• Title/Summary/Keyword: 만족도 변화

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A Study on Management of Records of Art Archives (미술 아카이브의 미술기록관리 방안 연구)

  • Jeong, Hye-Rin;Kim, Ik-Han
    • The Korean Journal of Archival Studies
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    • no.20
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    • pp.151-212
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    • 2009
  • Museums are producing new value and being redefined as places that reproduce context, as the process of globalization are being reflected in museum activities. The new additional functions and roles to the traditional mission of museums allow artworks to find potential functions of art archive and meseum. At the same time, the public has faced originality and aura of an artwork by viewing the physical subject. However, with the appearance of a new digital object, the initiative of viewing has moved over from the artwork to the hands of the public. Now, the public does not go to the museum to see an artwork, but has started to adopt to an opposite paradigm of bringing the artwork forward to the screen. Therefore, they are not satisfied any longer with just seeing an artwork, but demand more information about the artworks and reproduce it as knowledge. Therefore, this study aimed to find types and characteristics through definition and range selection of art archive at this point where the value of art archive is enhanced and systematic management is required, and to present record management methods according to art archive structure and core execution function. It especially stressed that the basis of overall art archive definition was in an 'approach' paradigm rather than a 'preservation' paradigm, and embodied various application methods of digitalized art records. The digital object of an artwork was recognized as the first materialization of an actual artwork, and the digital original of an artwork was presented as the core record. Art archive managed under physical and intellectual control were organically restructured focusing on digital original copies of artworks, which are the core record in a digital technology environment, and could be provided to users in forms of various services that meet their demands. The beginning of systematic management of such art records will become a first step to enhance historical value, establish art cultural identity, and truly possess art culture.

The Phenomenological Study on School Dropout of Specialized Vocational High School Students (특성화고등학교 학생의 학업중단에 대한 현상학적 연구)

  • Lee, Myung-Hun
    • 대한공업교육학회지
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    • v.44 no.1
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    • pp.23-51
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    • 2019
  • The purpose of this study was to analysis school dropout of specialized vocational high school students using phenomenological research method. The interview for the research was carried out with 10 adolescents who dropped out specialized vocational high school from December 8 to 23, 2018. According to the result of the research, 31 themes were extracted from interviews with 10 research participants. And 10 theme clusters were categorized from these. And these clusters were divided into 3 domains : 'before school dropout', 'causes & process of school dropout, feeling about school dropout', 'after school dropout' Based on the finding of the study, major conclusions of this study were as follow: First, adolescents who dropped out specialized vocational high school suffered from hard school life, disappointing lead from teachers, stereotypical lesson. And they committed misdeeds, and had psychological difficulties. Some of them kept up the good relationship with their friends, teachers, parents, some of them did not. Some of them kept up the good relationship with their friends, teachers and parents, while some of them did not. Second, they chose dropout due to various different causes. The procedures of school dropout proceeded with comparative ease. The effect of dropout prevention program is very limited. The feeling they felt at the time of school dropout varied individually. Some adolescents who dropped out specialized vocational high school were satisfied while others were stressed out, regretting their decision. Third, they lived diligently working part-time jobs or preparing General Equivalency Diploma (GED) test after dropout. They experienced positive changes in their daily lives after dropout. But sometimes they experienced various difficulties and negative changes. Most of them had their goals, and they were preparing for them. Their expectation was low that their life will succeed if they returned to school. They wanted people to understand their decision about dropout. And multiple institutions are supporting adolescents who dropped out specialized vocational high school. They need practical support : Various information, activity for career experience, counseling etc.

A Study on the Concept and User Perception of Smart Park - Focused on the IoT See Park Users in Daegu City - (스마트공원 개념 정립 및 공원 이용자 인식에 관한 연구 - 대구 IoT See 시범사업 공원 이용자를 대상으로 -)

