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Analysis of Pulmonary Metastases according to a New Staging Proposal (새로운 병기 제안에 따른 전이성 폐암의 분석)

  • 강정한;백효채;이진구;정경영
    • Journal of Chest Surgery
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    • v.34 no.8
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    • pp.615-620
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    • 2001
  • The new stage of metastatic lung cancer based upon resectability, disease-free interval, and the number of pulmonary metastases was proposed in 1998 by Ginsberg, et al. We evaluated the validity of the new staging proposal for pulmonary metastases through the analysis of experiences at Severance Hospital. Material and Method: The cases of 111 patients who underwent resection of metastatic lung cancer during the eleven-year period (1990-2000) were reviewed. Of these patients, 103(92.8%) underwent compete surgical resection. The primary tumor was carcinoma in 60 cases, sarcoma in 46, and others in 5. The disease-free interval(DFI) was 0 to 35 months in 79 cases adn more than 36 months in 32 cases. Single metastasis accounted for 53 cases and multiple lesions for 58 cases. Mean follow-up was 49 months. Result: The actuarial survival after complete metastasectomy was 48.2% at 3 years and 32.6% at 5 years; the corresponding values for incomplete resection were 21.9% at 3 years. The 3-year survival rate(3-YSR) for complete resction was 40.5% and 5-year survival rate(5-YSR) was 30.4% for patients with a DFI less than 36 months, the 3-YSR, 75.8% and 5-YSR, 39.0% for those with a DFI equal or more than 36 moths; 45.8% and 30.5% for single lesions, 50.0% and 34.4% for multiple lesions. The 3-YSR and 5-YSR were 58.5% and 43.8% for stage I patients, 54.0% and 37.4% for stage II, 38.2% and 27.9% for stage III and 21.9% for stage IV. Conclusion: The result of the analysis of new stage of pulmonary metastases showed that the survival rate was different according to stage and there was no statistical significance. We need more experiences and long-term follow up to determine the prognostic factor of metastatic lung cancer surgery.

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Clinical Outcome of Pulmonary Metastasectomy in Patients with Pulmonary Metastasis (전이성 폐암에 대한 폐절제술의 성적)

  • Lee, Young-Ok;Lee, Eung-Bae;Ryu, Kyoung-Min
    • Journal of Chest Surgery
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    • v.40 no.10
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    • pp.674-679
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    • 2007
  • Background: Surgical resection is accepted widely as the standard therapy for complete resectable pulmonary metastases. The number of cases of pulmonary metastasectomy and its survival rate is increasing due to the development of the therapeutic modalities. We attempted to analyze the survival rate and prognosis factors of pulmonary metastasectomy during the last 10 years. Material and Method: We retrospectively analyzed the data of 89 patients who underwent 96 procedures of pulmonary metastasectomy between January 1996 and December 2005. The factors that may influence the long term prognosis such as completeness of resection, the type of primary cancer, the disease-free interval, the number and size of metastasis and the laterality were investigated. Result: There was no operative mortality. The mean disease free interval (DFI) was $29.6{\pm}27.9$ months and there were 3 cases of synchronous metastasis (3.4%). The overall 3, 5 and 10 year survival rate was 52.5%, 32.1% and 20.7%, respectively. The median survival time was 38 months. The 5-year survival rate according to the IRLM appraisal was 63.5%, 33.3%, 22.1% and 0% for stage I, II, III and IV, respectively Univariate analysis showed a better prognosis for patients with a disease free interval of 36 months or more, unilateral metastasis and 4 or less metastases. Conclusion: The survival rate for completely resectable pulmonary metastasectomy was favorable. The disease free interval, laterality and the number of metastasis were the prognosis factors.

Using Synoptic Data to Predict Air Temperature within Rice Canopies across Geographic Areas (종관자료를 이용한 벼 재배지대별 군락 내 기온 예측)

