Critical Information Infrastructure

학위논문(석사)--서울대학교 대학원 :국제대학원 국제학과(국제통상전공),2019. 8. 신성호.우리나라의 국가 사이버안보는 관리체계가 다양한 정부부처들 간에 분산되어 있음은 물론, 공공, 민간, 군사 부문들 간에도 조정과 연계체계 매우 부실하다. 따라서 고도로 지능화되고 복잡해 지고 있는 각종 사이버 공격에 제대로 대처하는 데 한계를 노출하고 있다. 그리고 사이버안보체계의 안정성 면에서도 문제가 적지 않다. 따라서 국가 사이버안보체계 전반에 대한 점검과 재구조화가 필요한 시점이다. 이러한 배경 하에서, 본 논문의 목적은 거버넌스(governance) 관점에 입각하여 핵심정보인프라 분야에서의 국가 사이버안보체계의 실태와 문제점을 분석하고 또한 미국의 사이버안보체계에 대한 사례분석을 행하며, 이를 토대로 핵심정보인프라 분야에서의 사이버안보체계 강화방안을 제언하고자 하는 것이다. 이러한 연구목적을 달성하기 위하여 본 논문은 우선 사회과학 분야에서 널리 사용되고 있는 거버넌스 관점의 등장배경, 의의, 거버넌스 능력 등에 관한 이론적 논의를 행하였다. 다음에는 이러한 이론적 논의를 참조하여 거버넌스의 구성요소, 거버넌스의 성공 요건 등을 중심으로 분석틀을 설정하였다. 이어서 일종의 벤치마킹을 위한 시도로 미국의 사이버안보체계의 실태를 거버넌스 관점에 입각하여 사례분석을 행하였다. 다음 장에서는 앞에서 설정된 분석틀에 입각하여 우리나라 사이버안보 거버넌스 체계의 실태와 문제점을 실증적으로 분석하였다. 마지막으로는 미국의 사이버안보 거버넌스 체계에 대한 사례 분석과 우리나라의 사이버안보체계의 실태 및 문제점에 대한 분석을 토대로, 보다 안정적이고 지속가능한 사이버안보 거버넌스 체계를 구축하기 위한 구체적인 정책방안들을 제시하였다.Koreas national cybersecurity governance system is characterized by high levels of fragmentation and instability, unable to form coherent national-level response to increasingly sophisticated and devastating cyber attacks, with the public, private and military sector each struggling to provide for its own cybersecurity. The purpose of this paper is to analyze the contemporary situation and underlying problems of South Koreas national cybersecurity in the area of critical information infrastructure from the governance perspective, then suggest relevant policy measures to bolster cybersecurity of critical information infrastructure. In order to fulfill the objective, this paper first examines the theories pertinent to the concept and emergence of the governance perspective in the disciplines of social science. Then, the components of governance and the requirements for successful governance are explored in order to establish the dimensions of analysis. Subsequently, the paper undertakes a case study of the U.S. cybersecurity governance system to draw relevant policy implications. The following chapter examines the contemporary situation and underlying problems of South Koreas cybersecurity governance, in accordance with the five dimensions of the governance system. This paper concludes with policy suggestions to consolidate a stable and sustainable cybersecurity governance system in Korea.CHAPTER I. Introduction 1.1 Research Background 1 1.2 Research Purpose and Research Questions 5 CHAPTER II. Theoretical Underpinning and Research Design 2.1 Theoretical Underpinning 8 1) Cybersecurity 8 2) Critical Infrastructure or Critical National Infrastructure 9 3) Critical Information Infrastructure 11 4) Emergence of Governance Perspective 12 5) Conceptualizing Governance 14 6) Governance Capacity and Good Governance 17 7) Conditions for Governance Formation 18 8) Requirements for Successful Governance 19 2.2. Literature Review 22 1) Literatures on Regional and Global Cybersecurity Governance 22 2) Literatures on Cybersecurity Governance in South Korea 24 3) Common Limitations of Precedent Studies 27 2.3 Research Method: Document Research and Case Study 28 2.4 Rationale for U.S. Cybersecurity Governance as Case Study 32 2.5 Dimensions of Analysis 33 CHAPTER III. The Cybersecurity Governance System of the United States 3.1 An Overview of Cybersecurity Legislation and Policies in the U.S. 35 3.2 Legal and Institutional Systems: Roles and Responsibilities 43 3.3 Federal Cybersecurity Budget 45 3.4 Public-Private Partnership: Critical Infrastructure Sector Partnership 47 3.5 Federal Cybersecurity Monitoring and Evaluation Systems 51 CHAPTER IV. An Analysis of South Koreas National Cybersecurity Governance System on Critical Information Infrastructure 4.1 An Overview of South Koreas National Cybersecurity Challenges 53 4.2 An Analysis of the Cybersecurity Governance System of South Korea 57 1) Legal and Institutional Systems 57 2) Administrative System for Critical Information Infrastructure 67 3) Finance and Budget Systems 76 4) Public-Private Partnership 79 5) Monitoring and Evaluation Systems 81 CHAPTER V. Policy Measures to Consolidate the National Cybersecurity Governance System in South Korea 5.1 Policy Suggestions to Consolidate the Cybersecurity Governance System 1) Legal and Institutional Systems 84 2) Administrative System 86 3) Finance and Budget Systems 90 4) Public-Private Partnership 92 5) Monitoring and Evaluation Systems 95 5.2 Engineering Cyber Resilient Governance 101 CHAPTER VI. Conclusion        6.1 Conclusion and Implications 105        6.2. Future Avenues of Research 109 Bibliography 110Maste

