A Dilemma on SMEs Design Innovation in China

디자인 전략과 혁신 모형은 제조 공정의 축적에서 나온다. 제조 실무를 기반으로 해서 독특한 특징을 가진 혁신적인 모형이 등장하는 것이다. 이 모형이란 바로 디자인의 방식과 전략이다. 특정한 관점에서 볼 때, 디자인의 심적 경향과 전략, 그리고 혁신 모델은 개인이 처한 사회적, 경제적, 정치적 환경에 의해 발전되고 영향을 받는다. 산업화 과정의 발전과 더불어 이러한 혁신적 사고는 제조 공정에 의해 지속적으로 활용되고 통합될 것이다. 하지만 많은 측면에서 다른 국가들은 각각의 특색을 가지고 각자 다른 상황에 놓여 있다. 산업이나 경제의 그 어떤 새로운 방향은 그들의 특정한 시공간뿐 아니라 그 시공간을 횡단하는 방향으로 귀속되게 된다. 중국의 최근 경제 발전 현황은 매우 의미 심장한 일이며, 중소기업들은 그 과정에 엄청난 기여를 해 왔다. 지난 30년간 중국의 개방 과정은 산업화의 진행 과정일 뿐 아니라 지역 기업들의 독립적인 기술 혁신을 위한 성장 무대였다. 범국가적 세계 경제에 참여하는 과정에서 경제 구조의 재구성을 경험하면서, 중국은 첫 세계 경제 위기를 대면하고 있는데, 이 위기란 본래의 자국 경제 구조와 세계 경제 구조 간의 충돌로 볼 수 있는 것이다. 이 과도기에서 내부적, 국제적으로 나타나는 경쟁의 압력을 받으며 중국의 중소기업들은 어려운 결정을 해야만 한다. 예전 방식의 고유 행로를 유지할 것인가, 혹은 혁신의 마인드로 도전적인 방향을 향해 전환할 것인가? Design strategy and innovation model are derived from accumulative manufacturing practice. Based on those practice, innovative models with unique features could be found. Those models are design method and strategy. From speci­c point of view, design mind-set, design strategy and design innovation model are developed and in uenced by individual circumstances of society, economy, and politics. With developing of industrialization process, these innovative thinking will be continuously optimize and integrated continuously by manufacturing practice. However, in many aspects, different country has own unique features and different circumstances. Any new direction in industry or economy not only based on the speci­c time and place, but also the path traversed. Chinas current economic development status is very signi­cant, in which SMEs made a huge contribution to them. In the past 30 years, the progress of opening up in China is not only a progress of industrialization but also a growth stage of local enterprises for independent innovation. Experienced the restructure of economic system, in the process of joining into global economic, China is facing on the ­rst global economic crisis, which can also be seen as a collision between original economic system and world economic system. Under the inner and abroad competitive pressure, in this transitional period, China SMEs are making a tough decision: to keep walking in the original direction with old method or turn around to a challenging direction with innovation mind-set

우엽을 이용한 성인간 부분 간이식에서 중간정맥의 재건 아주대학교병원의 경험

Reconstruction of the middle hepatic vein (MHV) tributaries, in modified right lobe grafts, appears to be effective for solving the congestion problem of the right paramedian sector (segment V, VIII). Various methods have been proposed to maintain efficient graft outflow for right lobe grafts without the middle MHV by centers with a high volume of procedures. . Since December 2005, we adopted the bench procedure for reconstruction of a modified right lobe graft into the shape of an extended right lobe graft with a venous pouch to form a common trunk between the MHV (or newly reconstructed MVH) and right hepatic vein (RHV) using a cryoperserved aortic patch or bovine pericardium. Before December 2005, the graft RHV and MVH were anastomosed to the recipients’ RHV and MHV/left hepatic vein. In this study, we compared the results of these two different methods (23 recipients of the direct and separate anastomosis, group A; 40 recipients of formation of a common outflow trunk, group B). The two groups were comparable in terms of preoperative parameters. Compared with group A, the middle hepatic vein patency length in group B was much better (p = 0.000). The necessity of metallic stenting due to early occlusion of the hepatic vein was significantly decreased in Group B (Group A; 5/21 vs. Group B; 2/40, p = 0.042). However, 1-year patient and graft survival was not different between the two groups (p = 1.000). Our procedure for constructing a modified right lobe graft into an anatomical figure with the extension of the right lobe graft and reconstruction of a wider outflow tract might provide an effective functioning liver mass and help to improve the outcomes in these patients

