medical error of the total sum claimed, and dismissal of the claim made by the plaintiff (patient) accounted for 34.3%; 26.1% of cases develop infection. For the amount of claim for damage, the average amount of claim was 181,998,036 won; in the judgement amount, the average amount of judgement was 58,897,161 won. Conclusion: The most frequent procedure in orthopedics was surgery and spine surgery comprised a large proportion of these surgeries. Future studies to determine root causes of medical accidents should be conducted to reduce medical lawsuits and to plan against the repeating of medical accidents.

아크릴계 점착제의 제조와 가교물성에 관한 연구

김판수 ( Pan Soo Kim ),이상무 ( Sang Mu Lee ),정신혜 ( Sin Hye Jung ),이원기 ( Won Ki Lee1 ) 한국접착및계면학회 2013 접착 및 계면 Vol.14 No.1

압력감응성 아크릴 점착제의 물성은 가교를 위한 관능성그룹을 가진 단량체를 이용하여 쉽게 물성을 조절할 수 있다. 본 연구에서는 두개의 다른 가교제, isocyanate 및 epoxy형 가교제에 따른 아크릴 점착제의 가교특성과 물성을 연구하였다. 2-Ethylhexyl acrylate, acrylic acid (AA)와 2-hydroxyethyl methacrylate를 주 단량체로 하여 이소시아네이트 또는 에폭시형 가교제로 가교한 점착제의 박리점착 특성, 볼텍, 유지력 및 수축성을 고찰하였다. 점착특성은 AA함량 증가와 더불어 증가하였고 가교점이 많고 ether와 같은 유연한 결합을 생성하는 에폭시형 가교제에서 우수한 물성을 나타내었다. The physical properties of the acrylic pressure sensitive adhesives (PSAs) can be easily controlled by a proper functional monomer which has functional groups for crosslinking. This study was to investigate the effect of crosslinking agents, isocyanate and epoxy types, of acrylic PSAs on adhesive properties. 2-Ethylhexyl acrylate, acrylic acid (AA), and 2-hydroxy ethyl methacrylate as monomer were used. The obtained samples with different AA contents were partially crosslinked with epoxy- or isocyanate-typed agent. Peel strength, balltack, holding power test and contraction percentage of the obtained PSA were evaluated. Most properties of acrylic PSAs were increased with AA content and acrylic PSAs with epoxy-typed crosslinking agent (4 crosslinking sites) which produces flexible link (ether), showed better properties than those of isocyanate-typed one (3 crosslinking sites).

백서에서 수술 후 복부 유착방지용 재료들의 효능평가

심희수(Hee Soo Shim),이영우(Young Woo Lee1),이영무(Young Moo Lee),오영하(Young Ha Oh),권성원(Sung Won Kwon),김진홍(Jin Hong Kim),손승국(Seung Kook Sohn) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.63 No.3

Analysis of acne-related judicial precedents from 1997 to 2018 in South Korea

( Ji Hoon Yang ),( Soo Ick Cho ),( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Dae Hun Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Medicolegal disputes are increasing in practical medicine. Acne is a common problem but is usually related to cosmetic problems such as acne scars. Medications or procedures related to acne could lead to medical malpractice. Objectives: To analyze medical litigation associated with acne or acne scar in South Korea. Methods: Acne-related judgements were searched using the Supreme Court of Korea’s Written Judgment Management System based on the keywords “acne” or “acne scar.” Results: Eleven cases were selected as litigated cases of acne or acne scar. Eight cases (72.7%) were related to acne scar and three (27.3%) were related to acne. Treatment modalities such as peeling (n = 6), laser treatment (n = 3), photodynamic therapy (n = 1), and antibiotic (n = 1) resulted in lawsuit. Claimed sequelae of the treatment were hyperpigmentation (n = 5), scar worsening (n = 5), erythema (n = 3), skin bumps (n = 1), and liver transplant (n = 1). Eight cases (72.7%) were awarded to the plaintiff, and the others were dismissed. The average awarded amount was 16,801,324± 24,452,486 (mean±standard deviation) Korean Won. Conclusion: Various treatments for acne or acne scar can cause medical disputes. Unnecessary litigation could be prevented if simple measures such as history taking, choosing proper procedure, and adequate management after the procedure along with sufficient informed consent were performed.

