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Quality of Life after Curative Surgery in Patients with Gastric Cancer: Comparison between a Subtotal Gastrectomy and a Total Gastrectomy (위암 환자에 있어서 위의 절제범위에 따른 수술 후 삶의 질 비교)

  • -Yu, Wansikik;Lee, Chang-Hwan;Chung, Ho-Young
    • Journal of Gastric Cancer
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    • v.1 no.1
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    • pp.44-49
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    • 2001
  • Purpose: Quality of life (QOL) assessment should be applied in surgical settings to compare treatment options. We compared QOL after a subtotal versus a total gastrectomy for gastric cancer to identify which resection would produce a better QOL for the patient. Patients and Methods: We studied 362 patients with no evidence of recurrent disease after curative surgery for gastric cancer. The QOL was measured by assessing patient health perceptions according to the Spitzer index and Troidl score and by treatment-specific symptoms according to Korenaga and others with some modifications. High scores reflect a better QOL. Results: The mean score of the Spitzer index was $8.87\pm1.36$ after a subtotal gastrectomy and $8.80\pm1.23$ after a total gastrectomy. More than $80\%$ of the patients in both groups maintained good quality of life when measured by the Spitzer index. The mean Troidl score was $10.41\pm2.12$ after a subtotal gastrectomy and $9.79\pm2.16$ after a total gastrectomy (p=0.033). Swallowing difficulty was more frequent after a total gastrectomy (p=0.002). There was a statistically significant difference in the meal size (p=0.044). Other variables of the Troidl score revealed no statistically significant differences. Dizziness was significantly more frequent after a total gastrectomy than after a subtotal gastrec tomy (p=0.009). Conclusion: We conclude that in terms of postoperative quality of life, a subtotal gastrectomy has advantages over a total gastrectomy. In those cases where an adequate proximal safety margin can be achieved by a subtotal gastrectomy, that procedure is preferable to a total gastrectomy.

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Factors Affecting Blood Loss During Thoracoscopic Esophagectomy for Esophageal Carcinoma

  • Urabe, Masayuki;Ohkura, Yu;Haruta, Shusuke;Ueno, Masaki;Udagawa, Harushi
    • Journal of Chest Surgery
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    • v.54 no.6
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    • pp.466-472
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    • 2021
  • Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

Improving the water yield capabilities using reservoir emergency storage and water supply adjustment standard (합천댐의 비상용량 및 용수공급 조정기준을 활용한 용수공급능력 제고)

  • Ahn, Jaehong;Lee, Youngmok;Yi, Jaeeung
    • Journal of Korea Water Resources Association
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    • v.49 no.12
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    • pp.1027-1034
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    • 2016
  • One of the most important purpose of multi-purpose reservoir is storing a large amount of water for utilization in a dry season. However, multi-purpose reservoirs that were constructed according to the limited hydrologic information available at the time of construction may encounter problems such as decreased water inflow due to climate change and an inability to cope with a water shortage. To solve these problems, in 2015, the Ministry of Land, Infrastructure and Transport suggested a revised water supply standard in case of water shortage for reservoirs. However, the revised standard has not been sufficiently discussed to determine its effectiveness. In addition, multi-purpose reservoirs in South Korea have secured and stored water for emergencies, but there is currently no way to utilize the stored water. Determining how to utilize the stored water effectively may be a useful method for preparing drought. Therefore, this article discusses the revised water supply standard as it relates to a water shortage in reservoirs and a method of utilizing the water stored for emergencies in multi-purpose reservoirs. The options for utilizing the water storage were evaluated using a water shortage safety degree index, and the results showed that the options may slightly and limitedly increase the water supply capacity. However, the evaluation also showed that a complex application of two options may overcome the exisiting problem and to supply water more effectively.

Improvement on the Managerial Method of Price Fluctuation System (물가변동제도 운영방식 개선방안)

  • Lee, Jae-Seob;Shin, Young-Chul
    • Korean Journal of Construction Engineering and Management
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    • v.12 no.2
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    • pp.3-11
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    • 2011
  • There are several causes to recalculate the contract amount in public construction projects. Among them, the escalation clause was introduced in 1969 and now the condition to recalculate the cost is effective after 90 days from the date of contract and the rate of fluctuation should be more than 3% from the date of bidding. The two calculation methods for the rate of fluctuation are item-adjustment and index-adjustment. According to the results of investigation into 4 public institutions and 163 projects, all of them have used the method of index-adjustment and the rate of projects that spend over 6 months obtaining the approval of contract amount adjustment is more than 90%. The reason for spending lots of time is caused by problems of the calculation method on the price fluctuation rate. Therefore, it is necessary that the calculation method should be diversified to cope with the problems and a option of the builder should be expanded as well. Furthermore, if the way to apply correction factors to construction price index and average index based on the producer and consumer price index made by the bank of Korea is added, then the duration will be reduced without additional expenses. This study proposed the diversification of the calculation method using price fluctuation rate and builders' expanded options as improvement on the managerial method of Price Fluctuation System for the prompt and efficient contract amount adjustment.

