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Does a Blepharospasm mean the Presymptom of Stroke? (안검경련(眼瞼痙攣)을 중풍 전조증상이라 할 수 있는가?)

  • Jung, Ki-yong;Go, Ho-yeon;Jeong, Seung-min;Hsia, Yu-chun;Jew, Jae-hong;Jung, Hee;Choi, You-kyung;Kim, Dong-woo;Han, Chang-ho;Ko, Seung-gyu;Cho, Ki-ho;Park, Jong-hyung;Jun, Chan-yong
    • The Journal of the Society of Stroke on Korean Medicine
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    • v.7 no.1
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    • pp.46-53
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    • 2006
  • Objectives : The purposes of this study were to investigate that a blepharospasm means the presymptom of stroke based on the traditional hypothesis in the oriental medicine and to compare a blepharospasm with warning signs of stroke in the western medicine. Methods : In the time period Oct. 2005 to Oct. 2006, 409 patients with a first-ever stroke admitted in the department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital, Kyunghee University Oriental Medical Hospital, Dongguk Il-san Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. Stroke patients were interviewed by residents who studied standard operation procedures in Fundamental Study for Standardization and Objectification of Differentiation and Pattern Identification of Syndrome of Oriental Medicine for Stroke. A questionnaire was completed by a question-and-answer form between patients and residents after explanation details to patients and the agreement of patients. Results : Age, care of patients or grandson, diabetes mellitus, and smoking were higher among cerebral infarction group, while smoking was higher among hemorrhage group. Female, young age, hyperlipidemia, hypertension in the family history and fat body in waist-hip ratio were higher among patients undergoing the blepharospasm before stroke onset. And the incidence of blepharospasm was lower in patients who dislike the fast food. Finally, when we compared a blepharospasm with warning signs of stroke in the western medicine, the incidence of blepharospasm in this study were the most frequent. Conclusion : In this study, the incidence of blepharospasm in patients before stroke onset was more frequent than that of warning signs in the western medicine. But more data from prospective cohort studies should be collected to be accepted that the blepharospasm is the presymptom of stroke as like warning signs in the western medicine.

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A Study on Influence of Foodservice Managers' Emotional Intelligence on Job Attitude and Organizational Performance (급식관리자의 개인적 감성지능이 직무태도 및 조직성과에 미치는 영향)

  • Jung, Hyun-Young;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.12
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    • pp.1880-1892
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    • 2010
  • The purposes of this study were to: a) provide evidence concerning the effects of emotional intelligence on job outcomes, b) examine the impacts of emotional intelligence on employee-related variables such as 'job satisfaction', 'organizational commitment', 'organizational performance', and 'turnover intention' c) identify the conceptual framework underlying emotional intelligence. A survey was conducted to collect data from foodservice managers (N=231). Statistical analyses were completed using SPSS Win (16.0) for descriptive analysis, reliability analysis, factor analysis, t-test, correlation analysis, cluster analysis and AMOS (16.0) for confirmatory factor analysis and structural equation modeling. The concept of emotional intelligence (EI) has been on the radar screens of many leaders and managers over the last several decades. The emotional intelligence is generally accepted to be a combination of emotional and interpersonal competencies that influence behavior, thinking and interaction with others. The main results of this study were as follows. The four EI (Emotional Intelligence) dimensions correlated significantly with age. The means of job satisfaction score were above the midpoint (3.04 point) scale. The organizational commitment score was above the midpoint (3.41 point) scale and was higher at 'loyalty' factor than 'commitment' factor. The means of organizational performance score were above the midpoint (3.34) scale. The correlations among the four EI (emotional intelligence) factors were significant with job satisfaction; organizational commitment, organizational performance and turnover intention. The test of hypothesis using structural equation modeling found that emotional intelligence produced positive effects on job attitude and job performance. Emotional intelligence enhanced organizational commitment, and in turn, managers' attitude produced positive effects on organizational performance; emotional intelligence also had a direct impact on organizational performance. This study has identified the effect of emotional intelligence on organizational performance and attitudes toward one's job.

