A Study on the Development of Port Logistics Business using Eco-friendly New Renewable Energy

전세계적으로 에너지 자원의 고갈은 점점 심각해지고 있으며 이로 인한 유가의 상승이나 에너지 수급의 불안정은 피할 수가 없다. 최근 들어 미세 먼지 등 여러 가지로 대두되고 있는 환경 문제에 대한 사회적 관심이 대단히 높아지고 있으며, 이러한 사회적 관심 속에 기존의 석유, 석탄과 같은 화석연료, 원자력을 대체할 수 있는 친환경 신재생 에너지가 새로운 에너지원으로 주목받고 있다. 기존에는 유럽과 북미 지역의 선진국을 중심으로 단순히 에너지 보조수단으로써만 사용하였으나, 그 단계를 넘어 화석 연료를 대체할 수 있는 주요한 에너지원으로 인식하기 시작하였으며, 특히, 일본의 후쿠시마 원전사고를 기점으로 신재생 에너지에 대한 관심은 더욱 고조되었고, 2015년 파리협정(Paris Agreement)을 채택하며 선진국과 개발도상국 등 195개국이 모두 온실가스 감축 의무에 참여하는 것을 선언하면서 전 세계적으로 고효율 에너지에 대한 근본적인 패러다임 전환을 촉구하고 있다. 특히 유럽의 경우, 해저지형이 완만한 지리적 이점과 양질의 풍력자원을 이용하여 최근 해상풍력이 급성장세를 보이고 있다. 이러한 세계적인 관심과는 달리 우리나라에서는 경제성을 이유로 화석발전과 원자력발전에 비해 친환경 신재생 에너지에 대한 추진력은 매우 낮았으며, 따라서 관련 산업분야도 초기 단계에 머무르고 있는 수준이었다. 우리나라에서 친환경 신재생 에너지 산업분야가 발전하지 못한 가장 큰 이유는 초기투자비용, 즉 높은 발전단가라 할 수 있고, 이로 인해 국내 전력생산의 대부분은 화력 및 원자력 발전이 담당하고 있었다. 하지만 최근 들어 더욱 심해진 환경오염, 미세먼지와 함께 2020년에는 해운 역사 상 가장 강력한 국제해사기구(IMO)의 환경 규제를 앞두고 우리나라 역시 세계의 환경에 대한 인식 흐름에 발맞추어 저탄소 그린 정책을 추진하며 친환경 신재생 에너지 산업 분야가 충분한 경제적 효용성을 가지고 자리 잡을 수 있도록 발판을 마련하려는 노력이 각지에서 이루어지고 있다. 특히 청정연료로 간주되는 LNG를 이용한 인천항만공사의 LNG 냉열 물류센터 구축은 우리나라에서 처음으로 시도되는 사업으로 많은 기대효과가 예상된다. 미활용된 LNG 냉열을 이용한 냉동냉장 물류센터 개발을 통해 냉동·냉장창고 건설에 대한 미래 청사진을 제시할 뿐만 아니라 향후 이러한 물류센터의 구축이 우리나라 항만배후단지 및 해양경제특구 개발 전략에도 새로운 아이템으로 활용될 수 있는 가능성을 제시하고 있다. 무엇보다 가장 중요한 기대효과는 기존냉동·냉장창고 운영비의 절감 및 냉동냉장화물의 유통비용 절감을 통해 생활의 안정성 도모에 크게 기여할 것으로 기대된다는 점이다. 따라서 신재생 에너지에 대한 관심이 높아진 것 뿐만 아니라 관련 기술도 지속적으로 개발하여 현재는 상업성을 논할 수 있을 만큼 발전단가가 다소 낮아진 상태이며, 그동안 크게 부각되지 않았던 원자력발전이나 화력발전이 갖는 환경비용을 고려했을 때 신재생 에너지 관련 산업의 기반을 다지는 것은 매우 중요하다. 또한 해상풍력발전이 급상승하는 유럽의 사례는 삼면이 바다로 둘러 쌓여 있고 활용 가능한 국토면적에 한계가 있는 우리나라에도 시사하는 바가 크다. 에너지 수급의 불안정 문제를 원초적으로 해결하기 위해 국가적 차원의 친환경 신재생 에너지 개발은 더욱 박차를 가할 시점이라 보여진다. 그러므로 이 연구에서는 에너지 합리화 정책에 부합하고자 친환경 신재생 에너지, 즉 풍력, 태양, 수력, 조력, 지열, 수열, 생물자원, 수소 연료 전지, 미활용되고 있는 LNG 냉열 등에 대한 국내·외 활용 사례를 살펴보고, 친환경 신재생 에너지의 활용 및 발전 방안을 연구하고자 한다.제1장 서 론 1 제1절 연구의 배경과 목적 1 제2절 연구의 방법 및 구성 2 제2장 이론적 배경 3 제1절 친환경 물류의 현황과 전망 3 제2절 신재생 에너지 산업에 관한 고찰 10 제3장 신재생 에너지를 활용한 항만물류 사례 18 제1절 풍력을 활용한 군산항 18 제2절 태양광을 활용한 부산,광양,인천,평택항 19 제3절 LNG 냉열을 활용한 평택오성물류센터 24 제4절 해외 항만의 신재생 에너지 활용 사례 38 제4장 신재생 에너지를 활용한 항만물류산업의 발전 전략 48 제1절 신재생 에너지의 활용 방안과 기대 효과 48 제2절 발전 전략 50 제5장 결론 52 제1절 연구의 요약과 시사점 52 제2절 연구의 한계점과 향후 연구과제 53 참고문헌 54Maste

