Cost-Effectiveness of Rivaroxaban Compared to Warfarin for Stroke Prevention in Atrial Fibrillation

Background and Objectives Rivaroxaban is noninferior to warfarin for preventing stroke or systemic embolism in patients with high-risk atrial fibrillation (AF) and is associated with a lower rate of intracranial hemorrhage (ICH). We assessed the cost-effectiveness of rivaroxaban compared to adjusted-dose warfarin for the prevention of stroke in patients with nonvalvular AF. Methods We built a Markov model using the Korean Health Insurance Review & Assessment Service database. The base-case analysis assumed a cohort of patients with prevalent AF who were aged 18 years or older without contraindications to anticoagulation. Results Number of patients with CHA2DS2-VASc scores 0, 1 and ≥2 were 56 (0.2%), 1,944 (6.3%) and 28,650 (93.5%), respectively. In patients with CHA2DS2-VASc scores ≥2, the incidence rate of ischemic stroke was 3.11% and 3.76% in warfarin and rivaroxaban groups, respectively. The incidence rates of ICH were 0.42% and 0.15%, and those of gastrointestinal bleeding were 0.32% and 0.15% in warfarin and rivaroxaban, respectively. Patients with AF treated with rivaroxaban lived an average of 11.8 quality-adjusted life years (QALYs) at a lifetime treatment cost of $20,886. Those receiving warfarin lived an average of 11.4 QALYs and incurred costs of$17,151. Patients with rivaroxaban gained an additional 0.4 QALYs over a lifetime with an additional cost of $3,735, resulting in an incremental cost-effectiveness ratio of$9,707 per QALY. Conclusions Patients who had been treated with rivaroxaban may be a cost-effective alternative to warfarin for stroke prevention in Korean patients with AF.ope

Serum phosphorus levels are associated with carotid intima-media thickness in asymptomatic postmenopausal women

Objective: Serum phosphorous is a significant risk factor for increased carotid intima-media thickness. Increased thickness of the carotid intima is a known cause of cardiovascular disease. Coronary heart disease is a significant cause of mortality and morbidity in postmenopausal women. This study aimed to compare the relationship between serum phosphorous concentration and carotid intima-media thickness in healthy asymptomatic postmenopausal women. Methods: A retrospective review of the medical records from a health checkup center in Gangnam Severance hospital between March 2007 and September 2017 was conducted. We examined asymptomatic postmenopausal female patients with age range between 56 and 66 (N = 361) who underwent measurement of carotid intima-media thickness by B-mode ultrasonography. The physiological variables analyzed included mean blood pressure, body mass index, renal function (serum creatinine and estimated glomerular filtration rate), cholesterol levels (total cholesterol, triglyceride, and high- and low-density lipoprotein), serum phosphorous, calcium, electrolytes, diabetic status, hypertension, and albumin. Results: Pearson correlation test showed that carotid intima-media thickness was significantly associated with age (r = 0.192, P < 0.001), mean blood pressure (r = 0.116, P = 0.029), diastolic blood pressure (r = 0.146, P = 0.029), serum phosphorous (r = 0.134, P = 0.012), and lactate dehydrogenase (r = 0.106, P = 0.047). On the basis of age-adjusted multivariate linear regression analysis, carotid intima-media thickness was significantly correlated with serum phosphorous levels (β = 0.273, P = 0.022) in asymptomatic menopausal women. Increased carotid intima-media thickness (cut-off 1.5 mm) was detected, although serum phosphorous was within the normal range (2.8-4.5 mg/dL). Conclusions: Serum phosphorus concentration is significantly associated with carotid intima-media thickness in asymptomatic menopausal women.ope

Clinical Outcomes of Transcatheter Aortic Valve Implantation for Native Aortic Valves in Patients with Low Coronary Heights

Purpose: Acute coronary occlusion is a rare but fatal complication that may occur during trans-catheter aortic valve implantation (TAVI) and appears more frequently in patients with low coronary heights. We evaluated the feasibility of self-expanding valves in patients with low coronary heights undergoing TAVI. Materials and methods: TAVI for native aortic valve stenosis was conducted in 276 consecutive patients between 2015 and 2019 at our institute. Using multi-detector computed tomography (MDCT), information on the aortic valve, coronary arteries, and vascular anatomy in 269 patients was analyzed. Patients with low coronary heights were defined as those with coronary heights of 10 mm or less during MDCT analysis. Results: Among the 269 patients, 29 (10.8%) patients had coronary arteries with low heights. The mean coronary height was 8.9±1.2 mm in the left coronary artery. These patients with low coronary heights were treated with self-expandable (n=28) or balloon-expandable (n=1) valves. Prophylactic coronary protection with a guidewire, balloon, or stent prepositioned down at-risk coronary arteries was not pursued in all patients. No acute coronary occlusion occurred in any of these patients during TAVI. Five patients (17.9%) died during follow-up (average of 553.8 days), including four from non-cardiogenic causes and one from a cardiogenic (aggravation of heart failure) cause. Conclusion: A considerable number of patients with low coronary heights were observed among TAVI candidates in this study. Use of a self-expandable valve may be feasible for successful TAVI without acute coronary occlusion in patients with low coronary heights.ope

