여대생들의 Cap에 대한 선호도 조사 연구

정혜락 ( Hye-rak Jeong ) 한국고등직업교육학회 2004 한국고등직업교육학회논문집 Vol.5 No.2

This paper is designed to research and analyse the cap preference of women college students. The results are as follows. Individuality and distinction are very important for women college students when they purchase the caps. They are mostly satisfied with the present designs and the sizes of the caps. They thought that the fashion which goes very well with the caps is the casual and the colors they like are white, black and beige. Women college students wear the caps in summer to prevent their skin from the ultraviolet. The color is their major consideration and design, material, price, sewing condition and brand are their another choice when they purchase the caps. They are not satisfied with the sweat band and this would be the problem to be improved. The price range of the caps is between 10,000 and ₩20,000. They purchase one or two caps a year but they actually wear more than that. Their recognition and preference of the cap brand mostly follow the global brand. The motivation of the cap purchasing usually depends on their purchase need or atmosphere and they go shopping with their friends. More than 60 % of the students get the information of the caps from the advertising of mass media . They purchase the caps at the bonded goods store, the professional cap store and the department store. They wash the caps with the quality direction and keep them on the wall, in the closet or using the hanger.

원내 균혈증의 예방을 위한 정맥 수액의 병마개 소독관리에 관한 연구

김용순,전희선,박지원,진혜영,곽연식 대한감염학회 1997 감염 Vol.29 No.3

목적: 병원에 입원한 환자는 자체내 방어능력의 저하, 기관지 튜브, 도뇨 튜브, 정맥주입 튜브 사용과 치료 자체나 치료과정을 통하여 미생물로 인한 감염을 일으킬 수 있다. 따라서 인체에 사용하는 모든 기구는 무균적이어야 하며, 여기에 사용되는 기구나 주입하는 용액은 가장 오염되기 쉬운 것으로 진단 및 치료를 위한 침습시술(invasive procedure)로 인한 감염은 비교적 예방가능한 것으로 보고되고 있다. 그러므로 정맥주사용 수액 고무마개의 수분 잔존여부에 따른 오염여부를 조사하고, 소독방법에 따른 수액 고무마개에 대한 소독 전. 후의 균주를 비교하여 수액 고무마개로 인한 병원감염을 예방하기 위함이다. 방법: 900병상 규모의 일개 대학병원에 입고된 수액 중 총 95개의 수액을 무작위 표본 추출하였다. 수액 고무마개에 대한 오염 여부 조사를 위해서 3차에 걸쳐 수액마개의 배양을 하였고, 수분있는 마개에 대한 소독액의 살균력을 조사하기 위해서 70% 알콜솜 단독과 70% 알콜 및 베타딘 솜을 사용하여 소독 전후의 수액마개를 배양하였다. 결과: 1) 수액 고무마개에 대한 오염여부 조사는 3차에 걸쳐 총 95개의 수액마개 중 50개(52.6%)에서 수분이 고여 있었고, 이중 28개(56.0%)에서 병원성 세균이 검출되었으며, 수분이 없는 45개의 마개에서는 1개(2.2%)에서만 세균인 분리되었는데 이는 Pseudomonas species, Burkholderia picketti 이었다. 2) 수액 고무마개 세균배양 검사에서 동정된 세균은 29개 중 15개(51.7%)에서 Burkholderia picketti가 배양되어 가장 높은 검출율을 보였으며, 그밖에 Pseudomonas species, Glucose Nonfermenting Bacilli, Alcinetobacter lowffii, Acaligenes species 등이 분리되었다. 3) 수액고무마개 소독방법에 따른 살균력은 70% 알콜솜만 가지고 소독하거나, 70% 알콜솜과 베타딘솜을 함께 사용하는 경우 모두에서 100% 살균력을 나타냈다. 결론: 이상의 결과에서 수액 고무마개에 수분이 묻어있는 경우 수액오염의 가능성이 높으며, 이는 70% 알콜솜으로 철저히 소독함으로써 예방 가능함을 확인할 수 있었다. Background: We have experienced sporadic cases of nosocomial bacteremia/sepsis due to contaminated rubber caps of intravenous(Ⅳ) fluid bottles from May through August in 1996. We investigated the possible sources of the infections, and developed the measures to control this type of nosocomial infections. Methods: During initial investigation of an outbreak of sporadic nosocomial bacteremia we could not found possible sources of infections from medical care providers. However, some rubber caps of Ⅳ fluid bottles showed water drops on top of them, and were suspected as possible sources of the infection. A total of 95 caps including 50 wet caps and 45 dry caps, were randomly selected from nursing stations and pharmacy receiving area for culture. We also investigated if routine disinfection methods were effective to sterilize the contaminated caps as follows; Twenty of 50 wet caps were randomly selected and were divided into 2 groups. Caps of one group were disinfected with 70% isopropanol alcohol wipes and the other with 70% isopropanol alcohol wipes plus betadine. All caps were subjected to culture before and after disinfections. Cultures were performed on blood agar plate after inoculating by using swab. Results: The result of culture showed that 128 of 50(56%) wet caps were contaminated by Burkholderia picketti, Pseudomonas species, Glucose Nonfermenting Bacilli, Acinetobacter lowffii and Alkaligenes species. One of 45(2.2%) dry caps grew Burkholderia picketti and Pseudomonas species. Both 70% isopropanol alcohol and 70% isopropanol alcohol plus betadine wipes sterilized contaminated caps effectively when they were used for disinfecting caps. Conclusion: It is concluded that wet caps of Ⅳ fluid bottles are indicative of possible contaminations by microorganisms. And use of alcohol wipe and/or betadine to disinfect contaminated caps at time preparing for infusion of Ⅳ fluids can be one of effective sterilization methods.

“SOFT PRICE REGULATION” IN THE NON-REGULATED INDUSTRY: PRICE CAP INFLUENCE ON THE INCENTIVES TO COLLUDE

Dina Tsytsulina,Svetlana Avdasheva 글로벌지식마케팅경영학회 2014 Global Marketing Conference Vol.2014 No.7

Antitrust deals with the competitive consequences of conduct by firms in the market. Marketing places emphasis on understanding how firms compete from individual perspective; by studying the thinking and motivations of managers and purchase preferences of consumers. As an academic discipline marketing aims to describe and predict the performance of companies engaged in exchange to reach organizational goals (Gundlach, Phillips, & Desrochers, 2002). For antitrust, the complementary nature of marketing's constitutes in providing a basis for understanding the nature of competitive conduct and the welfare of consumers. The influence of antitrust on marketing strategy raises many concerns. There is a strand of literature investigating how the antitrust law perceives different marketing activities. Many common marketing practices are coming under greater scrutiny from regulators, antitrust lawyers and scholars. It is essential for companies to understand how that will affect competition. When considering marketing issues such as distribution policy, product line extension, enhancing the company’s positive image, they may not realize the increasing likelihood of violating antitrust laws (Bush & Gelb, 2005). Brodley (1982) analyzes how joint ventures may threaten competition by falsifying competitive incentives among joint venture participants. He describes various incentive-modifying remedies that mitigate anticompetitive risks, and then applies this presumptive approach to various types of joint ventures. Some papers analyze how antimonopoly decisions can influence management of transaction. Joskow (2002) shows the importance of the application of transaction cost economics (TCE) to antitrust legal rules and antitrust remedies specification because it may result in different legal rules comparing to cases ignoring TCE ideas. He emphasizes that antitrust legal rules must be sensitive to the information and analytical capabilities of institutions in the market, the characteristics of potential anticompetitive behavior, market structures etc. Not only the development of marketing practices challenges antitrust enforcement. Antitrust policy can impose significant and long-lasting restrictions on marketing policies of companies, including pricing decisions. One relevant for Russia example is pricing antitrust remedies under the merger deals clearance or investigations on the abuse of dominance. In order to prevent abuse in a form of excessive price antitrust authorities set ‘soft price cap’ on the domestic market price using different benchmarks including quotes in the world commodity markets, price of export contracts, price of export contracts net of transport cost and custom duties, best (lowest) price of export contract etc. This type of remedies is already applied for chemicals, electric steel, cocking coal, aluminum and other commodities. Reform of tariff regulation in Russia takes this path also: from the next year price cap for natural gas for industrial customers will be set at the level of contract price of the largest supplier Gazprom net of transport cost. We argue that this type of remedies being imposed in order to protect customers of dominant company can diminish incentives to compete, along with the restricting incentives for an efficiency-improvement. This paper investigates how soft price regulation affects companies` behavior. In many regulated industries over the world price cap as a method of price regulation replaces cost-plus pricing. It is a kind of incentive regulation introduced in order to enhance productive efficiency by strengthening sellers’ incentives for cost reduction (Laffont, 1993; Cabral & Riordan, 1989) as well as incentives for more efficient pricing. A price-cap regulation might be suggested to address the market by making it extremely difficult for the industry to use price as a marketing strategy and by reducing the available sources the industry has for spending on marketing and lobbying. However pricing under cap is not neutral for competition in the market. We argue that the impact of price cap regulation on market competition depends on the design of cap. More specifically if cap for one (regulated) market depends on the price of the supplier in other (non-regulated) market, there is sub-type of price cap regulation (known in Russian tariff regulation as ‘netback minus’) that enhance incentives to collude in non-regulated market. Traditionally impact of price caps on collusion is analyzed in the framework of focal point problem. Price ceilings might weaken competition serving as collusive focal points for pricing decisions (Schelling, 1960; Scherer & Ross, 1990). According to the Folk Theorem (Tirole, 1988) any individually rational prices can occur as a Nash equilibrium in infinitely repeated games with sufficiently high discount factor. In collusive equilibrium, companies face a coordination problem so that price ceilings may become a focal point on which companies may coordinate. It means that price ceilings may facilitate tacit collusion, increase its stability and lead to higher prices on the market. In addition, price ceilings may become a signal that if firms charge prices below that level than they would not be investigated for collusion by government authorities. Thus, it becomes less risky to maintain collusion at price level that government assess as binding. There is a strand of literature providing the empirical evidence for a collusive focal-point effect of price ceilings in different markets. Knittel and Stango (2003), studying data on state-level price ceilings on credit card charges during the 1980s, find that companies used state-level price ceilings as focal points to sustain tacit collusion. Ma (2007) investigates price ceilings in Taiwan’s flour market and argues that firms set prices above competitive levels during most of the regulation period. Moreover, all flour firms set their prices equal to ceilings. Some studies try to explain the existence of asymmetric retail price adjustments to crude oil price or wholesale price shocks by market power and possible collusion effects (Deltas, 2008; Borenstein, Cameron, & Gilbert, 1997). Sen, Clemente and Jonker (2011) evaluating the effects of price ceiling on retail gasoline prices in Eastern Canada 1999-2007 find the evidence that the enactment of such regulation is significantly correlated with higher prices. A potential explanation is that price ceilings serve as focal points stimulating firms to set higher prices. In contrast, laboratory experiments do not find a collusive focal-point effect of price ceilings. Coursey and Smith (1983) find convergence to the competitive equilibrium prices and no collusive effects of price ceilings in posted-offer markets. Despite in the design of Coursey and Smith (1983) the incentives to collude are small, Engelmann and Normann (2009) also find the evidence against the focal-point hypothesis, who study posted-offer markets with four symmetric sellers but larger incentives for collusion at the price ceiling. Finally, Engelmann and Muller (2011) results again fail to support the focal-point hypothesis. Collusion is as unlikely in markets with a price ceiling as in markets with unconstrained pricing. The possible explanation for different results in the laboratory and in the field is the lack of the focal-point effect in the field. The field results might be driven by other factors. These might include explicit collusion (which might either be triggered by the introduction of the price ceiling or might be easier to keep up in its presence) or other reasons that the empirical studies failed to control for (Engelmann & Muller, 2011). However the design of our research differs from ‘focal point’ approach. It is much closer to the literature on the multimarket contacts (Bernheim & Whinston, 1990; Spagnolo, 1999). Multimarket contacts was also analyzed in the context of multimarket rivalry (Phillips & Mason, 1996) but not from the point of view of cap design as we do. The goal of this paper is to show the mechanism by means of which the establishment of the domestic regulated prices ceiling can promote the stability of collusion and conditions at which it occurs. Intuition of the paper is the following. Under price cap which depends on price in deregulated market deviation from collusion in this market decreases profit in regulated market (in the punishment phase). In the model we think about regulated market as domestic and about completely deregulated market as world market. Under certain conditions the establishment of a price ceiling of domestic market by the principle price would not excess of the world price can promote the collusion stability in the world market. We argue that there is an unexpected ratio between the principle of the internal price establishment based on a world indicative and collusion incentives: the difference between the world and internal price to which the regulator aspires is higher, the negative impact of this practice on the competition is higher. Not all the versions of price cap which are based on the world market benchmark provide the same impact on the incentive to collude. Other important variables which reflect transport cost (or more generally all cost of trade). Price cup under model ‘world price plus trade (transport) cost’ provides no impact on the incentives to collude under some level of trade (transport) cost. Price cap under model ‘world price minus trade (transport) cost’ supports the collusion to the greatest extent. This paper represents an interesting focus for the marketing field. The price cap for domestic customer influences companies` incentives to collude in the world markets. Thus, marketing needs to recognize the incentives for cooperative behavior as a strategic marketing tool under soft price cap. Important implication is that pricing remedies imposed on Russian exporting companies will affect prices for the customers of their international competitors.

