• 제목/요약/키워드: Low birth weight

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조산아의 발달 지연 선별 검사로 사용되고 있는 ASQ의 효용성 (A Validity Study of the Korean Ages and Stages Questionnaires: Screening for Developmental Delay in Preterm Infant)

  • 김윤주;이주영;손진아;이은희;이진아;최창원;김이경;김한석;김병일;최중환
    • Neonatal Medicine
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    • 제17권2호
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    • pp.217-223
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    • 2010
  • 목적 : 지난 20년간 주산기 관리 및 신생아학의 발전으로 28주 미만의 조산아 및 1,000 g 미만의 초극소 저체중 출생아의 생존률은 증가하였으나 이환률의 감소는 뚜렷하지 않다. 이러한 고위험군 신생아들의 신경 발달 문제에 대해서는 조기 진단을 통해 적절한 시기에 중재를 시작하는 것이 예후를 개선한다고 알려져 있어 발달 지연을 선별하는 수단들의 개발이 이루어지고 있다. 본 연구에서는 한국형 Ages and stages Questionnaires(K-ASQ)의 효용성을 검증하기 위하여 Bayley scales of infant and toddler development (BSID-III)의 결과와 비교분석 하였다. 방법 : 2006년 10월 30일부터 2010년 8월 1일까지 기간 동안 서울대학교 어린이 병원 신생아 분과 외래에서 K-ASQ 및 BSID-III를 모두 시행한 37주미만 조산아를 대상으로 하였다. BSID-III의 -1SD 미만을 발달 지연으로 보고 K-ASQ의 민감도, 특이도를 산출하고 각 발달 영역에 따라 다시 분석하였다. 결과 : 대상 환자의 평균 출생 주수는 28$\pm$2.87 week(median, 28.43 weeks; range 23.57-35.86 weeks) 이었으며 출생 체중은 1,027$\pm$363 g (median, 950 g; 480-2,870 g) 이었다. 8개월 BSID-III를 시행한 환아는 115명, 18개월 BSID-III를 시행했던 환아는 58명으로 전체 138명을 대상으로 하였다. 8개월 K-ASQ의 민감도는 0.2, 특이도는 0.93, 18개월 K-ASQ의 민감도는 0.72, 특이도는 0.94로 높은 특이도를 보이고 민감도는 연령이 증가함에 따라 상승하였다. BSID-III와 K-ASQ의 항목별로 짝을 지어 민감도 및 특이도도 산출하였으며 K-ASQ의 문제해결 항목의 민감도는 8개월에 0.09, 18개월에 0.3 였고 의사소통 항목은 민감도가 8개월에 0, 18개월에 0.29 대근육 항목은 8개월에 0.11, 18개월에 0.8, 소근육 항목은 8개월에 0.2, 18개월에 0.67 였다. 특이도는 최소 항목이 0.92로 지속적으로 높은 결과를 보였다. 결론: ASQ는 개발 과정에서 전체 인구를 대상으로 선별 검사를 할 목적으로 만들어져 민감도가 높지 않았으며 이는 미숙아를 대상으로 한 본 연구에서도 같은 결과를 보였다. 따라서, ASQ를 고위험군에서의 선별검사로서 이용하기에는 제한점이 있었으며 이러한 경향은 낮은 연령에서 더욱 뚜렸하였다.