Administration of Low-Dose Dexmedetomidine Did Not Affect Acute Inflammatory Response after Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy: A Double-Blind Randomized Controlled Trial

During cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), attenuation of inflammatory responses that increase susceptibility to postoperative complications, morbidity, and mortality is important. We aimed to evaluate whether intraoperative dexmedetomidine infusion impacted inflammatory response in patients undergoing CRS with HIPEC. Fifty-six patients scheduled for CRS with HIPEC were randomly assigned to the control (n = 28) and dexmedetomidine (n = 28) groups. The primary endpoint was the effect of dexmedetomidine on the interleukin-6 (IL-6) level measured at pre-operation (Pre-OP), before HIPEC initiation (Pre-HIPEC), immediately after HIPEC; after the end of the operation; and on postoperative day (POD) 1. In both groups, the IL-6 levels from Pre-HIPEC until POD 1 and the C-reactive protein (CRP) levels on PODs 1, 2, and 3 were significantly higher than the Pre-OP values (all Bonferroni corrected, p < 0.001). However, total differences in IL-6 and CRP levels, based on the mean area under the curve, were not detected between the two groups. The continuous intraoperative infusion of dexmedetomidine (0.4 μg/kg/h) in patients undergoing CRS with HIPEC did not significantly lower the inflammatory indices. Further dose investigative studies are needed to find the dexmedetomidine dose that provides anti-inflammatory and sympatholytic effects during HIPEC.ope

A Case of Familial Hypocalciuric Hypercalcemia Coexisting with Low Bone Mass

Familial hypocalciuric hypercalcemia is caused by heterozygous loss-of-function mutation of the calcium sensing receptor gene, and this is characterized by mild, persistently elevated levels of serum calcium without symptoms or complications. We present a case of clinically diagnosed familial hypocalciuric hypercalcemia with unexpected low bone mass. A 19-year-old man presented with incidentally discovered hypercalcemia. He showed normal growth and sexual maturation. Biochemical studies showed hypercalcemia, increased parathyroid hormone, hypocalciuria, a decreased urinary calcium-creatinine ratio and decreased serum 25-hydroxy-vitamin D. The other hormonal studies were normal. Dual energy x-ray absorptiometry showed low bone mineral density, and the Sestamibi scan showed no abnormality in the parathyroid glands. Iliac bone biopsy showed a general decrease in bone density and increased porosity of the cortical bone. Normal mineralization was also shown, but in part, osteoid deposition was also found. Direct sequencing of the patient's calcium sensing receptor gene showed a point mutation at exon7, Q926R.ope

Impact of Body Composition on Postoperative Outcomes in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction

Nipple-areolar complex (NAC)-related complications are common during nipple-sparing mastectomy (NSM), with obesity as a risk factor. Although the incidence of NAC-related complications after robotic NSM (RNSM) with immediate breast reconstruction (IBR) is lower than that after conventional NSM, it remains one of the most unwanted complications. We aimed to evaluate body composition-based risk factors for NAC-related complications after RNSM with IBR. Data of 92 patients with breast cancer who underwent RNSM with IBR using direct-to-implant or tissue expander from November 2017 to September 2020 were analyzed retrospectively. Risk factors for NAC-related complications were identified with a focus on body composition using preoperative transverse computed tomography at the third lumbar vertebra level. Postoperative complications were assessed for 6 months. The most common complication was NAC ischemia, occurring in 15 patients (16%). Multivariate analysis revealed a low skeletal muscle index/total adipose tissue index (SMI/TATI) ratio as an independent NAC ischemia risk factor. An increase in the SMI/TATI ratio by one decreased the incidence of NAC ischemia by 0.940-fold (p = 0.030). A low SMI/TATI ratio is a risk factor for postoperative NAC ischemia in patients undergoing RNSM with IBR for breast cancer. Preoperative body composition-focused evaluation is more valuable than simple body mass index assessment.ope

