• Title/Summary/Keyword: 유사 정도

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Hydroponic Nutrient Solution and Light Quality Influence on Lettuce (Lactuca sativa L.) Growth from the Artificial Light Type of Plant Factory System (인공광 식물공장에서 수경배양액 및 광질 조절이 상추 실생묘 생장에 미치는 영향)

  • Heo, Jeong-Wook;Park, Kyeong-Hun;Hong, Seung-Gil;Lee, Jae-Su;Baek, Jeong-Hyun
    • Korean Journal of Environmental Agriculture
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    • v.38 no.4
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    • pp.225-236
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    • 2019
  • BACKGROUND: Hydroponics is one of the methods for evaluating plant production using the inorganic nutrient solutions, which is applied under the artificial light conditions of plant factory system. However, the application of the conventional inorganic nutrients for hydroponics caused several environmental problems: waste from culture mediums and high nitrate concentration in plants. Organic nutrients are generally irrigated as a supplementary fertilizer for plant growth promotion under field or greenhouse conditions. Hydroponic culture using organic nutrients derived from the agricultural by-products such as dumped stems, leaves or immature fruits is rarely considered in plant factory system. Effect of organic or conventional inorganic nutrient solutions on the growth and nutrient absorption pattern of green and red leaf lettuces was investigated in this experiment under fluorescent lamps (FL) and mixture Light-Emitting Diodes (LEDs). METHODS AND RESULTS: Single solution of tomatoes (TJ) and kales (K) deriving from agricultural by-products including leaves or stems and its mixed solution (mixture ration 1:1) with conventional inorganic Yamazaki (Y) were supplied for hydroponics under the plant factory system. The Yamazaki solution was considered as a control. 'Jeockchima' and 'Cheongchima' lettuce seedlings (Lactuca sativa L.) were used as plant materials. The seedlings which developed 2~3 true leaves were grown under the light qualities of FL and mixed LED lights of blue plus red plus white of 1:2:1 mixture in energy ratio for 35 days. Light intensity of the light sources was controlled at 180 μmol/㎡/s on the culture bed. The single and mixture nutrient solutions of organic and/or inorganic components which controlled at 1.5 dS/m EC and 5.8 pH were regularly irrigated by the deep flow technique (DFT) system on the culture gutters. Number of unfolded leaves of the seedlings grown under the single or mixed nutrient solutions were significantly increased compared to the conventional Y treatment. Leaf extension of 'Jeockchima' under the mixture LED radiation condition was not affected by Y and YK or YTJ mixture treatments. SPAD value in 'Jeockchima' leaves exposed by FL under the YK mixture medium was approximately 45 % higher than under conventional Y treatment. Otherwise, the maximum SPAD value in the leaves of 'Cheongchima' seedlings was shown in YK treatment under the mixture LED lights. NO3-N contents in Y treatment treated with inorganic nutrient at the end of the experiment were up to 75% declined rather than increased over 60 % in the K and TJ organic treatment. CONCLUSION: Growth of the seedlings was affected by the mixture treatments of the organic and inorganic solutions, although similar or lower dry weight was recorded than in the inorganic treatment Y under the plant factory system. Treatment Y containing the highest NO3-N content among the considered nutrients influenced growth increment of the seedlings comparing to the other nutrients. However effect of the higher NO3-N content in the seedling growth was different according to the light qualities considered in the experiment as shown in leaf expansion, pigmentation or dry weight promotion under the single or mixed nutrients.