선천성 장폐쇄증 2차 조사 - 대한소아외과학회 회원을 주 대상으로 한 전국조사 - (Intestinal Atresia - The Second National Survey)

  • 김성철;김대연;김상윤;김인구;김인수;김재억;김재천;김현영;박귀원;박우현;박진영;서정민;설지영;오수명;오정탁;이남혁;이명덕;이석구;이성철;정상영;정성은;정연준;정풍만;최금자
    • Advances in pediatric surgery
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    • 제16권1호
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    • pp.1-10
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    • 2010
  • 본 조사는 2007년부터 2009년까지 3년간 본 학회 정회원들에 의하여 수술받은 장폐쇄증 환아를 대상으로 한 후향적 조사이다. 또한 본 학회에서는 1994년부터 1996년까지 3년간의 증례를 대상으로 같은 조사(1 차조사)를 진행한 바 있다. 1 차 조사와 비교하여 본 조사에서 보이는 특징은 아래와 같이 요약할 수 있다. - 총 증례 수는 비슷하였으나 출생률을 감안하여야 할 것이다. - 각 기형별 비율은 비슷하였다. - 미숙아 및 저출생체중아의 비율은 증가 하였다. - 산전진단율은 증가하였다. - 복부단순촬영만 한 경우는 감소하였다. - 다른 기형이 동반된 예가 증가하였다. - 사망률이 13.8 %에서 3.6 %로 감소하였다. 장운동의 회복은 공장폐쇄증에서 십이지장이나 회장폐쇄증에서 보다 더뎠다. 하지만 십이지장-공장 이행부에서 문합부까지의 거리가 기술되지 않은 예가 많아 소위 "High Jejunal obstruction"에서의 장운동 회복기간을 알아 보지 못 하는 아쉬움이 있었다. 또한 주름형성술(plication) 또는 장의 직경을 줄이는 수술(tapering)의 효과도 시행한 예수가 작고, 문합부 위치의 기술 부족으로 알아 보지 못 하였다. 십이지장폐쇄증의 화타씨유두부와 위치 역시 향후 보다 정확한 수술기록을 토대로 조사되어야 할 것으로 생각된다. 치료 성적의 눈부신 향상은 여러 회원들의 각고의 노력과 의학의 발달에 기인한 것으로, 사망률 0 %를 향한 노력이 지속되어야 할 것이다.

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선천성 장폐쇄증 - 대한소아외과학회 정회원을 대상으로 한 전국조사 - (Intestinal Atresia - A Survey by the Korean Association of Pediatric Surgeons -)

  • 김인구;김상윤;김신곤;김우기;김재억;김재천;김현학;박귀원;박영식;박우현;송영택;양정우;오수명;유수영;이두선;이명덕;이석구;이성철;장수일
    • Advances in pediatric surgery
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    • 제5권1호
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    • pp.75-81
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    • 1999
  • 대한소아외과학회 회원들을 대상으로 시행한 조사결과이기 때문에 별도의 고안이 필요없을 것으로 생각되며, 다만 한두가지를 언급하고자 한다. 통상 성서(textbook)에서는 선천성 장폐쇄증을 십이지장폐쇄증과 공회장폐쇄증으로 나누어 기술하고 있다. 본 조사에서는 십이지장, 공장, 회장을 각각 나누어 분석하여 보았다. 재태기간의 조사에서 공장폐쇄증에서 미숙아의 비율이 가장 높았고(48.6%), 장운동의 회복기간을 비교분석한 자료에서는 상부 공장폐쇄증 환아에서 나머지 공회장폐쇄증 환아보다 유의하게 길게 나타남을 관찰할 수 있었다. 이는 상부 공장폐쇄증이 있을 때 이차적으로 확장된 십이지장이 그 직경이 정상으로 돌아와 정상적인 장운동을 회복할때까지 상당한 시간이 걸릴 수 있으며 이 폐쇄증에는 다발성 폐쇄증이 빈발하는것도 긴 회복시간과 관계가 있다고 생각된다. 상부 공장폐쇄증의 또 한가지 특성은 소위 크리스마스 나무 (Christmas tree)기형이라고 하는, 전상부 장간막동맥의 결손을 동반하는 기형이 이 폐쇄증의 상당 부분을 차지하기 때문에 그 하부의 공회장폐쇄증과는 다른 특이한 소견을 나타낸다고 생각된다. 이에 Donnellan등은 "high jejunal obstruction" 에 대하여 "Abdominal Surgery of Infancy and Childhood" 에서 따로 기술하고 있다. 따라서 추후 조사에서는 이점은 참고하여야 할 것으로 생각되었다. 상부 공장페쇄증 환아에서의 주름형성술 또는 장의 직경을 줄이는 수술의 효과는 통계적으로 의미가 없는 것으로 분석되었으나, 상기 술식을 시행한 예수가 적기 때문에(9례) 이 점에 대하여서도 추후 조사에서 재검토하여야 할 사항으로 생각되었다. 주제 토의(topic discussion)시간에 가정 큰 쟁점이 되었던 점은 임신 기간과 출생시 체중이 우리의 예상과 다른 결과를 보였기 때문이다. 특히 공장폐쇄증(jejunal atresia)에서 72례의 환아 중 35례(48.6%)가 37주 미만의 조산아이었는데 출생시 체중에서는 24례(33.3 %)만이 2.5 kg 미만의 저체중아로 분석되었다. 등록된 환아들의 분석과정에 잘못이 있었는지 재조사하여 보았으나, 분석과정에는 오류가 없었음이 확인되었다. 또 한가지 큰 쟁점 되었던 사항은 십이지장폐쇄증의 화타씨유두부와의 위치가 문제이었다. 등록된 환아의 기록에서 정확하게 기술이 안된 예가 상당수있어 이점은 공회장폐쇄증의 정확한 형(type)과 같이 재조사 하였으며, 대부분의 회원들이 재조사에 성실히 협조하여 좀더 명확한 자료를 얻을 수 있었다. 이외에도 병인론에 입각한 분류법인 십이지장폐쇄증과 공회장폐쇄 증으로 나누지 않고 십이지장, 공장, 회장을 따로 분석하였느냐는 지적도 많았다. 장폐쇄증의 분석에서는 협착증은 제외하고 폐쇄증 만을 분석하여야 한다는 주장도 있었다. 회원들이 근무하고 있는 병원의 사정이 다르기는 하지만 조사 기간동안 각 회원들이 치험한 환아의 숫자는 큰 차이가 없었던 점은 본 질환의 발생율이 지역간 차이가 없는 것으로 추정되었다. 그러나 치료방법은 수술술식과 사용 기술에 굉장한 다양성이 있음을 알게 되었다. 대한소아외과학회 회원들의 다양한 소아외과 연수배경이 한가지 원인으로 생각되었다. 이번 주제토의를 통하여 우리소아외과회원 각자들도 많은 것을 느끼고 생각하게 되었으리라고 생각한다.