  • Lee, Hyung-Sook;Min, Byoung-Wook;Yang, Tae-Jin;Eum, Jeong-Hee;Kim, Kwon;Lee, Ju-Yong
    • Journal of the Korean Institute of Landscape Architecture
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    • v.47 no.5
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    • pp.41-48
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    • 2019
  • Our daily lives are changing at a rapid pace and the concept of smart city is spreading, as the information communication technologies apply to various fields. However, efforts to prepare for changes in society due to technological evolution are insufficient in the field of landscape architecture. The purposes of this study are to explore the concept of smart parks, to investigate how smart technology has been applied to parks, and to identify the users' perception and satisfaction on smart park services. To this end, we conducted literature review, focus group interviews with experts, and a questionnaire survey with 180 users of the IoT See pilot smart park in Daegu. Smart parks can, as a result, be defined as sustainable parks that improve users' experience in parks and solve social and environmental problems faced by utilizing various high technology. Smart technologies introduced at the park so far have been mostly focused on safety and environmental areas, including AI CCTV, smart street lamp, and fine dust warning devices. The results of survey showed that not many users were aware of the smart services the park provided due to the lack of public communication as well as the nature of maintenance-oriented smart services. The survey also found that AR services for the education of historic parks were the least utilized, while solar power benches and WiFi service were most preferred by the park users. In conclusion, smart technologies need to be integrated with diverse park contents more centered user needs, providing services to enhance safety and environmental management in order to develop user-oriented smart parks.

Characterization of quality changes of whole super sweet corn (Zea mays saccharata Sturt.) during thermal sterilization for shelf-stable products (상온유통을 위한 가열살균 중의 통 초당옥수수의 품질변화 연구)

  • Lee, Yun Ju;Yoon, Won Byong
    • Journal of Applied Biological Chemistry
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    • v.62 no.1
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    • pp.25-30
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    • 2019
  • This study investigated the quality changes in whole super sweet corn during thermal processing to extend its shelf-life. To minimize the reduction of unique texture of whole sweet corn after the sterilization, the alcohol sanitation applied and the cold point of a whole corn ear was determined using a computer simulation. The cold point was located between the corn kernel and the cob. The microorganisms on the surface of sweet corn were reduced by more than 1 log CFU/g after alcohol sanitation, then the whole corn was treated to satisfy the degree of sterilization ($F_{121.1}=4$). The quality of sterilized sweet corn was compared with the control that was treated with steaming. The quality changes of sterilized sweet corn during storage were monitored for 9 months at $25^{\circ}C$. The hardness was maintained within 30% of its initial value. The minimum of hardness was $464.50{\pm}103.35g$ and maximum of hardness was $514.50{\pm}81.83g$. The differences in the sugar content among the samples were found, but the sugar content of corn kernel remained within 30% of the control, ranging from $28.83{\pm}1.05$ to $34.36{\pm}0.42%$. The yellowness was higher than that of control by 5%. The maximum value of yellowness was $34.36{\pm}0.42$. The general bacteria and molds and yeasts in corn kernel stored at $25^{\circ}C$ were not detected after 9 months of storage at $25^{\circ}C$. Therefore, in this study, we have demonstrated that the thermal sterilized method extends the shelf-life of whole sweet corn with minimizing its quality changes over 6 months in room temperature.

The Optimal Operation on Auxiliary Spillway to Minimize the Flood Damage in Downstream River with Various Outflow Conditions (하류하천의 영향 최소화를 위한 보조 여수로 최적 활용방안 검토)

  • Yoo, Hyung Ju;Joo, Sung Sik;Kwon, Beom Jae;Lee, Seung Oh
    • Journal of Korean Society of Disaster and Security
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    • v.14 no.2
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    • pp.61-75
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    • 2021
  • Recently, as the occurrence frequency of sudden floods due to climate change increased and the aging of the existing spillway, it is necessary to establish a plan to utilize an auxiliary spillway to minimize the flood damage of downstream rivers. Most studies have been conducted on the review of flow characteristics according to the operation of auxiliary spillway through the hydraulic experiments and numerical modeling. However, the studies on examination of flood damage in the downstream rivers and the stability of the revetment according to the operation of the auxiliary spillway were relatively insufficient in the literature. In this study, the stability of the revetment on the downstream river according to the outflow conditions of the existing and auxiliary spillway was examined by using 3D numerical model, FLOW-3D. The velocity, water surface elevation and shear stress results of FLOW-3D were compared with the permissible velocity and shear stress of design criteria. It was assumed the sluice gate was fully opened. As a result of numerical simulations of various auxiliary spillway operations during flood season, the single operation of the auxiliary spillway showed the reduction effect of maximum velocity and the water surface elevation compared with the single operation of the existing spillway. The stability of the revetment on downstream was satisfied under the condition of outflow less than 45% of the design flood discharge. However, the potential overtopping damage was confirmed in the case of exceeding the 45% of the design flood discharge. Therefore, the simultaneous operation with the existing spillway was important to ensure the stability on design flood discharge condition. As a result of examining the allocation ratio and the total allowable outflow, the reduction effect of maximum velocity was confirmed on the condition, where the amount of outflow on auxiliary spillway was more than that on existing spillway. It is because the flow of downstream rivers was concentrated in the center due to the outflow of existing spillway. The permissible velocity and shear stress were satisfied under the condition of less than 77% of the design flood discharge with simultaneous operation. It was found that the flood damage of downstream rivers can be minimized by setting the amount allocated to the auxiliary spillway to be larger than the amount allocated to the existing spillway for the total outflow with simultaneous operation condition. However, this study only reviewed the flow characteristics around the revetment according to the outflow of spillway under the full opening of the sluice gate condition. Therefore, the various sluice opening conditions and outflow scenarios will be asked to derive more efficient utilization of the auxiliary spillway in th future.

