트랜스젠더 강제전역처분의 위법성 - 심신장애 전역처분에 대한 법리를 중심으로 -

박보람(Boram BAK) 한국젠더법학회 2023 젠더법학 Vol.14 No.2

2020년 1월 트랜스젠더 직업군인에 대한 강제전역조치의 근거는 심신장애 현역부적합 전역제도였다. 본고는 심신장애 현역부적합 전역제도 법리를 상세히 검토하여 이 제도가 우리 군인사 행정에서 가지는 의미와 함께 군인으로서의 적합성을 젠더 관점에서 어떻게 구축해 왔는지 살핀다. 「군인사법」 제37조는 강제전역의 사유로 심신장애 현역부적합을 들고 있으나 심신장애의 의미와 이를 판단하는 기준은 규정하고 있지 않고, 하위규정에 위임하고 있지도 않다. 우리 법에서 장애는 불변하는 것이 아니라, 일정한 활동이나 기능에 제약이 있거나 직무를 수행·복무하는 데 제약이 있는 상태로 이해되어야 한다. 그러나 군인사법 시행규칙은 군사 임무의 수행과 관련 없는 질병 또는 장해를 망라하여 규정하면서 성별 또는 성별정체성에 따라 차별적 효과를 발생시키고 있다. 더 나아가 우리 군인사 법제는 징병 행정상으로는 트랜스젠더 국민이 존재함을 인정하면서도 트랜지션 정도에 따라 4급 또는 5급에 처하여 현역병으로 복무할 수 없게 하거나, 각 군 규정 중 신체검사를 통하여 장교·부사관으로 임관될 수 없게 하여 군인으로서의 복무를 제한한다. 이처럼 군인사 행정은 제도적으로 군에서 트랜스젠더를 배제하며, 복무 중을 규율하는 규정에서는 트랜스젠더 관련 내용이 전무함으로 인하여 군에서 이념적으로 트랜스젠더를 배제하는바, 본고는 위 심신장애 부적합 규정을 트랜스젠더의 트랜지션에 적용하는 것은 부당함을 논증한다. 전역처분 취소판결인 대전지방법원 2020구합104810 판결은 트랜스젠더에 관하여 공백이 크고 불균형한 상태의 입법과 이를 보충하여 전횡하는 군인사 행정 및 관행을 저지하는 데 일정 부분 기여하였다. 처분의 상대방인 원고뿐만 아니라 성정체성의 혼란 또는 성별불일치의 인식으로 성전환수술을 하는 사람들이 존재한다는 사실을 언급하고, 심신장애 판단에 있어 트랜스젠더의 성별에 관하여 적극적으로 심리하여 당연히 여성을 기준으로 판단하여야 한다고 하였으며, 보론으로 성 소수자의 기본적 인권을 언급하기도 하였다. 그러나 시행규칙의 법규적 효력 여부, 시행규칙이 음경 상실·고환 결손을 심신장애 사유로 정한 것 자체의 정당성도 판단하지 않았으며, 트랜스젠더에 대하여 심신상실 현역복무 부적합 규정을 적용하는 것이 타당한지 여부와 이 사건 처분이 트랜스젠더에 대한 차별인지에 대한 논점이 상실되었다. 해외에서는 단지 트랜스젠더 군인의 복무를 허하는 것을 넘어, 차별을 금지하고, 상담이나 의료, 트랜지션 과정을 지원하는 방향으로 나아가고 있다. 트랜스젠더의 고유한 경험과 문제를 반영한 구체적이고 명확하며 세심한 기준이 마련되어야 할 것으로 생각된다. In January 2020, the existence of transgender professional soldiers became visible for the first time in Korea when a sergeant after Sex Reassignment Surgery while on leave. She was being screened for Disability disqualification for military service. The sergeant hoped to continue her military service and had applied to the court for gender recognition, but after 55 days of SRS, the Army discharged her. In October 2021 the court revoked the dismissal and the Army gave up its appeal, so the ruling became final. Article 37 of the Military Personnel Management Act stipulates compulsory discharge based on mental and physical disabilities, but does not stipulate the meaning of the disabilities and criteria for determining disabilities inappropriate for active service. Moreover, the Article does not delegate them to sub-regulation. Disability should be understood as a state that there are restrictions on certain activities or functions, such as performing military service, rather than fixed medical meaning. However, Table 1 of the Enforcement Rule of the Act, covering diseases or obstacles that are not related to the performance of military duties, is discriminatory based on gender. Although the military administration recognizes the existence of transgender people in conscription administration, it restricts their service by discharging them from serving as soldiers or being appointed as officers or lieutenants through physical examinations. As such, it not only systematically excludes transgender people but ideologically excludes them because there is no content related to transgender people in the regulations. The Daejeon District Court’s ruling, which revoked the discharge, contributed in part by deterring the arbitrary military administration due to an ambiguous and unbalanced legal system. It referred, besides the plaintiff, to the fact that there are people who undergo SRS due to gender identity disorder or gender incongruence. It also showed it is necessary to examine the gender of a transgender person in determining disabilities. It also mentioned the basic human rights of LGBTQ people. However, it did not review whether Article 53(1) of the Rule has legal effect, nor did the justification of the penile/testicular loss as a reason for disability. The issue of whether it is appropriate to apply the provision to transgender people and whether the discharge constitutes discrimination against transgender has been lost. Foreign countries move far beyond simply allowing transgender to serve in ways that prohibit discrimination and support counseling, medical care, and transition processes. There should be specific, clear, and meticulous standards that reflect the unique experiences and problems of transgender people.

