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Total Gastrectomy with Distal Pancreatico-splenectomy for Treating Locally Advanced Gastric Cancer (진행 위암에서의 위 전절제술에 동반된 원위부 췌-비장 절제)

  • Lee, Sung-Ho;Kim, Wook;Song, Kyo-Young;Kim, Jin-Jo;Chin, Hyung-Min;Park, Jo-Hyun;Jeon, Hae-Myung;Park, Seung-Man;Ahn, Chang-Jun;Lee, Jun-Hyun
    • Journal of Gastric Cancer
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    • v.7 no.2
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    • pp.74-81
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    • 2007
  • Purpose: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. Results: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 0.8%. Conclusion: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.

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Surgical Treatment of Complications after Fontan Operation (Fontan수술후의 합병증에 대한 수술적 치료)

  • 박정준;홍장미;김용진;이정렬;노준량
    • Journal of Chest Surgery
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    • v.36 no.2
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    • pp.73-78
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    • 2003
  • The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.

Establishment of Food Processing Methods for Larvae of Allomyrina dichotoma, Korean Horn Beetle (식약용으로의 장수풍뎅이 유충 전처리 방법에 대한 연구)

  • Chung, Mi Yeon;Kwon, Eun-Young;Hwang, Jae-Sam;Goo, Tae-Won;Yun, Eun-Young
    • Journal of Life Science
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    • v.23 no.3
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    • pp.426-431
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    • 2013
  • With the objective of developing a functional food source, we established optimal processing conditions for the larvae of Allomyrina dichotoma, which have been used in traditional medicine to treat hepatic disorders in Korea. Without suitable processing, the larvae are difficult to consume as a food because of their disgusting taste and smell; moreover, in this form they might be a potential microbial hazard. In this study, we investigated the effect of feeding material, sterilization, and powdering after freeze-drying on the food quality of the larvae of A. dichotoma and on cytotoxicity against Raw 264.7 cells. Three to five days feeding with the sawdust from discarded oak-trees is sufficient for the breeding process. The sawdust was sterilized by vapor for five minutes. Sterilization of the larvae at a high temperature ($115^{\circ}C$ for 5 min, 0.9 $kgf/cm^2$) is necessary to eliminate pathogenic bacteria and fungi. The results of the cytotoxicity assay showed no toxicity in the prepared extract from larvae of A. dichotoma. In addition, to prepare the larvae for human consumption, various feeds were used and the smell, color, and taste were evaluated. Our results suggested that larvae of A. dichotoma could be developed as food source when a suitable processing method is established.

Acute Renal Failure after On-pump Coronary Artery Bypass Surgery (체외순환하 시행한 관상동맥우회술 후 발생한 급성신부전증)

  • Jin, Ung;Jo, Min-Seop;Park, Chan-Beom;Sa, Young-Jo;Kim, Chi-Kyung
    • Journal of Chest Surgery
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    • v.37 no.5
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    • pp.416-422
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    • 2004
  • Acute renal failure (ARF) is a common postoperative complication after the cardiac surgery. Postoperative ARF have various causes, and are combined with other complications rather than being the only a complication. It deteriorates the general condition of the patient, and makes it difficult to manage the combined complications by disturbing the adequate medication and fluid therapy. We have planned this study to evaluate the effects of postoperative ARF after the on-pump coronary artery bypass surgery (CABG) on the recovery of patients and identify the risk factors. Method and Material: We reviewed the medical records of patients who underwent CABG with cardiopulmonary bypass by a single surgeon from Jan. 2000 to Dec. 2002, We checked the preoperative factors; sex, age, history of previous serum creationism over 2.0 mg/㎗, preoperatively last checked serum creatinine, diabetes, hypertension, left ventricular ejection fraction, intraoperative factors; whether the operation is an emergent case or not, cardiopulmonary bypass time, aortic cross clamp time, the number of distal anastomosis, postoperative factors: IABP. Then we have studied the relations of these factors and the cases of postoperative peak serum creatinine over 2.0 mg/㎗. Result: There were 19 cases with postoperative peak serum creatinine over 2.0 mg/㎗ in a total 97 cases. Dialysis were done in 3 cases for ARF with pulmonary edema and severely reduced urine output. There were 8 cases (42.1%) with combined complications among the 19 patients. This finding showed a significant difference from the 5 cases (6,4%) in the patients whose creatinine level have not increased over 2.0 mg/㎗. The mortalities are different as 1.3% to 10.5%. The risk factors that are related with postoperative serum creatinine increment over 2.0 mg/㎗ are diabetes, the history of previous serum creatinine over 2.0 mg/㎗ and left ventricular ejection fraction. Conclusion: Postoperative ARF after the on-pump CABG is related with preoperative diabetes, the history of previous serum creatinine over 2,0 mg/㎗ and left ventricular ejection fraction. Postoperative ARF could De the reason for increased rate of complications and mortality after on-pump CABG. Therefore, in the patients with these risk factors, the efforts to prevent postoperative ARF like off-pump CABG should be considered.