Analysis of Judicial Precedents Cases Regarding Skin Cancer from 1997 to 2017 in Republic of Korea

( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Gwanghyun Jo ),( Je-ho Mun ),( Soo Ick Cho ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.3

Background: Both medical disputes and the incidence of skin cancer are increasing in Korea. Objective: The aim of this study was to figure out the medical litigation related to skin cancer and propose a method to prevent the medical disputes. Methods: Skin cancer-related judgments were searched by The Supreme Court of Korea’s Written Judgment Management System based on the keywords for skin cancer. The search system included sentenced cases at the Lower Courts, the Appellate Courts, and the Supreme Court from 1997 to 2017. Results: Seven cases were selected as the litigation cases related to skin cancer. Four cases (57.1%) presented malignant melanoma, while the rest presented squamous cell carcinoma, metastatic skin cancer, and peripheral T cell lymphoma (1 case in each). Four cases resulted in death from cancer metastasis, and 3 cases presented as sequelae. The legal issues related to the medical disputes could be categorized as follows: misdiagnosis, delayed diagnosis, performance error, and lack of informed consent. Delayed diagnosis and lack of informed consent were the most common issues (n=4) in the precedents. Five cases (71.4%) were sentenced the awarded amounts to the plaintiff, including 2 cases of settlement decision. The average awarded amount was 42,553,644±27,567,455 Korean won. Conclusion: Physicians should pay attention to the cases of the skin cancer to prevent medical malpractice and disputes. The practices pertaining to proper diagnosis, treatment plans, and obtaining an informed consent should be followed during the course of treating skin cancer. (Ann Dermatol 31(3) 300∼306, 2019)

Original Articles : Clinical significance of occult hepatitis B virus infection in chronic hepatitis C patients

( Jae Young Jang ),( Soung Won Jeong ),( Sung Ran Cheon1 ),( Sae Hwan Lee1 ),( Sang Gyune Kim ),( Young Koog Cheon ),( Young Seok Kim1 ),( Young Deok Cho1 ),( Hong Soo Kim ),( So Young Jin ),( Yun Soo 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3

Background/Aims: We investigated the frequency of occult hepatitis B virus (HBV) infection in anti-hepatitis C virus (HCV)-positive individuals and the effects of occult HBV infection on the severity of liver disease. Methods: Seventy-one hepatitis B virus surface-antigen (HBsAg)-negative patients were divided according to their HBV serological status into groups A (anti-HBc positive, anti-HBs negative; n=18), B (anti-HBc positive, anti-HBs positive; n=34), and C (anti-HBc negative, anti-HBs positive/negative; n=19), and by anti-HCV positivity (anti-HCV positive; n=32 vs. anti-HCV negative; n=39). Liver biopsy samples were taken, and HBV DNA was quantified by real-time PCR. Results: Intrahepatic HBV DNA was detected in 32.4% (23/71) of the entire cohort, and HBV DNA levels were invariably low in the different groups. Occult HBV infection was detected more frequently in the anti-HBc-positive patients. Intrahepatic HBV DNA was detected in 28.1% (9/32) of the anti-HCV-positive and 35.9% (14/39) of the anti-HCV-negative subjects. The HCV genotype did not affect the detection rate of intrahepatic HBV DNA. In anti-HCV-positive cases, occult HBV infection did not affect liver disease severity. Conclusions: Low levels of intrahepatic HBV DNA were detected frequently in both HBsAg-negative and anti-HCV-positive cases. However, the frequency of occult HBV infection was not affected by the presence of hepatitis C, and occult HBV infection did not have a significant effect on the disease severity of hepatitis C. (Korean J Hepatol 2011;17:206-212)

2010 파주, 안산지역 갈대, 억새 등 야초류의 이용실태와 사료가치 평가

서성(Sung Seo),김원호(Won Ho Kim),정민웅(Min Woong Jung),박형수(Hyung Soo Park),심재진(Jae Jin Shim),박진길(Jin Gil Park),성하균(Ha Guyn Sung),김종덕(Jong Duk Kim),이종경(Joung Kyong Lee) 한국초지조사료학회 2011 한국초지조사료학회지 Vol.31 No.2