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한국인(韓國人) 중고교생(中高校生)들의 흡연실태(吸煙實態)에 관(關)한 연구 (A Study on the Smoking Status of the Korean Middle and High School Students)

  • 박순영
    • 한국학교보건학회지
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    • 제7권1호
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    • pp.57-71
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    • 1994
  • I investigated actual conditions of smoking of teenagers who were randomly chosen middle and high school students. 1. Juvenile smoking 1) Parents' opinions of juvenile smoking Most parents do not want their children to smoke after growth : 88.6% of fathers (middle school students: 88.9%, high school students: 88.4%) and 95.1% of mothers (middle school students: 93.4%, high school students :95.5%). 2) Teenagers' opinions of smoking after growth The rate of students who will smoke after growth is 10.8% (middle school students: 12.0%, high school students: 9.9%): students in agricultural areas show the higher rate than those in cities. 3) Parents' opinions of their children's smoking now 1.5% of fathers want their children to smoke now (middle school students: 1.3%, high school students: 1.6%) and 1.1% of mothers do (middle school students: 0.6%, high school students: 1.5%). This shows that most parents do not want their children to smoke now. 4) Students' opinions of their friends' smoking now Students who want their friends smoke now cover 7.8% (middle school students: 7.1%, high school students: 8.4%). This rates are higher than those of parents shown in (3). And more high school students and more girl students gave the positive reponse than middle school boy and girl students, respectively. 5) Students' views of smoking "Look like an adult" covers the rate of 4.0% (boy: 7.8%, girl:3.6%) 6.7% of middle school students have this view, while 3.7% of high school students have. 16.1% of students had an experience of smoking during the last one year (boy: 29.9%, girl: 8.6%): this shows that the rate of the boy students is more than 3 times greater than that of the girl students and high students who experienced smoking last year covers 20.2%, while middle school students shows 10.9%. 6) Actual conditions of students' smoking The present rate of students' smoking is 22.4% (boy:38.3%, girl:13.8%): the rate of boy students is greater than that of girl students. Students who smoke more than pack of cigarettes a day cover 8.2% (boy: 17.5%, girl: 3.2%): 5.2% of middle school students (boy:11.4%, girl: 2.1%) smoke more than one pack while 10.7% of high school students do (boy:21.5%, girl: 4.2%). This shows that the rate of boy students' smoking is greater than that of girl students' smoking. 7) The rate of smoking of students' parents 75.4% of fathers (city: 74.5%, agricultural area:75.9%) smoke: and more than a half (62.4%) smoke more than a pack cigarettes a day. On the other hand, the rate of smoking mothers is 5.2%(city: 4.3%, agricultural area: 7.3%): the rate is higher in agricultural areas. 