Study on the Limitation of AVO Responses Shown in the Seismic Data from East-sea Gas Reservoir (동해 가스전 탄성파 자료에서 나타나는 AVO 반응의 한계점에 대한 고찰)

  • Shin, Seung-Il;Byun, Joong-Moo;Choi, Hyung-Wook;Kim, Kun-Deuk;Ko, Seung-Won;Seo, Young-Tak;Cha, Young-Ho
    • Geophysics and Geophysical Exploration
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    • v.11 no.3
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    • pp.242-249
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    • 2008
  • Recently, AVO analysis has been widely used in oil exploration with seismic subsurface section as a direct indicator of the existence of the gas. In the case of the deep reservoirs like the gas reservoirs in the East-sea, it is often difficult to observe AVO responses in CMP gathers even though the bright spots are shown in the stacked section. Because the reservoir becomes more consolidated as its depth deepens, P-wave velocity does not decrease significantly when the pore fluid is replaced by the gas. Thus the difference in Poisson's ratio, which is a key factor for AVO response, between the reservoir and the layer above it does not increase significantly. In this study, we analyzed the effects of Poisson's ratio difference on AVO response with a variety of Poisson's ratios for the upper and lower layers. The results show that, as the difference in Poisson's ratio between the upper and lower layers decreases, the change in the reflection amplitude with incidence angle decreases and AVO responses become insignificant. To consider the limitation of AVO responses shown in the gas reservoir in East-sea, the velocity model was made by simulation Gorae V structure with seismic data and well logs. The results of comparing AVO responses observed from the synthetic data with theoretical AVO responses calculated by using material properties show that the amount of the change in reflection amplitude with increasing incident angle is very small when the difference in Poisson's ratio between the upper and lower layers is small. In addition, the characteristics of AVO responses were concealed by noise or amplitude distortion arisen during preprocessing. To overcome such limitations of AVO analysis of the data from deep reservoirs, we need to acquire precisely reflection amplltudes In data acquisition stage and use processing tools which preserve reflection amplitude in data processing stage.

Surgical Treatment of Congenital Cystic Lung Disease (선천성 낭성 폐질환의 수술적 치료)

  • Wi, Jin-Hong;Lee, Yang-Haeng;Han, Il-Yong;Yoon, Young-Chul;Hwang, Youn-Ho;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.335-342
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    • 2008
  • Background: Congenital cystic diseases of the lung are uncommon, and they share similar embryogenic and clinical characteristics. But they are sometimes vary widely in their presentation and severity. Therefore they are often difficult to make different diagnosis each other, and all require surgical treatment. Material and Method: From 1993 to 2006, 38 patients underwent surgical procedures under these diagnostic categories in the Depart. of Thoracic and. Cardiovascular Surgery, Busan-Paik Hospital, College of Medicine, Inje University. And we retrospectively reviewed these patients' charts for clinical presentations, surgical procedures, pathologic findings and postoperative morbidity and mortality. Result: There were 22 males and 16 females, ages ranged from 1 month after birth to 51 years and mean age was 20.8 years. The main symptoms were 19 fever, cough, sputum production due to recurrent infection, 7 dyspnea, 8 chest discomfort, 4 hemoptysis, but eight patients were asymptomatic. Computed tomography was chosen as diagnostic modalities and available for operation plan for all of patients. For all the cases, surgical resection were performed. Lobectomy was performed in 28 patients, simple excision (resection) in 8 patients, segmentectomy or wedge resection in 2 patients. There were 10 pulmonary sequestrations, 15 congenital cystic adenomatoid malformations (CCAM), 11 bronchogenic cysts, and 2 congenital lobar emphysemas. They all were confirmed by pathologic exams. The complications were 6 wound disruption or infection, 2 chylothorax, 1 ulnar neuropathy, but all of them were resolved uneventful. There was no persistent air leakage, respiratory failure, operative mortality and recurrence. Conclusion: We performed immediate surgical removal of congenital cystic lung lesions after diagnosis and obtained good results, so reported them with literature review.