본 연구는 부존 조사료자원의 이용을 활성화하여 수입사료를 줄이고 가축 사료비를 절감하고자 2010년도에 경기 파주 (민통선 지역)와 경기 안산 (시화지구)에서 갈대와 억새 등 야초자생지를 탐색하고, 수확?이용실태 조사와 함께 사료가치를 분석하였다. 파주 민통선 내억새 (Miscanthus sinensis)와 갈대 (Phragmites communis) 혼합 자생지는 90~100 ㏊ 규모로, 1차 곤포작업으로 사일리지 520톤 (㏊당 6톤), 2차로 380톤 (㏊당 4톤)을 조제하여, 연 사일리지 900톤 (㏊당 10톤)을 생산하였다. 곤포의 유통가격은 롤당 52~55천 원으로 ㎏당 130~137.5원이었다. 곤포는 자가소비 50~70%, 판매유통 30~50%로, 수익성은 인건비 정도로 추정되었다. 초장 70 ㎝의 재생 억새는 조단백질 9.6%, 상대사료가치 82.4 (건초 4등급), 건물 소화율 67.7%, 초장 70 ㎝의 재생 갈대는 각각 13.8%, 84.3 (4등급), 67.9%로 사료가치는 높았으며, 수확이 늦어짐에 따라 사료가치는 크게 낮아졌다. 안산 시화지구 (3공구)의 갈대 등 야초류자생지는 100 ㏊ 정도로 2009년도에는 50 ㏊에서 사일리지 550톤 (㏊당 11톤)을 생산하여 롤당 50천 원에 유통하였으며, 2010년도는 잦은 강우와 장마로 부분 이용에 그쳤다. 고초기의 갈대는 건물률 89.8%, 조단백질 2.2%, NDF 80.6%, ADF 55.4%, 상대사료가치 52.9 (5등급), 건물 소화율 36.4%로 볏짚에 비해서도 사료가치는 크게 낮았다. 초장 80 ㎝의 재생 갈대는 조단백질 12.9%, 상대사료가치 99.8 (3등급), 건물 소화율 66.6%로 사료가치는 양호하였으며, 개화기의 초장 150 ㎝ 갈대는 조단백질 4.5%, 상대사료가치 59.9 (5등급), 건물 소화율 42.2%로 볏짚의 사료가치와 비슷하였다. 이상의 결과를 종합하여볼 때, 갈대, 억새 등 야초류는 현 상태에서 최대한 수거?이용하되, 사료가치를 유지하고 가축 기호성을 고려한 시기에 수확하는 것이 중요하며, 최소한 볏짚과 비슷하거나 그 이상의 사료가치를 기대하기 위해서는 7월 중순 이전 (늦어도 7월까지)에 수확?이용하는 것이 권장된다. 본 연구에서 조사된 대부분의 야초류는 상대사료가치가 75 이하인 건초 5등급으로 사료가치는 매우 낮았으며, 키가 작은 영양생장기에 수확한 경우에만 4등급으로 나타났다. 부존 조사료자원의 이용은 양질의 사료작물 생산과 병행하여 추진하는 것이 바람직하였다. This study was carried out in 2010 to investigate the utilization and nutritive value of native grasses, such as Phragmites communis and Miscanthus sinensis which might reduce the cost of feeding domestic cattle. The regions within the Civilian Control Line in Paju and Sihwa region in Ansan were surveyed. In Paju, the yearly silage production was 900 MT harvested from 90 ha (10 MT/㏊). About 30~50% of these were sold out at the marketing price of 52,000~55,000 Won per roll (130~137.5 Won/㎏). Regrown Miscanthus sinensis of 70 ㎝ in length contained 9.6% of crude protein (CP), 82.4 of relative feed value (RFV), and 67.7% of in vitro dry matter digestibility (IVDMD). Regrown Phragmites communis of 70 ㎝ in length contained 13.8% of CP, 84.3 of RFV, and 67.9% of IVDMD. As harvesting was delayed, the quality was decreased dramatically. In Ansan region, Phragmites communis plantation covers 100 ha. The silage production was 550 MT from the area of 50 ha (11 MT/㏊) in 2009. And the marketing price was 50,000 Won per roll. But in 2010 only a small amount of grasses could have been baled due to frequent and much rainfall from spring to summer season. However, the good forage quality was observed from regrown Phragmites communis of 80 ㎝ in length, 12.9% CP, 99.8 RFV and 66.6% IVDMD, while that of late matured grasses was very low, 2.2% CP, 52.9 RFV and 36.4% IVDMD, greatly lower than forage quality of rice straw. The quality of grasses at bloom stage of 150 ㎝ in length was similar to that of rice straw, showing 4.5% CP, 59.9 RFV and 42.2% IVDMD. In conclusion, the overall quality of most native grasses in this survey were very poor. Therefore, we recommend that Phragmites communis and Miscanthus sinensis should be harvested during June or July to obtain better forage quality which is richer in forage values than rice straw. Production of high quality forage crops was also desirable for self sufficiency of forage.

