• 제목/요약/키워드: Medical System

검색결과 12,295건 처리시간 0.05초

A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities

  • Ah Young Park;Myoungae Kwon;Ok Hee Woo;Kyu Ran Cho;Eun Kyung Park;Sang Hoon Cha;Sung Eun Song;Ju-Han Lee;JaeHyung Cha;Gil Soo Son;Bo Kyoung Seo
    • Korean Journal of Radiology
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    • 제20권5호
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    • pp.759-772
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    • 2019
  • Objective: To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD). Materials and Methods: Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed. Results: Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05). Conclusion: US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.

A novel method for determining dose distribution on panoramic reconstruction computed tomography images from radiotherapy computed tomography

  • Hiroyuki Okamoto;Madoka Sakuramachi;Wakako Yatsuoka;Takao Ueno;Kouji Katsura;Naoya Murakami;Satoshi Nakamura;Kotaro Iijima;Takahito Chiba;Hiroki Nakayama;Yasunori Shuto;Yuki Takano;Yuta Kobayashi;Hironori Kishida;Yuka Urago;Masato Nishitani;Shuka Nishina;Koushin Arai;Hiroshi Igaki
    • Imaging Science in Dentistry
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    • 제54권2호
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    • pp.129-137
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    • 2024
  • Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion: The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

중심성 교뇌수초용해 환자의 치료 경과에 따른 보행 기능의 정량적 평가 (Case Report: Quantitative Evaluation of Gait Function Following Treatment Progression in a Patient with Central Pontine Myelinolysis)

  • 지상호;강선이;김지우;소영조;이상관;김철현
    • 대한한방내과학회지
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    • 제45권2호
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    • pp.190-198
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    • 2024
  • Introduction: Central pontine myelinolysis (CPM) is a rare neurological disorder marked by symmetric nerve fiber damage, commonly following rapid hyponatremia correction, with no established treatment and a poor prognosis. The condition, often linked to alcoholism, malnutrition, and various diseases, lacks comprehensive studies on its impact on gait. This research aims to quantitatively analyze gait changes in CPM patients receiving both traditional Korean and conventional rehabilitation treatments, addressing a gap in current understanding of CPM management. Case presentation: A 56-year-old male diagnosed with CPM following an initial misdiagnosis underwent combined electoracupuncture and rehabilitative treatment at ○○ university Korean medical center, resulting in significant gait improvements. A treadmill gait analysis system was used to measure changes in key gait parameters at 2-week intervals, and the patient's progress was documented. Conclusions: The quantitative analysis revealed significant gait improvements. Foot rotation decreased from 8.9° to 6.4° (right) and from 11.1° to 7.2° (left); lateral symmetry improved from -7.8 to 0.8; step length increased from 21 cm to 44 cm (right) and from 19 cm to 44 cm (left); and velocity increased from 1.2 m/s to 2.7 m/s. These findings highlight decreased foot rotation and lateral symmetry, along with increased step length and velocity, suggesting a positive outcome of the treatment regimen. Notably, the patient experienced no adverse effects related to the treatments. Despite limitations, including the singe case focus and lack of prior gait-focused CPM research, this case report provides valuable insights into effective CPM management strategies, paving the way for future research in this domain.

Human Recombinant Apyrase Therapy Protects Against Myocardial Ischemia/Reperfusion Injury and Preserves Left Ventricular Systolic Function in Rats, as Evaluated by 7T Cardiovascular Magnetic Resonance Imaging