  • 윤영관;윤진일
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.3 no.4
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    • pp.199-205
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    • 2001
  • This study was conducted to figure out temperature profiles of a partially developed paddy rice canopy, which are necessary to run plant disease forecasting models. Air temperature over and within the developing rice canopy was monitored from one month after transplanting (June 29) to just before heading (August 24) in 1999 and 2001. During the study period, the temporal march of the within-canopy profile was analyzed and an empirical formula was developed for simulating the profile. A partially developed rice canopy temperature seemed to be controlled mainly by the ambient temperature above the canopy and the water temperature beneath the canopy, and to some extent by the solar altitude, resulting in alternating isothermal and inversion structures. On sunny days, air temperature at the height of maximum leafages was increased at the same rate as the ambient temperature above the canopy after sunrise. Below the height, the temperature increase was delayed until the solar noon. Air temperature near the water surface varied much less than those of the outer- and the upper-canopy, which kept increasing by the time of daily maximum temperature observed at the nearby synoptic station. After sunset, cooling rate is much less at the lower canopy, resulting in an isothermal profile at around the midnight. A fairly consistent drop in temperature at rice paddies compared with the nearby synoptic weather stations across geographic areas and time of day was found. According to this result, a cooling by 0.6 to 1.2$^{\circ}C$ is expected over paddy rice fields compared with the officially reported temperature during the summer months. An empirical equation for simulating the temperature profile was formulated from the field observations. Given the temperature estimates at 150 cm above the canopy and the maximum deviation at the lowest layer, air temperature at any height within the canopy can be predicted by this equation. As an application, temperature surfaces at several heights within rice fields were produced over the southwestern plains in Korea at a 1 km by 1km grid spacing, where rice paddies were identified by a satellite image analysis. The outer canopy temperature was prepared by a lapse rate corrected spatial interpolation of the synoptic temperature observations combined with the hourly cooling rate over the rice paddies.

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A study on the impact of online contents characteristics on customer loyalty - Mediated effect of flow perspective - (고객충성도에 영향을 미치는 온라인 콘텐츠 특성에 관한연구 -몰입(Flow)의 매개효과를 중심으로 -)

  • Shin, Young-Chul;Jeong, Seung-Ryul
    • Journal of Internet Computing and Services
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    • v.14 no.5
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    • pp.101-117
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    • 2013
  • As the number of online game user has been rapidly increased thanks to the recent vitalization of online contents market, not only new business opportunity but also the opportunity to create high profits have been provided as well. However, the increase of the number of online game user and the rapid expansion of the market evoke a cutthroat completion among online game service providers, and also high barriers to entry to online game market have been erected. Thus, what kinds of efforts need for the business success and sales increase in online game market? In lots of researches regarding online contents business, the deepening of loyalty was considered as a critical factor for the business success. According to the study on user's behavior in online environment, users would experience the Flow while using online service, and then, if they were in state of the Flow, they would use the service constantly. High customer loyalty to online game means high will to use the online game too. The purpose of this research was i) to examine what factors enable users to be naturally immersed in online game while playing it, ii) to examine what properties of online game can make game more interesting and exciting, iii) to verify that such factors are critical in deepening customer loyalty, and iv) to suggest some essential factors to be fun and exciting games, on where the focus should be put, and the directionality for the development for sales expansion of online game developer or online game service provider. The research results are as below: First, the involvement and the perceived quality which were characteristics of brand appeared to be factors most affecting Flow. This shows that once game user get interested in online game that user has played frequently, even though new games are released, user will continuously flow the game not moving to new games, and also shows that users not only get more interested but also put more trust in games in the site to where users are frequently going than games in other sites, and consequently user can increasingly flow the game. Second, the compensation and graphics which are the characteristics of contents appeared to be factors affecting Flow. Proper compensation which is given to game users triggers fun and interests in game and makes them flow more and more. And graphics make users to feel game space as if real space and let them flow in game with more reality. Third, challenges, support, and the stability which are technical characteristics appeared to be factors affecting Flow. Challenges enable users to not only experience new virtual world but also solve various difficulties and obstacles. Once users feel fun and interests through this challenge, they can naturally flow games. In addition, the stability of network provides reliability in security and hacking. By doing so, it can induce users to flow more and more. Lastly, when aforementioned characteristics including contents characteristics, technical characteristics, and brand characteristics are organically combined each other, game users feel fun and total minutes are naturally increased, so that game users experience Flow, and consequently the customer loyalty will be deepened as well.

End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience (심폐소생술 금지 동의 후 사망한 환자의 현황과 연명의료 실태 조사: 단일 의료기관 경험)

  • Yoon, Sang Eun;Nam, Eun Mi;Lee, Soon Nam
    • Journal of Hospice and Palliative Care
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    • v.21 no.2
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    • pp.51-57
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    • 2018
  • Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

The Comparison between High Dose and Low Dose Morphine in Terminal Cancer Patients During the Last 1 Week to Death (고용량과 저용량의 몰핀을 쓰는 말기 암 환자에서 임종 1주일동안 비교)