하수처리장 적용을 위한Semi-카플란 수차가 장착된 마이크로수력발전 시스템

채규정(Kyu Jung Chae),김동수(Dong Soo Kim),천경호(Kyung Ho Cheon),김원경(Won Kyoung Kim),김정연(Jung Yeon Kim),이철형(Chul Hyung Lee),박완순(Wan Soon Park) 大韓環境工學會 2013 대한환경공학회지 Vol.35 No.5

소수력발전은 하수처리장 에너지 자립을 위한 효과적인 대안이다. 본 연구는 유량변동이 크고 유효낙차가 낮은 중소형하수처리장(기흥레스피아) 적용을 위해 피치조절형 세미카플란(semi-kaplan) 마이크로수력발전의 적용 타당성을 평가하였다. 가변피치 semi-kaplan 수차는 유량조절을 위한 가이드베인은 생략하고 피치조절형 런너를 장착하여 기계적 결함은 줄이면서 유량변동이 큰 처리장에 특화된 기술이다. 마이크로수력발전 시스템은 설계조건(유량 0.35 m3/s, 유효낙차 4.7 m)에서 90.2%의 수차효율 달성이 가능하였고 발전용량은 13.4 kW로 산정되었다. 설비가동률 74%로 가동 시 연간 약 86.8 MWh 에너지 생산을 통해 2.1%의 에너지 자립이 가능하고 이는 연간 49톤의 CO₂ 감축효과와 맞먹는다. 경제성 평가결과 초기 건설공사비가 200,000,000원 이하인 경우에는 내부수익률은 6.1%, 순현가는 15,539,000원, 편익-비용률은 1.08, 투자회수년은 15.5년으로 경제성이 충분한 것으로 나타났다. Small scale hydropower is one of most attractive and cost-effective energy technologies for installation within sewage treatment plants. This study was conducted to evaluate the potential of a semi-kaplan micro-hydropower (MHP) system for application to sewage treatment plants with high flow fluctuations and a low head. The semi-kaplan MHP is equipped with an adjustable runner blade, and is without a guide vane, so as to reduce the incidence of mechanical problems. A MHP rating 13.4 kWp with a semi-kaplan turbine has been considered for Kiheung Respia sewage treatment plant, and this installation is estimated to generate 86.8 MWh of electricity annually, which is enough to supply electricity to over 25 households, and equivalent to an annual reduction of 49 ton CO₂. The semi-kaplan turbine showed a 90.2% energy conversion efficiency at the design flow rate of 0.35 m3/s and net head of 4.7 m, and was adaptable to a wide range of flow fluctuations. Through the MHP operation, approximately 2.1% of total electricity demand of Kiheung Respia sewage treatment plant will be achievable. Based on financial analysis, an exploiting MHP is considered economically acceptable with an internal rate of return of 6.1%, net present value of 15,539,000 Korean Won, benefit- cost ratio of 1.08, and payback year of 15.5, respectively, if initial investment cost is 200,000,000 Korean Won.

P206 : Integral hair lipid based barrier in human hair follicle

( Long Quan Pi ),( Sungjoo Tommy Hwang ),( Won Soo Lee ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Integral hair lipid (IHL) plays an important role in all compartments of hair and skin substructures and also in involvement of hair development and function. Objectives: In this study, we described the IHL based barrier in human hair follicle according to the hair keratinization. Methods: The techniques of immunofluorescence and of transmission electron microscopy were performed to observe the ultrastructure of the hair lipid. Hair follicles were cut and observed longitudinally along the hair axis. For revealing IHL with electron microscopy, Lee’s fixative, composed of OsO4 and RuO4 was designed and used. Results: Ultrastructure of anagen hair follicle at the level where Henle layers are keratinizing, showed the intercellular lipid layer (IL) and lamellar structure (LS). Ultrastructure of anagen hair follicle at the level where the inner root sheath (IRS) is completely keratinized showed multiple LS and lamellar granules (LG). Multitudes of LS and IL are observed between the keratinized cells in IRS. Conclusion: The IHL in the hair follicle may be regarded as hair barrier to be similar to the epidermal lipid layer functioning as skin barrier.