Patterns of Antiplatelet Therapy During Noncardiac Surgery in Patients With Second-Generation Drug-Eluting Stents

Background Continuing antiplatelet therapy (APT) has been generally recommended during noncardiac surgery, but it is uncertain if preoperative discontinuation of APT has been avoided or harmful in patients with second-generation drug-eluting coronary stents. Methods and Results Patients undergoing noncardiac surgery after second-generation drug-eluting coronary stent implantation were assessed in a multicenter cohort in Korea. Net adverse clinical events within 30 days postoperatively, defined as all-cause death, major adverse cardiac events, and major bleeding, were evaluated. Of 3582 eligible patients, 49% patients discontinued APT during noncardiac surgery. The incidence of net adverse clinical events was comparable between patients with continuation versus discontinuation (4.1% versus 3.4%; P=0.257) of APT during noncardiac surgery. Perioperative discontinuation of APT did not impact on net adverse clinical events (adjusted hazard ratio [HR], 1.00; 95% CI, 0.69-1.44; P=0.995). In subgroup analysis, patients undergoing intra-abdominal surgery were exposed to less risk of major bleeding by discontinuing APT (adjusted HR, 0.26; 95% CI, 0.08-0.91; P=0.035). Prolonged discontinuation of APT for ≥9 days was associated with higher risk of a major adverse cardiac event compared with continuing APT (adjusted HR, 3.38; 95% CI, 1.36-8.38; P=0.009). Conclusions APT was discontinued preoperatively in almost half of patients with second-generation drug-eluting coronary stents. Our explorative analysis showed that there was no significant impact of discontinuing APT on the risk of perioperative adverse events except that discontinuing APT may be associated with decreased hemorrhagic risk in patients undergoing intra-abdominal surgery. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03908463.ope