Repair of Acute Aortic Arch Dissection with Hypothermic Circulatory Arrest and Retrograde Cerebral Perfusion (저체온순환정지와 역행성 뇌관류에 의한 대동맥궁을 침범한 급성 대동맥 박리증의 수술결과)

  • 이삼윤
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.43-49
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    • 2004
  • Background: Acute thoracic aortic dissections involving the aortic arch differ in diagnosis, surgical procedures, and operative results compared to those that do not involve the aortic arch. In general cerebral perfusion under deep hypothermic circulatory arrest (HCA) is performed during the repair of the aortic arch dissection. Here, we report our surgical results of the aortic arch dissection repair using retrograde cerebral perfusion (RCP) and its safety. Material and Method: Between January 1996 and June 2002, 22 consecutive patients with aortic arch dissection underwent aortic arch repair. In 20 of them RCP was performed under HCA. RCP was done through superior vena cava in 19 patients and by systemic retrograde venous perfusion in 1, in whom it was difficult to reach the SVC. When the patient's rectal temperature reached 16 to 18$^{\circ}C$, systemic circulation was arrested, and the amount of RCP amount was 481.1 $\pm$292.9 $m\ell$/min with perfusion pressure of 20∼30 mmHg. Result: There were two in-hospital deaths (4.5%) and one late death (9.1%). Mean circulatory arrest time (RCP time) was 54.0$\pm$ 13.4 minutes (range, 7 to 145 minutes). RCP time has no correlation with the appearance of consciousness, recovery of orientation, or ventilator weaning time (p=0.35, 0.86, and 0.92, respectively). Ventilator weaning was faster in patients with earlier recovery of consciousness and orientation (r=0.850, r=926; p=0.000, respectively). RCP of more than 70 minutes did not affect the appearance of consciousness, recovery of orientation, ventilator weaning time, exercise time, or hospital stay (p=0.42, 0.57, 0.60, 0.83, and 0.51, respectively). Conclusion: Retrograde cerebral perfusion time under hypothermic circulatory arrest during repair of aortic arch dissection may not affect recovery of orientation, ventilator weaning time, neurologic complications, and postoperative recovery.

Application for Identification of Food Raw Materials by PCR using Universal Primer (일반 프라이머를 이용한 PCR의 식품원료 진위 판별에 적용)