Expiration-Day Effects: The Korean Evidence (주가지수 선물과 옵션의 만기일이 주식시장에 미치는 영향: 개별 종목 분석을 중심으로)

  • Choe, Hyuk;Eom, Yun-Sung
    • The Korean Journal of Financial Management
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    • v.24 no.2
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    • pp.41-79
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    • 2007
  • This study examines the expiration-day effects of stock index futures and options in the Korean stock market. The so-called 'expiration-day effects', which are the abnormal stock price movements on derivatives expiration days, arise mainly from cash settlement. Index arbitragers have to bear the risk of their positions unless they liquidate their index stocks on the expiration day. If many arbitragers execute large buy or sell orders on the expiration day, abnormal trading volumes are likely to be observed. If a lot of arbitragers unwind positions in the same direction, temporary trading imbalances induce abnormal stock market volatility. By contrast, if some information arrives at market, the abnormal trading activity must be considered a normal process of price discovery. Stoll and Whaley(1987) investigated the aggregate price and volume effects of the S&P 500 index on the expiration day. In a related study, Stoll and Whaley(1990) found a similarity between the price behavior of stocks that are subject to program trading and of the stocks that are not. Thus far, there have been few studies about the expiration-day effects in the Korean stock market. While previous Korean studies use the KOSPI 200 index data, we analyze the price and trading volume behavior of individual stocks as well as the index. Analyzing individual stocks is important for two reasons. First, stock index is a market average. Consequently, it cannot reflect the behavior of many individual stocks. For example, if the expiration-day effects are mainly related to a specific group, it cannot be said that the expiration of derivatives itself destabilizes the stock market. Analyzing individual stocks enables us to investigate the scope of the expiration-day effects. Second, we can find the relationship between the firm characteristics and the expiration-day effects. For example, if the expiration-day effects exist in large stocks not belonging to the KOSPI 200 index, program trading may not be related to the expiration-day effects. The examination of individual stocks has led us to the cause of the expiration-day effects. Using the intraday data during the period May 3, 1996 through December 30, 2003, we first examine the price and volume effects of the KOSPI 200 and NON-KOSPI 200 index following the Stoll and Whaley(1987) methodology. We calculate the NON-KOSPI 200 index by using the returns and market capitalization of the KOSPI and KOSPI 200 index. In individual stocks, we divide KOSPI 200 stocks by size into three groups and match NON-KOSPI 200 stocks with KOSPI 200 stocks having the closest firm characteristics. We compare KOSPI 200 stocks with NON-KOSPI 200 stocks. To test whether the expiration-day effects are related to order imbalances or new information, we check price reversals on the next day. Finally, we perform a cross-sectional regression analysis to elaborate on the impact of the firm characteristics on price reversals. The main results seem to support the expiration-day effects, especially on stock index futures expiration days. The price behavior of stocks that are subject to program trading is shown to have price effects, abnormal return volatility, and large volumes during the last half hour of trading on the expiration day. Return reversals are also found in the KOSPI 200 index and stocks. However, there is no evidence of abnormal trading volume, or price reversals in the NON-KOSPI 200 index and stocks. The expiration-day effects are proportional to the size of stocks and the nearness to the settlement time. Since program trading is often said to be concentrated in high capitalization stocks, these results imply that the expiration-day effects seem to be associated with program trading and the settlement price determination procedure. In summary, the expiration-day effects in the Korean stock market do not exist in all stocks, but in large capitalization stocks belonging to the KOSPI 200 index. Additionally, the expiration-day effects in the Korean stock market are generally due, not to information, but to trading imbalances.

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Evaluation of RO Process Feasibility and Membrane Fouling for Wastewater Reuse (하수처리수 재이용을 위한 RO 공정의 타당성 및 막오염 평가)

  • Hong, Keewoong;Lee, Sangyoup;Kim, Changwoo;Boo, Chanhee;Park, Myunggyun;An, Hochul;Hong, Seungkwan
    • Journal of Korean Society on Water Environment
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    • v.26 no.2
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    • pp.289-296
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    • 2010
  • The purpose of this study is to evaluate various pre-treatment methods and proprieties of water quality for wastewater reuse using reverse osmosis (RO) processes. Secondary effluents were sampled from wastewater treatment plants and lab scale pre-treatments and RO filtration test were conducted systematically. Specifically, different types of pre-treatments, such as coagulation, microfiltration and ultrafiltration, were employed to evaluate the removal efficiency of particle and organic matters which may affect the membrane fouling rate. RO process was later added to eliminate trace amounts of remaining organic matters and salt from the raw water for wastewater reclamation. The permeate through the RO process satisfied water quality regulations for industrial water uses. The experimental results showed that the initial fouling tendency differed not only by the feed water properties but also by the membrane characteristics. Membrane fouling was greater for the membranes with large surface roughness, regardless of the hydrophobicity and zeta potentials. Thus both careful consideration of pre-treatment options and proper selection of RO membrane are of paramount importance for an efficient operation of wastewater treatment.