조선후기 한중 방한모자의 비교

장경희 동방문화대학원대학교 문화예술콘텐츠연구소 2019 문화와예술연구 Vol.14 No.-

Scholars regarded being in full dress as an etiquette in Joseon period, showing a touch of style with white robe and a black Gat (a traditional Korean top hat). This study addressed the type of hats worn by scholars, and reviewed how the winter cap evolved characteristically in the late Joseon period, compared with that in Chinese Qing period. The outline of this study is as follows: First, there were wider variety of types and shapes in Joseon period than in Chinese Qing period. Only two types of hat, including Taepyeonggeon and Malaeg, were used in everyday cloths in Qing period, whereas ten types of hat, including Manggeon, Tanggeon, Gat, Jeongjagwan, Jujagwan, Hyeomgyegwan, Dongpagwan, Chungjeonggwan and Banggwan, were used in Joseon period. Although hats were named after the renowned Chinese scholars, the materials, shapes and skills were localized in Joseon. The style acquired new and unique tastes with different materials and skills. As hats evolved toward the scholar's aesthetic taste, the hat craftsmanship was commercially specialized in the style (Manggeonjang, Tanggeonjang, Yangtaejang and Ipjajang). Second, the winter caps were available in wider variety of types and shapes in Joseon period than in Chinese Qing period. A winter cap was limited to an ear cover (Itu and Ieui), Pungmo (a modified hat) and Chomo (a fur hat) in Qing period. On the other hand, the ear cover variously evolved into Bolki, Aegeom, Hoaeg, Hohang, Pungcha, Hangpungcha, Sopungcha, Pigyeon, Samcheongeon and Yangjeongeon in Joseon period. A winter cap was developed on the ground that Gat was vulnerable in cold weather during the winter. In Qing period, Taepyeonggeon and Malaeg were still used as a winter cap, though the materials were changed into fur. For the winter cap in Joseon period, not only the materials, but the types and shapes were completely different from those of an ordinary hat Gat. The winter caps were mainly worn by men till 18th century, and were in fashion among women and children since 19th century when the use of wig was banned to the end of Joseon Dynasty. The winter caps became more colorful and used more decorative objects. However, an opening on the top to let a topknot stand out was traditionally remained in a men's winter cap. Third, a variety of winter caps was developed in Joseon period, because Gat, a symbol of scholars, was vulnerable to the cold weather. The winter caps were mostly dark, and has an opening on the top to let a topknot stand out. As men tied a topknot, wore Mangeon around the head across the forehead, and then wore Tanggeon before wearing Gat in Joseon period, a winter cap was worn on top of Tanggeon. Gat was made of bamboo and horsehair to maintain a neat and proper shape, whereas a winter cap was made of fabric and wool to be foldable. Hats also had come into fashion among women and children without distinction of age or sex. 본고는 조선후기 조선과 청나라에서 착용한 방한용 모자의 종별과 형식적 특징을 비교하여, 조선 모자의 종류가 많고 조선만의 고유한 특징을 지니고 있음을 밝혔다. 유교를 국시로 삼았던 조선은 衣冠을 갖추어 예의를 지키고자 하였기에, 항상 모자를 착용하여 종류가 많았다. 중국의 모자는 太平巾과 抹額 뿐이었지만, 조선의 모자는 網巾․탕건․笠[갓]을 비롯하여 程子冠․朱子冠․濂溪冠․東坡冠․沖正冠․方冠 등 10여 가지로 다양하였다. 이러한 모자는 선비들의 미적 취향으로 발전된 것이면서, 그것을 만드는 장인의 제작기술은 오늘날까지 전승되어 우리의 고유문화가 되었다. 조선의 방한모자 또한 중국의 것보다 종류가 풍부하였다. 중국의 방한모자는 耳套․耳衣, 태평모에서 개선된 風帽, 抹額에서 발전한 臥兎兒, 氈笠形이나 鉢笠形으로 제작한 貂帽 등 비교적 한정되었으나, 조선의 것은 耳掩을 비롯하여 볼끼 및 額掩[아얌]․護額․護項․風遮(項風遮․小風遮․披肩․三山巾․陽轉巾) 등 다양하였다. 특히 조선 선비의 상징인 갓을 비롯한 관모들은 추위에 약하여 이것을 보완하기 위해 검은색에, 상투를 세울 수 있도록 위가 트인 독특한 형태로 발전하였다. 이러한 남자들의 방한모자가 점차 여자용과 어린이용으로 확산되면서도, 그 색과 형태는 여전히 유지되어 한국 방한모자의 특징이 되었다.

연동형 최고금리 규제 사례에 관한 연구

김상봉,권혁준,이승진 사단법인 한국신용카드학회 2023 신용카드리뷰 Vol.17 No.3

본 연구는 우리나라의 법정최고금리 체계의 문제점을 밝히고 해외 법정최고금리 체계와의 비교를 통해 연동형 최고금리 체계 도입 필요성을 제시한다. 대부분의 선진국에서는 상대적인 법정최고금리를 사용한다. 고정형 법정최고금리 체계에서는 저신용자 배제, 합법적 대부업체의 수익 감소 및 시장 퇴출, 금융시장 불안 확산 등의 부작용이 발생했기 때문이다. 대표적인 연동형 최고금리를 채택한 국가는 프랑스이다. 프랑스 역시 과거에 낮은 수준의 고정형 최고금리 체계를 채택하였지만, 약탈적 고리대금업 및 불법 대부업의 활성화로 인해 연동형 최고금리로 변화하였다. 반대로 미국은 대표적인 고정형 최고금리 체계를 도입한 국가이다. 하지만 우리나라와 달리 주별로 경제 상황에 맞는 시장금리를 결정할 수 있으며, 상품별로 다양한 규제가 존재한다. 미국 역시 낮은수준의 금리로 인해 많은 사회적 문제가 발생했다. 미국은 이러한 문제를 해결하기 위해 연동형금리체계 도입 대신 최고금리를 시장 상황에 맞는 수준으로 높이는 방식을 택했다. 선행연구와 해외 사례를 통해 다음과 같은 연동형 최고금리 체계 도입을 제시한다. 첫째, 연동형 최고금리 적용상품의 범위는 대부금융으로 제한한다. 둘째, 최고금리상한 개수는 다중 상한을 제시한다. 셋째, 금리상한 유형은 상대적인 상한으로 제시한다. 넷째, 최고금리산출 방법은 고정 스프레드를 사용한다. 다섯째, 금리 기준은 카드채 발행금리를 기준으로 설정될 필요가 있다. 마지막으로 금리의실효성을 위해 최고금리는 시장금리보다 높게 설정되어야 한다. This study introduces the problems of Korea's interest rate cap and suggests the need to introduce an relative interest rate cap through comparison with the overseas interest rate cap. Most developed countries use the relative interest rate cap. This is because the fixed interest rate cap has side effects such as excluding low-credit borrowers, reducing profits of legal lenders and exiting the market and spreading financial market instability. France has adopted a relative interest rate cap. France also adopted a low-level fixed interest rate cap in the past, but it has changed to a relative interest rate cap due to the activation of predatory loan business and illegal loan business. USA has adopted the fixed interest rate cap. However, unlike Korea, each state can determine interest rate and there are various regulations for each product. In the US, low interest rates have caused many social problems. In order to solve this problem, the interest rate cap was decided at a level suitable for the market situation. Through previous studies and overseas cases, the introduction of the following relative interest rate cap is suggested. First, the scope of products subject to the interest rate is limited to loan finance. Second, the maximum number of interest rate caps presents multiple caps. Third, the type of interest rate cap is presented as a relative upper limit. Fourth, the method of calculating the highest interest rate uses a fixed spread. Fifth, the interest rate standard needs to be set based on the issuance rate of card bonds. Finally, for the effectiveness of interest rates, the maximum interest rate must be set higher than the market interest rate.