Reliability Analysis on Stability of Armor Units for Foundation Mound of Composite Breakwaters (혼성제 기초 마운드의 피복재 안정성에 대한 신뢰성 해석)

  • Cheol-Eung Lee
    • Journal of Korean Society of Coastal and Ocean Engineers
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    • v.35 no.2
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    • pp.23-32
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    • 2023
  • Probabilistic and deterministic analyses are implemented for the armor units of rubble foundation mound of composite breakwaters which is needed to protect the upright section against the scour of foundation mounds. By a little modification and incorporation of the previous empirical formulas that has commonly been applied to design the armor units of foundation mound, a new type formula of stability number has been suggested which is capable of taking into account slopes of foundation mounds, damage ratios of armor units, and incident wave numbers. The new proposed formula becomes mathematically identical with the previous empirical formula under the same conditions used in the developing process. Deterministic design have first been carried out to evaluate the minimum weights of armor units for several conditions associated with a typical section of composite breakwater. When the slopes of foundation mound become steepening and the incident wave numbers are increasing, the bigger armor units more than those from the previous empirical formula should be required. The opposite trends however are shown if the damage ratios is much more allowed. Meanwhile, the reliability analysis, which is one of probabilistic models, has been performed in order to quantitatively verify how the armor unit resulted from the deterministic design is stable. It has been confirmed that 1.2% of annual encounter probability of failure has been evaluated under the condition of 1% damage ratio of armor units for the design wave of 50 years return period. By additionally calculating the influence factors of the related random variables on the failure probability due to those uncertainties, it has been found that Hudson's stability coefficient, significant wave height, and water depth above foundation mound have sequentially been given the impacts on failure regardless of the incident wave angles. Finally, sensitivity analysis has been interpreted with respect to the variations of random variables which are implicitly involved in the formula of stability number for armor units of foundation mound. Then, the probability of failure have been rapidly decreased as the water depth above foundation mound are deepening. However, it has been shown that the probability of failure have been increased according as the berm width of foundation mound are widening and wave periods become shortening.

Improving the nutrition quotient and dietary self-efficacy through personalized goal setting and smartphone-based nutrition counseling among adults in their 20s and 30s (개인별 목표 설정과 스마트폰 기반 영양상담을 통한 20-30대 성인의 영양지수 및 식이 자아효능감 향상)

  • Dahyeon Kim;Dawon Park;Young-Hee Han;Taisun Hyun
    • Journal of Nutrition and Health
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    • v.56 no.4
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    • pp.419-438
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    • 2023
  • Purpose: This study examines the effectiveness of personalized goal setting and smartphone-based nutrition counseling among adults in their 20s and 30s. Methods: Nutrition counseling was conducted for a total of 30 adults through a 1:1 chat room of a mobile instant messenger, once a week for 8 weeks. The first week of counseling included a preliminary online questionnaire survey and a dietary intake survey. Based on the results of the preliminary survey, 2 dietary goals were set in the second week and the participants were asked to record their achievements on a daily checklist. From the third week onwards, counselors sent feedback messages based on the checklist and provided information on dietary guidelines in a card news format every week. Post-counseling questionnaires and dietary intake surveys were conducted in the seventh week. Changes in dietary habits during the counseling were reviewed in the eighth week, followed by a questionnaire survey on the evaluation of the counseling process. Results: The nutrition quotient (NQ) scores and self-efficacy scores were significantly higher after nutrition counseling. The NQ scores of consumption frequencies of fruits, milk and dairy products, nuts, fast food, Ramyeon, sweet and greasy baked products, sugarsweetened beverages, the number of vegetable dishes at meals, and breakfast frequency were significantly higher after nutrition counseling. The intake of protein, vitamin A, thiamin, riboflavin, folate, calcium, and iron, and the index of nutritional quality of vitamin A, riboflavin, folate, calcium, and iron were higher after nutrition education. The participants were satisfied with the nutrition counseling program and the provided nutrition information. Conclusion: Personalized goal setting and smartphone-based nutrition counseling were found to be effective in improving the quality of diet and self-efficacy in young adults. Similar results were obtained in both the underweight/normal weight and the overweight/obese groups.