The changes of economic though (The trial of supply-side economics) (경제사상의 변화 (공급측면 경제학의 시험))

  • 서홍석
    • Journal of Applied Tourism Food and Beverage Management and Research
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    • v.8
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    • pp.89-121
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    • 1997
  • Many of the measures and policies advocated by supply-siders, such as lower taxation, less government intervention, more freedom from restrictive legislation and regulation, and the need for increased productivity can be found in writing the classical economist. Nor is supply-side economics a complete divorcement from Keynesian analysis. In both camps the objectives are the same-high level employment, stable prices and healthy economic growth, the means or suggestions for attaining the objectives, however, differ. Consequently, recommended economic policies and measures are different. keynesians rely primarily on the manipulation of effective demand to increase output and employment and to combat inflation. They assume ample resources to be available in order that supply will respond to demand. The supply-siders emphasize the need to increase savings, investment, productivity and output as a means of increasing income. Supply-siders assume that the increase in income will lead to an increase in effective demand. Keynesians suggest that savings, particularly those not invested, dampen economic activity. Supply-siders hold that savings, or at least an increase in after-tax income, stimulates work effort and provides funds for investment. Perhaps keynesians are guilty of assuming that most savings are not going to be invested, whereas supply-siders may erroneously assume that almost all savings will flow into investment and/ or stimulate work effort. In reality, a middle ground is possible. The supply-siders stress the need to increase supply, but Keynes did not preclude the possibility of increasing economic activity by working through the supply side. According to Keynes' aggregate demand-aggregate supply framework, a decrease in supply will increase output and employment. It must be remembered, however, that Keynes' aggregate supply is really a price. Lowering the price or cost of supply would there by result in higher profit and/ or higher output. This coincides with the viewpoint of supply-siders who want to lower the cost of production via various means for the purpose of increasing supply. Then, too, some of the means, such as tax cuts, tax credits and accelerated depreciation, recommended by suply-siders to increase productivity and output would be favored by Keynesians also as a means of increasing investment, curbing costs, and increasing effective demand. In fact, these very measures were used in the early 1960s in the United State during the years when nagging unemployment was plaguing the economy. Keynesians disagree with the supply-siders' proposals to reduce transfer payments and slow down the process of income redistribution, except in full employment inflationary periods. Keynesians likewise disagree with tax measures that favored business as opposed to individuals and the notion of shifting the base of personal taxation away from income and toward spending. A frequent criticism levied at supply-side economics is that it lacks adequate models and thus far has not been quantified to any great extent. But, it should be remembered that Keynesian economics originally was lacking in models and based on a number of unproved assumptions, such as, the stability of the consumption function with its declining marginal propensity to consume. Just as the economic catastrophe of the great depression of the 1930s paved the way for the application of Keynesian or demand-side policies, perhaps the frustrating and restless conditions of the 1970s and 1980s is an open invitation for the application of supply-side policies. If so, the 1980s and 1990s may prove to be the testing era for the supply-side theories. By the end of 1990s we should have better supply-side models and know much more about the effectiveness of supply-side policies. By that time, also, supply-side thinking may be more crystallized and we will learn whether it is something temporary that will fade away, be widely accepted as the new economics replacing Keynesian demand analysis, or something to be continued but melded or fused with demand management.

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Changes in Quality Characteristics of Venison Jerky Manufactured under Different Dry Time during Storage (건조시간을 달리하여 제조한 사슴고기 육포의 저장 중 품질 특성 변화)

  • Kim Il-Suk;Jin Sang-Keun;Park Ki-Hoon;Kim Dong-Hoon;Hah Kyung-Hee;Park Seok-Tae;Kwuak Kyung-Rak;Park Jung-Kwon;Kang Yang-Su
    • Food Science of Animal Resources
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    • v.26 no.2
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    • pp.166-174
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    • 2006
  • To determine the proper processing and storage conditions, physico-chemical, microbial and sensory properties of venison jerky under different dry times were measured during storage at $30^{\circ}C$ for 28 days. Samples were dried for 3 hr (T1), 4 hr (T2) and 5 hr (T3) at $75^{\circ}C$ in the smoke chamber, respectively. The pH of T1 was slightly lower than those of T2 and T3 as storage time increased. As dry and storage time increased, TBARS of T2 and T3 were significantly higher (p<0.05) than that of T1. In meat color, $L^*$ values of T3 showed slightly higher than those of T1 and T2, while at values were not clearly tendency by the passage of storage time. $b^*$ values of T2 and T3 were higher than that of T1. The water activity were significantly lower (p<0.05) in ,the order of T3$log_{10}$ CFU/g until 28 days and its number were accepted by sensory evaluation. In conclusions, T2 and T3 showed slightly high overall acceptability and lipid oxidative stability compared to T1 conditions. These results indicated that longer dry time ($4{\sim}5 hr$) of venison jerky would be better characteristics as compared to shorter dry time (3 hr) with increased storage time at $30^{\circ}C$.