Factors influencing the axes of anterior teeth during SWA on masse sliding retraction with orthodontic mini-implant anchorage: a finite element study (교정용 미니 임플랜트 고정원과 SWA on masse sliding retraction 시 전치부 치축 조절 요인에 관한 유한요소해석)

  • Jeong, Hye-Sim;Moon, Yoon-Shik;Cho, Young-Soo;Lim, Seung-Min;Sung, Sang-Jin
    • The korean journal of orthodontics
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    • v.36 no.5
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    • pp.339-348
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    • 2006
  • Objective: With development of the skeletal anchorage system, orthodontic mini-implant (OMI) assisted on masse sliding retraction has become part of general orthodontic treatment. But compared to the emphasis on successful anchorage preparation, the control of anterior teeth axis has not been emphasized enough. Methods: A 3-D finite element Base model of maxillary dental arch and a Lingual tipping model with lingually inclined anterior teeth were constructed. To evaluate factors influencing the axis of anterior teeth when OMI was used as anchorage, models were simulated with 2 mm or 5 mm retraction hooks and/or by the addition of 4 mm of compensating curve (CC) on the main archwire. The stress distribution on the roots and a 25000 times enlarged axis graph were evaluated. Results: Intrusive component of retraction force directed postero-superiorly from the 2 mm height hook did not reduce the lingual tipping of anterior teeth. When hook height was increased to 5 mm, lateral incisor showed crown-labial and root-lingual torque and uncontrolled tipping of the canine was increased.4 mm of CC added to the main archwire also induced crown-labial and root-lingual torque of the lateral incisor but uncontrolled tipping of the canine was decreased. Lingual tipping model showed very similar results compared with the Base model. Conclusion: The results of this study showed that height of the hook and compensating curve on the main archwire can influence the axis of anterior teeth. These data can be used as guidelines for clinical application.

Tc-99m ECD Brain SPECT in MELAS Syndrome and Mitochondrial Myopathy: Comparison with MR findings (MELAS 증후군과 미토콘드리아 근육병에서의 Tc-99m ECD 뇌단일 광전자방출 전산화단층촬영 소견: 자기공명영상과의 비교)

  • Park, Sang-Joon;Ryu, Young-Hoon;Jeon, Tae-Joo;Kim, Jai-Keun;Nam, Ji-Eun;Yoon, Pyeong-Ho;Yoon, Choon-Sik;Lee, Jong-Doo
    • The Korean Journal of Nuclear Medicine
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    • v.32 no.6
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    • pp.490-496
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    • 1998
  • Purpose: We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. Materials and Methods: Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke-like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were Performed and imaging features were analyzed. Results: MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. Conclusion: Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.

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Metamorphic Evolution of the central Ogcheon Metamorphic Belt in the Cheongju-Miwon area, Korea (청주-미원지역 중부 옥천변성대의 변성진화과정)

  • 오창환;권용완;김성원
    • The Journal of the Petrological Society of Korea
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    • v.8 no.2
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    • pp.106-124
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    • 1999
  • In the Cheongju-Minwon area which occupies the middle part of the Ogcheon Metamorphic Belt, three metamorphic events(M1, M2, M3) had occurred. Intermediate P/T type M2 regional metamorphism formed prevailing mineral assemblages in the study area. Low PIT type M3 contact metamorphism occurred due to the intrusion of granites after M2 metamorphism. M1 metamorphism is recognized by inclusions within garnet. During M2 metamorphism, the metamorphic grade increased from the biotite zone in the southeastern part to the garnet zone in the northwestern part of the study area. This result is similar to the metamorphic evolution of the southwestern part of the Ogcheon Metamorphic Belt. Garnets in the garnet zone are classified into two types; Type A garnet has inclusions whose trail is connected to the foliation in the matrix and Type B garnet has inclusion rich core and inclusion poor rim. Type A garnet formed in the mica rich part with crenulation cleavage whereas Type B garnet formed in the quartz rich part with weak crenulation cleavage. In some outcrops, two types garnets are found together. Compared to the rim of Type A garnet, the rim of Type B garnet is lower in grossular and spessartine contents but higher in almandine and pyrope contents. In some Type B garnets, the inclusion poor part is rimmed by muddy colored or protuberant new overgrowth. In the inclusion poor part and new overgrowth, a rapid increase in grossular and decrease in spessartine is observed. However, the compositional patterns of Type A and B are similar; Ca increases and Mn decreases from core to rim. Two types garnets formed mainly due to the difference of bulk chemistry instead of metamorphic and deformational differences. The metamorphic P-T conditions estimated from Type A garnets are 595-690 OC15.7-8.8 kb, which indicates M2 metamorphism is intermediate P/T type metamorphism. On the other hand, a wide range of P-T conditions is calculated from Type B garnets. The P-T conditions from most Type B garnet rims are 617-690 OC16.2-8.9 kb which also indicates an intermediate P/T type metamorphism. However, at the rim part with flat end or weak overgrowth, grossular content is low and 573-624OC14.7-5.8 kb are estimated. The P-T conditions calculated from plagioclase and biotite inclusions in garnet are 460-500 0C/1.9-3.0 kb. The P-T conditions from rim part with weak overgrowth and inclusions within garnet, indicate that low P/T type M1 regional metamorphism might have occurred before intermediate P/T type M2 regional metamorphism. The P-T conditions estimated from samples which had undergone low PIT type M3 metamorphism strongly, are 547-610 0C/2.1-5.0 kb.