The Effects of Perceived Quality Factors on the Customer Loyalty: Focused on the Analysis of Difference between PB and NB (지각된 품질요인이 고객충성도에 미치는 영향: PB와 NB간의 차이분석)

  • Ye, Jong-Suk;Jun, So-Yon
    • Journal of Distribution Research
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    • v.15 no.2
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    • pp.1-34
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    • 2010
  • Introduction As consumers' purchase behavior change into a rational and practical direction, the discount store industry came to have keen competition along with rapid external growth. Therefore as a solution, distribution businesses are concentrating on developing PB(Private Brand) which can realize differentiation and profitability at the same time. And as improvement in customer loyalty beyond customer satisfaction is effective in surviving in an environment with keen competition, PB is being used as a strategic tool to improve customer loyalty. To improve loyalty among PB users, it is necessary to develop PB by examining properties of a customer group, first of all, quality level perceived by consumers should be met to obtain customer satisfaction and customer trust and consequently induce customer loyalty. To provide results of systematic analysis on relations between antecedents influenced perceived quality and variables affecting customer loyalty, this study proposed a research model based on causal relations verified in prior researches and set 16 hypotheses about relations among 9 theoretical variables. Data was collected from 400 adult customers residing in Seoul and the Metropolitan area and using large scale discount stores, among them, 375 copies were analyzed using SPSS 15.0 and Amos 7.0. The findings of the present study followed as; We ascertained that the higher company reputation, brand reputation, product experience and brand familiarity, the higher perceived quality. The study also examined the higher perceived quality, the higher customer satisfaction, customer trust and customer loyalty. The findings showed that the higher customer satisfaction and customer trust, the higher customer loyalty. As for moderating effects between PB and NB in terms of influences of perceived quality factors on perceived quality, we can ascertain that PB was higher than NB in the influences of company reputation on perceived quality while NB was higher than PB in the influences of brand reputation and brand familiarity on perceived quality. These results of empirical analysis will be useful for those concerned to do marketing activities based on a clearer understanding of antecedents and consecutive factors influenced perceived quality. At last, discussions about academical and managerial implications in these results, we suggested the limitations of this study and the future research directions. Research Model and Hypotheses Test After analyzing if antecedent variables having influence on perceived quality shows any difference between PB and NB in terms of their influences on them, the relation between variables that have influence on customer loyalty was determined as Figure 1. We established 16 hypotheses to test and hypotheses are as follows; H1-1: Perceived price has a positive effect on perceived quality. H1-2: It is expected that PB and NB would have different influence in terms of perceived price on perceived quality. H2-1: Company reputation has a positive effect on perceived quality. H2-2: It is expected that PB and NB would have different influence in terms of company reputation on perceived quality. H3-1: Brand reputation has a positive effect on perceived quality. H3-2: It is expected that PB and NB would have different influence in terms of brand reputation on perceived quality. H4-1: Product experience has a positive effect on perceived quality. H4-2: It is expected that PB and NB would have different influence in terms of product experience on perceived quality. H5-1: Brand familiarity has a positive effect on perceived quality. H5-2: It is expected that PB and NB would have different influence in terms of brand familiarity on perceived quality. H6: Perceived quality has a positive effect on customer satisfaction. H7: Perceived quality has a positive effect on customer trust. H8: Perceived quality has a positive effect on customer loyalty. H9: Customer satisfaction has a positive effect on customer trust. H10: Customer satisfaction has a positive effect on customer loyalty. H11: Customer trust has a positive effect on customer loyalty. Results from analyzing main effects of research model is shown as