  • Cho, Doo-Yeoun;Cha, Kyu-Jin;Yoon, Bang-Boo;Yeom, Chang-Hwan
    • Journal of Hospice and Palliative Care
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    • v.5 no.1
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    • pp.24-30
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    • 2002
  • Background : Pain is one of the most feared consequences of cancer. $65{\sim}85%$ of cancer patients experienced severe pain, and sometimes high dose morphine is used to these patients. But many doctors still have 'opioid-phobia' and hesitate to use high dose morphine. We investigated the morphine therapy in terminal cancer patients during the last 1 week to death, and found any differences according to the morphine dosage. Methods : 93 patients admitted to National Health Insurance Corporation Ilsan Hospital, department of family medicine for hospice care between September 2000 and the end of October 2001 and lived more than 1 week entered in the study. We investigated the demographic data, laboratory tests and sufficient dosage of morphine for pain control. According to the calculated dosage by OME(oral morphine equivalent), patients were divided into low dosage group (${\leq}150mg/day$) and high dosage group (>150 mg/day). The chi-squared test were used to evaluate the influence of age, gender, tumor sites, metastasis and adverse effects of morphine. Results : Mean age was $65.0{\pm}13.1year$ in low dosage group and $59.9{\pm}11.6year$ in high dosage group. 32 men (50.0%) and 32 women (50.0%) were included in low dosage group and 15 men (51.7%) and 14 women (48.3%) in high dosage group. Stomach was the most frequent tumor site and lung was the next. Metastasis were found 58 (90.6%) in low dosage group and 28 (96.6%) in high dosage group. In other palliative radiotherapy and adverse effects, there were no differences in both group. Conclusion : During the last 1 week to death in cancer patients, there were no difference according to the morphine dosage. So we don't have to have 'opioid-phobia' in treating the terminal cancer patients.

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The Review of Environment, Food and Exercise on Allergy Anaphylaxis (환경, 음식 및 운동 알레르기 반응에 대한 고찰)

  • Kwak, Yi-Sub;Baek, Young-Ho;Kim, Seung-Hyun;Kim, Young-Il;Yoo, Byung-In
    • Journal of Life Science
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    • v.20 no.1
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    • pp.147-152
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    • 2010
  • Exercise-induced anaphylaxis (EIA) is a physical allergy, sometimes severe, triggered by exertion following specific food intake. It was defined for the first time in 1980. EIA is associated with different kinds of exercise. The clinical manifestations progress from itching, erythema and urticaria to some combination of cutaneous angioedema and vascular collapse. Mast cell participation in the pathogenesis of this syndrome has been proved by the findings of an elevated serum histamine level during exhaustive exercise. As predisposing factors of EIA, a specific or even nonspecific sensitivity to food has been reported. Food-dependent exercise-induced anaphylaxis (FDEIA) is a distinct form of food allergy induced by physical exercise. It is typified by the onset of anaphylaxis during exercise which was preceded by the ingestion of the causal food allergens. The diagnosis of FDEIA is heavily dependent on clinical history. Allergy tests may need to be performed using a broad panel of food and food additives. As with food allergies, FDEIA diagnosis is based on interview, biological test and skin test. Prophylaxis aims to prevent a recurrence; the patient should be given an emergency kit to deal with any recurrent episodes. After the food allergen has been identified, it should be avoided for at least 4 to 5 hours before any exercise. Two cases of EIA are presented (EIA to circumstances; FDEIA) in this paper, The diagnosis, pathophysiology and therapy of FDEIA are also reviewed.

Investigating the Cognitive Process of a Student's Modeling on a Modeling-Emphasized Argument-Based General Chemistry Experiment (모델링을 강조한 논의 기반 일반화학실험에서 학생들의 모델링에 대한 인지과정 탐색)

  • Lee, Dongwon;Cho, Hey Sook;Nam, Jeonghee
    • Journal of The Korean Association For Science Education
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    • v.35 no.2
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    • pp.313-323
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    • 2015
  • The purpose of this study is to investigate the cognitive process of student's modeling on a modeling-emphasized argument-based general chemistry experiment. The participants were twenty-one freshman students. Six topics were carried out during the first semester and semi-structured interview was implemented at the end of the semester. Semi-structured interview questions were used to elicit elements of effective model, modeling strategies, difficulties that students have experienced during modeling, and resolving the difficulties that students have experienced during modeling. All student interview data were collected and transcribed. The results of this study are summarized as follows: (1) Elements of effective model were considered to be visual expression, persuasive explanation, and rhetorical structure. (2) Modeling strategies included arranging important keywords or writing the outline, and during the modeling process, students used various data, suggested data after reconstructing, suggested definitions and explanations of core concepts, used meta-cognition, and considering rhetorical structure. (3) Difficulties students have experienced during modeling could be categorized as lack of modeling strategy and understanding. (4) Resolving difficulties students have experienced during modeling could be categorized as modeling strategy and understanding. Students learn the strategy by feedback, modeling experience, evaluation of experimental report, models which they constructed previously and references, and the understanding of contents were achieved through arguments which occurred during classes and during the process of writing the experimental reports. These results suggest that when using modeling in teaching and learning, the argument-based learning strategy can be effective in enhancing students' modeling by helping them to understand meta-modeling with scientific concepts.