간세포암 파열의 위험인자 검토와 치료 방침

Backgrounds/Aims : The incidence of the spontaneous rupture of hepatocellular carcinoma (HCC), which is a life-threatening condition, is reported to be 2.2-17.9% in Korea. This study was conducted to analyze the risk factors of HCC rupture and to make a treatment strategy. Methods : We reviewed 370 patients with HCC in terms of the clinicopathologic features, the prognosis according to the type of treatment. Results : The incidence of HCC rupture was 13% (48/370). The suspected risk factors of tumor rupture, except protrusion of tumor, showed no significant difference in this series. Among the 48 patients with ruptured HCC, 15 underwent hepatic resection and the remaining 33 received hepatic artery ligation, transarterial embolization or conservative management. The median survival time of patients with resection and non-resection were 9.0±2.4 months and 0.6±0.2 months, respectively (p<0.05). In stage VIA HCC, the median survival time of patients with resection and non-resection were 6.0±1.5 months and 0.6±0.2 months, respectively (p<0.05). Conclusions : The protrusion of tumor beyond the liver surface is the only significant risk factor of HCC rupture. Partial hepatectomy seems to be an effective modality for lifesaving as well as long-term survival for patients with ruptured HCC

난치성 양엽형 간내결석에 대한 새로운 술식

Background/Aims: Treatmant for hepatolithiasis is characterized by high failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but the development of percutaneous transhepatic cholangioscopy and lithotripsy has played an important role in the treatment of these patients. Therefore, we undertook this prospective study to assess the role of surgery in the treatment of bilateral intractable hepatolithiasis in new era of the endoscopy. Methods: We evaluated our results of 12 patients with bilateral intrahepatic stones treated by preoperative percutaneous transhepatic cholangioscopic approach and new definitive surgical approach (suprahilar approach and hilar cholangiotomy). Results: The rate of complete stone removal was 100%. There was no incidence of procedure and operative mortality. Conclusions: In this new endoscopic era, we carefully foresee that the major role of surgical treatment may be concentrated in the intractable cases of hepatolithiasis. Therefore, we suggest that more definitive surgery must be tried in the treatment of intractable bilateral hepatolithiasis

간경화를 동반한 위암 환자의 예후에 대한 평가

Backgrounds: Prognosis following surgery of gastric cancer has markedly improved as a result of early diagnosis, advances in operative techniques and perioperative managements. However, gastrointestinal surgery in patients with hepatic cirrhosis has continued to be associated with a high operative morbidity and mortality. The purpose of this retrospective study is to evaluate the prognostic factors on postoperative morbidity and survival in gastric cancer patients with hepatic cirrhosis. Methods: We analysed 24 gastric cancer patients with hepatic cirrhosis between November 1994 and October 1999 (19 patients with Child A, 5 patients with Child B) to evaluate postoperative complications and survivals. Results: There were no significant differences in age, sex, stage, operative types, and range of dissection between Child A and B. Postoperative complications occurred more commonly in the patients with more severe hepatic cirrhosis (Child A 5/19, Child B 4/5, p<0.05). There was no significant difference in 5-year survival rates between patients with Child A and B hepatic cirrhosis. Only the stage of cancer was proved to be the most significant prognostic factor. Conclusion: Patients with gastric cancer accompanied by hepatic cirrhosis can be successfully managed surgically on the basis of an appropriate preoperative assessment of hepatic conditions, proper selection of surgical procedures, and careful perioperative management