CXCL1 induces senescence of cancer-associated fibroblasts via autocrine loops in oral squamous cell carcinoma

Cancer-associated fibroblasts (CAFs) have emerged as one of the main factors related to cancer progression, however, the conversion mechanism of normal fibroblasts (NOFs) to CAFs has not been well elucidated. The aim of this study was to investigate the underlying mechanism of CAF transformation from NOFs in oral squamous cell carcinoma (OSCC). This study found that NOFs exposed to OSCC cells transformed to senescent cells. The cytokine antibody array showed the highest secretion levels of IL-6 and CXCL1 in NOFs co-cultured with OSCC cells. Despite that both IL-6 and CXCL1 induced the senescent phenotype of CAFs, CXCL1 secretion showed a cancer-specific response to transform NOFs into CAFs in OSCC, whereas IL-6 secretion was eventuated by common co-culture condition. Further, CXCL1 was released from NOFs co-cultured with OSCC cells, however, CXCL1 was undetectable in mono-cultured NOFs or co-cultured OSCC cells with NOFs. Taken together, this study demonstrates that CXCL1 can transform NOFs into senescent CAFs via an autocrine mechanism. These data might contribute to further understanding of CAFs and to development of a potential therapeutic approach targeting cancer cells-CAFs interactions.ope

Role of adjuvant cisplatin-based chemotherapy following radical cystectomy in locally advanced muscle-invasive bladder cancer: Systematic review and meta-analysis of randomized trials

Purpose: We purposed to assess the effects of adjuvant chemotherapy (ACH) on survival outcomes in patients with locally advanced muscle-invasive bladder cancer (MIBC) who are treated with radical cystectomy (RC). Materials and Methods: Literature search was conducted in PubMed, Embase, and Cochrane library databases for all articles that were published until February 2018. Systematic review and meta-analysis were performed by pooling the randomized controlled trials (RCTs) that compared patients with locally advanced MIBC who received ACH after RC to those who underwent cystectomy alone. Endpoints were progression free survival (PFS) and overall survival (OS). Results: Four RCTs with a total of 490 patients were selected for the analysis. These four trials included patients with locally advanced MIBC. Pooled HRs for PFS and OS across the studies were 0.48 (95% confidence interval [CI], 0.39-0.60; p<0.00001) and 0.63 (95% CI, 0.48-0.83; p=0.0009), respectively. Absolute increases in PFS and OS for locally advanced MIBC were 17% and 10%, respectively (i.e., equivalent to numbers needed to treat of 5.9 and 10). Conclusions: ACH following RC may improve the survival outcomes of locally advanced MIBC patients. Beneficial effect of ACH might be more marked in patients with locally advanced MIBC when comparing the previously reported meta-analysis with all MIBC patients.ope