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Choline and Betaine Concentrations in Breast Milk of Korean Lactating Women and the Choline and Betaine Intakes of Their Infants (한국 수유부 유즙의 콜린과 베타인 농도 및 영아의 콜린과 베타인 섭취량)

  • Jeong, Han-Ok;Suh, Yoon-Suk;Chung, Young-Jin
    • Journal of Nutrition and Health
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    • v.43 no.6
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    • pp.588-596
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    • 2010
  • Most nutrients taken by pregnant women are secreted into their breast milk. Food contains choline together with betaine, and in human body choline is oxidized to betaine which transfer methyl group. The aim of the study was to estimate the concentrations of choline and betaine in breast milk of Korean lactating women and the choline and betaine intakes of their infants. Total choline, free choline and betaine concentrations in breast milk of some lactating women living in Daejon Metropolitan city were analyzed every month by using HPLC-MS and enzymatic method during the first five months. Total choline concentrations of breast milks were 157.64 mg/L (1.52 mmol/L), 157.83 mg/L (1.52 mmol/L), 165.99 mg/L (1.60 mmol/L), 153.67 mg/L (1.48 mmol/L), 145.05 mg/L (1.39 mmol/L) by month after delivery for five months. The concentrations of total choline and free choline in breast milks were not significantly changed for the five months while the betaine concentrations gradually decreased. Daily intake of total choline of the infants appears to be adequate for the infant's requirement according to the US DRI; 124.6 mg/d, 120.9 mg/d, 126.5 mg/d 104.1 mg/d from 2nd to 5th month after birth. Free choline and betaine intakes of the infants were not significantly changed during the four months except showing decrease in betaine intake per kg body weight. Choline intakes of the infants more correlated with choline concentrations of the breast milks (r = 0.982, p = 0.000) than intake amount of the breast milk (r = 0.414, p = 0.028). These results suggest that the choline intake of Korean breast-fed infants appears to be adequate and the intake could be affected by the choline concentration of the breast milk.

The Effect of Brand Extension of Private Label on Consumer Attitude - a focus on the moderating effect of the perceived fit difference between parent brands and an extended brand - (PL의 브랜드확장이 소비자태도에 미치는 영향에 관한 연구 : 모브랜드 적합도 인식 차이의 조절효과를 중심으로)

