The purpose of this paper is to produce a policy decision making model most appropriate for formulating mental health policy in Korea. This research will also illuminate the legislation process and make accurate predictions about the revision process of the Mental Health Act. Using the Allison Models, we analyzed the legislation process of for the Korean Mental Health Act from the 1980s to 1995, which was largely divided into two periods. We applied the three types of model to each of these two periods. The results of the comparative analysis show that the process of the Mental Health Act enactment can be explained through by each of the three types of Allison models and that there is no dominant model. However, the analysis shows that, compared with the 'Rational Actor' model, the 'Organizational Behavior' model and the 'Governmental Politics' model are better able to explain the decision making process compared to the 'Rational Actor' model.
Decision Making ; Korea ; Mental Health ; Policy Making

PURPOSE: In laparoscopic distal gastrectomy for gastric cancer, most surgeons prefer extra-corporeal anastomosis because of technical challenges and unfamiliarity with intra-corporeal anastomosis. Herein, we report the feasibility and safety of intra-corporeal Billroth-II anastomosis in gastric cancer. METHODS: From April 2004 to March 2011, 130 underwent totally laparoscopic distal gastrectomy with intra-corporeal Billroth-II reconstruction, and 269 patients underwent laparoscopy-assisted distal gastrectomy with extra-corporeal Billroth-II reconstruction. Surgical efficacies and outcomes between two groups were compared. RESULTS: There were no differences in demographics and clinicopathological characteristics. The mean operation and reconstruction times of totally laparoscopic distal gastrectomy were statistically shorter than laparoscopy-assisted distal gastrectomy (P = 0.019; P < 0.001). Anastomosis-related complications were observed in 11 (8.5%) totally laparoscopic distal gastrectomy and 21 (7.8%) laparoscopy-assisted distal gastrectomy patients, and the incidence of these events was not significantly different. Post-operative hospital stays for totally laparoscopic distal gastrectomy were shorter than laparoscopy-assisted distal gastrectomy patients (8.3 +/- 3.2 days vs. 9.9 +/- 5.3 days, respectively; P = 0.016), and the number of times parenteral analgesic administration was required in laparoscopy-assisted distal gastrectomy patients was more frequent after surgery. CONCLUSION: Intra-corporeal Billroth-II anastomosis is a feasible procedure and can be safely performed with the proper experience for laparoscopic distal gastrectomy. This method may be less time consuming and may produce a more cosmetic result.
Cosmetics ; Demography ; Gastrectomy ; Humans ; Incidence ; Length of Stay ; Stomach Neoplasms

Gastric cancer remains still the most frequent type of cancer despite its declining incidence in Korea. As a result of the health promotion policy of the Korean government and increase in concern for individuals' health, screening endoscopy for detecting early gastric cancer and general physical exams have become widespread. Thereby, the incidental detection of gastric submucosal tumors (SMTs) are now occasionally diagnosed by screening endoscopy. Since endoscopic examination gives little information on SMTs, a variety of studies have been conducted to determine the etiology of SMTs and to distinguish them from extra-luminal compressive lesions. Here, we report one clinical case of cavernous hemangioma on the left lateral section of the liver and one case of omental cyst, which was preoperatively mistaken as gastric SMT.
Endoscopy ; Health Promotion ; Hemangioma, Cavernous ; Incidence ; Korea ; Liver ; Mass Screening ; Stomach Neoplasms

PURPOSE: Laparoscopic surgery is now being applied to most abdominal surgeries. We evaluated the surgical outcomes of laparoscopic primary repair with an omental patch for treating perforated duodenal ulcer as compared to that of open surgery. METHODS: A total of 124 consecutive patients who underwent repair of perforated peptic ulcer from January 2000 to February 2009 were included in the study. The surgical outcomes that were evaluated were the operation time, the use of intravenous/intramuscular analgesics, the complication rate, the hospital stay and the postoperative endoscopic findings. RESULTS: 124 patients underwent surgical repair for perforated peptic ulcer disease (81 open repairs and 43 laparoscopic repairs). The mean age was 43.7+/-16.6 in the laparoscopic group and 45.7+/-18.3 in the open group, respectively (p=0.55). Laparoscopic repair had a similar operation time as open repair (110.4+/-37.5 minutes vs 101.2+/-30.8 minutes p=0.149, respectively). There were statistical differences for the hospital stay (7.8+/-3.0 days laparoscopy vs 9.9+/-4.0 days open; p=0.004) and the need for analgesics (range; 0~17 open vs 0~16 laparoscopic; p=0.026). But the complication rate was not significant different in both group (2.3% open vs 12.3% laparoscopic; p=0.062). CONCLUSION: Laparoscopic repair is a feasible and safe surgical option for patients with perforated peptic ulcer and it is an excellent alternative to open procedure when performed by experienced hands.
Analgesics ; Duodenal Ulcer ; Hand ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer

The nucleolus is the largest, membrane-less organelle within the nucleus of eukaryotic cell that plays a critical role in rRNA transcription and assembly of ribosomes. Recently, the nucle olus has been shown to be implicated in an array of processes including the formation of sig nal recognition particles and response to cellular stress. Such diverse functions of nucleolus are mediated by nucleolar proteins. In this study, we characterized a gene coding a putative protein containing a nucleolar localization sequence (NoLS) in the rice blast fungus, Magnaporthe oryzae. Phylogenetic and domain analysis suggested that the protein is ortholo gous to Rrp8 in Saccharomyces cerevisiae. MoRRP8-GFP (translational fusion of MoRRP8 with green fluorescence protein) co-localizes with a nucleolar marker protein, MoNOP1 fused to red fluorescence protein (RFP), indicating that MoRRP8 is a nucleolar protein. Deletion of the MoRRP8 gene caused a reduction in vegetative growth and impinged largely on asexual sporulation. Although the asexual spores of ΔMorrp8 were morphologically indistinguishable from those of wild-type, they showed delay in germination and reduction in appressorium formation. Our pathogenicity assay revealed that the MoRRP8 is required for full virulence and growth within host plants. Taken together, these results suggest that nucleolar processes mediated by MoRRP8 is pivotal for fungal development and pathogenesis.