  • Ziqian Xu;Wei Chen;Ruzhi Zhang;Lei Wang;Ridong Chen;Jie Zheng;Fabao Gao
    • Korean Journal of Radiology
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    • 제21권6호
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    • pp.647-659
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    • 2020
  • Objective: The occurrence of intramyocardial hemorrhage (IMH) and microvascular obstruction (MVO) in myocardial infarction (MI), known as severe ischemia/reperfusion injury (IRI), has been associated with adverse remodeling. APT102, a soluble human recombinant ecto-nucleoside triphosphate diphosphohydrolase-1, can hydrolyze extracellular nucleotides to attenuate their prothrombotic and proinflammatory effects. The purpose of this study was to temporally evaluate the therapeutic effect of APT102 on IRI in rats and to elucidate the evolution of IRI in the acute stage using cardiovascular magnetic resonance imaging (CMRI). Materials and Methods: Fifty-four rats with MI, induced by ligation of the origin of the left anterior descending coronary artery for 60 minutes, were randomly divided into the APT102 (n = 27) or control (n = 27) group. Intravenous infusion of APT102 (0.3 mg/kg) or placebo was administered 15 minutes before reperfusion, and then 24 hours, 48 hours, 72 hours, and on day 4 after reperfusion. CMRI was performed at 24 hours, 48 hours, 72 hours, and on day 5 post-reperfusion using a 7T system and the hearts were collected for histopathological examination. Cardiac function was quantified using cine imaging and IMH/edema using T2 mapping, and infarct/MVO using late gadolinium enhancement. Results: The extent of infarction (p < 0.001), edema (p < 0.001), IMH (p = 0.013), and MVO (p = 0.049) was less severe in the APT102 group than in the control group. IMH size at 48 hours was significantly greater than that at 24 hours, 72 hours, and 5 days after reperfusion (all p < 0.001). The left ventricular ejection fraction (LVEF) was significantly greater in the APT102 group than in the control group (p = 0.006). There was a negative correlation between LVEF and IMH (r = -0.294, p = 0.010) and a positive correlation between IMH and MVO (r = 0.392, p < 0.001). Conclusion: APT102 can significantly alleviate damage to the ischemic myocardium and microvasculature. IMH size peaked at 48 hours post reperfusion and IMH is a downstream consequence of MVO. IMH may be a potential therapeutic target to prevent adverse remodeling in MI.

임신 중 벨 마비 한방치료에 대한 국내외 증례 연구 고찰 (A Review of Clinical Research Trends on Korean Medicine Treatment for Bell's Palsy during Pregnancy)

  • 김효정;안영태;현지수;최소연;김백준;이윤재
    • 대한한방부인과학회지
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    • 제37권3호
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    • pp.1-19
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    • 2024
  • Objectives: The purpose of this study is to analysis the clinical study trends on Korean Medicine treatment for Bell's palsy during pregnancy. Methods: Key words such as 'facial palsy', 'Bell's palsy, 'Korean medicine', 'herbal medicine', 'acupuncture', 'pregnancy' were searched through the 'RISS', 'OASIS', 'KISS', 'PubMed' and 'CNKI' databases. Results: Ten clinical studies with 107 patients were selected, and 1 randomized controlled trial and 9 case reports were included as the target studies. In the 9 case reports, the gestational age at the onset of facial palsy was most common in the third trimester (29-42 weeks) in 38 cases (56.7%). The most commonly used Korean medicine interventions were acupuncture, with the most frequently used acupoints being ST4, ST2, ST6, BL2, TE23, LI20, GB1, GB14, SI18, and CV24. The herbal medicine treatment most commonly utilized was Geumgwedanggwi-san (金匱當歸散), which is related to the principles of clearing heat, nourishing blood, and stabilizing the fetus (淸熱養血安胎). Among the 65 participants evaluated using the House-Brackmann facial nerve grading system, 81.5% showed complete recovery to grade 1, while 6% remained at grade 4 with no effect, indicating the efficacy of Korean medicine treatment for facial palsy during pregnancy. All the selected studies reported no abnormalities in the mothers or fetal growth, and all participants who had the reported delivery had full-term childbirth. Conclusions: The effect on Korean Medicine treatment for Bell's palsy during pregnancy had mostly positive results. However, further large, well-designed clinical trials are needed to establish the foundation of Korean Medicine treatment for Bell's palsy during pregnancy.

Clinical outcomes of open Latarjet-Patte procedures performed for recurrent anterior shoulder instability with primary bone loss versus failed arthroscopic Bankart repair

  • Neil Gambhir;Aidan G. Papalia;Matthew G. Alben;Paul Romeo;Gabriel Larose;Soterios Gyftopoulos;Andrew S. Rokito;Mandeep S. Virk
    • Clinics in Shoulder and Elbow
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    • 제27권2호
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    • pp.176-182
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    • 2024
  • Background: This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). Methods: LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. Results: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). Conclusions: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss.