8) Opinions of smoking population in the future 61.4% of students answered that smoking population will increase, while 27.0% have the opinion that smoking population will decrease. 2. Opinions of the effects of smoking on health 1) Have you heard that smokers are likely to suffer from tuberclosis? 78.3% of students said yes (boy: 80.8%, girl: 76.4%): it is shown that the rate of boys is greater than that of girls. 2) Have you heard that smokers are likely to get out of endurance? 76.6% of students (boy: 69.3%, girl: 49.7%) answered yes: it is shown that the rate of boys is greater than that of girls. 3) Have you heard that heart-beats get fast when one smokes? 32.5% of students (boy: 35.5%, girl: 30.9%) answered yes: 32.2% in cities(boy: 33.0%, girl: 31.8%) and 33.5% in agricultural areas(boy: 41.8%, girl: 28.8%): and 28.7% middle students and 35.5% of high school students answered yes. 4) Have you heard that smokers are likely to have heart-diseases? 35.1% of students (boy: 34.0%, girl: 34.1%) answered yes: 35.3% in cities (boy: 37.2%, girl: 34.2%) and 36.7% in agricultural areas (boy: 39.0%, girl: 33.9%): 34.8% of middle school students and 35.4% of high school students. 5) Have you heard that smokers are likely to have a lung cancer? 91.4% of students (boy: 93.2%, girl: 89.9%) answered yes: 90.35% in cities and 94.2% in agricultural areas. 6) Have you heard that the life of smokers gets shorter? 94.3% of students (boy:94.6%, girl: 92.2%) answered yes. 7) Have you heard that pregnant smokers will deliver a baby with low birth weight? 29.6% of students (boy: 29.8%, girl: 29.4%) answered yes: the rates of boys and girls almost the same. 8) Have you heard that one feels calm when one smokes? 80.1% of students (boy: 81.8%, girl: 79.2%) answered yes: boys and girls showed almost the same rate. 3. Preventive measures Smoking people continued to increase all over the world because smoking not only mitigated emotional uneasiness such as loneliness, nervousness and so on, but also could be very helpful from the social perspective. This was so because they did not consider harmful effects of smoking on health, and victims. However, because any -one can have physical disorders caused by smoking, people should always keep in mind the following preventive measures. 1) Doctors or teachers should set an example of giving up smoking. Informing patients or students of harmful effects of smoking to persuade their family and relatives not to smoke. 2) Through mass media like newspapers, periodicals or broadcasting, to make people know harmful effects of smoking and not smoke. 3) To prohibit selling teenagers cigarette by law. 4) To prohibit smoking in public places like work places, offices, lecture rooms, recreation rooms, buses, trains and so on. 5) To decrease the rate of life insurance for non-smokers as in foreign countries and to give a warming of the harmful effects on cigarette packets or ads.