Net Buying Ratios by Trader Types and Volatility in Korea's Financial Markets (투자자별 순매수율과 변동성: 한국 금융시장의 사례)

  • Yoo, Shiyong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.15 no.1
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    • pp.189-195
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    • 2014
  • In this research, we investigate the relationship between volatility and the trading volumes of trader types in the KOSPI 200 index stock market, futures market, and options market. Three types of investors are considered: individual, institutional, and foreign investors. The empirical results show that the volatility of the stock market and futures market are affected by the transaction information from another market. This means that there exists the cross-market effect of trading volume to explain volatility. It turns out that the option market volatility is not explained by any trading volume of trader types. This is because the option market volatility, VKOSPI, is the volatility index that reflects traders' expectation on one month ahead underlying volatility. Third, individual investors tend to increase volatilities, whereas institutions and foreign investors tend to stabilize volatilities. These results can be used in the areas of investment strategies, risk management, and financial market stability.

Application of Transcranial Doppler Ultrasonography(TCD) for the Diagnosis of Migraine : Preliminary Results (Transcranial Doppler Ultrasonography를 이용한 편두통의 진단: 예비연구)

  • Lee, Young-Seok;Kim, Byung-Kun
    • Annals of Clinical Neurophysiology
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    • v.1 no.1
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    • pp.31-35
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    • 1999
  • Dignosis of migraine is only based on the medical history, and objective methods to aid the clinical diagnosisare absent. Although transcranial Doppler ultrasonography (TCD) abnormalities in headache-free migraineurs have been reported previously, diagnostic criteria for migraine is still lacking and this may limit the practical application of TCD for migraine. We prospectively studied several abnormal TCD indices in interictal migraineurs and their sensitivity and specificity to define the optimal diagnostic criteria. Young (20 yrs$age=29.0{\pm}6.1yrs$) were compared to 69 controls (M:F=25:44, Mean $age=31.2{\pm}5.5yrs$). Elevated MFV (> 2SD)was observed in 63% of migraineurs while n 12% of control (p<0.01). High AI (>25%) or high HI (>3.0) was present in 17% of migraineurs, while 3% and none in controls (p<0.01). Sensitivity of elevated MFV, high AI, and high HI was 63%, 17%, 17% and specificity was 88%, 97%, 100%, respectively. If all these indices were combined, sensitivity and specificity reached 69% and 86%. These preliminary results suggest pathophysiological implication of vasospasm in interictal migraineurs, and TCD may be practically applicable for migraine. Optimal diagnostic criteria and therapeutic options for patients with abnormal TCD findings remain to bo determined.

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Clinical and Radiologic Analysis of Posterior Apophyseal Ring Separation Associated with Lumbar Disc Herniation

  • Bae, Jung-Sik;Rhee, Woo-Tack;Kim, Woo-Jae;Ha, Seong-Il;Lim, Jae-Hyeon;Jang, Il-Tae
    • Journal of Korean Neurosurgical Society
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    • v.53 no.3
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    • pp.145-149
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    • 2013
  • Objective : We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. Methods : We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. Results : PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were $3.6{\pm}2.9$ and $5.4{\pm}6.4$ in the unresected PARS group, $5.8{\pm}2.1$ and $11.3{\pm}7.1$ in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. Conclusion : The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

Review of Korean Clinical Studies on Treatment for Childhood Obesity (소아비만의 치료에 대한 국내 임상연구 동향)

  • Kim, Kyoung Ri;Han, Jae Kyoung;Kim, Yun Hee
    • The Journal of Pediatrics of Korean Medicine
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    • v.30 no.3
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    • pp.108-120
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    • 2016
  • Objectives The purpose of this study is to investigate Korean clinical studies on treatment of childhood obesity and to propose for better treatment options for childhood obesity. Methods Based on RISS, KISS, OASIS, KMbase with the keyword 'childhood obesity', 'child obesity', 'obese child', 'overweight child', total of 21 randomized controlled trials (RCTs), 11 single clinical studies, 3 chart reviews and 3 case reports have been found, and were analyzed. Results and Conclusion 1. Some study subjects were classified based on their sex - only men or women in a group or sometimes both. Another way of classify the study subjects were based on their age - preschooler, primary school students, middle school students, and high school students. The diagnostic criteria of the subjects were BMI (body mass index), Body fat percentage, Obesity index, Weight and unknown criteria. 2. The treatments used in 38 studies were exercise alone, education alone, both exercise and education or herbal therapy. The 7 studies that used herbal therapy as part of their study intervention had a study group with herbal intervention only and the other 2 study group with herbal treatment in addition to exercise and education. 3. 9 studies included herb medicines, electroacupuncture, auricular acupuncture, cupping, aroma massage, infrared light, and abdomen pad. Herb medications used in 5 studies included Chegameuiin-tang 2 kinds, Sobieum, Biman-tnag, and I-razin. 4. The methods of assessment used in 38 studies were classified by 7 categories and anthropometry parameters which is the basic methods are used in all studies 5. Almost studies (29 studies in all 38 studies) were using anthropometric parameters results on significantly effectiveness of childhood obesity. 6. More studies are needed to prove true effectives from various treatments, especially herbal therapy for childhood obesity.