인간 BMP-2-생리기능 복합 바이오활성 세라믹스를 이용한 조골 세포 분화 유도

김향(Hyang Kim),문성환(Seong-Hwan Moon),이정욱(Jeong-Wook Lee),김현민(Hyun-Min Kim),박민(Min Park),이환모(Hwan-Mo Lee) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.3

목적: Glass-ceramics 표면에 코팅된 인산칼슘-재조합 인간 BMP-2 (CaP-rhBMP-2) 복합체의 특성과 조골 세포 분화능 검증을 위함이다. 대상 및 방법: 기판으로는 바이오활성 glass-ceramics를, 기판 함침을 위한 인산칼슘용액(CaP, pH7.4)을 준비하였다. 재조합 인간 골 형태형성 단백질-2 (rhBMP-2)은 BMP-2 cDNA가 전이된 CHO-Kl 세포로부터 분리 정제하였다. Glass-ceramics은 생리식염수, CaP 단독 용액, rhBMP-2가 포함된 CaP 용액에 3일 동안 상온에서 함침하였다. 복합체가 코팅된 기판 표면의 특성을 확인하고자, 주사 전자현미경, 적외선 반사 분광학, 박막 x-선 회절과 항-인간 BMP-2에 대한 면역 형광 염색을 시행하였다. 또한, 조골세포 분화능을 평가하고자, 마우스 조골아세포인 MC3T3-El 세포를 흡착시킨 후, 조골세포 표식 유전자에 대한 RT-PCR과 SEM을 시행하였다. 결과: CaP-rhBMP-2 복합체가 glass-ceramics 표면에 코팅되어 있음을 SEM, FT-IR 및 TF-XRD, IF 결과를 통해 확인할 수 있었다. Glass-ceramics 위의 CaP-rhBMP-2 복합체는 미세한 침상 구조로 덮인 구형을 나타낸 반면, CaP 군에서는 glass-ceramics 표면에 미세한 침상 구조가 평평하게 퍼져있었다. 제1형 교원질과 알칼리 인산화 효소 mRNA의 발현은 세포 흡착 후 4시간째에, 또한 osteocalcin mRNA의 발현은 3일째에 CaP-rhBMP-2 복합체군에서 표준군, CaP군과 비교하여 뚜렷하게 증가되어 있었다. SEM 촬영 결과, 실험군에 흡착된 MC3T3-El세포에서 다른 군과 비교하여 활성화된 filopodia 형성이 관찰되었다. 조골세포와 CaP-rhBMP-2 복합체 주변에는 신생 세포기질의 합성도 관찰되었다. 결론: 바이오 활성 glass-ceramic에서의 CaP-rhBMP-2 복합체-표면 코팅 기술의 적용은 조골 분화 유도에 있어서 매우 강력한 기법이다. Purpose: To assess the properties and the osteogenic potency of the calcium phosphate-recombinant human morphogenetic protein-2 (CaP-rhBMP-2 composite) on glass-ceramics. Materials and Methods: Bioactive glass-ceramics, as a scaffold, and a calcium phosphate (CaP) solution (pH7.4) were prepared. Recombinant human bone morphogenetic protein-2 (rhBMP-2) was purified from CHO-K1 cells by transfecting the cells with BMP-2 cDNA. The glass-ceramics were soaked for 3 days at room temperature in saline, a CaP only solution, and a CaP solution containing rhBMP-2. Scanning electron microscopy (SEM), Fourier transform infrared reflection spectroscopy (FT-IR), thin film X-ray diffraction (TF-XRD) and immunofluorescent staining (IF) of the anti-human BMP-2 tot composite-coated scaffold were performed to verify the characterization of the scaffold surface. In addition, RT-PCR of osteogenic marker gene and SEM photography were performed after adhering the mouse preosteoblast MC3T3-E1 cells in order to assess the osteoinductivity. Results: CaP-rhBMP-2 composite was coated on the surface of glass-ceramics, as confirmed by SEM, FT-IR, TF-XRD spectrum, and IF. The CaP-rhBMP-2 composite on the glass-ceramic showed a globular shape covered with fine spikes while the CaP on the glass-ceramic showed a fine spike structure on the flat glass surface. The expression of collagen type Ⅰ and alkaline phosphatase mRNAs had increased 4 hours after cell seeding. In addition, the level of osteocalcin mRNA ex-pression had increased significantly by 3 days in the CaP-rhBMP-2 composite compared with the control and CaP group. The SEM photographs showed more active filopodia formation in the CaP-rhBMP-2 composite than the other groups. There was extensive newly synthesized extracellular matrix around the osteoblasts and CaP-rhBMP-2 composite nodule. Conclusion: The application of Cap-rhBMP-2 composite-surface coating technique on bioactive glass-ceramic is a powerful tool for osteoinduction.

일개 도시 노인에서의 MDS-HC (Minimum Data Set-Home Care)를 활용한 CAPs (Client Assessment Protocols)

강창규,이무식,김은영,박정호,윤재선 대한가정의학회 2008 Korean Journal of Family Medicine Vol.29 No.12

Background: This study used MDS-HC 2.0 (Minimum Data Set-Home Care) to analyze the health and the state of function of the traveling health objects. This study was intended to make use of it with the basic materials for providing them with traveling health service suited for the requirement on the health of the traveling health objects. Methods: The subjects of this study were 1160 people (over 65 years) living under management control of local Health Center from September 7th to October 3th, 2006. This study was analyzed with inter RAI program & SPSS/WIN 10.0, χ2-test, t-test, and ANOVA. Results: The result showed that 8.97 CAPs per an elderly person was identified and the subjects over 60% had an injury problem from a fall, health prevention service, vision, IADL, pain, and cognition. The number of CAPs in general was high in higher age and the less educated, and those without a job. But, in subjects that had a life partner and a spouse, the number of CAPs was low. In CAPs by the distinction of sex, CAPs which was much more in man than women in statistics were the improvement of health, the abuse of alcohol and drinking wine, bedsore, and the weak supply system. CAPs which women had much more were the function of the heart and the lungs, pain, the performance of the doctor's advice, health prevention service, and incontinence of urine and insertion of catheter. According to the results comparing CAPs by the level of the ADL, the number of CAPs was shown that the group of ADL 2 was higher than group ADL 1. The matter in which the traveling health service had to be applied in all both ADL1 and ADL2 was injury from a fall, health prevention service, and vision. Conculsion: MDS-HC is applicable to decide the care needs for health and social service supplies. The results can be further applicable for careplan, and referral criteria in continuum of care service over long-term care spectrums. 연구배경: 본 연구는 방문보건사업 대상자의 건강 및 기능 상태를 MDS-HC 2.0을 이용 분석하여 대상자의 케어 요구 목록(CAPs)을 규명하고 그에 따른 방문보건사업 대상자의 건강 요구에 부응하는 방문보건사업서비스를 우선순위 원칙하에 제공하기 위한 기초자료로 활용하고자 함이다. 방법: 연구대상은 경기도 일개 시지역의 일개 구에 소재하고 있는 일개 보건소 관할지역의 방문보건사업 대상자 중에서 65세 이상 노인 1,160명을 대상으로 2006년 9월 7일부터 10월 3일까지 28일간 자료를 수집하였다. 연구 도구는 MDS-HC (Minimum Data set-Home care)version 2.0을 사용하였고, 수집된 자료는 inter RAI 프로그램과 SPSS/WIN 10.0, χ²-test, t-test, ANOVA를 이용하여 CAPs선정과 이에 따른 케어요구 사정 및 요구 목록을 파악하였다. 결과: 30개의 CAPs 중 평균 8.97개의 케어요구 목록이 확인되었고, 대상자의 60% 이상이 호소하는 문제는 낙상, 예방적 조치, 시각기능, 수단적 일상생활수행, 통증, 인지 등의 순이었다. 그러나 실제로 이러한 문제를 가진 대상자는 케어요구에 상응하는 방문보건사업서비스를 제공받지 못하는 것으로 나타났다. 일반적 특성에 따른 문제목록 수는 연령이 증가할수록, 교육수준이 낮을수록, 무직인 경우에 더 많았으며, 배우자가 있는 경우와 기혼인 경우 통계적으로 유의하게 적은 수의 CAPs수를 보였다. 성별에 따른 CAPs빈도를 비교한 결과 건강증진, 알코올남용과 위험한 음주, 욕창, 약한 지지체계는 남성에서 높게 나타났으며, 여성에서는 심장-호흡기계, 통증, 치료 지시의 이행, 예방적 조치, 요실금과 삽입 카테터 의 문제 목록에서 높게 나타났다. ADL군에 따른 문제목록을 비교한 결과 ADL 1군의 경우 CAPs 수는 8.69개, ADL 2군은 CAPs 수는 12.14개로 나타났다. ADL 1군과 ADL 2군 모두에게 보다 중점적인 서비스로 적용되어야 할 목록은 낙상, 예방적 조치, 시각기능 문제인 것으로 나타났다. 결론: 본 연구를 통하여 MDS-HC 2.0의 활용은 장기간 질병관리 및 요양을 요하는 노인의 포괄적인 기능과 건강상태를 평가하고, 케어 요구 목록 규명과 케어 요구 사정 및 분류를 시행하여 이를 통해 보건복지서비스의 연계를 용이하게 할 수 있으며, 다분야 전문가 참여로 인한 케어요구 사정 및 환자 분류에 대한 공통도구로 활용할 수 있음을 제언한다.