The efficacy and adverse effects of PARP inhibitor in the treatment of ovarian cancer patient

( Boram Choi ),( Keun Hoo Lee ),( Seongeun Bak ),( Sang Hyun Cho ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: Niraparib and olaparib are an oral PARP inhibitor that has shown clinical activity in patients with ovarian cancer. PARP inhibitor has been associated with increased progression-free survival among patients with ovarian cancer, regardless of the presence or absence of BRCA mutations. The aim of this study is to evaluate the the reason for the maintenance and interruption of of PARPi treatment. Methods: This is an observational, retrospective, single-arm study conducted from January 2017 to January 2022 in patients with ovarian or peritoneal or tubal cancer under PARPi treatment at Seoul St Marys Hospital. PARPi was continued until further progression of the disease. Results: We performed a cohort study of 68 female cases who received olaparib or niraparib maintenance therapy after first or later line treatment. The median age was 49.5 years (range 35-73). Thirty-eight patients(55%) ceased olaparib or niraparib maintenance therapy, and 9 patients in 68 cases(13%) relapsed after PARPi maintenance therapy. Of these, 6 patients switched to chemotherapy and 1 patient received radiation therapy. Three of the patients who switched to chemotherapy were treated with topotecan. 5 out of 38 patients discontinued PARPi due to adverse reactions or at the request of the patient. Thirteen of 38 patients was expired or were transferred to the hospice unit during the follow-up period. Conclusion: Although various studies have demonstrated the efficacy of PARPi, the discontinuation rate was very high at 55%, when actually applied to patient treatment. Also, the recurrence rate during PARPi maintenance treatment was confirmed to be as high as 13%. The proportion of patients who discontinued due to side effects among all patients was low, and the cause of side effects was not significant. In addition, it is considered that additional research is needed on which treatment, especially which anticancer drugs, will be effective or the effect of cross-treatment when recurrence occurs after using PARPi.

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients

Minjung Bak,Minyeong Kim,Boram Lee,Eun Kyoung Kim,Taek Kyu Park,Jeong Hoon Yang,Duk-Kyung Kim,Sung-A Chang 대한심장학회 2023 Korean Circulation Journal Vol.53 No.3

Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient’s prognosis.

Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

Kim Pyeong Hwa,Young Ah Cho,윤희망,Boram Bak,Jin Seong Lee,Ah Young Jung,Oh Seak Hee,Kim Kyung Mo 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.4

Purpose: This study evaluated the accuracy of attenuation imaging (ATI) for the assessment of hepatic steatosis in pediatric patients, in comparison with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP). Methods: Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using the Spearman test. The AC cutoff value for discriminating hepatic steatosis corresponding to a CAP value of 241 dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of the association between AC and CAP. The diagnostic accuracy of AC cutoffs was estimated using the imperfect gold-standard methodology based on a two-level Bayesian latent class model. Results: Seventy patients (median age, 12.5 years; interquartile range, 11.0 to 14.0 years; male:female, 58:12) were included. AC and CAP showed a moderate-to-good correlation (ρ =0.646, P<0.001). Multivariable regression analysis affirmed the significant association between AC and CAP (P<0.001). The correlation was not evident in patients with a body mass index ≥30 kg/m2 (ρ=-0.202, P=0.551). Linear regression revealed that an AC cutoff of 0.66 dB/cm/MHz corresponded to a CAP of 241 dB/m (sensitivity, 0.93; 95% confidence interval [CI], 0.85 to 0.98 and specificity, 0.87; 95% CI, 0.56 to 1.00). Conclusion: ATI showed an acceptable correlation with CAP values in a pediatric population, especially in patients with a body mass index <30 kg/m2. An AC cutoff of 0.66 dB/cm/MHz, corresponding to a CAP of 241 dB/m, can accurately diagnose hepatic steatosis.

Bone Age Assessment Using Artificial Intelligence in Korean Pediatric Population: A Comparison of Deep-Learning Models Trained With Healthy Chronological and Greulich-Pyle Ages as Labels

Kim Pyeong Hwa,Yoon Hee Mang,Kim Jeong Rye,Hwang Jae-Yeon,Choi Jin-Ho,Hwang Jisun,Lee Jaewon,Sung Jinkyeong,Jung Kyu-Hwan,Bae Byeonguk,Jung Ah Young,Cho Young Ah,Shim Woo Hyun,Bak Boram,Lee Jin Seong 대한영상의학회 2023 Korean Journal of Radiology Vol.24 No.11

Objective: To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. Materials and Methods: A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343; median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male: female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). Results: Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. Conclusion: The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.