Background: Prolonged mechanical ventilation (PMV) is a common complication after liver transplantation surgery. However, owing to the clinical and economic benefits of early extubation, many efforts have been used to assess the clinical predictors for PMV. The aim of our study was to explore the impact of perioperative risk factors, including candidate gene polymorphisms, for PMV in patients undergoing liver transplantation. Methods: One hundred forty patients who underwent liver transplantation surgery were enrolled. The duration of mechanical ventilation after surgery was examined, along with the length of intensive care unit and hospital stay, and 30-day mortality. Patient-related clinical factors and single nucleotide polymorphisms of candidate genes were assessed with regard to PMV, which was defined as mechanical ventilation for > 48 h. Results: Twenty-six (19%) patients continued to receive mechanical ventilation at 48 h after surgery. Intraoperative continuous renal replacement therapy (CRRT) and an elevated serum lactate level during the postoperative period were significantly associated with the PMV group, compared to the non-PMV group (odds ratio [OR] = 24.731 [1.077, 567.915] versus OR = 3.008 [1.497, 6.045]). A significant association existed between the HLA-DPA1 rs8486 polymorphism and the risk of PMV under the allele model (OR = 8.060 [1.451, 44.765]). Conclusions The rs8486 polymorphism in HLA-DPA1 can independently affect the risk of PMV in liver transplantation recipients, along with intraoperative CRRT application, and elevated lactate level during the postoperative period.

PURPOSE: Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. MATERIALS AND METHODS: From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. RESULTS: Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). CONCLUSION: Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.
Aged ; Bone Development ; Bone Wires ; Clinical Study* ; Femur* ; Follow-Up Studies ; Fracture Fixation ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans ; Hypertrophy ; Osteolysis ; Rehabilitation ; Walking

PURPOSE: The authors performed an autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. METHODS: We retrospectively reviewed medical records and radiographs of 30 patients who underwent a cancellous bone graft and headless compression screw fixation for scaphoid waist nonunion. There 28 men and 2 women with a mean age of 32.8 year-old (range, 21–63 year-old). The mean time to surgery from initial injury was 10 months (range, 3–25 months) and the average follow-up duration was 37.5 months (range, 15–52 months). The authors analyzed bony union, lateral intrascaphoid angle (LISA), scapholunate angle (SLA), radiolunate angle (RLA), and scaphoid length in radiographs and evaluated the modified Mayo wrist score (MMWS) as a functional outcome. RESULTS: Bony union was achieved in all cases. In lateral plain X-ray, preoperative anatomic alignment including LISA, SLA, RLA, and scaphoid length was recovered at immediate postoperative measurement. Those alignment restoration was likely to maintain in final follow-up in despite of statistical difference. The wrist motion and the MMWS improved significantly at the last follow-up. CONCLUSION: A non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II nonunion in the middle one-third of the scaphoid.
Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies ; Transplants* ; Wrist

PURPOSE: The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer. MATERIALS AND METHODS: Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center. RESULTS: The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage. CONCLUSIONS: Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.
Disease-Free Survival ; Far East ; Gastrectomy ; Gyeonggi-do ; Health Facility Size ; Humans ; Korea* ; Length of Stay ; Mortality ; Prognosis ; Seoul ; Stomach Neoplasms* ; Surgeons

OBJECTIVE: The systemic inflammatory response syndrome (SIRS) criteria used in the triage scale have been implemented incompletely without laboratory data, such as the white blood cell (WBC) count, so the validity of SIRS as a triage tool has been uncertain. This study assessed the validity of the Korean Triage and Acuity Scale (KTAS) in applying SIRS with or without a WBC count. METHODS: The KTAS level was simulated by the number of SIRS criteria. This new KTAS level that did not apply the WBC count was defined as the partial-simulated KTAS (PS-KTAS), and the KTAS level including the WBC count was called the total-simulated KTAS (TS-KTAS). The authors used the intensive care unit (ICU), overall admission rate, and use of emergent interventions as the primary outcomes. RESULTS: A total of 1,077 patients with a suspected infection were triaged using the SIRS in KTAS. Multivariable logistic regression analysis showed that the odds ratio for overall admission was greater with a higher KTAS level than with KTAS level 4 in both the PS-KTAS and TS-KTAS. All areas under the curve of the PS- and TS-KTAS for ICU admission and emergent intervention rate both showed very low discriminant powers. CONCLUSION: Compared to TS-KTAS, PS-KTAS showed a similar or partially better relationship between the KTAS level and the use of critical medical resource. Future research is recommended to improve the matching between the SIRS scoring and each KTAS level to better classify the patient severity status and develop or discover new infection assessment tools that can be applied to KTAS.
Humans ; Intensive Care Units ; Leukocyte Count ; Leukocytes ; Logistic Models ; Odds Ratio ; Systemic Inflammatory Response Syndrome ; Triage