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고려의 원시영역 유목초지, 그 부르칸(불함)이즘과 한국축산의 비전 (Burqanism from the Origin of the Pastoral Nomadic Koryo Region and the Vision of Korean Livestock Farming)

  • 주채혁
    • 한국초지조사료학회지
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    • 제25권1호
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    • pp.71-82
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    • 2005
  • Khori(高麗) refers to the Chaabog(reindeer) that live on lichens(蘚) on Mt. Soyon(鮮) in which pastures are the cold and dry plateau of North Eurasia. Thus, the origin region of the Khori or Koguryo that are the ancestors of the reindeer-herding pastoral nomads(馴鹿 遊牧民) can be said to be the Steppe-Taiga-Tundra pastoral areas of North Eurasia and North America. When the pastoral nomads moved on to the great mountain(大山) zone of the Jangbaek(長白) to the Baekdu(白頭) Mountains, they could have been in contact with pastoral farmers or agricultural farmers living there and they became the farmers remaining on agricultural farms. They were the Koryo people, the ancestors of Korea. Staying in one place, they gradually forgot the origin of their reindeer-herding pastoral nomadic history in the Northwest area of Mt. Soyon, the small mountain(小山) zone of the Steppe-Taiga-Tundra pastoral areas. In other words, they lost their identity as reindeer-herding pastoral nomads when they entered the agricultural area after leaving the pastoral area. However, since their basic genes had already formed when they lived on the cold and dry plateau of North Eurasia, it is possible to study their pastoral nomadic history focusing on 'the minority living in the broad area(廣域少數)', by utilizing highly advanced biotechnological science and focusing on genes and information technology innovation, and removing various past hindrances in research. Therefore, it is not so difficult to restore the reindeerherding pastoral nomadic history of the Koguryo(高句麗) people and secure their pastoral nomadic identity, of which the first steps have already been taken into their historical stages. The Eurasian continent and the Korean peninsula, especially the cold and dry plateau of North Eurasia and the Korean peninsula have been closely related to each other ecologically and historically. They can never be a separate space at all. The Eurasian continent lies horizontally east to west and thus, the continent forms an isothermal zone. Also, since the time of producing their own foods, it was relatively easy for people with their technology to move to other places owing to the pastoral nomadic characteristic of mobility. Unlike the Chungyen(中原) region, western Asia and the regions covering the Siberia-Manchu-Korean peninsula where food production revolution was first made were connected to the Mongolian lichens route(蘚苔之路: Ni, ukinii jam) and steppe roads. Although the ecological conditions of nature have changed a bit throughout a long history, it was natural for the many tribes in North Asia living on the largest Steppe-Taiga-Tundra area in the world to have believed 'the legends related to animals in relation to their founders and ancestors(獸祖傳說)'. Assuming that Siberian tigers and the tigers living on Mt. Baekdu were connected ecologically and genetically because of the ecological characteristics of the animals, and their migration from plateau to plateau, we would suspect that the Chosun(朝鮮) tribe living on Mt. Baekdu were ethnically and culturally more closely connected to the farther removed Ural-Altai tribes that lived on the cold and dry plateau region than to the Han(i14;) tribe who lived in Chungyen(中原) that was close to Mt. Baekdu. More evidence is the structure of the Korean language which has the form of 'Subject + Object + Verb', which is assumed to have originated from the speedy lifestyle of the reindeer-herding pastoral nomads. The structure is quite different from that of the Han(漢) language, which is based on agricultural life. Also, it is natural for reindeer riding reindeerherding pastoral nomads or horse-riding sheep-herding pastoral nomads(騎馬, 羊遊牧民) to have held military and political power over the region and eventually to have established an ancient pastoral nomadic empire in the process of their conquest of agricultural regions. The stages for founding global empires in the history of mankind maybe largely divided into two, in terms of ecological conditions and occupations. They are the steppes and the oceans. Of course, the steppe-based empires were established based on the skills to deal with horses and the ability to shoot arrows while riding horses, along with the use of iron ware in the 8th century BC. The steppe-based empires became the foundation for an oceanic empire, which could have been established by the use of warships and warship guns since the 15th Century. Based on those facts, we know that Chosun, Puyo(夫餘), and Koguryo are the products of a developmental process of pastoral nomadic empires on the steppes. Maybe we can easily find the pastoral