APPLICATION OF FUZZY SET THEORY IN SAFEGUARDS

  • Fattah, A.;Nishiwaki, Y.
    • 한국지능시스템학회:학술대회논문집
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    • 한국퍼지및지능시스템학회 1993년도 Fifth International Fuzzy Systems Association World Congress 93
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    • pp.1051-1054
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    • 1993
  • The International Atomic Energy Agency's Statute in Article III.A.5 allows it“to establish and administer safeguards designed to ensure that special fissionable and other materials, services, equipment, facilities and information made available by the Agency or at its request or under its supervision or control are not used in such a way as to further any military purpose; and to apply safeguards, at the request of the parties, to any bilateral or multilateral arrangement, or at the request of a State, to any of that State's activities in the field of atomic energy”. Safeguards are essentially a technical means of verifying the fulfilment of political obligations undertaken by States and given a legal force in international agreements relating to the peaceful uses of nuclear energy. The main political objectives are: to assure the international community that States are complying with their non-proliferation and other peaceful undertakings; and to deter (a) the diversion of afeguarded nuclear materials to the production of nuclear explosives or for military purposes and (b) the misuse of safeguarded facilities with the aim of producing unsafeguarded nuclear material. It is clear that no international safeguards system can physically prevent diversion. The IAEA safeguards system is basically a verification measure designed to provide assurance in those cases in which diversion has not occurred. Verification is accomplished by two basic means: material accountancy and containment and surveillance measures. Nuclear material accountancy is the fundamental IAEA safeguards mechanism, while containment and surveillance serve as important complementary measures. Material accountancy refers to a collection of measurements and other determinations which enable the State and the Agency to maintain a current picture of the location and movement of nuclear material into and out of material balance areas, i. e. areas where all material entering or leaving is measurab e. A containment measure is one that is designed by taking advantage of structural characteristics, such as containers, tanks or pipes, etc. To establish the physical integrity of an area or item by preventing the undetected movement of nuclear material or equipment. Such measures involve the application of tamper-indicating or surveillance devices. Surveillance refers to both human and instrumental observation aimed at indicating the movement of nuclear material. The verification process consists of three over-lapping elements: (a) Provision by the State of information such as - design information describing nuclear installations; - accounting reports listing nuclear material inventories, receipts and shipments; - documents amplifying and clarifying reports, as applicable; - notification of international transfers of nuclear material. (b) Collection by the IAEA of information through inspection activities such as - verification of design information - examination of records and repo ts - measurement of nuclear material - examination of containment and surveillance measures - follow-up activities in case of unusual findings. (c) Evaluation of the information provided by the State and of that collected by inspectors to determine the completeness, accuracy and validity of the information provided by the State and to resolve any anomalies and discrepancies. To design an effective verification system, one must identify possible ways and means by which nuclear material could be diverted from peaceful uses, including means to conceal such diversions. These theoretical ways and means, which have become known as diversion strategies, are used as one of the basic inputs for the development of safeguards procedures, equipment and instrumentation. For analysis of implementation strategy purposes, it is assumed that non-compliance cannot be excluded a priori and that consequently there is a low but non-zero probability that a diversion could be attempted in all safeguards ituations. An important element of diversion strategies is the identification of various possible diversion paths; the amount, type and location of nuclear material involved, the physical route and conversion of the material that may take place, rate of removal and concealment methods, as appropriate. With regard to the physical route and conversion of nuclear material the following main categories may be considered: - unreported removal of nuclear material from an installation or during transit - unreported introduction of nuclear material into an installation - unreported transfer of nuclear material from one material balance area to another - unreported production of nuclear material, e. g. enrichment of uranium or production of plutonium - undeclared uses of the material within the installation. With respect to the amount of nuclear material that might be diverted in a given time (the diversion rate), the continuum between the following two limiting cases is cons dered: - one significant quantity or more in a short time, often known as abrupt diversion; and - one significant quantity or more per year, for example, by accumulation of smaller amounts each time to add up to a significant quantity over a period of one year, often called protracted diversion. Concealment methods may include: - restriction of access of inspectors - falsification of records, reports and other material balance areas - replacement of nuclear material, e. g. use of dummy objects - falsification of measurements or of their evaluation - interference with IAEA installed equipment.As a result of diversion and its concealment or other actions, anomalies will occur. All reasonable diversion routes, scenarios/strategies and concealment methods have to be taken into account in designing safeguards implementation strategies so as to provide sufficient opportunities for the IAEA to observe such anomalies. The safeguards approach for each facility will make a different use of these procedures, equipment and instrumentation according to the various diversion strategies which could be applicable to that facility and according to the detection and inspection goals which are applied. Postulated pathways sets of scenarios comprise those elements of diversion strategies which might be carried out at a facility or across a State's fuel cycle with declared or undeclared activities. All such factors, however, contain a degree of fuzziness that need a human judgment to make the ultimate conclusion that all material is being used for peaceful purposes. Safeguards has been traditionally based on verification of declared material and facilities using material accountancy as a fundamental measure. The strength of material accountancy is based on the fact that it allows to detect any diversion independent of the diversion route taken. Material accountancy detects a diversion after it actually happened and thus is powerless to physically prevent it and can only deter by the risk of early detection any contemplation by State authorities to carry out a diversion. Recently the IAEA has been faced with new challenges. To deal with these, various measures are being reconsidered to strengthen the safeguards system such as enhanced assessment of the completeness of the State's initial declaration of nuclear material and installations under its jurisdiction enhanced monitoring and analysis of open information and analysis of open information that may indicate inconsistencies with the State's safeguards obligations. Precise information vital for such enhanced assessments and analyses is normally not available or, if available, difficult and expensive collection of information would be necessary. Above all, realistic appraisal of truth needs sound human judgment.