    , and moderating effects is shown as
    . Results This study is designed with 16 research hypotheses, Results from analyzing their main effects show that 9 of 11 hypotheses were supported and other 2 hypotheses were rejected. On the other hand, results from analyzing their moderating effects show that 3 of 5 hypotheses were supported and other 2 hypotheses were rejected. H1-1: (SPC: Standardized Path Coefficient)=-0.04, t-value=-1.04, p>. 05). H1-2: (${\Delta}\chi^2$=1.10, df=1, p> 0.05). H1-1 and H1-2 are rejected, so it is prove that perceived price is not a significant decision variable having influence on perceived quality and there is no significant variable between PB and NB in terms of influence of perceived price on perceived quality. H2-1: (SPC=0.31, t-value=3.74, p<. 001). H2-2: (${\Delta}\chi^2$=3.93, df=1, p< 0.05). H2-1 and H2-2 are supported, so it is proved that company reputation is a significant decision variable having influence on perceived quality and, in terms of influence of company reputation on perceived quality, PB has relatively stronger influence than NB. H3-1: (SPC=0.26, t-value=5.30, p< .001). H3-2: (${\Delta}\chi^2$=16.81, df=1, p< 0.01). H3-1 and H3-2 are supported, so it is proved that brand reputation is a significant decision variable having influence on perceived quality and, in terms of influence of brand reputation on perceived quality, NB has relatively stronger influence than PB. H4-1: (SPC=0.31, t-value=2.65, p< .05). H4-2: (${\Delta}\chi^2$=1.26, df=1, p> 0.05). H4-1 is supported, but H4-2 is rejected, Therefore, it is proved that product experience is a significant decision variable having influence on perceived quality and, on the other hand, there is no significant different between PB and NB in terms of influence of product experience on product quality. H5-1: (SPC=0.24, t-value=3.00, p<. 05). H5-2: (${\Delta}\chi^2$=5.10, df=1, p< 0.05). H5-1 and H5-2 are supported, so it is proved that brand familiarity is a significant decision variable having influence on perceived quality and, in terms of influence of brand familiarity on perceived quality, NB has relatively stronger influence than PB. H6: (SPC=0.91, t-value=19.06, p< .001). H6 is supported, so a fact that customer satisfaction increases as perceived quality increases is proved. H7: (SPC=0.81, t-value=7.44, p<. 001). H7 is supported, so a fact that customer trust increases as perceived quality increases is proved. H8: (SPC=0.57, t-value=7.87, p< .001). H8 is supported, so a fact that customer loyalty increases as perceived quality increases is proved. H9: (SPC=0.08, t-value=0.76, p> .05). H9 is rejected, so it is proved influence of customer satisfaction on customer trust is not significant. H10: (SPC=0.21, t-value=4.34, p< .001). H10 is supported, so a fact that customer loyalty increases as customer satisfaction increases is proved. H11: (SPC=0.40, t-value=5.68, p< .001). H11 is supported, so a fact that customer loyalty increases as customer trust increases is proved. Implications Although most of existing studies have used function, price, brand, design, service, brand name, store name as antecedent variables for perceived quality, this study used different antecedent variables in order to analyze and distinguish purchase group PB and NB through preliminary research. Therefore, this study may be used as preliminary data for a empirical study that is designed to be helpful for practical jobs. Also, this study is made to be easily applied to any practical job because SEM(Structural Equation Modeling), most strongly explaining the relation between observed variable and latent variable, is used for this study. This study suggests a new strategic point that, in order to increase customer loyalty, customer's perceived quality level should satisfied for inducing customer satisfaction, customer trust, and customer loyalty. Therefore, after finding an effective differentiating factors in perceived quality in order to increase customer loyalty through increasing perceived quality, this factor was made to be applied to PB and NB. Because perceived quality factors which is recognized as being important by consumers is different between PB and NB, this study suggests how to efficiently establish marketing strategy by enhancing a factor. Companies have mostly focused on profitability in terms of analyzing customer loyalty, but this study included positive WOM(word of mouth). Hence, this study suggests that it would be helpful for establishing customer loyalty when consumers have cognitive satisfaction and emotional satisfaction together. Limitations This study used variables perceived price, company reputation, brand reputation, product experience, brand familiarity in order to determine whether each constituent factor has different influence on perceived quality between purchase group PB and NB. These characteristic variables are made up on the basis of the preliminary research, but it is expected that more precise research result would be obtained if additional various variables are included in study. This study selected a practical product that is non-durable, low-priced and bestselling product in a discount store through the preliminary research because it can be easily estimated by consumers. Therefore. generalization of study would be more easily obtained if more various product characteristics is included. Regarding a sample used in this study, it was only based on consumers who purchase products in a large-scale discount store located in Seoul and in the capital area. Accordingly, this sample has some geographical limitation, If a study is expanded by including more areas, more representative research results may be produced. Because this study is only designed to analyze consumers who purchase a product in a large-scale discount store, some difference may be found according to characteristics of each business type. In other words, there is certainly some application limitation, so research result from this study may not be applied to other business types. Future research may have fruitful results if it adjusts a variable to each business type.