미세플라스틱의 건강 피해 저감 연구(Ⅲ)

박정규,서양원,주문솔,박하늘,한선영 한국환경연구원 2021 사업보고서 Vol.2021 No.-

Ⅰ. 연구의 배경 및 목적 □ [배경] 인류는 1970년대부터 플라스틱 폐기물로 인한 해양오염 문제 해결을 고민해 왔지만 여전히 그에 대한 해답을 찾지 못하는 가운데, 지구상 곳곳에서 미세플라스틱이 확인되고 있고, 현존하는 미세플라스틱과 잠재적 미세플라스틱(폐플라스틱)에 대한 정확한 추정은 어려운 실정으로 이에 대한 정책적 관리가 필요함 □ [목적] 미세플라스틱으로 인한 환경문제에 대응하고 관련된 과학 지식과 이슈를 기반으로 국내 정책의 현안 문제를 진단하기 위한 목적으로 2019년부터 2021년까지 3년 간의 정책 연구를 수행함 □ [건강 피해 개념] 본 연구는 생체와 환경 시스템의 건전성에 영향을 미칠 수 있는 미세플라스틱에 대한 모든 범위의 문제로서 ‘건강 피해’를 정의하고, 그것으로부터 유발될 수 있는 생태계와 생물종, 인체에 대한 영향을 저감할 수 있는 정책 방안 마련을 목표로 함 Ⅱ. 매체별 환경오염 연구 분석 □ 환경오염에 관하여 그동안 수행된 미세플라스틱 연구 내용을 종합해 보면, 미세플라스틱은 지구상의 모든 공간에 분포하는 오염물질이 되었음. 관련 연구가 50여 년 가까이 진행되고 있음에도 지역이나 국가별로, 또는 계절이나 연차별로 미세플라스틱의 농도가 어떻게 변하고 분포상의 특징이 어떤지를 예측하기에는 어려움이 있음 □ 특정한 공간이나 생태계, 지역 또는 국가를 대상으로 한 개별 연구 사례는 점차 늘어가고 있는 추세이지만 한 지역에 대한 장기적인 모니터링 연구 사례가 드물며, 동일한 지역을 대상으로 한 연구라 할지라도 조사 방법론과 식별 등의 분석 기법, 통계적 처리 등에 있어 편차가 커 연구적 일반성을 담보하기 어려움 □ 그동안의 연구는 해양을 대상으로 하는 연구가 주류이며, 육상 담수를 대상으로 한 다양한 연구 사례가 늘고 있으나, 여전히 토양과 대기 부문에 대한 연구는 부족함. 물, 토양 부문에 있어 중국에서의 연구가 가장 활발하며, 아프리카 및 동남아시아 지역과 국내의 연구 사례가 부족한 실정임 □ 최근에는 매체별 환경오염에 대한 리뷰 연구가 증가하고 있으며 분석기기, 샘플링 방법 등과 연계하여 공간별 오염도 분석의 민감도를 살펴보는 연구 사례가 누적되고 있음 □ 아직까지는 환경오염 연구에 있어 개념과 방법론적 기반 확립이 부족한 실정이므로, 유사한 연구 방법론과 동일한 분석 단위를 가진 연구에 한정하여 정량적 비교·분석을 하는 것이 필요하며, 이를 절대적 지표로 판단하고 정책적으로 해석하거나 오염 수준을 평가하는 잣대로 활용하는 것은 지양할 필요가 있음 Ⅲ. 미세플라스틱 영향 분석 □ 미세플라스틱의 노출 및 영향 ○ 미세플라스틱의 크기 - 최근 국제 표준화 기구(ISO: International Organization for Standardization)에서 정의하는 미세플라스틱 크기(1~5,000㎛)를 따르는 움직임이 관찰되었음 ○ 미세플라스틱의 노출 및 영향 연구 동향 - 국내의 미세플라스틱 노출과 관련하여 남해 개방 해역의 미세플라스틱 분포 특성 연구(민병규, 2021) 및 대기 중 미세플라스틱 농도 측정 연구연구1) 검토 - 최근 주목할 만한 미세플라스틱의 영향 관련 논문으로는 일회용 종이컵에서 용출되는 미세플라스틱에 관한 연구, 유아 및 신생아의 미세플라스틱 노출 관련 연구, 미세플라스틱의 생물 체내 거동 및 코로나 19 팬데믹 이슈와의 연계 연구 등이 있음 Ⅳ. 미세플라스틱 위해성 평가 방법론 검토 □ 생태 위해성 평가 분야 ○ 정성적 생태 위해성 평가 방법론 - 우리나라의 해안 중 미세플라스틱 분포 연구 결과를 토대로 정성적 생태 위해성 평가 방법론을 적용하여 시범 결과를 지도화하여 제시함 ○ 예비적인 확률론적 생태 위해성 평가 방법론 - 우리나라의 담수 중 미세플라스틱 분포 연구 결과를 토대로 예비적인 확률론적 생태 위해성 평가 방법론을 적용 - 시범 적용 결과 현재 담수 중 미세플라스틱 분포 수준에서 위해성이 높지 않은 것으로 확인되었음. 다만 담수에 대한 노출 자료 및 독성 자료가 부족한 한계점이 확인되었으므로 향후 충분한 자료 확보 후 재평가가 요구됨 □ 인체 위해성 평가 분야 ○ 인체 위해성 평가 방법론 - 인체 위해성 평가 기법 자체에 대한 연구는 상당히 부족한 상황으로 전반적인 현황을 진단하되, 음용수 섭취 등 미세플라스틱이 검출되는 노출 경로 및 노출 수준의 평가에 관한 문헌을 중심으로 분석함 ○ 국내 인체 노출 평가 기법 적용 방법론 검토 - 설문조사를 통하여 일회용 종이컵 등을 통한 국내 음용수 노출 실태를 조사함 - 선행연구 및 설문조사 결과를 적용하여 일회용 종이컵에 의한 미세플라스틱 섭취량을 시범적으로 추정함 □ 위해성 평가 현황 진단 및 추진사항 ○ 위해성 평가 및 위해 관리를 위한 고려사항 - 생태 위해성의 경우 대상 매체 및 생물종별 자료의 한계를 감안해 정성적 및 정량적 위해성 평가 방법을 모두 고려할 필요가 있으며, 하천 등 육상 수계 미세플라스틱의 유형별 모니터링 농도 자료 확보가 병행되어야 함 - 인체 위해성의 경우에도 노출 경로별 자료의 한계를 감안해 정성적 및 정량적 위해성 평가 방법을 모두 개발할 필요가 있으며, 우선적으로 노출 경로별 노출 자료 확보를 위한 모니터링이 필요함 - 정확한 정량적 위해성 평가를 위해서는 미세플라스틱의 크기 및 유형별 특성을 고려한 위해성 평가 기법 개발 연구가 필수적임 □ 위해성 평가의 정책 연계를 위한 시사점 ○ 위해성 연구의 한계를 감안한 규제 검토 방안 모색 - 현재 인체 위해성 연구에 대한 한계를 고려해 EU와 같이 배출 규모 및 생태 위해성을 근거로 규제를 검토하는 방안을 모색할 필요가 있음 - 위해성 평가 수행 이전 단계에서 주기적 환경 매체 및 노출 경로 모니터링과 스크리닝을 통해 우려 지역 및 고위험 제품군 도출을 통한 관리 우선순위 선정 방안을 마련할 필요가 있음 - 인체 노출 가능성이 높은 제품에 대한 교육 및 캠페인 등을 통해 플라스틱 용기 사용 자제 등 소비자 행동을 활성화하는 방안을 모색할 필요가 있으며, 탄소중립 정책 등과의 연계를 통한 시너지 효과도 기대할 수 있을 것임 Ⅴ. 1차 미세플라스틱 저감 방안 마련 □ [발생원] 1차 미세플라스틱 규제를 준비 중인 EU의 ECHA 정보를 참고로 할 때, 1차 미세플라스틱의 발생원은 화장품류(미용품 포함 개인위생·관리제품), 세제 및 유지관리제, 농업 및 원예 제품, 도료·페인트·잉크류, 의료기기 및 의약품, 인조잔디 충전재, 석유 및 가스 산업(oil and gas), 건축 자재·용품 등으로 정리됨 □ [정책 동향] 1차 미세플라스틱 관리를 위한 정책적 대응은 ‘범국가적 공동 대응’과 ‘국가 및 지역 단위의 개별 대응’ 사례로 구분할 수 있음 ○ 개별 국가 차원의 대응은 호주 등을 중심으로 하는 자율 규제와 미국, 캐나다, 아르헨티나, 프랑스, 영국, 스웨덴, 이탈리아, 뉴질랜드, 한국, 대만 등 10개국 입법 규제 사례로 정리됨 ○ EU는 REACH 제도하에 의도적으로 제품에 사용하는 1차 미세플라스틱의 사용을 제한하거나 제품 정보 공개(labeling) 및 보고(reporting) 의무 이행 등을 주요 내용으로 하는 1차 미세플라스틱 규제제안서의 채택을 위한 입법 준비를 2019년부터 진행하고 있음 - 지난 2월 사회경제성 및 위해성평가위원회(SEAC and RAC) 에 제출된 최종 의견의 통합 이후, 2021년 10월 현재 부속서 XVII 개정 초안 작업 등의 후속 작업이 진행 중임. 이후 회원국 간 토론과 투표, 유럽의회와 이사회의 정밀 조사 등을 거쳐 규제 제안서의 채택 여부를 결정 예정 □ [기술 동향] 1차 미세플라스틱을 대체하는 물질과 기술 개발은 주로 자연 소재의 물질로 대체하거나 미세플라스틱을 사용하지 않는 방식이 중심이 되고 있으며, 화장품과 세정제 부문을 중심으로 마이크로비즈를 대신하여 천연물질을 사용하는 추세를 보임 ○ 방출 제어 기능에 사용되는 미세캡슐 및 코팅 등은 대체기술 개발에 어려움이 있으며 유럽지역의 농업용 작물에서 미세캡슐화 기술 개발 사례와 관련 제품 상용화, 종자 등에 활용되는 천연물질 기반의 바인더(binder)와 코팅제 개발 등의 일부 사례가 존재함. 다른 산업 부문에서는 대체기술 개발이 미흡한 실정이며 바이오 기반 플라스틱의 상용화에는 보다 시간이 걸릴 것으로 보임 □ [대국민 설문 조사] 미세플라스틱 인식과 이해도, 주요 정책 대안에 대한 국민 수요를 파악하는 설문조사가 시행되었고, 이를 통해 미세플라스틱에 대한 일반 국민의 이해 수준이 많이 낮다는 사실이 확인됨. 1차 미세플라스틱 관리를 위한 정책은 입법 규제, 대체물질로의 사용 전환 등 적극적인 대응의 요구가 높은 것으로 파악되며, 발생원별 정책 선호도는 농업 부문, 화장품 및 개인위생용품, 건축 자재 및 용품, 페인트 및 도료 등이 높고, 인조잔디는 정책적 우선순위가 낮게 평가됨 □ [정책 제언] 우리나라는 세정제 5종과 헹굼형 화장품 및 의약외품에 대한 1차 미세플라스틱 사용을 규제하고 있지만, 그 외 다른 발생원과 하위 제품군에 대해서는 관리가 부재한 실정으로 다음의 정책 방안들을 고민하는 것이 필요함 ○ 이미 규제가 시행 중인 화장품 및 의약외품 중 개인위생·관리제품, 세정제 중에서 아직 규제 대상이 아니지만 제품군 단위의 사용량과 환경 중 배출량이 많은 하위 제품들의 단계적 규제 방침을 구체적으로 계획하고 준비할 필요가 있음 ○ 아직 국내에서 미세플라스틱 발생원으로의 인식이 부족한 농업 및 원예 부문, 의료기기 및 의약품, 인조잔디 충전재 등은 규제의 필요성에 대한 사회적 공감대가 부족함. 정책 홍보로 정책 설계의 당위성을 확보하는 것이 우선되어야 하며 EU ECHA의 규제 시행을 대비하여 국내 관리 방안이 준비되어야 함 Ⅵ. 2차 미세플라스틱 관리 방안: 하수도에서의 유출 저감 및 병뚜껑 관리 방안 □ 타이어 마모 분진 및 미세섬유의 하수도에서의 유출 저감 방안 ○ 미세플라스틱의 발생정보뿐 아니라 환경 중으로의 유출경로 파악 및 경로 관리가 필요 - 1차 연도에는 타이어 마모 분진 발생량을, 2차 연도에는 미세섬유 발생량을 추정함 - 3차 연도에는 발생량 이후 하수도시스템에서의 유출경로 파악 - 특히, 하수처리시설 방류수 이외에 미처리 유출수를 중심으로 흐름분석 실시 ○ 하수도 보급률, 분류식화율, 월류유출부하율, 강우이벤트 발생일수, 분류식 오접률, 처리시설에서의 처리효율, 하수슬러지 발생과 처리현황 등 자료를 수집 - 하수도 통계를 기반으로 관련 연구보고서 및 사례결과 참고 - 합류식에서 강우시 월류로 유출되는 오염물질 부하율(월류유출부하율)의 경우 월류수 내의 미세플라스틱 농도 데이터가 부재하여 미세플라스틱과 BOD의 거동에 상관성이 있다는 연구 결과를 토대로 BOD 유출 부하율을 추정한 결과, 22.7%가 강우시 월류에 의해 유출되는 것으로 추정됨 - 분류식에서도 오접에 의해 월류가 발생하며 그 영향은 연구문헌을 참고하여 합류식의 37%로 가정함 - 분류식 오접률은 분류식화율이 100%인 제주시와 울산광역시 사례를 참고로 13%로 가정함 - 하수처리시설에서의 처리효율은 미세플라스틱을 대상으로 발표된 국내외 논문을 바탕으로 가정하였으며, 하수처리시설은 98.5%, 오수처리시설(생물학적 처리)은 90%, 강우시 차집 처리(1차 처리만 진행) 85%로 가정함 ○ 2019년 기준 우리나라 미세섬유 유출 흐름도를 작성하였고, 발생량의 10.4%가 수계로 유출되는 것으로 추정됨 - 유출량으로 보면 연간 242톤의 미세섬유가 수계로 유출 - 하수처리시설 효율은 98.5%이지만 미처리 유출수에 의해 유출량이 더 많아짐 - 수계로의 유출기여도는 분류식에서 오접에 의한 오수의 우수관 유출수 > 하수처리 시설 방류수 > 월류수 > 처리구역 유출수 순으로 나타남 - 하수슬러지에 집적된 미세섬유가 퇴비화를 통해 토양으로 유출되는 양은 154.6톤/년으로 추정됨 ○ 미세섬유는 오수 중에 발생하므로 분류식화율이나 미처리구역 비율이 주요 유출경로 영향 인자라고 볼 수 있어 합류식 비중이 높은 서울시와 미처리구역 비율이 높은 경상북도의 흐름을 별도로 분석한 결과, 서울시의 경우 발생량의 7.5%가 수계로 유출되며 수계 유출 기여도는 합류식의 월류수가 가장 크게 나타났으며, 경상북도의 경우 발생량의 14.6%가 수계로 유출되며 미처리구역 유출수가 미세섬유 유출에 가장 크게 기여하는 것으로 나타남 - 이는 실제 서울시와 경상북도의 결과라기보다는 합류식 비중이 높은 경우와 미처리 구역이 높은 경우에 따른 유출 흐름 변화로 이해하는 것이 필요(지역별 특성화 입력 데이터 보완 필요) ○ 2019년 우리나라 타이어 마모 분진의 유출 흐름도를 작성하였고, 발생량(대기로의 이동 10% 제외)의 73%가 수계로 유출되는 것으로 추정됨. 본 결과는 도로비점오염저감시설이나 도로청소의 효과를 고려하지 않음 - 수계 유출 기여도는 분류식의 우수관 유출이 가장 크게 나타남 - 타이어 마모 분진은 우수 중에 존재하며 분류식화율과 하수처리구역 외 비율이 주요 영향 인자이므로 합류식 비중이 높은 서울시와 하수처리구역 외 비율이 높은 충청남도의 흐름을 별도로 분석함 - 서울시의 경우 발생량의 34.4%가 수계로 유출되며, 충청남도의 경우 86.2%가 수계로 유출됨 ○ 사용 중 마모 미세플라스틱의 수계 유출에는 분류식의 미처리 우수나 오접에 의한 영향이 가장 큰 것으로 나타나며, 합류식의 경우 월류수 관리가 필요함 ○ 본 연구는 주로 국가통계자료나 연구문헌 값을 차용하였고, 시범적으로 유출 흐름도를 작성하였으며 시도별 적용 시 보다 정확한 데이터를 바탕으로 보완하는 것이 필요하며, 가정뿐 아니라 산업계 발생에 대한 추정도 필요 ○ 본 연구의 유출 흐름도에서는 세탁망이나 도로청소와 같은 발생원에서의 저감행동을 고려하지 않음 - 세탁배수 필터 사용을 고려하는 경우 약 50%의 유출을 저감할 수 있음(Coraball 제거효율 26%, LUV-R 제거효율 87%의 평균값) - 타이어 마모 분진의 경우 도로비점오염저감 대책과 재비산먼지 대책과 맞물려 관련 사업이 진행되고 있어 일부 저감효과가 있을 것으로 생각되지만 제거효율이나 설치 비율 등 자료를 토대로 정확한 유출저감량을 산출할 필요가 있음 ○ 미세플라스틱 유출 영향 우려지역(패류나 해조류양식업, 염전, 상수원 등)과 더 나아가 농업용수나 토양에의 영향을 포함하여 환경부, 국토교통부, 해양수산부, 농림축산 식품부 공동으로 정확한 지역별 미세플라스틱 유출량을 산정하여 관리할 필요가 있음 - 특히 우수에 의한 비점오염 관리대책이 시급함(타이어 마모 분진) □ 매크로플라스틱 중 병뚜껑의 수집 및 재활용 방안 ○ 2019년에 수행한 1차 연도 연구에서는 해양폐기물 발생현황, 재질 및 형태적 위해도, 재활용 현황, 관리 수준 등을 토대로 관리 우선순위를 선정하였으며, 해양수산부와 해양환경공단이 매년 시행하고 있는 해안쓰레기 모니터링 사업 결과를 토대로 육상기인 폐기물 상위 6개 품목을 조사한 결과, 음료수병과 뚜껑류가 가장 많은 발생량을 나타냄 - 국내에서는 뚜껑류에 대한 관리 정책이 검토된 사례가 전무한 반면, 유럽에서는 병뚜껑 투기 방지를 위한 전략이 시행되고 있음 - 유럽에서는 용기부착형 병뚜껑이 의무화되었으며(2024년 7월 전면의무화), 보증금제 실시에도 병뚜껑을 포함하도록 요구하는 등 뚜껑류 관리에 대한 관심이 높음 - 병뚜껑은 특히 조류에 피해가 큰 것으로 나타남(새들이 병뚜껑을 좋아함) ○ 물질의 경제적 가치가 높을수록 해양쓰레기로 투기될 확률이 적다는 측면에서 해양쓰레기의 자원순환성 제고가 결과적으로 투기를 방지하는 전략이 될 수 있음 - 병뚜껑의 투기 현황과 폐기물로서의 관리 현황, 자원순환성 제고를 위한 정책 대안 등을 검토함 ○ 국내 뚜껑류의 해안 투기 현황은 해양쓰레기 모니터링 지점별로 차이가 큼 - 유독 거제 두모 몽돌해변과 포항 구룡포에서 뚜껑류가 많이 발생하는 것으로 나타났으며, 음료수병의 발생과 비교해도 훨씬 많은 수치를 기록함 - 음료병 뚜껑 이외의 가스캔 보호뚜껑 등의 영향 검토 필요 - 지역별 발생 편차가 크므로 지역별 해양쓰레기 모니터링 데이터 활용 필요 ○ 병뚜껑 분리배출 방식의 경우 국가별 차이가 존재 - 일본에서만 페트병과 분리해서 수집하고 있으며 유럽과 미국의 경우 대부분 결합하여 배출하도록 권하거나 별도의 지침이 없음 - 국내의 경우 투명 페트병 별도 분리배출 정책 시행으로 뚜껑류는 페트병과 결합하여 배출하도록 유도하고 있는 반면, 2018년 수도권 폐비닐 수거거부 이후 폐기물에 대한 국민관심이 높아지고 지역 플라스틱 순환운동인 프레셔스 플라스틱 운동이 확산되면서 병뚜껑 별도 회수 프로그램이 확산됨 ○ 병뚜껑의 혼입이 페트병 재활용 공정에 미치는 영향, 공정 중 분리된 병뚜껑의 재활용 현황, 시민의 병뚜껑 분리배출 참여 의향 등을 고려한 병뚜껑 분리배출 정책 결정을 위한 의사결정 트리(Decision tree)를 제안함 - 현장조사 및 업체 서면조사 결과, 병뚜껑이 페트병 순도나 재활용 공정에 미치는 영향은 적으며, 공정 중 분리된 병뚜껑 재질(LDPE)은 라벨 재질(PP)과 혼합되어 파렛트 등으로 재활용되고 있음 - 병뚜껑 분리배출 참여 의향에 대한 시민 설문조사 결과, 단지 내 수거함인 경우 93.3%, 가까운 수거거점은 59.7%, 본인 부담의 택배배송도 26.0%로 참여 의향이 높은 것으로 분석됨 - 페트병 재활용 업계의 병뚜껑 수용성이 높기 때문에 기본적으로 전국단위 지침에는 병뚜껑을 페트병과 결합하여 배출하도록 하는 현재의 지침이 합당하지만, 병뚜껑 재질의 더 나은 재활용 체계 구축을 위해 지역별로 별도 회수체계를 구축하는 것도 가능함. 