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임지의 축산적 이용에 관한 연구 제2보. 강원도의 새마을 "소" 임간공동방목사업의 문제점과 개선책 (Studies on the Utilization of Woodland for Livestock Farming II. Problem and Its Improvement Followed by the Join Cattle Grazing in king Won Do)

  • 맹원재;윤익석;유제창;정승헌
    • 한국초지조사료학회지
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    • 제3권2호
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    • pp.100-111
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    • 1983
  • 본(本) 연구(硏究)는 강원도(江原道) 새마을 '소' 임간공동방목사업(林間共同放牧事業)의 일환(一環)으로 81년도(年度)에 개설(開設)된 105개(個)의 공동방목장(共同放牧場)과 '82년도(年度)에 개설(開設)된 103개(個)의 공동방목장(共同放牧場)의 경영실태와 분석(分析)된 문제점(問題點) 그리고 개선방안(改善方案)에 관한 연구결과(硏究結果)를 요약(要約)하면 다음과 같다. 1. 공동방목(共同放牧) 사업(事業)의 효과 1) 방목기간중(放牧期間中) 1 일(日) 평균(平均) 증체량은 0.46kg으로서 농가(農家) 관행사육(慣行飼育)의 0.33kg보다 높았다. 2) '82년도(年度) 208개(個) 공동방목장(共同放牧場)의 방목기간(放牧期間)(5-10 월(月))중(中) 임간공동방목(林間共同放牧) 사업(事業)의 효과를 경제분석하면, 관행사육(慣行飼育)보다 293,075.,300원의 증체효과, 543,838,750원의 인건비(人件費) 절감효과 및 194,443,270원의 사료비(飼料費) 절감효과를 얻어 약(約) 1,031,357,320원의 소득효과를 가져왔다. 3) 208개(個) 공동방목장(共同放牧場)의 설문(設問) 조사(調査) 결과(結果), 농가(農家) 관행(慣行) 사육(飼育)보다 공동방목장(共同放牧場) 순위별(順位別) 효과에 대해서 농민들은 첫째 노동력(勞動力) 절감(節減). 둘째 사료비(飼料費) 절감(節減), 셋째 질병(疾病) 넷째 다두사육(多頭飼育) 가능(可能), 다섯째 협동심고취(協同心鼓吹), 여섯째 증체 효과, 일곱째 사양관리(飼養管理) 용역(容易), 여덟째 시설비(施設費) 절감(節減)을 들고 있다. 2. 공동방목(共同放牧) 사업(事業)의 문제점(問題點) 1) 임간공동방목(林間共同放牧) 2년차(年次)부터는 야생초(野生草)의 재생력(再生力)이 현저하게 저하(低下)되어 풀의 부족 현상이 일어난다. 2) 임간공동방목장(林間共同放牧場) 적지(適地)가 국유지(國有地)에 많으나 산림청(山林廳)의 이용(利用) 허가(許可)가 나지 않아 이용이 불가능하다. 