술전 금식이 90％ 간 절제술로 유도된 급성 간부전 백서의 생존에 미치는 영향

Purpose: To study whether preoperative fasting would influence postoperative prognosis and to measure the variation of the ketone body amount and ketone body ratio, kidney function during the postoperative period in the model of 90% hepatectomy. Materials and Methods:: Total of 180, seven weeks old, male, specific pathogen free Sprague-Dawley rats, divided into two groups of the fasted and the fed. First, 80 rats were divided into two groups of 40 each; 40 of that were denied food for 48 hours before the operation, other 40 were fed. Following 90% hepatectomy they were investigated by Kaplan-Meier method, drawing a survival curve. Secondly, 100 rats were divided into two groups of 50 each, 50 of that were denied food for 48 hours before the operation, and the other 50 were fed. Following 90% hepatectomy, they were investigated by the method of Student’s T-test and Mann-Whitney test on the following: the amount of arterial ketone body in the blood in the blood sampled from abdominal aorta, reading at preoperative 48 hours, at the time of operation, postoperative 6 hours, 12 hours, 24 hours, 48 hours periods. Results: The mean survival time after operation: the fasted group was 53.0+/-3.7 hours and the fed group was 34+/-1.7 hours and it had the statistical significance(p=0.0008). Rats which had long term survival over 72 hours were 14(35%) in fasted group, but only 2(5%) in fed group. In preoperative fasted group arterial ketone body ratio was recovered earlier than fed group and ketone body amount elevated, but in preoperative fed group, there was no significant change in ketone body amount. Blood glucose level lowered in both groups. Blood ammonia was severely increased in preoperative fed group, suggested bad liver function and destruction of muscle. BUN and blood creatinine was elevated in preoperative fed group, suggested lowered kidney function. Conclusion: Preoperative fasting has a positive influence on survival of the rats which has acute liver failure induced by 90% hepatectomy, because it could be caused by increased ketone body amount by preoperative fasting

간이식 수술 2회 후 발생한 말초신경병증

A 29 year old man, carrier of B viral hepatitis, was diagnosed with level C liver cirrhosis according toChild Pugh classification in March 2007. The liver cirrhosis progressed to liver failure and the patientreceived his first liver transplantation in May 2007 which was failed due to portal embolism. The patientunderwent second operation after 14 days using a cadaveric liver and spent 33 days in an intensive careunit. Four months after the second liver transplantation, the patient was referred to electrodiagnostic labfor weakness and muscular atrophy of extremities. The patient showed abnormality in the left median,ulnar and bilateral peroneal nerves and was diagnosed with peripheral polyneuropathy. Follow up electrodiagnostictest after thirteen months showed improvement in polyneuropathy

한국의 간세포암과 Aflatoxin 관련 P53 codon249 점돌연변이와의 관계

Purpose: P53 point mutation, especially G to T transversion at codon 249, has been found in many cases of the aflatoxin-related hepatocellular carcinoma(HCC). This study was aimed to exam the mutations of the third base at codon 249 of the p53 gene in Korean HCC. Materials and Methods:Forty two patients with resectable HCC were enrolled. Genomic DNA was prepared by proteinase K digestion and phenol/chloroform extractions. A part of DNA including axon 7 of p53 was amplified by PCR. Restriction fragment polymorphism (RFLP) was analyzed after treatment of Hae III restriction enzyme. And the point mutation were confirmed using the direct sequencing method. Results: P53 point mutation, G to T transversion at codon 249 was observed in only one tissue specimen(2.4%). Conclusion: P53 point mutation at codon 249 does not correlate with HCC in Korea

우엽 또는 확대 우엽을 이용한 성인간 부분 간이식시 냉동 보관된 대동맥 patch를 이용한 혈류 재건술

Methods: Living donor liver transplantation (LDLT) using a right lobe graft has been widely used to compensate for the cadaveric organ shortage. Successful reconstruction of the middle hepatic vein (MHV) is required to provide an adequate functional volume in LDLT with using the right lobe. We describe herein a new technique using a cryo-preserved aortic patch for outflow reconstruction of the right lobe graft with or without MHV. Methods: From November 2005 through March 2006, 20 adult patients who received a right lobe graft (n=10) or an extended right lobe graft (n=10) for LDLT were included. During the bench procedure of the right lobe graft, we reconstructed the new MHV with using cryopreserved veins just like the MHV of the extended right lobe graft, and we then made a venous pouch to form a common trunk between the MHV (or new MHV) and the RHV of the right lobe graft with using a cryopreserved aortic patch. During graft implantation, anastomosis of an outflow tract was made between the venous pouch of the graft and the common trunk of recipient’s RHV-MHV-LHV. One week following the transplantation, measurement of the pressure gradient between the MHV and IVC was done, as well as performing regular follow-up 3D-CT scans and liver function tests. Results: The mean pressure gradient between the reconstructed MHV and the recipient’s IVC was 2.3±1.2mmHg, and in all cases, the serial liver function tests showed gradual improvement as the days progressed post-operatively. There was no evidence of hepatic venous congestion of the graft and/or obstruction of the reconstructed MHVs according to the serial postoperative follow-up images of the Doppler US and MD-CT Conclusion: We suggest that reconstructing the outflow tract with a cryopreserved aortic patch is a good alternative technique for preventing anterior segment congestion in LDLT with using a right lobe graft with or without MHV