A Study on the Countermeasures Taken By the Korean Healthcare and Life Sciences Industry Regarding U.S. Import Refusals: Focus on the Analysis of FDA Violation Codes (한국 바이오헬스 산업의 미국 수입거부 대응 방안 연구 : FDA 위반코드 분석을 중심으로)

  • Yu-Han Lee;Hag-Min Kim
    • Korea Trade Review
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    • v.48 no.3
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    • pp.131-150
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    • 2023
  • The purpose of this study was to find a countermeasure to the U.S. import refusals for the Korean healthcare and life sciences industry. To this end, an analysis of trends during the pandemic was conducted using the KITA Border Rejection Database, which includes information on items and types of import refusals. The reason for rejection was also analyzed according to the FDA violation codes. The degree of countermeasure for import refusals was identified by measuring the unit rejection rate (URR). The results of the analysis showed that the major U.S. import refusals for the Korean healthcare and life sciences industry had expanded from contact lenses to COVID-19 diagnostic kits and drugs after the pandemic broke out. The major reasons for import refusals were non-compliance with the Predicate Device and Drugs Act and non-approval by the FDA for products and facilities. On the other hand, the unit rejection rate (URR) of major items in the Korean healthcare and life sciences industry was measured higher than the industry average. The results therefore showed a low level of response to U.S. import refusals. The results of the analysis of reasons for import refusals by item according to FDA violation codes were as follows. First of all, the main violation for contact lenses and COVID-19 diagnostic kits corresponded to misbranding. This was often due to the fact that Korean companies did not provide the relevant notices and information required by the FDA. Many cases also failed to demonstrate a substantial equivalency compared to predicate devices already on the market. On the other hand, applications for new unapproved drugs were not accepted as they had yet to pass relevant regulations that would prove their safety and efficacy. In conclusion, import refusals for the Korean healthcare and life sciences industry were found to be closely related to technical barriers to trade (TBT).

The Literatual Study on the Wea symptom in the View of Western and Oriental Medicine (위증에 대한 동서의학적(東西醫學的) 고찰(考察))