3) 방목(放牧)으로 인(因)하여 발정(發精)한 암소를 발견하기 어려워서 수정시기(授精時期)를 놓치는 경우가 많다. 4) 각(各) 방목우(放牧牛)에 대한 방역(防疫) 및 진료(診療)의문제점이 많다. 3. 임간공동방목(林間共同放牧) 사업(事業)의 개선책(改善策) 1) 공동방목장(共同放牧場) 2년차(年次)부터는 겉뿌림초지(草地)나 제경초지(蹄耕草地)를 조성(造成)하여 충분한 조사료(粗飼料)를 확보(確保)시킬 것. 2) 정부(政府)는 강원도(江原道) 내(內) 모든 국유지(國有地)의 방목(放牧) 적지(適地)는 임간공동방목장(林間共同放牧場)으로 이용하여 우육(牛肉) 증산(增産), 독우(犢牛) 생산(生産) 지대(地帶)로 활용(活用)되도록 조치(措置)할 것. 3) 여지(與地)의 방목장(放牧場)에는 우수(優秀) 종빈우(種牝牛)를 혼목(混牧)시켜 번식성적(繁殖成績)을 올리도록 한 것. 그리고 발정(發情) 촉진(促進) 홀몬 주사(注射)로 동시(同時) 발정(發情)을 유도(誘導)해서 일괄 수정(授精)시킬 것. 4) 방목장(放牧場)에 토양병(土壤病)인 기종저의 예방(豫防) 주사(注射), 간질충에 대한 구충제의 년간(年間) 2회(回) 투여, 진드기 방제(防除)를 위하여 약욕(藥浴)을 시킬 것. 4. 임간공동방목장(林間共同放牧場) 육성(育成)을 위한 정책방향(政策方向) 1) 정부(政府)는 전국(全國)의 임야(林野)를 대상(對象)으로 임간공동방목장(林間共同放牧場) 적지(適地)를 조사(調査)할 것. 2) 정부(政府)는 임간공동방목장(林間共同放牧場) 적지(適地)로 판단되는 지역은 국공유림(國公有林)이나 법적(法的) 제한(制限) 지역(地域)도 목장(牧場) 개설(開設)이 가능하도록 조치할 것. 3) 정부(政府)는 여지(餘地)에 있는 공동방목장(共同放牧場) 적지(適地)에는 도로(道路) 개설(開設)과 전기목붕(電氣牧棚) 시설(施設)을 정부(政府) 자금(資金)으로 지원할 것. 4) 새마을 운동(運動)의 방향(方向)을 축산소득증대(畜産所得增大)에 두고 강원도(江原道)의 특성(特性)에 맞게 계속 임간공동방목(林間共同放牧) 사업(事業)이 추진(推進)될 수 있도록 정책적(政策的)인 배려가 필요하다. 5) 정부(政府)는 공동방목장(共同放牧場) 경영에 있어서 번식(繁殖) 성적(成績) 향상(向上)을 위한 인공수정상말비점(人工受精上末備点)을 보완(補完)해 줄 것. 6) 정부(政府)는 소 값의 적정(適定) 가격(價格) 수준(水準)을 유지(維持)하기 위한 가격(價格) 정책(政策)을 실시(實施)할 것. 7) 정부(政府)는 임간공동방목장(林間共同放牧場)에서 초지조성(草地造成)의 신청(申請)이 있을 때는 우선적으로 허가(許可)해 줄 것.

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대나무류(類)의 유관속초(維管束鞘)에 의(依)한 형태학적(形態學的) 연구(硏究) (A Morphological Study of Bamboos by Vascular Bundle Sheath)