  • Park, Yong-Chjun;Jin, Sang-Ook;Lim, Ji-Young;Kim, Kyu-Heon;Lee, Jae-Hwang;Cho, Tae-Yong;Lee, Hwa-Jung;Han, Sang-Bae;Lee, Sang-Jae;Lee, Kwang-Ho;Yoon, Hae-Seong
    • Journal of Food Hygiene and Safety
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    • v.27 no.3
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    • pp.317-324
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    • 2012
  • In order to determine an authenticity of food ingredient, we used DNA barcode method by universal primers. For identification of animal food ingredients, LCO1490/HCO2198 and VF2/FISH R2 designed for amplifying cytochrome c oxidase subunit1 (CO1) region and L14724/H15915 for cytochrome b (cyt b) region on mitochondrial DNA were used. Livestock (cow, pig, goat, sheep, a horse and deer) was amplified by LCO1490/HCO 2198, VF2/FISH R2 and L14724/H15915 primers. Poultry (chicken, duck, turkey and ostrich) was amplified by LCO1490/HCO 2198 and VF2/FISH R2 primers. But, Fishes (walleye pollack, herring, codfish, blue codfish, trout, tuna and rockfish) were only amplified by VF2/FISH R2 primers. For plant food ingredients, 3 types of primers (trnH/psbA, rpoB 1F/4R and rbcL 1F/724R) have been used an intergenic spacer, a RNA polymerase beta subunit and a ribulose bisphosphate carboxylase region on plastid, respectively. Garlic, onion, radish, green tea and spinach were amplified by trnH/psbA, rpoB 1F/4R and rbcL 1F/724R. The PCR product sizes were same by rpoB 1F/4R and rbcL 1F/724R but, the PCR product size using trnH/psbA primer was different with others for plants each. We established PCR condition and universal primer selection for 17 item's raw materials for foods and determine base sequences aim to PCR products in this study. This study can apply to determine an authenticity of foods through making an comparison between databases and base sequences in gene bank. Therefore, DNA barcode method using universal primers can be a useful for species identification techniques not only raw materials but also processed foods that are difficult to analyze by chemical analysis.

The Production Techniques of Korean Dried-lacquer Buddha Statue seen through the Seated Dried-lacquer Bodhisattva Statue in Okura Museum of Art in Tokyo (도쿄 오쿠라슈코칸 협저보살좌상(東京 大倉集古館 夾紵菩薩坐像)을 통하여 본 한국 협저불상의 제작기법)

  • Jeong, Ji-yeon
    • Korean Journal of Heritage: History & Science
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    • v.46 no.3
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    • pp.172-193
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    • 2013
  • This study examines the production techniques and raw materials shown in the Korean dried-lacquer statues of Buddha through a careful observation of the Seated Dried-lacquer Bodhisattva Statue from the late Goryeo Dynasty which is currently possessed by Okura Museum of Art in Tokyo. As a method of study, the X-ray data and the results from a field survey were combined to analyze the production techniques and the characteristics of raw materials. Based on this analysis, a hypothesis was established on the production process and verified through a reenactment of the actual production process. Then, the characteristics of the techniques applied to each process and the raw materials were recorded in detail. Specifically, the dried lacquer techniques and the raw materials were estimated based on the results of naked-eye observation in comparison with the literature, especially the records of "Xiu Shi Lu" written by Huang Cheng of the Ming Dynasty which is considered as 'the textbook of lacquer techniques.' The raw materials used in the production of the traditional Korean lacquerware inlaid with mother-of-pearl were also referenced. As a result, it was found that the features of production techniques and the raw materials found in the Statue at Okura Museum of Art have many similarities with those of the Seated Dried-lacquer Statue of Lohan (Arhat) from Yuanfu 2 Nian Ming (1098) of the Song Dynasty which is currently at the Honolulu Museum of Art. In particular, the similarities include that the interior of the statue being vacant because the clay and the wood core were not replaced after being removed from the prototype, that the complete form was made in the clay forming stage to apply the lacquer with baste fiber fabric, that the clay and the wood core were removed through the bottom of the statue, and that the modeling stage was omitted and the final coat over the statue is very thin. Additionally, decorating with ornaments like Bobal and Youngrak made of plastic material was a technique widely popular in the Song Dynasty, suggesting that the Seated Dried-lacquer Bodhisattva Statue in Okura Museum of Art was greatly affected by the production techniques of the Dried-lacquer Buddha Statue from the Song Dynasty. There is no precise record on the origin and history of the Korean Dried-lacquer Buddha Statues and the number of existing works is also very limited. Even the records in "Xuanhe Fengshi Gaoli Tujing" that tells us about the origin of the Dried-lacquer Buddha Statue from the Yuan Feng Period (1078~1085) do not indicate the time of transmission. It is also difficult to trace the clear route of transmission of production techniques through existing Dried-lacquer Buddha Statues. Fortunately, this study could at least reveal that the existing Dried-lacquer Buddha Statues of Korea, including the one at Okura Museum of Art, have applied the production techniques rather differently from those used in the production of Japanese Datsukatsu Dried-lacquer Buddha Statues that have been known as the standard rule in making dried-lacquer statues of Buddha for a long time.