무인회수기 도입 시에는 페트병과 동시에 병뚜껑 회수도 진행 필요 ○ 자발적 병뚜껑 별도 회수 프로그램인 ‘플라스틱방앗간’ 사례분석 실시(서울환경운동 연합 이동이 팀장 원고 의뢰) - 국제적인 플라스틱 지역순환 운동인 프레셔스 플라스틱 운동 차원에서 다양하게 진행되고 있으며, 초기에는 택배배송으로 수집하다 최근 수거거점을 두고 수집하기 시작함 - 병뚜껑은 비교적 안전한 재질로 다양한 생활용품 제작이 가능(실용적인 제품 생산 추구)하나, 공방 공간 마련 및 인력 지원 필요 등은 한계점으로 도출됨 - 병뚜껑 별도 회수 프로그램을 통해 일회용 플라스틱 사용 자제에 대한 시민 인식이 증가하는 교육적 효과도 기대 가능하여 교육적 측면과 자원순환적 측면에서 지자체지원도 고려 필요 - 리워드 제공을 통해 시민 참여나 수집 가능성을 높이는 것이 필요하며, 특히 해양투기가 발생할 수 있는 해안지역에 적극 활용하는 것이 필요 - 대전 사례와 같이 지역 자원 연계 방안이나 해양쓰레기와 프레셔스 플라스틱을 연계한 제주의 ‘재주도좋아’ 사례 등이 보다 확산될 필요가 있음 ○ 미세플라스틱 저감 측면에서의 병뚜껑 자원순환성 제고방안 - 물질의 자원순환성 확대 및 경제적 가치 증진은 미세플라스틱 유출을 방지 - 병뚜껑 물질재활용 고품질화(동일용도 우선, 가치가 높은 순서로 재활용) - 재활용 공정 중 미세플라스틱 발생 모니터링 필요(파쇄 후 비중분리) - 병뚜껑 별도 회수 프로그램 시범실시 확대 및 회수 리워드 확대 ○ 투기 방지를 위한 용기부착형 병뚜껑 도입 검토 필요 - 시민 설문조사 결과, 병뚜껑 유실 경험이 65.5%이고 용기부착형 병뚜껑 구매의향에 대해서는 63.5%가 구매의향이 있다고 응답하였고, 9.7%는 구매의향이 없다고 응답(나머지는 보통) - 페트병 재활용 시설은 병뚜껑 혼입에 대한 부담이 없고, 부착형 병뚜껑은 분리할 때도 링까지 제거 가능하기 때문에 별도 회수체계에서도 유용한 역할을 할 수 있음 Ⅶ. 미세플라스틱 연구 및 정책 DB와 정보 플랫폼 개발 □ 환경오염 및 영향 관련 선행연구의 분석내용을 다룬 연구 DB 3개와 국가별 규제 현황을 분석한 정책 DB 1개를 포함하여, 미세플라스틱 정보 플랫폼인 KMPic(KEI Microplastic & Plastic Information Channel) 개발을 완성함. 정책적 활용도가 높을 것으로 예상되므로 지속적인 DB 데이터 업데이트와 관리를 위한 후속 사업 추진의 고민이 필요함 Ⅰ. Background and Objectives □ [Background] Since the 1970s, humans have been struggling to solve the problem of marine pollution caused by plastic waste, but no clear solution has been reached. While this journey is still ongoing, microplastics have been identified worldwide, and it is difficult to accurately estimate the number of existing and potential microplastics (waste plastics); as such, policy management is required evidently. □ [Purpose] Policy research has been conducted for three years from 2019 to 2021 to respond to environmental problems caused by microplastics and identify the pending domestic policy issues based on relevant scientific knowledge and issues. □ [Definition of health damage] The purpose of this study is to define ‘health damage’ regarding the wide range of microplastic problems affecting the health of living organisms and environmental systems, and to prepare policies to reduce the impact on ecosystems, species, and human health resulting from such problems. Ⅱ. Research and Analysis of Environmental Pollution by Medium □ If all of the studies conducted on microplastics related to environmental pollution are integrated, we can deduce that microplastics have become pollutants distributed across the Earth. Although nearly 50 years of research have been conducted, it is still difficult to predict how concentrations change in different regions, countries, seasons, and years, and how the distribution characteristics differ. □ Although the number of individual research cases in specific locations, ecosystems, regions, or countries is gradually increasing, studies involving long-term monitoring of a single region are rare. Furthermore, research generality is difficult to guarantee, as even studies conducted in the same region have large deviations in the analytical techniques, such as research methodology and identification, and statistical processing. □ To date, most of the mainstream research involved the ocean, but various studies on freshwater on land are becoming popular. However, research on soil and the atmosphere remains lacking. China is showing the most activity in water and soil research, while insufficient research is being conducted in Africa, Southeast Asia, and Korea. □ Owing to the lack of a conceptual and methodological basis for research on environmental pollution, quantitative comparisons should only be conducted in studies with similar research methods and analysis units. Furthermore, it is necessary to avoid using these comparisons as an absolute indicator to interpret policies or evaluate pollution levels. Ⅲ. Analysis of the Effects of Microplastics □ Exposure and effects of microplastics ○ Size of microplastics - Recently, there has been a tendency to regard those having a size of 1 to 5,000 μm as microplastics as defined by the International Organization for Standardization (ISO). ○ Research trends in exposure and the effects of microplastics - We reviewed the following studies conducted in Korea on exposure to microplastics: Distribution Characteristics of Microplastics in Southern Sea of Korea (Min et al., 2021) and Measurement of Microplastics Concentration in the Atmosphere (Seoul Research Institute of Public Health and Environment, 2021). - Recent papers on the effect of microplastics that should be noted include research on microplastics dissolved in disposable paper cups, microplastics exposure in infants and newborns, in vivo biological behavior of microplastics and microplastics in connection with COVID-19. Ⅳ. Review of Risk Assessment Methods for Microplastics □ Ecological risk assessments ○ Qualitative ecological risk assessment methodology - Based on the results of research on the distribution of microplastics on the coasts of Korea, qualitative ecological risk assessments are conducted, and the results are mapped. ○ Preliminary probabilistic ecological risk assessment methodology - Preliminary probabilistic ecological risk assessments are conducted based on the results of research on the distribution of microplastics in freshwater areas in Korea. - The results confirmed that the risk was not high at the current distribution level. However, due to the lack of data on exposure and toxicity in freshwater, a re-evaluation was deemed necessary once sufficient data are secured. □ Human risk assessment ○ Human risk assessment methodology - Owing to the lack of research on techniques to evaluate human risk, we identified the overall status while referring to literature on exposure levels and pathways in which microplastics are detected, such as drinking water intake. ○ Review of the application of human exposure assessments in Korea - We investigated the current status of people drinking water from disposable paper cups through a survey. - Microplastic intake through disposable paper cups was estimated as an example by applying previous research and survey results. □ Diagnosis of the current risk assessment status and aspects to be improved ○ Consideration points for risk assessment and management - Both qualitative and quantitative risk assessment methods should be considered for ecological risks due to the limitations of the target media and biological data. Data obtained from monitoring the concentrations of each type of microplastic in water systems on land, such as rivers, must be acquired. - Both qualitative and quantitative risk assessment methods should be developed for human risk due to the limitations of the data on different exposure pathways. Acquiring data from monitoring exposure for different exposure pathways must be prioritized. - For accurate quantitative risk assessment, research on developing the risk assessment methods which take into account the size and characteristics of microplastics by type should be conducted. □ Implications for policy coordination in risk assessment ○ Seeking methods to review regulations that consider the limitations of risk research - Considering the current limitations of human risk assessments, ways to review regulations based on emission size and ecological risks must be identified, as demonstrated in the EU. - Before conducting risk assessment, methods to designate management priorities based on the concerned areas and high-risk product ranges derived through periodic monitoring and screening of environmental media and exposure pathways must be prepared. - Methods that can persuade consumers to refrain from using plastic containers, such as public education and campaigns on products that are likely to be exposed to the human body, must be identified. Synergistic effects are expected if such methods are conducted in conjunction with carbon neutrality policies. Ⅴ. Preparation of Measures to Reduce Primary Microplastics □ [Source] According to the ECHA information of the European Union, who are preparing regulations on primary microplastics, there are eight sources of primary microplastics, including cosmetics (personal hygiene and personal care products, including beauty care products), detergents and cleaning agents, agricultural and horticultural products, paints and inks, medical devices and pharmaceuticals, synthetic infill materials, oil and gas, and construction materials and products. □ [Policy trends] Policy responses for the management of primary microplastics can be divided into ‘international joint responses’ and ‘individual responses on a national and regional basis.’ ○ Individual responses on a national basis can be further classified into autonomous regulations centered around Australia and legislative regulations in ten countries, including the United States, Canada, Argentina, France, the United Kingdom, Sweden, Italy, New Zealand, South Korea, and Taiwan. ○ The European Union has been deliberately restricting the use of primary microplastics in products under the REACH regulation, and have adopted a regulation proposal on primary microplastics since 2019, with the main content outlining product information labeling and reporting. - After the final proposals submitted to the Socio-Economic Analysis Committee (SEAC) and Risk Assessment Committee (RAC) were integrated last February, follow-up work, such as the first draft of the revision of Annex XVII, has been underway since October 2021. □ [Technology trends] The development of substances and technologies to replace primary microplastics involves using natural materials as alternatives, or not using microplastics at all. The trends show that natural materials are replacing microbeads in the cosmetics and detergent industries. ○ It is difficult to develop alternative technologies to microcapsules and coatings used for emission control. There are examples of cases where microcapsule technologies were developed in crops in Europe, and cases of binders and coating agents based on natural materials being developed to be applied in seeds and the commercialization of related products. The development of alternative technologies in other industries is currently lacking, and the commercialization of bio-based plastics is expected to take longer as a result. □ [Nationwide survey] A survey was conducted to determine public knowledge regarding the perception, understanding, and main policy alternatives of microplastics, and confirmed that the general public has a severely low level of understanding of microplastics. Policies regarding the management of primary microplastics are deemed to require highly active responses, such as legislation and regulations, and transitions to using alternative materials. Agriculture, cosmetics and personal hygiene products, construction materials and supplies, and paints are the sources with high policy preference, and synthetic infill materials have low policy priority. □ [Policy proposal] South Korea has restricted the use of primary microplastics in five detergent products, rinse-off cosmetics, and quasi-drugs. However, as there are no special management policies regarding other sources and sub-standard products, the following policy measures must be considered. ○ Among the cosmetics and quasi-drugs that are currently being regulated, personal hygiene and care products and detergents are not yet regulated. However, step-by-step regulations of many products with high usage and environmental emissions must be planned and prepared in detail. ○ Agriculture and horticulture, medical devices and pharmaceuticals, and synthetic infill materials are not yet well recognized as microplastic sources in Korea, indicating that the social consensus regarding the need for regulation is lacking. Securing the legitimacy of the policy design should be prioritized through the development and promotion of policy information, and domestic management measures should be prepared for the implementation of regulations by the European Union ECHA. Ⅵ. Secondary Microplastic Management Plans: Measures to Reduce Outflow to Sewage Systems and Manage Bottle Caps □ Measures to reduce microplastics from tire abrasion and fine fiber outflow to sewage systems ○ In addition to being aware of how microplastics are generated, we also need to understand the outflow routes of microplastics into the environment and manage them accordingly. - In the first year, the amount of tire abrasion microplastics generated was estimated, and the amount of fine fiber generated was estimated in the second year. - The outflow route in the sewage system was identified in the third year. - In particular, flow analysis was mainly conducted on untreated outflowing water, excluding the effluent of the sewage treatment facilities. ○ We collected data on the sewer distribution rate, proportion of separate sewage systems, leaked overflow loading rate, number of days of heavy rainfall, misconnection rate in separate sewage systems, treatment efficiency in treatment facilities, sludge prevalence in sewage, and treatment status. - Related research reports and case results were referred to based on sewer statistics. - In the case of the loading rate of pollutants (leaked overflow loading rate) leaked as overflow during heavy rainfall in combined sewer systems, data on the concentration of microplastics in overflow is unavailable. According to the estimation of the BOD outflow loading rate based on the research result proving that there is a relationship between microplastics and BOD behavior, 22.7% are estimated to be leaked due to overflow during heavy rainfall (Analysis request made to Professor Jae Il Oh of Chung-Ang University). - Overflow also occurs in separate sewer systems due to misconnection, and we assumed the effect to be 37% of that of combined sewer systems by referring to relevant literature. - We assumed the misconnection rate in separate sewer systems to be 13% based on the cities of Jeju and Ulsan, where the proportion of separate sewage systems are 100%. - The treatment efficiency in sewage treatment facilities was assumed based on domestic and international papers published on microplastics (98.5% in sewage treatment facilities, 90% in wastewater treatment facilities (biological treatment), and 85% in intercept treatments during heavy rainfall (only primary treatment conducted)). ○ The outflow of fine fibers was determined based on the 2019 data for Korea, and 10.4% of the generated fine fibers are assumed to flow out to the water system. - 242 tons of fine fibers leak to the water system annually. - The efficiency of sewage treatment facilities is 98.5%, but the outflow volume increases due to untreated outflow. - The wastewater leaking from rainwater pipes due to misconnections in separate sewage systems is the greatest contributor to outflow to water systems, followed by effluents in sewer treatment facilities, overflow, and untreated outflowing water. - The amount of fine fibers stacked onto sewage sludge leaked into the soil through composting is estimated to be 154.6 tons per year. ○ As fine fibers are generated in wastewater, we can deduce that the proportions of separate sewage systems and untreated areas are the main factors influencing outflow routes. The independent analysis of Seoul City and Gyeongsangbuk-do, where there are high proportions of combined sewer systems and untreated areas, respectively, showed that 7.5% of the generated fine fibers are leaked into the water system in Seoul, with the highest contribution being observed for overflow in combined sewer systems. In Gyeongsangbuk-do, 14.6% of the generated fine fibers are leaked into the water system, with outflowing water in untreated areas making the highest contribution. - This should be understood as a change in outflow due to the high proportion of combined sewer systems and untreated areas, rather than as actual states of Seoul City and Gyeongsangbuk-do (it is necessary to supplement input characterization data for each region). ○ A flow chart showing the outflow of tire abrasion microplastics in 2019 in Korea was created, and 73% of the generated microplastics (excluding the 10% that move to the atmosphere) are estimated to be leaked into water systems. This result does not consider facilities that reduce nonpoint source pollution on roads and the effect of road cleaning. - Outflow from the rainwater pipes of separate sewer systems is the greatest contributor to outflow into water systems. - Tire abrasion microplastics exist in rainwater, and, as the proportions of separate sewer systems and sewage treatment areas are the main influencing factors, we separately analyzed the flow in Seoul City and Chungcheongnam-do, where there are high proportions of combined sewer systems and sewer treatment facilities, respectively. - 34.4% of the generated microplastics are leaked into water systems in Seoul, and 86.2% of the generated microplastics are leaked into water systems in Chungcheongnam-do. ○ We confirmed that the outflow of abrasion microplastics to water systems was most affected by unprocessed rainwater or misconnections in separate sewer systems. Overflow management was deemed necessary in combined sewer systems. ○ This study mainly adopted