  • 김재생
    • 한국산림과학회지
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    • 제25권1호
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    • pp.13-47
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    • 1975
  • 대나무류(類)는 열대방지(熱帶方地)에서 총생(叢生)하는 대형(大型)의 대나무가 많고, 온대(溫帶)가 되면 소형(小型)의 세류(笹類)로 퇴화(退化)하여, 그 종류(種類)는 세계(世界)에 50속(屬) 1,000여종(餘種)이나 있다고하여 그 종류수(種類數)는 대단(大端)히 많다. 이와 같은 대나무는 동양(東洋)에서는 건엽용(建葉用)과 공예용(工藝用)으로 이용(利用)되고있으며, 또한 죽순(竹筍)은 식용(食用)으로서 특유(特有)한 맛이있어 상용(賞用)되고있을 뿐만아니라 최근(最近)에는 세류(笹類)의 액즙(液汁)이 암(癌)에도 효과(効果)가 있다고 하여 중요(重要)한 산업(産業)으로서 발달(發達)하게되었다. 그리고 동남아(東南亞)에서는 삽목(揷木)으로서 용이(容易)하게 증산(增産)하여 pulp재(材)로 사용(使用)하게되여 대단(大端)히 중요시(重要視)하고있다. 이와같이 대나무는 인류생활(人類生活)에 필요부가결(必要不可決)한 목본식물(木本植物)이지만 아직까지 그 형태(形態)의 분류(分類)가 명확(明確)하게 되어 있지 않고 지연되여 있는 형편이다. 18세기(世紀) 중반기(中半期)의 Linne시대(時代)에 들어와서 생식기관(生殖器管)을 주체(主體)로 한 그 형태(形態)의 분류체계(分類體系)가 만들어진 이래(以來) 수정(修正)이 거듭되여온 바 있으나 대나무는 개화(開花)가 일정(一定)한 주기(周期)가 있어서 60-120년(年)의 기나긴 세월(歲月)이 소요(所要)되기 때문에 그의 형태적(形態的) 분류체계(分類體系)를 완성(完成)하는일은 극(極)히 어려운 일이었다. 오늘날까지 대나무에 관(關)한 많은 문헌(文獻)이 있기는 하나 그 시료(試料)가 적기때문에 불확실(不確實)한 기재(記載)도 많이있었고 속(屬)이 변경(變更)된것도 간혹(間或)있어서 그것을 공인(公認)할수 없는 것이 많이 있다. 그래서 내부(內部)의 형태적(形態的)인 분류(分類)에 관(關)하여는 근년(近年)에 이르러 중국(中國)의 Liese씨(氏)에 의(依)하여 겨우 시작(始作)이 되였으며, 또한 독일(獨逸)의 Grosser씨등(氏等)이 유관속(維管束)의 형태(形態)에 착안(着眼)하여 새로운 형태(形態)의 분류(分類)를 시도(試圖)한바있다. 그러나 이들의 이 형태(形態)에 관한 분류(分類)는 Holttum의 자방(子房)의 형태(形態)에 의(依)한 분류(分類)와 밀접(密接)한 관계(關係)가 있는것 뿐이었다. 따라서 필자(筆者)는 유관속초(維管束鞘)의 형태(形態)에 의(依)해 자유중국산(自由中國産)의 대나무 11속(屬) 26종류(種類)를 재료(材料)로하여 대나무의 형태(形態)에 관(關)한 분류체계(分類體系)에 대(對)하여 재고(再考)를 시도(試圖)하여 보았다. 그 결과(結果) Grosser씨(氏) 등(等)의 형태(形態)의 분류(分類)와 일부(一部)는 일치(一致)하였으나, Bambusa와 Dendrocalamus는 분류(分類)하기가 곤란(困難)하였던 것을 고립유관속초(孤立維管束鞘)의 존부(存否)로서 명확(明確)히 구별(區別)할수있었고 또한 종류(種類)가 많은 Bambusa를 2개(個)의 형(型)으로 나눌수가 있었다. 따라서 이 결과(結果)는 앞으로 아속(亞屬)이나 혹(或)은 절(節)로서의 분류(分類)로서 고려(考慮)되여야 할 문제(問題)라고 생각한다. 왜냐하면 이 근거(根據)는, 죽간(竹稈)의 최외층(最外層)에서 최내층(最內層)으로 향(向)하여 변화(變化)하고있는 형태(形態)에 착안(着眼)하여, 그 분화적(分化的)인 면(面)을 관찰(觀察)하였기 때문이다. 이 형태적(形態的)인 분화(分化)에 관(關)한 관찰(觀察)은 형태분류(形態分類)의 철칙(鐵則)인 "간단(簡單)한 것에서 복잡(複雜)한 것으로 진화(進化)한다"라고하는 철칙(鐵則)에 있어서도 충분(充分)히 조사(調査)하여 보았는데, 그 결과(結果)는 생식기관(生殖器官)의 형태적분류(形態的分類)와 대조(對照)하여 결정(決定)되어야 할 것이며, 금후(今後)의 문제(問題)로서 계속연구(繼續硏究)할까 생각한다.

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중환자의 욕창 예방 연구 : 욕창 예방 QI팀을 중심으로 (CQI Action Team Approach to Prevent Pressure Sores in Intensive Care Unit of an Acute Hospital Korea)

  • 강소영;최은경;김진주;주미정
    • 한국의료질향상학회지
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    • 제4권1호
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    • pp.50-63
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    • 1997
  • Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

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