高宗의 親政과 開國政策硏究, 1873년~1876년

조선은 1876년 2월 일본과 &amp;apos;韓日修好修規(강화도조약)를 체결하면서 나라를 개방하였으며 새로운 근대적 외교체제 속으로 편입하게 되었다. 조선의 개국에 대해서는 그동안 다양한 분야에서 연구가 진행되어 왔으나 조선의 정치적 상황속에서 이 문제를 본격적올 다룬 연구는 많지 않았다. 따라서 본고에서는 조선의 개국이 일본의 강제성에 의한 타율적인 면이 있지만 한편으로는 조선 정부가 최종 결정을 내린 정책이었다는 것에 주목하여 조선의 정치적인 상황 속에서 開國이 가지는 의미에 대해 살펴보고자 하였다. 당시 조선에서는 오랫동안 집권하였던 대원군이 물러나고 국왕인 고종에 의한 정치가 새롭게 실시되고 있었다. 1873년 11월 최익현의 상소를 계기로 친정을 선포한 고종은 그동안 대원군에 의해 변칙적으로 운영되어 오던 정계를 재편하여 국왕을 중심으로 하는 새로운 정치체제를 구축하고자 노력하였다. 이를 위해 고종은 여전히 정치적 기반을 유지하고 있었던 안동김씨 세력과의 정치적인 연합을 시도하여 불안한 정국을 안정시키면서 자신의 친위세력을 육성하였다. 이때 고종의 대표적인 친위세력은 조녕화로 대표되는 풍양 조씨세력과 민겸호, 민규호 등의 여흥 민씨세력, 이최웅, 이재면 등 대원군에 반감을 가지고 있었던 일부 종친세력들이었다. 고종은 친위세력들을 호조나 병조, 중앙 군영의 대장, 무위소의 도통사와 제조 등 주로 군사와 재정을 관할하는 국가의 핵심부서에 배치함으로써 이들을 통해 정계의 재편을 시도하였다. 그러나 소수의 친위세력만으로 최고 의사결정기관인 의정부에까지 실질적인 영향력을 행사하기에는 어느 정도 한계가 있었다. 고종은 친위세력을 중심으로 친정체계를 구축하는 한편 왕권의 강화를 위해 대원군의 세력을 약화시켜나갔다. 이를 위해 먼저 고종은 都城門稅와 沿江收稅 등의 商品流通稅와 淸錢을 폐지하여 대원군의 정치적 자금을 봉쇄하였으며, 三軍府와 鎭撫營을 약화시키고 무위소를 설립하여 대원군의 군사적 기반을 축소시켜나갔다. 이러한 고종의 노력들은 그동안 民弊가 되어왔던 정책들을 일신하고 변칙적으로 운영되었던 정계를 다시 국왕을 중심으로 하는 정상적인 체제로 전환하는 데에는 도움이 되었으나, 사후 대책에는 소홀하여 조선의 재정과 군사력이 악화되는 부작용이 초래되었다. 한편 이러한 정치적 변화는 조선의 외교정책에도 영향을 끼쳤다. 고종 親政直後 조정의 가장 큰 외교적 관심사는 서계 문제로 인하여 단절되었던 일본과의 외료관계를 개선하는 문제였다. 이 문제는 1875년(고종 11년) 6월 중국으로부터 일본의 조선 침략 가능성에 대한 자문을 받은 이후 본격적으로 논의되었다. 이 과정에서 고종을 비롯한 친위세력들은 일본이 기존과는 다른 격식의 서계를 보내 온 것은 일본 국내 사정의 변화에 따른 것으로, 서로 和好하고자 하는 의도 자체가 변한 것은 아니라는 점을 강조하였다. 따라서 일단 서계를 수용하고 일본과의 외교관계를 개선하여 앞으로 예상되는 무력충돌을 사전에 대비하고자 하였다. 그러나 이 문제는 김병학, 김병국 등을 위시한 정부 대다수의 대신들이 격식에 어긋난 서계를 수용할 수 없다는 입장을 고수하면서 쉽게 해결되지 않았으며, 결국은 1876년 운양호사건을 빌미로 한 일본의 무력적 위험을 계기로 일본과 새로운 수호통상조약을 체결하는 방향으로 진행되었다. 고종을 중심으로 한 친위세력들이 일본과의 무력충동을 원하지 않았던 것은 아직 친정체제가 확고하게 성립되지 않았을 뿐 안라 악화된 재정상태와 국사력의 약화 등 조선이 당면한 현실적인 문제도 크게 작용하였다. 즉 정치적으로 조명해 보았을 때 조선의 開國은 고종의 친정체제를 보다 안정화시키기 위해 용인된 측면이 있었다. 그러나 간과하지 말아야 � 것은 고종의 친정체제가 무조건적인 명분론보다는 보다 현실적이고 실리적인 입장에서 이 문제에 접근하고 있었으며, 고종을 비롯한 일부 집권층을 중심으로 국제정세와 서양의 근대적 문물을 바라보는 시각이 변화되고 있었다는 점이다. 물론 開國 당시의 대외 인식의 수준은 변화된 국제정세에 대해 인지하고 富局强兵을 위해 서양 문물의 수입 가능성을 예측해 보는 초보적인 단계에 불과하여, 근대적인 통상조약에 대한 지식과 이로 인한 경제적인 폐해에 대해 깊게 인식하지 못한 한계가 있었다. 그러나 이러한 고종과 새로운 정치세력들의 변화된 대외인식은 앞으로 조선의 개국정책을 계속해서 수행하게 되는 기반이 되었다.;In this theses, I focused on the significance of the opening of Chosun(朝鮮) to foreign countries in the political situation that it was a final decision of Choson dynasty government even though it was forced to open. At that time, King Kojong(高宗) newly reigned the political power after long-term seizure of Daewonkun(大院君). He proclaimed to govern in person upon getting an appeal from Choi Ik-Hyun(崔益鉉) in November 1873, and tried to build a new political system centered by the king to reorganize the political world governed by Daewonkun. To make a new political trend, Ko-jong politically united with Andong-Kim Family(安東金氏) to settle down an unrest political situation and to establish his own party. His supporters were Cho Nyung-Ha(趙寧夏) of Poongyang-Cho Family(豊壤趙氏), Min Kyum-Ho(閔謙鎬) and Min Kyu-Ho(閔奎鎬) of Yeoheung-Min Family(驪興閔氏), and part of Lee Choi-Woong(李最應), Lee Jae-Myun(李載冕) of the Royal family who were antipathetic toward Daewonkun. Kojong appointed his supporters to the country s main government post which controled the army and finance such as Hojo(戶曹), Byungjo(兵曹), general at the central military camp, Dotongsa(都統使) and Chejo(提調) at Mooweeso(武衛所). He tried to reorganize the political circles by this action too, but there was a limitation to affect a real power to Uijungbu(議政府), the highest decision making institution, with this minority group. As he directly ruled over the country, he tried, on the other hand, to decrease Daewonkun s power. He abolished circulation tax such as Dosungmoonsae(都城門稅) , Yeongangsoosae(沿江收稅), and Cheongjeon(淸錢) to blockade political funds of Daewonkun. In addition, he weakened Samsungbu(三軍府) and Jinmooyoung(鎭撫營) to reduce Daewonkun s military base, and newly established Mooweeso(武衛所) to try to have control over the military and finance of the country. However, these suddenly made actions without any provision, on the contrary, made Cho sun s economy worse and weakened military strength. On the other hand, these political changes influenced Choson dynasty s diplomatic policy. Right after Kojong took the power, improving diplomatic relationship with Japan, which severed as a result of diplomatic notes change, was the government s greatest concern. This matter was debated in earnest after China had advised Choson dynasty a possibility of Japanese invasion in 1874(Kojong 11). Kojong as well as his supporters emphasized that Japan sent a different form of letter because of their internal situation change, not because of their intention to keep good relations. They insisted that they should prepare for the expected armed conflict in advamce by accepting the letter to improve their diplomatic relationships. But this matter remained unsettled as the most ministers adhered to their views that they could not accept the informal letter. Kojong and his supporters did not want to be in conflict with Japan because his political power was not set up firmly in Choson dynasty government. Also, Choson dynasty was facing a couple of realistic problems that financial situation was getting worse and the military was gradually losing its power. It can be said that Kojong allowed Choson dynasty to open its door to stabilize his power over the government. However, he did not justify his direct governing. He approached in a realistic and practical way. And there was a change looking at the international situation and Western culture in a part of ruling classes including Kojong. At that time of opening, Choson dynasty was at an early stage that it just expected the possibility of adopting Western cultures to increase country s wealth and military power and perceived merely the change of international situation. So Choson dynasty could not fully recognize the knowledge of modern commercial treaty and this affected to the countrys economy badly. Kojong and his supporters changed view point to look at foreign countries laid a foundation of carrying out open-door policy continuously.I. 머리말 = 1 II. 親政體制의 구축과 政治勢力의 재편 = 5 1. 親政여건의 조성 = 5 2. 親政體制의 구축 = 16 3. 政策의 변화와 방향 = 30 III. 開國政策의 형성과 역사적 의미 = 39 1. 親政前後의 對外關係 = 39 2. 開國政策의 전개와 형성 = 47 3. 親政體制가 開國에 미친 영향과 의미 = 70 V. 맺음말 = 74 參考文獻 = 79 ABSTRACT = 8