nomadic identity of the Koguryo more than we expected when we trace the origins and history of the Korean tribe living in the pastures located in the northwest area of Mt. Jangbaek by focusing on pastoral nomadic mobility and organization just as we have investigated the historic origins of Anglo-Saxons in America by focusing on the times before the 15th Century. In the process, we should keep in mind that English culture originated from the Industrial Revolution and was directly delivered to the American continent, although America was far from England and was not an intermediate point on long sojourns either. Further, American culture came back to England in a more advanced form later. The most important thing currently to be resolved is to cause Koreans to look back on their own history in a freer way of thinking and with diverse, profound, and sharp insight, taking away the old and existing conventional recognition that is entangled with complicated interests with Korean people and other countries. The meanings of Chosun, Khori, and Solongos have been interpreted arbitrarily without any historic evidence by the scholars who followed conventional tradition of fixed-minded aristocrats in an agricultural society. If the Siberian cultural properties of the stone age, the earthenware age, the bronze age, and the iron age are analyzed in such a way, archaeological discovery will never be able to contribute to the restoration of the Koguryo's pastoral nomadic identity. One should transcend the errors that tend to interpret the cultural properties discovered in the pastoral nomadic regions as not being differentiated from those of agricultural regions and just interpret them altogether from the agricultural point of view. A more careful intention is required in the interpretation of cultural properties of ancient Korean empires that seem to have been formed due to mutual interactions of pastoral nomadic and agricultural cultures. Also, it is required that the conventional recognition chain of 'reverse-genes' be severed, which has placed more weight on agricultural properties than pastoral nomadic ones, since their settlement on agricultural farms was made after the establishment of their ancient pastoral nomadic empires. There is no reason at all to place priority on stoneware, earthenware, bronze ware, and iron ware than on wooden ware(木器) and other ware which were made of animal skins(皮器), bones and horns(骨角器), in analyzing the history in the regions of reindeer or sheep pastures. Reading ancient Korean history from the perspective of pastoral nomadic history, one feels strongly the instinctive emotions to return to the natural 'mother place'. The reindeer-herding pastoral nomadic identity of the Koguryo people that has been accumulated in volumes in their genes and hidden deep inside and have interacted organically could be reborn with Burqanism(Burqan refers to 不咸 in Chinese), which was their religion by birth and symbolized as the red willow(紅柳=不咸). The mother place of the Koguryo's people is the endless vast green pastures of North Eurasia and North America, where we anticipated the development of Korean livestock farming following the inherent properties in the genes of the reindeer-herding pastoral nomads with Korean ancestors. We anticipate that the place would be the core resource that could contribute to the development of life of living creatures following the inherent properties of their genes and biotechnological factors. In other words, biotechnology used for a search for clues on the well-being of humans could be the fruit brought by Burqanism of the Koguryo people and the fruit of the globalization of Korean livestock farming. It is the Chosun farmer in China come from the vast nomadic reindeer pastures of North Eurasia that resolved the food problem of a billion Chinese people with lowland paddy rice seeds (水稻) by transforming Heilongjiang Province(黑龍江省) into an oceanic lowland paddy rice field(水田). Even Mao Tse-tung(毛擇東) could not resolve the food problem by his revolution campaigns for tens of years. Today is the very time that requires the development of special livestock farming following the inherent properties of the ancient Korean reindeer-herding pastoral nomads that respected the dignity of life on the cold and dry plateau of North Eurasia and the America continent. I suggest that research should be started from the pastures of the Dariganga Steppe in East Mongolia that was the homeland of Hanwoo(韓牛) and the central horse-herding steppe place(牧馬場) of Chingis Khan's Mongolia. The Dariganga Steppe is awash with an affluent natural environment for pastoral nomadic living however, the quality of life of the pastoral nomads there is still low. I suggest we Koreans, the descendents of the Koguryo, should take our first steps for our livestock farming business project and develop the Northern nomadic pastures, here at the pastures of the Dariganga Steppe, which is the Mongolian core place of state-of-the-art technology for military weapons.