Inflammatory Cytokines and Oral Squamous Cell Carcinoma

Inflammation functions as a double-edged sword against external stimulus. For instance, inflammation can have anti-cancer effect and simultaneously can play cancer-promoting factors. Recent studies have shown that cytokine plays an important role in tumor biology by influencing tumor growth, invasion and metastasis. We classify these cytokines by cancer type and review current knowledge of cytokines in terms of carcinogenesis. Here, we also focus on whether cytokines can act as biomarkers for early detection of oral squamous cell carcinoma (OSCC). This review will provide basis for further approach to study the role of cytokines in carcinogenesis and evaluating the possibilities of cytokines as biomarkers for cancer detection.ope

Predictors of Uric Acid Stones: Mean Stone Density, Stone Heterogeneity Index, and Variation Coefficient of Stone Density by Single-Energy Non-Contrast Computed Tomography and Urinary pH

We analyzed the capacities of pertinent parameters (determined by single-energy non-contrast computed tomography [NCCT]) and urinary pH to predict uric acid stones. We reviewed the medical records of 501 patients whose stones were removed surgically or passed spontaneously between December 2014 and April 2016. Qualifying participants (n = 420) were stratified by the nature of the stone (calcium oxalate, uric acid, or infectious). Based on NCCT, we determined maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) using Hounsfield units (HU) and calculated the variant coefficient of stone density (VCSD = SHI/MSD × 100). Urinary pH was also ascertained. Mean patient age was 55.55 ± 15.46 years. MSD (448.59 ± 173.21 HU), SHI (100.81 ± 77.37 HU), and VCSD (22.58 ± 10.55) proved to be significantly lower in uric acid versus other types of stones, as did urinary pH (5.33 ± 0.56; all p < 0.001). Receiver operating characteristic (ROC) curves depicting predictability of uric acid stones yielded area under ROC curve (AUC) values for MSD, SHI, VCSD, and urinary pH of 0.806 (95% CI: 0.761⁻0.850), 0.893 (95% CI: 0.855⁻0.931), 0.782 (95% CI: 0.726⁻0.839), and 0.797 (95% CI: 0.749⁻0.846), respectively, with corresponding cutpoints of 572.3 HU, 140.4 HU, 25.79, and 6.0. Among these four parameters, SHI was verifiably (DeLong's test) the most effective predictor of uric acid stones (all p < 0.001). Compared with MSD, VCSD, and urinary pH, SHI may better predict uric acid stones, using a cutpoint of 140.4 HU.ope

What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials

We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.ope

Effect of Androgen-Deprivation Therapy on Bone Mineral Density in Patients with Prostate Cancer: A Systematic Review and Meta-Analysis

We aimed to evaluate the change in bone mineral density (BMD) in patients with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) compared to those with PCa or other urologic conditions not receiving ADT. Literature searches were conducted throughout October 2018. The eligibility of each study was assessed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the Participant, Intervention, Comparator, Outcome, and Study design method. The outcomes analyzed were the mean difference (MD) of percent changes in BMD of lumbar spine, femur neck, and total hip. Five prospective cohort studies with a total of 533 patients were included in the present study. Statistically significant decreases of BMD change relative to the control group were observed in the ADT treatment group in the lumbar spine (MD -3.60, 95% CI -6.72 to -0.47, P = 0.02), femoral neck (MD -3.11, 95% CI -4.73 to -1.48, P = 0.0002), and total hip (MD -1.59, 95% CI -2.99 to -0.19, P = 0.03). There is a significant relationship between ADT and BMD reduction in patients with PCa. Regular BMD testing and the optimal treatment for BMD loss should, therefore, be considered in patients with PCa undergoing ADT.ope