Radioimmunoassay Reagent Survey and Evaluation (검사별 radioimmunoassay시약 조사 및 비교실험)

  • Kim, Ji-Na;An, Jae-seok;Jeon, Young-woo;Yoon, Sang-hyuk;Kim, Yoon-cheol
    • The Korean Journal of Nuclear Medicine Technology
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    • v.25 no.1
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    • pp.34-40
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    • 2021
  • Purpose If a new test is introduced or reagents are changed in the laboratory of a medical institution, the characteristics of the test should be analyzed according to the procedure and the assessment of reagents should be made. However, several necessary conditions must be met to perform all required comparative evaluations, first enough samples should be prepared for each test, and secondly, various reagents applicable to the comparative evaluations must be supplied. Even if enough comparative evaluations have been done, there is a limit to the fact that the data variation for the new reagent represents the overall patient data variation, The fact puts a burden on the laboratory to the change the reagent. Due to these various difficulties, reagent changes in the laboratory are limited. In order to introduce a competitive bid, the institute conducted a full investigation of Radioimmunoassay(RIA) reagents for each test and established the range of reagents available in the laboratory through comparative evaluations. We wanted to share this process. Materials and Methods There are 20 items of tests conducted in our laboratory except for consignment tests. For each test, RIA reagents that can be used were fully investigated with the reference to external quality control report. and the manuals for each reagent were obtained. Each reagent was checked for the manual to check the test method, Incubation time, sample volume needed for the test. After that, the primary selection was made according to whether it was available in this laboratory. The primary selected reagents were supplied with 2kits based on 100tests, and the data correlation test, sensitivity measurement, recovery rate measurement, and dilution test were conducted. The secondary selection was performed according to the results of the comparative evaluation. The reagents that passed the primary and secondary selections were submitted to the competitive bidding list. In the case of reagent is designated as a singular, we submitted a explanatory statement with the data obtained during the primary and secondary selection processes. Results Excluded from the primary selection was the case where TAT was expected to be delayed at the moment, and it was impossible to apply to our equipment due to the large volume of reagents used during the test. In the primary selection, there were five items which only one reagent was available.(squamous cell carcinoma Ag(SCC Ag), β-human chorionic gonadotropin(β-HCG), vitamin B12, folate, free testosterone), two reagents were available(CA19-9, CA125, CA72-4, ferritin, thyroglobulin antibody(TG Ab), microsomal antibody(Mic Ab), thyroid stimulating hormone-receptor-antibody(TSH-R-Ab), calcitonin), three reagents were available (triiodothyronine(T3), Tree T3, Free T4, TSH, intact parathyroid hormone(intact PTH)) and four reagents were available are carcinoembryonic antigen(CEA), TG. In the secondary selection, there were eight items which only one reagent was available.(ferritin, TG, CA19-9, SCC, β-HCG, vitaminB12, folate, free testosterone), two reagents were available(TG Ab, Mic Ab, TSH-R-Ab, CA125, CA72-4, intact PTH, calcitonin), three reagents were available(T3, Tree T3, Free T4, TSH, CEA). Reasons excluded from the secondary selection were the lack of reagent supply for comparative evaluations, the problems with data reproducibility, and the inability to accept data variations. The most problematic part of comparative evaluations was sample collection. It didn't matter if the number of samples requested was large and the capacity needed for the test was small. It was difficult to collect various concentration samples in the case of a small number of tests(100 cases per month or less), and it was difficult to conduct a recovery rate test in the case of a relatively large volume of samples required for a single test(more than 100 uL). In addition, the lack of dilution solution or standard zero material for sensitivity measurement or dilution tests was one of the problems. Conclusion Comparative evaluation for changing test reagents require appropriate preparation time to collect diverse and sufficient samples. In addition, setting the total sample volume and reagent volume range required for comparative evaluations, depending on the sample volume and reagent volume required for one test, will reduce the burden of sample collection and planning for each comparative evaluation.