  • Kim, Jong-Keun;Kim, Hyang-Mi;Lee, Jong-Ho
    • Journal of Distribution Research
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    • v.16 no.4
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    • pp.1-27
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    • 2011
  • Introduction: Sales of private labels(PU have been growing m recent years. Globally, PLs have already achieved 20% share, although between 25 and 50% share in most of the European markets(AC. Nielson, 2005). These products are aimed to have comparable quality and prices as national brand(NB) products and have been continuously eroding manufacturer's national brand market share. Stores have also started introducing premium PLs that are of higher-quality and more reasonably priced compared to NBs. Worldwide, many retailers already have a multiple-tier private label architecture. Consumers as a consequence are now able to have a more diverse brand choice in store than ever before. Since premium PLs are priced higher than regular PLs and even, in some cases, above NBs, stores can expect to generate higher profits. Brand extensions and private label have been extensively studied in the marketing field. However, less attention has been paid to the private label extension. Therefore, this research focuses on private label extension using the Multi-Attribute Attitude Model(Fishbein and Ajzen, 1975). Especially there are few studies that consider the hierarchical effect of the PL's two parent brands: store brand and the original PL. We assume that the attitude toward each of the two parent brands affects the attitude towards the extended PL. The influence from each parent brand toward extended PL will vary according to the perceived fit between each parent brand and the extended PL. This research focuses on how these two parent brands act as reference points to one another in the consumers' choice consideration. Specifically we seek to understand how store image and attitude towards original PL affect consumer perceptions of extended premium PL. How consumers perceive extended premium PLs could provide strategic suggestions for retailer managers with specific suggestions on whether it is more effective: to position extended premium PL similarly or dissimilarly to original PL especially on the quality dimension and congruency with store image. There is an extensive body of research on branding and brand extensions (e.g. Aaker and Keller, 1990) and more recently on PLs(e.g. Kumar and Steenkamp, 2007). However there are no studies to date that look at the upgrading and influence of original PLs and attitude towards store on the premium PL extension. This research wishes to make a contribution to this gap using the perceived fit difference between parent brands and extended premium PL as the context. In order to meet the above objectives, we investigate which factors heighten consumers' positive attitude toward premium PL extension. Research Model and Hypotheses: When considering the attitude towards the premium PL extension, we expect four factors to have an influence: attitude towards store; attitude towards original PL; perceived congruity between the store image and the premium PL; perceived similarity between the original PL and the premium PL. We expect that all these factors have an influence on consumer attitude towards premium PL extension. Figure 1 gives the research model and hypotheses. Method: Data were collected by an intercept survey conducted on consumers at discount stores. 403 survey responses were attained (total 59.8% female, across all age ranges). Respondents were asked to respond to a series of Questions measured on 7 point likert-type scales. The survey consisted of Questions that measured: the trust towards store and the original PL; the satisfaction towards store and the original PL; the attitudes towards store, the original PL, and the extended premium PL; the perceived similarity of the original PL and the extended premium PL; the perceived congruity between the store image and the extended premium PL. Product images with specific explanations of the features of premium PL, regular PL and NB we reused as the stimuli for the Question response. We developed scales to measure the research constructs. Cronbach's alphaw as measured each construct with the reliability for all constructs exceeding the .70 standard(Nunnally, 1978). Results: To test the hypotheses, path analysis was conducted using LISREL 8.30. The path analysis for verification of the model produced satisfactory results. The validity index shows acceptable results(${\chi}^2=427.00$(P=0.00), GFI= .90, AGFI= .87, NFI= .91, RMSEA= .062, RMR= .047). With the increasing retailer use of premium PLBs, the intention of this research was to examine how consumers use original PL and store image as reference points as to the attitude towards premium PL extension. Results(see table 1 & 2) show that the attitude of each parent brand (attitudes toward store and original pL) influences the attitude towards extended PL and their perceived fit moderates these influences. Attitude toward the extended PL was influenced by the relative level of perceived fit. Discussion of results and future direction: These results suggest that the future strategy for the PL extension needs to consider that positive parent brand attitude is more strongly associated with the attitude toward PL extensions. Specifically, to improve attitude towards PL extension, building and maintaining positive attitude towards original PL is necessary. Positioning premium PL congruently to store image is also important for positive attitude. In order to improve this research, the following alternatives should also be considered. To improve the research model's predictive power, more diverse products should be included in study. Other attributes of product should also be included such as design, brand name since we only considered trust and satisfaction as factors to build consumer attitudes.