Investigation of internal flow fields of evaporating of binary mixture droplets

If a liquid droplet evaporates on a solid substrate, when it completely dries, it leaves a peculiar pattern, which depends on the composition of the liquid. Not only a single component liquid but also complex liquids are studied for a different purpose. In particular, a binary mixture droplet has been widely studied and used for an ink-jet printing technology. In this study, we focus on investigating to visualize the internal flow field of an ethanol-water mixture by varying a concentration ratio between two liquids. We measure the in-plane velocity vector fields and vorticities. We believe that this fundamental study about the internal flow field provides a basic idea to understand the dried pattern of the binary mixture droplet

대학생의 학업성취 수준과 대학생활 인식간의 관계

학위논문(석사)--서울대학교 대학원 :교육학과 교육상담전공,2001.Maste

Development of multi-functional cable vibration control system based on electromagnetic damper

학위논문(석사) - 한국과학기술원 : 건설및환경공학과, 2019.2,[v, 50 p. :]케이블교량의 장경간화에 따라 케이블교량의 주요 부재인 케이블의 진동제어와 모니터링 시스템의 중요성이 증가하고 있다. 특히, 케이블은 큰 유연성과 작은 감쇠비 때문에 진동하중에 취약함을 보이고 있다. 이를 위해 다양한 진동제어 시스템이 제안되었고 감쇠기의 설치는 가장 효과적인 진동제어 방식으로 주목 받았다. 또한, 케이블의 장력은 해당 부재의 건전성을 평가하는데 중요한 지표로써 활용되어 왔다. 하지만 기존의 방식들은 독립적이며 별도의 전력원과 센서를 필요로 하는 한계점이 존재했다. 이에 본 연구에서는 전자기 감쇠기를 기반으로 동특성 측정과 에너지 수확이 가능한 진동제어 시스템을 제안하였다. 제안된 시스템은 에너지 수확 모드와 집중 진동제어 모드로 구분되어 작동한다. 별다른 진동제어가 필요 없는 상황에서 작동하는 에너지 수확 모드에서는 전자기 감쇠기에서 에너지를 생산하고 저장하며 측정된 동특성을 통해 케이블의 장력을 추정한다. 집중 진동제어 모드에서는 감쇠기에서 생성할 수 있는 최대 제어력으로 케이블의 진동을 제어한다. 제안된 시스템의 각각의 기능에 대해 성능평가를 진행하였고 그 방법으로 수치 해석과 실험실 규모의 실험을 실시하였다.한국과학기술원 :건설및환경공학과

Java VM에서 DBLS 구현

학위논문(석사)--서울대학교 대학원 :전기·컴퓨터공학부,2003.Maste

직업성 연 노출 남성 근로자의 성호르몬에 대한 연구

학위논문(석사)--서울대학교 보건대학원 :환경보건학과 산업보건전공,1999.Maste