Time to Disease Recurrence Is a Predictor of Metastasis and Mortality in Patients with High-risk Prostate Cancer Who Achieved Undetectable Prostate-specific Antigen Following Robot-assisted Radical Prostatectomy

Background: Robot-assisted radical prostatectomy (RARP) is a feasible treatment option for high-risk prostate cancer (PCa). While patients may achieve undetectable prostate-specific antigen (PSA) levels after RARP, the risk of disease progression is relatively high. We investigated metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS) outcomes and prognosticators in such patients. Methods: In a single-center cohort of 342 patients with high-risk PCa (clinical stage ≥ T3, biopsy Gleason score ≥ 8, and/or PSA levels ≥ 20 ng/mL) treated with RARP and pelvic lymph node dissection between August 2005 and June 2011, we identified 251 (73.4%) patients (median age, 66.5 years; interquartile range [IQR], 63.0-71.0 years) who achieved undetectable PSA levels (< 0.01 ng/mL) postoperatively. Survival outcomes were evaluated for the entire study sample and in groups stratified according to the time to biochemical recurrence dichotomized at 60 months. Results: During the median follow-up of 75.9 months (IQR, 59.4-85.8 months), metastasis occurred in 38 (15.1%) patients, most often to the bones, followed by the lymph nodes, lungs, and liver. The 5-year metastasis-free, cancer-specific, and OS rates were 87.1%, 94.8%, and 94.3%, respectively. Multivariate Cox-regression analysis revealed time to recurrence as an independent predictor of metastasis (P < 0.001). Time to metastasis was an independent predictor of OS (P = 0.003). Metastasis-free and CSS rates were significantly lower among patients with recurrence within 60 months of RARP (log-rank P < 0.001). Conclusion: RARP confers acceptable oncological outcomes for high-risk PCa. Close monitoring beyond 5 years is warranted for early detection of disease progression and for timely adjuvant therapy.ope

Impact of clinical trial participation on survival in patients with castration-resistant prostate cancer: a multi-center analysis

BACKGROUND: Clinical trial (CT) participation may confer access to new, potentially active agents before their general availability. This study aimed to investigate the potential survival benefit of participation in investigational CTs of novel hormonal, chemotherapeutic, and radiopharmaceutical agents in patients with castration-resistant prostate cancer (CRPC). METHODS: This multi-center, retrospective analysis included 299 consecutive patients with newly diagnosed, non-metastatic or metastatic CRPC between September 2009 and March 2017. Of these, 65 (21.7%) patients participated in CTs pertaining to systemic treatment targeting CRPC and 234 (78.3%) patients received pre-established, standard systemic treatment outside of a CT setting. The survival advantage of CT participation regarding cancer-specific survival (CSS) was investigated. RESULTS: An Eastern Cooperative Oncology Group performance status (ECOG PS) >/=2 at CRPC diagnosis was found in a lower proportion CT participants than in non-participants (4.6% vs. 14.9%; p = 0.033). During the median follow-up period of 16.0 months, CT participants exhibited significantly higher 2-year CSS survival rates (61.3% vs. 42.4%; p = 0.003) than did non-participants. Multivariate analysis identified prostate-specific antigen and alkaline phosphatase levels at CRPC onset, Gleason score >/= 8, ECOG PS >/=2, less number of docetaxel cycles administered, and non-participation in CTs as independent predictors for a lower risk of CSS. CONCLUSIONS: Patients diagnosed with CRPC who participated in CTs exhibited longer CSS durations than non-participants who received pre-established, standard systemic therapy outside of a CT setting. Our findings imply that CT participation is associated with CSS, and that CT participation should be offered to patients with CRPC whenever indicated.ope