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  • Dosimetric Effect on Selectable Optimization Parameters of Volumatric Modulated Arc Therapy (선택적 최적화 변수(Selectable Optimization Parameters)에 따른 부피적조절회전방사선치료(VMAT)의 선량학적 영향)

    • Jung, Jae-Yong;Shin, Yong-Joo;Sohn, Seung-Chang;Kim, Yeon-Rae;Min, Jung-Wan;Suh, Tae-Suk
      • Progress in Medical Physics
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      • v.23 no.1
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      • pp.15-25
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      • 2012
    • The aim of this study is to evaluate plan quality and dose accuracy for Volumetric Modulated Arc Therapy (VMAT) on the TG-119 and is to investigate the effects on variation of the selectable optimization parameters of VMAT. VMAT treatment planning was implemented on a Varian iX linear accelerator with ARIA record and verify system (Varian Mecical System Palo Alto, CA) and Oncentra MasterPlan treatment planning system (Nucletron BV, Veenendaal, Netherlands). Plan quality and dosimetric accuracy were evaluated by effect of varying a number of arc, gantry spacing and delivery time for the test geometries provided in TG-119. Plan quality for the target and OAR was evaluated by the mean value and the standard deviation of the Dose Volume Histograms (DVHs). The ionization chamber and $Delta^{4PT}$ bi-planar diode array were used for the dose evaluation. For treatment planning evaluation, all structure sets closed to the goals in the case of single arc, except for the C-shape (hard), and all structure sets achieved the goals in the case of dual arc, except for C-shape (hard). For the variation of a number of arc, the simple structure such as a prostate did not have the difference between single arc and dual arc, whereas the complex structure such as a head and neck showed a superior result in the case of dual arc. The dose distribution with gantry spacing of $4^{\circ}$ was shown better plan quality than the gantry spacing of $6^{\circ}$, but was similar results compared with gantry spacing of $2^{\circ}$. For the verification of dose accuracy with single arc and dual arc, the mean value of a relative error between measured and calculated value were within 3% and 4% for point dose and confidence limit values, respectively. For the verification on dose accuracy with the gantry intervals of $2^{\circ}$, $4^{\circ}$ and $6^{\circ}$, the mean values of relative error were within 3% and 5% for point dose and confidence limit values, respectively. In the verification of dose distribution with $Delta^{4PT}$ bi-planar diode array, gamma passing rate was $98.72{\pm}1.52%$ and $98.3{\pm}1.5%$ for single arc and dual arc, respectively. The confidence limit values were within 4%. The smaller the gantry spacing, the more accuracy results were shown. In this study, we performed the VMAT QA based on TG-119 procedure, and demonstrated that all structure sets were satisfied with acceptance criteria. And also, the results for the selective optimization variables informed the importance of selection for the suitable variables according to the clinical cases.

    Short-Term Efficacy of Steroid and Immunosuppressive Drugs in Patients with Idiopathic Pulmonary Fibrosis and Pre-treatment Factors Associated with Favorable Response (특발성폐섬유화증에서 스테로이드와 면역억제제의 단기 치료효과 및 치료반응 예측인자)

    • Kang, Kyeong-Woo;Park, Sang-Joon;Koh, Young-Min;Lee, Sang-Pyo;Suh, Gee-Young;Chung, Man-Pyo;Han, Jung-Ho;Kim, Ho-Joong;Kwon, O-Jung;Lee, Kyung-Soo;Rhee, Chong-H.
      • Tuberculosis and Respiratory Diseases
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      • v.46 no.5
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      • pp.685-696
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      • 1999
    • Background : Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the short-term efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. Method : Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednisolone (0.25mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders : (1) improvement of more than one grade in dyspnea index, (2) improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. Result : One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid ($23.8{\pm}16.3%$ vs $7.8{\pm}3.6%$, p<0.05), and less honeycombing in chest HRCT findings (0% vs $9.2{\pm}2.3%$, p<0.001). Conclusion : Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables.

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