Analgesic Efficacies of Intraoperative Pectoralis Nerve II Block under Direct Vision in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction: A Prospective, Randomized Controlled Study

This prospective, randomized study aimed to evaluate the efficacy of an intraoperative pectoralis nerve II block (PECS II block) under direct vision in the reduction of fentanyl consumption during postoperative 24 h in patients undergoing robotic nipple-sparing mastectomy (RNSM) with immediate breast reconstruction (IBR) using direct-to-implant (DTI) or tissue expander (TE). Thirty patients scheduled for RNSM with IBR were randomly allocated to the PECS (n = 15) or control (n = 15) groups. The PECS II block was applied under direct vision after RNSM. The primary outcome was the cumulative dose of fentanyl consumption. The secondary outcomes were pain intensity using a numerical rating scale (NRS) at rest and acting during the postoperative 24 h. The cumulative dose of fentanyl at 24 h was significantly lower in the PECS group than in the control group (p = 0.011). Patients in the PECS group showed significantly lower NRS scores during the first postoperative 2 h compared to those in the control group in both resting and acting pain (p &lt; 0.05). An intraoperative PECS II block under direct vision can reduce opioid consumption during the postoperative 24 h and provide effective analgesia in patients undergoing RNSM with IBR using DTI or TE.ope

Postoperative pain assessment of robotic nipple-sparing mastectomy with immediate prepectoral prosthesis breast reconstruction: a comparison with conventional nipple-sparing mastectomy

Aims: Nipple-sparing mastectomy (NSM) is a surgical procedure for patients with breast cancer without nipple-areolar complex (NAC) involvement. Robotic NSM (RNSM) with immediate breast reconstruction has been recently introduced; however, reports regarding RNSM are still lacking. Therefore, this study aimed to evaluate the postoperative assessment with a focus on postoperative pain of RNSM with prepectoral immediate prosthesis breast reconstruction (IPBR) compared with conventional NSM (CNSM) in patients with breast cancer without NAC invasion. Methods: This retrospective study included 81 patients who underwent RNSM (n = 40) or CNSM (n = 41) with prepectoral IPBR using direct-to-implant or tissue expander between January 2018 and June 2020. The primary endpoint was to compare postoperative pain intensity based on a numerical rating scale (NRS). The secondary endpoint was to evaluate the postoperative recovery profile, including postoperative nausea/vomiting (PONV) and complications. Results: A statistical difference was observed in the resting NRS scores at 0-6 postoperative hours between the RNSM and CNSM groups (3.2 ± 1.5 versus 4.2 ± 1.6, respectively; Bonferroni corrected P = 0.005), however, no difference was shown at other time periods. Also, no between-group difference was found in the NRS scores for acting pain within 48 postoperative hours and the number of patients requiring additional analgesics. Conclusions: Despite a statistical difference in the resting NRS scores during the early postoperative phase, the absence of any significant difference in the requirement of additional analgesics between the groups suggested that RNSM does not significantly attenuate postoperative pain intensity.ope

A rapidly progressing Lung abscess diagnosed as pulmonary mucormycosis associated with Wegener`s granulomatosis

Pulmonary mucormycosis is an uncommon opportunistic fungal infection associated with diabetes mellitus, leukemia, lymphoma and other debilitating diseases. The diagnosis is made by the pathology demonstration of typical hyphae within the lung tissue, and requires aggressive treatment including surgical and medical methods for reducing the overall mortality. In Korea, the association of pulmonary murcomycosis with Wegener's granulomatosis is rare. However, pulmonary mucormycosis with diabetes has been reported in several cases. Recently, we treated a case of pulmonary murcomycosis in 42-year-old woman with Wegener's granulomatosis, who had recurrent pneumothorax and a rapidly progressive lung abscess. Here we report this case and review the medical literature.ope

Applicability of American and European Spirometry Repeatability Criteria to Korean Adults

Background: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. Methods: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spiro-metric variability. Results: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. Conclusion: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results.ope

A Case of X-Linked Agammaglobulinemia with Btk Gene Intron 2 Mutation.

X-linked agammaglobulinemia is the most common type of primary immunodeficiency disorder. Mutation ofthe cytoplasmic tyrosine kinase gene, Btk (Bruton's tyrosine kinase), is known to be the etiology of X-linked agammaglobulinemia. The patients with this disease manifest a B-cell deficiency and low levels of serum immunoglobulin; due to the deficient antibodies, they suffers from recurrent upper and lower respiratory infections. We report here a 24-year-old male with an initial clinical impression of recurrent pneumonia and bronchiectasis. The patient presented with marked pan-hypogammaglobulinemia and the absence of circulating B-lymphocytes on the immunologic study, and he carried a splicing mutation of intron 2 in the Btk gene (IVS2 -3C>G).ope

A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.ope