national statistical data and literature values to prepare the flowchart of outflow as an example, indicating that more accurate data for each city and province must be supplemented. We also need to estimate cases in industries, in addition to households. ○ The flowchart of outflow produced in this study does not consider the reduction caused by certain sources, such as laundry bags and road cleaning. - Approximately 50% of the outflow can be reduced when using washing drainage filters (Coraball has a removal efficiency of 26%, while LUV-R has an average removal efficiency of 87%). - For tire abrasion microplastics, ongoing related projects, such as measures to reduce nonpoint source pollution on roads and measures regarding resuspended dust, may evoke partial reduction effects. However, it is necessary to calculate the exact level of outflow reduction based on data such as the removal efficiency and installation ratio. ○ The Ministries of Environment, Land, Infrastructure and Transport, Oceans and Fisheries, and Agriculture, Food, and Rural Affairs should jointly and accurately calculate the amount of microplastics outflow in each region, including areas where the effect of microplastics outflow is concerning (aquaculture of shellfish or seaweed, salt fields, water supply sources, and so on). The effect on agricultural water and soil must also be considered. - In particular, management plans regarding nonpoint source pollution caused by rainwater are urgently required (tire abrasion microplastics). □ Methods to collect and recycle bottle caps among macroplastics ○ During the first year of research in 2019, we ranked management priorities based on the prevalence of marine waste, material and morphological risks, recycling status, and management standards. The results of the investigation of the top six waste products on land based on the annual monitoring of marine waste conducted by the Ministry of Oceans and Fisheries and the Korea Marine Environment Management Corporation showed that drink bottles and bottle caps were the most produced types of marine waste. - There have been no cases of management policies reviewed for bottle caps in South Korea, but strategies to prevent bottle caps from being thrown away are being implemented in Europe. - Bottle caps attached to bottles will become compulsory in Europe as of July 2024, and there is a high interest in the management of caps, even after enforcing the security deposit. - Bottle caps were found to inflict a large amount of damage to birds in particular. ○ The higher the economic value of materials, the lower the probability of the materials being disposed of as marine waste, indicating that improving the resource circulation of marine waste can ultimately prevent waste disposal. - We investigated the disposal status of bottle caps, waste management status, and policy measures to enhance resource circulation. ○ The status of marine disposal of bottle caps in Korea differs greatly for each monitoring point. - A particularly large number of bottle caps were discovered in Dumo Mongdol Beach in Geoje City and Guryongpo in Pohang City, and their numbers were significantly larger than the number of PET drink bottles. - The effects of protective caps on gas cans need to be investigated along with bottle caps. - Owing to the large regional deviations, monitoring data on marine waste for each region need to be utilized. ○ Bottle cap separation and disposal methods differ between countries. - Bottle caps are separated from PET bottles in Japan before being disposed of, while bottle caps are recommended to be disposed of by being attached to their bottles in Europe and the United States, or no separate guidelines are provided. - In South Korea, bottle caps are recommended to be disposed of by being attached to their PET bottles following the clear plastic bottles separation and disposal policy. Meanwhile, after the movement of waste management companies in 2018, in which they refused to collect plastic waste in the Seoul Capital Area, the public interest in waste increased, leading to the proliferation of the ‘Precious Plastic Movement’, a regional social movement to circulate plastics and programs in which bottle caps were separately collected. ○ We propose a decision tree to determine a bottle cap separation anddisposal policy by considering the impact of mixing bottle caps on the recycling process, recycling status of bottle caps that are separated during the process, and citizen participation in the separation and disposal of bottle caps. - According to on-site investigations and written surveys completed by companies, the effect of bottle caps on the purity of PET bottles and the recycling process is low. The bottle cap (LDPE) and label (PP) materials separated during the process are mixed to be recycled as pallets. - The participation survey conducted on citizens regarding the separation and disposal of bottle caps showed that 93.3% will participate if collection boxes are available within their apartment complex, 59.7% will participate if collection points are nearby, and 26.0% will participate if the bottle caps must be sent as courier post using their own money. - Owing to the high receptivity of bottle caps in the PET bottle recycling industry, the current national guidelines for the disposal of bottle caps by being attached to their bottles are generally appropriate. However, separate collection systems can be constructed for different regions to establish a better recycling system for bottle cap materials. In the use of unmanned collecting stations, bottle caps need to be collected at the same time as the PET bottles. ○ We conducted a case study on ‘Plastic Mills,’ a voluntary program that separately collects bottle caps (submitted a request to the Team Leader Dong-Yi Lee of the Korean Federation for Environmental Movement). - Various activities are being conducted at the level of the Precious Plastic Movement, an international plastic regional circulation movement. The collection was initially conducted by courier delivery, but recently moved to be conducted at collection points. - Although the bottle caps can be used to produce a variety of daily necessities with relatively safe materials (drive to produce practical products), the need to prepare workshop spaces and acquire human resources is a limitation. - We can also expect educational effects to be evoked by increasing public awareness of the use of disposable plastics through separate bottle cap collection programs; as such, support from local governments must be considered from an educational and resource circulation perspective. - Public participation and collection probability must be increased through reward provisions, especially in coastal areas where marine disposal is likely to occur. - More cases, such as the regional resource linkage methods in Daejeon and the ‘Jaejudojoa’ program in Jeju Island, where marine waste and ‘Precious Plastics’ were combined, need to be expanded. ○ Plans to improve resource circulation of bottle caps regarding microplastic reduction - Expansion of materials resource circulation and enhancement of economic value prevent outflow of microplastics. - Quality improvement of bottle cap material recycling (same purpose prioritized, recycled in the order of highest value) - Monitoring of microplastics during the recycling process is required (gravity separation after crushing). - Expansion of separate bottle cap collection programs and rewards ○ Review needed on attaching bottle caps to bottles to prevent disposal - The public survey showed that 65.5% of the respondents lost bottle caps, 63.5% said they would buy bottles with attached caps, and 9.7% said they would not buy them (the rest of the responses were neutral). - PET bottle recycling facilities do not need to worry about mixing bottle caps. Even the rings of the attachable bottle caps can be removed during separation, meaning that they can play a significant role in separate collection systems. Ⅶ. Microplastics Research and Policy Database & Development of Information Platforms □ The development of the microplastics information platform, KMPic (KEI Microplastic & Plastic Information Channel), was completed. This includes the three research databases regarding the analysis of previous research related to environmental pollution and its influence, and a policy database that analyzed the regulation status for different countries. The utilization of policies is expected to be high; as such, it will be necessary to plan follow-up projects to consistently update and manage the data.