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The Environmental and Ecological Meaning of Bibo Landscape in Otgol Village (옻골마을 비보경관의 환경생태적 의미)

  • Jang, Byoung-Kwan;Whang, Bo-Chul
    • Journal of the Korean Institute of Landscape Architecture
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    • v.36 no.2
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    • pp.32-41
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    • 2008
  • An empirical study and environmental and ecological analysis were conducted on Otgol Village(a village of the Gyeongju Choi's clan in Daegu) where an enclosed pond and groves are still observed. In particular, the enclosed pond and groves and village water system were investigated from an ecological perspective. The enclosed landscape is described based on feng shui principles and the environmental and ecological significance were examined. In general, the environmental and ecological significance is very broad; however, they were analyzed in terms of the quality of life as an empirical study as follows: First, water quality was measured to investigate the improvement of continuous water system functions. In other words, water quality was measured at East Valley(resting space), West Valley(living space), the enclosed pond where the two valleys merge, and the stream that flows out of the pond. Second, the climate functions of the enclosed groves that border the village were examined. In other words, temperature was measured in two places(200m distance from the center of the groves). Third, whether or not a sound ecosystem can be sustained was investigated. In other words, landscape ecological indicators were chosen and measured. The results are as follows: First, the enclosed pond played the role of purifying water quality. While the East Valley has been popular with men for its rock walls and torrents, the West Valley has been popular with women as a living space(ex: doing the laundry). Therefore, the difference of water quality can be explained. Second, since enclosed groves are in a small village forest, they are very weak in terms of being wind proof and temperature reduction effects. Instead, they play the role of the village boundary. Third, the groves are ecologically sound considering the landscape ecological indicators and are similar to ordinary traditional rural villages. In terms of the connection of the green zone, the village groves are well connected to the village boundary wood. If the village groves are restored, in particular, they would offer a decent habitat for grove creatures. According to this study, the traditional village space was formed upon the influence of Feng Shui theories that are based on environmental and ecological principles that focus on the harmony between humans and nature. From the environmental and ecological perspective, the enclosed pond and groves are important factors in building a sustainable village. The diverse water space would help to improve water quality and increase water volume by promoting the water circulation system. In addition, the village woods would surround the village and decrease the temperature and humidity difference between winter and summer. If the groves are small and badly damaged, however, they are meaningful only in dividing the region. The overall improvement of a forestation system and botanical composition may increase the biological diversity and promote the migration of species. Otgol Village has developed an enclosed landscape to improve the village environment. In other words, a sound and refreshing living environment can be developed when the natural ecological system is well understood and properly preserved. Additionally, this traditional village planning will be the environmental and ecological method. From the perspective of environmental ecology, therefore, a traditional village is recommended.

Ecological Characteristics of Phytoplankton Communities in the Coastal Waters of Gori, Wolseong, Uljin and Younggwang II. Distributions of Standing Crops and Environmental Variables (1992~1996) (고리, 월성, 울진 및 영광 연안해역에서 식물플랑크톤 군집의 생태학적 특성 II. 현존량 분포 및 환경요인들(1992~1996))