The Smoking Status and Its Associated Factors of Some Army Soldiers (일부(一部) 병사(兵士)들의 흡연실태(吸煙實態)와 관련요인(關聯要因))

  • Jung, S.J.;Lee, C.G.;Ryu, S.Y.;Kim, K.S.
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.5
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    • pp.426-436
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    • 2001
  • Objective : This study was performed to determine the smoking status and its associated factors in military life among young Korean men to provide data for smoking prevention in military areas as a part of the health promotion program for soldiers. Methods : 1,033 infantrymen serving in 17 military units, which are located in suburbs of K city, were enrolled in this study. A questionnaire on the soldiers smoking status and other various characteristics was obtained from October 2nd to 12th, 2000. Logistic regression analysis was performed on the various variables in order to determine the factors related to smoking. Results : 1) 830(80.3%) out of 1033 subjects had smoked cigarettes and 759 persons(73.4%) were regular smokers. 2) Among the 734 soldiers who started smoking before their military service, 714 soldiers(97.2%) continued to smoke after, while 45 soldiers(15.0%) among the 299 non-smokers started smoking after joining the army. 3) Through the logistic regression analysis. the education level. specialty in the army. smoking amongst the friends they met before military service, smoking amongst soldiers in the army. dating girl friends, drinking, satisfaction with their army lives and the presence of convenient smoking places at the barracks were significant factors related to the prevalence of smoking in soldiers. Conclusion : The factors related with incidence of smoking in the army are the complicated interactions among the individuals personal background, general characteristics of the soldier and the special environment in the barracks. Therefore, to improve national soldiers' health, an active non-smoking campaign and education should be pushed to discourage smoking in the barracks.

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Symptom Questionnaire and Laboratory Findings in Subjects with Airflow Limitation: a Nation-wide Survey (기류 폐쇄(Airflow Limitation)의 유무와 호흡기 증상 및 검사실 성적에 관한 연구: 국가 단위 실태 조사)

  • Hwang, Yong Il;Kim, Young Chul;Lee, Jae Ho;Kang, Min Jong;Kim, Dong Gyu;Kim, Soo Ock;Jang, Tae Won;Lee, Min Ki;Ahn, Youngsoo;Yoo, Jee Hong;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.6
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    • pp.480-485
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    • 2007
  • Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. COPD has systemic effects, such as skeletal muscle dysfunction and abnormal weight loss. It also has been suggested that COPD is related to other chronic disease, such as cardiovascular disease, osteoporosis, and anemia. The aim of this study was to evaluate a symptom questionnaire and laboratory findings in subjects with air flow limitation. Methods: We evaluated a symptom questionnaire and laboratory findings in subjects with airflow limitation detected by spirometry in conjunction with the Second Korean National Health and Nutrition Examination Survey. A total of 9,243 adults over the age of 18 were recruited. Among the adults, we finally analyzed 2,217 subjects who met the acceptability and repeatability criteria of spirometry, showed normal findings on chest radiography, and were older than 40 years of age. Results: There were 288 subjects with airflow limitation as determined by spirometry. The frequency of respiratory symptoms such as cough, sputum and wheezing were significantly higher in subjects with airflow limitation (p <0.01). Hemoglobin and hematocrit levels were higher in subjects with airflow limitation (hemoglobin level 13.98 mg/dL vs. 13.62 mg/dL, hematocrit 42.10% vs. 40.89%; p<0.01). The HDL cholesterol level was lower in subjects with airflow limitation (44.95 mg/dL vs. 45.60 mg/dL; p<0.01). There was no significant difference in the total cholesterol, triglyceride, blood urea nitrogen, creatinine, and fasting glucose levels. Conclusion: In subjects with airflow limitation, prevalence of respiratory symptoms was higher than in normal spirometry subjects and the levels of hemoglobin and the hematocrit were higher. The HDL cholesterol level was lower in subjects with airflow limitation.