HCV, Alcoholic : PE-092 ; A promising clinical utility of the controlled attenuation parameter (CAP) for noninvasive assessment of steatosis using Fibroscan®

( Harry Yoon ),( Hana Park ),( Jeong Guil Lee ),( Kyu Sung Rim ),( Pil Won Park ),( Sung Pyo Hong ),( Kwang Hyun Ko ),( Chang Il Kwon ),( Won Hee Kim ),( Seong Gyu Hwang ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Until now, evaluation of steatosis by non-invasive methods has been challenging. Recently, CAP (controlled attenuation parameter) based on Fibroscan® was developed. In this paper, we report the use of CAP for the assessment of steatosis. Methods: 89 patients with chronic liver disease underwent blood tests and liver stiffness measurement (LSM) with simultaneous CAP determination using the Fibroscan®. Sonographic steatosis grade was assessed by one expert physician blinded to CAP, and compared with the steatosis grades based on CAP. Results: Characteristics of the 89 patients included were as follow: 56.2%male, median age 47.69 ± 11.26 years, BMI 23.75 ± 5.73 kg/m². Clinical and laboratory variables were well stratified according to the steatosis grades based on CAP , there were significant differences among the grades (body weight : S0 = 63.64 ± 11.82 m/s, S1=66.66 ± 7.98m/s, S2=66.09 ± 12.61m/s, S3=74.64 ± 12.75m/s, p=0.013 ; BMI : S0 = 22.84 ± 3.22m/s, S1=23.95 ± 6.49m/s, S2=20.50 ± 9.55m/s, S3=27.24 ± 3.74m/s, p=0.006 ; triglyceride: S0 = 83.62 ± 34.30m/s, S1= 126.19 ± 54.09m/s, S2=109.2 ± 55.37m/s, S3=150.25 ± 77.41 m/s, p=0.001). CAP showed positive correlations with body weight (r=0.372, p=0.001), BMI (r=0.318, p=0.004), triglyceride (r=0.344, p=0.002), and alanine aminotransferase (r=0.259, p=0.016). Although sequential differences of CAP depending on the sonographic steatosis grades were revealed (diffuse liver disease/normal = 220.37 ± 38.65m/s; mild fatty liver = 237.20 ± 56.42 m/s; moderate fatty liver = 286.43 ± 59.50 m/s; severe fatty liver = 330.33 ± 56.17 m/s, p<0.001), there were discordances between steatosis grades measured on the base of sonographic diagnosis and CAP. Conclusions: The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Advantages of CAP include its ease of measurement, simultaneous availability with LSM for fibrosis assessment, and provision of additional objective information to the sonographic diagnosis.

LC : A Promising Clinical Utility of the Controlled Attenuation Parameter (CAP) for Noninvasive Assessment of Steatosis Using Fibroscan®

( Hyun Jung Park ),( Hana Park ),( Harry Yoon ),( Pil Won Park ),( Sung Pyo Hong ),( Kwang Hyun Ko ),( Chang Il Kwon ),( Kyu Sung Rim ),( Seong Gyu Hwang ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The CAP (controlled attenuation parameter) based on Fibroscan® has been recently developed for the evaluation of steatosis by non-invasive method. In this study, we aim to report the usefulness of CAP for the assessment of steatosis. Methods: 482 patients with chronic liver disease underwent liver stiffness measurement (LSM) with simultaneous CAP determination using the Fibroscan® were included. Sonographic steatosis grade was assessed by one expert physician blinded to CAP, and compared with the steatosis grades based on CAP. Results: Characteristics of the 482 patients included were as follow: male 289 (60%), median age 46.43±11.20 years, BMI 21.62±8.01 kg/m². Clinical and laboratory variables were well stratified according to the steatosis grades based on CAP, and there were statistically significant differences of body weight, BMI, serum alanine aminotransferase level and serum triglyceride level among the grades. CAP showed positive correlation with body weight (r=0.427, P<0.001) and BMI (r=0.407, P<0.001). Although sequential differences of CAP depending on the sonographic steatosis grades were revealed (diffuse liver disease/normal=221.71±47.05dB/m; mild fatty liver=244.54 ± 47.14 dB/m; moderate fatty liver=294.56 ± 44.68dB/m; severe fatty liver=320.71 ± 48.46dB/m, P<0.001), there were discordances of steatosis grades between those based on sonography and CAP. Conclusions: The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Advantages of CAP include its ease of measurement, simultaneous availability with LSM for fibrosis assessment, and provision of additional objective information to the sonographic diagnosis of steatosis.