  • 강연식;최중기
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.7 no.3
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    • pp.108-128
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    • 2002
  • In order to investigate the ecological characteristics of phytoplankton communities around a nuclear power plant in Gori coastal waters of the South East Sea, Wolseong and Uljin coastal waters of the East Sea and Younggwang coastal waters of the Yellow Sea, the standing crops and chlorophyll-$\alpha$ concentrations of phytoplankton were studied during 1992~1996 and the relationships between standing crops and environmental variables were analyzed. The concentrations of nitrogenous nutrients were on average 0.101, 0.094, 0.072 and 0.108mg/$\ell$ and those of phosphorus were on average 0.007, 0.008, 0.006 and 0.009mg/$\ell$ in Gori, Wolseong, Uljin and Younggwang, respectively. The N:P ratios were highly variable, ranging from 3.2 to 57.3, from 3.1 to 109.0, from 2.6 to 102.0 and from 1.0 to 165.0 in Gori, Wolseong, Uljin and Younggwang, respectively. The concentrations of suspended solids were on average 18.7, 16.7, 11.6 and 52.7mg/$\ell$ and transparencies were on average 3.8, 5.4, 7.9 and 0.7 m in Gori, Wolseong, Uljin and Younggwang, respectively. Total standing crops of phytoplankton averaged 710,659, 687,508, 656,245 and 1,278,173cells/$\ell$ in Gori, Wolseong, Uljin and Yaunggwang, respectively. The standing crops of microplankton(>20${\mu}{\textrm}{m}$) averaged 357,546, 333,638, 276,407 and 592,975cells/$\ell$ those of nanoplankton(<20${\mu}{\textrm}{m}$) averaged 353,113, 353,870, 379,838 and 574,563cells/$\ell$ in Gori, Wolseong, Uljin and Younggwang, respectively. While standing crops of diatoms were averaged 282,009, 284,710, 238,758 and 574,563 cells/$\ell$, those of dinoflagellates were averaged 46,079, 35,401, 32,906 and 16,749 cells/$\ell$ in Gori, Wolseong, Uljin and Younggwang, respectively. The seasonal standing crops of diatoms in Gori, Wolseong and Uljin were higher in Spring than other seasons, but were lower in Summer than other seasons in Younggwang. The seasonal standing crops of dinoflagellates in Gori and Younggwang were higher in Summer than other seasons, but were higher in Autumn than other seasons in U]jin. Average of chlorophyll-$\alpha$ concentrations ranged from 2.16 to 4.28$\mu\textrm{g}$/$\ell$ in 4 study areas with the highest concentration occurred in Younggwang. Indices of species diversity ranged from 2.11 to 2.24 in 4 study areas. While community structures of phytoplankton were unstable during winter and stable during summer in Gori, Wolseong and Uljln coastal waters, those of phytoplankton were stable during winter and summer than during spring and autumn in Yaunggwang. The analysis results of Pearson product moment correlation coefficient between standing crops and environmental variables showed that distributions of standing crops were affected by transparencies, suspended solids, and some nutrient(N $O_3$$^{[-10]}$ -N, P $O_4$$^{3-}$-P), even though the degree of influences were a little different according to the season and the surveyed zone.

The Results of Combined External Radiotherapy and Chemotherapy in the Management of Esophageal Cancer (식도암의 방사선-항암화학 병용치료결과)

  • Lee Hyun Joo;Suh Hyun Suk;Kim Jun Hee;Kim Chul Soo;Kim Sung Rok;Kim Re Hwe
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.17-23
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    • 1996
  • Purpose : To evaluate the role of combination therapy of external radio-therapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. Materials and Methods : A retrospective review of evaluable 55 esophageal cancer patients referred to the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul, 1983 and Dec. 1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group (ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fifty patients had squamous cell carcinomas. Radiation doses of 2520-6480c0y were delivered over a period of 4-7weeks, using 4MV LINAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1, 2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. Resuts : Median follow up Period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months (20 days-73 months) in B group. The 1, 2 YSRs were $26.7\%$, $8.9\%$ in A group, $12.7\%$, $4.3\%$ in B group (p>0.05), respectively. The 1, 2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose (5000cGymore or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000cGy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were $43.8\%$. $25.0\%$, respectively. Complete response rate of $25.0\%$ in A and $8.3\%$ in B were achieved. The local failure and distant metastsis were $52.4\%$. $23.8\%$ in A group, $64.3\%$, $14.3\%$ in 8 group, respectively. The combination therapy revealed more frequent leukopenia and nausea/vomiting than radiation alone group, but degree of side effects was only mild to moderate. Conclusion : The combined external radiotherapy and chemotherapy for advanced esophageal cancer appears to improve the response rate, local control rate and survival rate, but the improvement was not statistically significant. The side effects of combined modalities were mild to moderate without significant morbidity. Therefore it may be worthwhile to continue the present combined external radiotherapy and chemotherapy in the management of advanced esophageal cancer to confirm our result.

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Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.343-352
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    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.