  • Kim, Yong Seong;Kim, Chul Jung
    • Journal of Haehwa Medicine
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    • v.8 no.2
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    • pp.211-243
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    • 2000
  • This study was performed to investigate the cause, symptom, treatment, medicine of Wei symptom through the literature of oriental and western medicine. The results obtained were as follows: 1. Wei symptom is the symptom that reveals muscle relaxation without contraction and muscle relaxation occures in the lower limb or upper limb, in severe case, leads to death. 2. Since the pathology and etiology of Wei symptom was first described as "pe-yeol-yeop-cho"(肺熱葉焦) in Hung Ti Nei Ching(黃帝內經), for generations most doctors had have accepted it. but after Dan Ge(丹溪), it had been classified into seven causes, damp-heat(濕熱), phlegm-damp(濕痰), deficiency of qi(氣虛), deficiency of blood(血虛), deficiency of yin(陰處), stagnant blood(死血), stagnant food(食積). Chang Gyeng Ag(張景岳) added the cause of deficiency of source qi(元氣). 3. The concept of "To treat Yangming, most of all"(獨治陽明) was emphasized in the treatment of Wei symptom and contains nourishment of middle warmer energy(補益中氣), clearance of yangming-damp-heat(淸化陽明濕熱). 4. Since Nei-ching era(內經時代), Wei and Bi symptom(痺症) is differenciated according to the existence of pain. After Ming era(明代) appeared theory of co-existence of Wei symptom and pain or numbness but they were accepted as a sign of Wei symptom caused by the pathological factor phelgm(痰), damp(濕), stagnancy(瘀). 5. In the western medical point of view, Wei symptom is like paraplegia, or tetraplegia. and according to the causative disease, it is accompanied by dysesthesia, paresthsia, pain. thus it is more recommended to use hwal-hyel-hwa-ae(活血化瘀) method considering damp-heat(濕熱), qi deficiency of spleen and stornach(脾胃氣虛) as pathological basis than to simply differenciate Wei and Bi symptom according to the existence of pain. 6. The cause of Gullian-Barre syndrome(GBS) is consist of two factors, internal and external. Internal factors include asthenia of spleen and stomach, and of liver and kidney. External factors include summur-damp(暑濕), damp-heat(濕熱), cold-damp(寒濕) and on the basis of "classification and treatment according to the symptom of Zang-Fu"(臟腑辨證論治), the cause of GBS is classified into injury of body fluid by lung heat(肺熱傷津), infiltration of damp-heat(濕熱浸淫), asthenia of spleen and kidney(脾腎兩虛), asthenia of spleen and stomach(脾胃虛弱), asthenia of liver and kidney (肝腎兩虛). 7. The cause of GBS is divided by according to the disease developing stage: Early stage include dryness-heat(燥熱), damp(濕邪), phlegm(痰濁), stagnant blood(瘀血), and major treatment is reducing of excess(瀉實). Late stage include deficiency of essence(精虛), deficiency with excess(虛中挾實), and essencial deficiency of liver and kidney(肝腎精不足) is major point of treatment. 8. Following is the herbal medicine of GBS according to the stage. In case of summur-damp(暑濕), chung-seu-iki-tang(淸暑益氣湯) is used which helps cooling and drainage of summer-damp(淸利暑濕), reinforcement of qi and passage of collateral channels(補氣通絡). In case of damp-heat, used kun-bo-hwan(健步丸), In case of cool-damp(寒濕), used 'Mahwang-buja-sesin-tang with sam-chul-tang'(麻黃附子細辛湯合蓼朮湯). In case of asthenia of spleen and kidney, used 'Sam-lyeng-baik-chul san'(蔘笭白朮散), In case of asthenia of liver and kidney, used 'Hojam-hwan'(虎潛丸). 9. Following is the herbal medicine of GBS according to the "classification and treatment according to the symptom of Zang-Fu"(臟腑辨證論治). In the case of injury of body fluid by lung heat(肺熱傷津), 'Chung-jo-gu-pae-tang'(淸燥救肺湯) is used. In case of 'infiltration of damp-heat'(濕熱浸淫), us-ed 'Yi-myo-hwan'(二妙丸), In case of 'infiltration of cool-damp'(寒濕浸淫), us-ed 'Yui-lyung-tang', In case of asthenia of spleen, used 'Sam-lyung-bak-chul-san'. In case of yin-deficiency of liver and kidney(肝腎陰虛), used 'Ji-bak-ji-hwang-hwan'(知柏地黃丸), or 'Ho-jam-hwan'(虎潛丸). 10. Cervical spondylosis with myelopathy is occuered by compression or ischemia of spinal cord. 11. The cause of cervical spondylosis with myelopathy consist of 'flow disturbance of the channel points of tai-yang'(太陽經兪不利), 'stagnancy of cool-damp'(寒濕凝聚), 'congestion of phlegm-damp stagnant substances'(痰濕膠阻), 'impairment of liver and kidney'(肝腎虛損). 12. In treatment of cervical spondylosis with myelopathy, are used 'Ge-ji-ga-gal-geun-tang-gagam'(桂枝加葛根湯加減), 'So-hwal-lack-dan-hap-do-hong-eum-gagam(小活絡丹合桃紅飮加減), 'Sin-tong-chuck-ue-tang-gagam(身痛逐瘀湯加減), 'Do-dam-tang-hap-sa-mul-tang-gagam'(導痰湯合四物湯加減), 'Ik-sin-yang-hyel-guen-bo-tang'(益腎養血健步湯加減), 'Nok-gakyo-hwan-gagam'(鹿角膠丸加減). 13. The cause of muscle dystropy is related with 'the impairement of vital qi'(元氣損傷), and 'impairement of five Zang organ'(五臟敗傷). Symptoms and signs are classified into asthenia of spleen and stomach, deficiency with excess, 'deficiency of liver and kidney'(肝腎不足) infiltration of damp-heat, 'deficiency of qi and blood'(氣血兩虛), 'yang deficiency of spleen and kidney'(脾腎陽虛). 14. 'Bo-jung-ik-gi-tang'(補中益氣湯), 'Gum-gang-hwan'(金剛丸), 'Yi-gong-san-hap-sam-myo-hwan'(異功散合三妙丸), 'Ja-hyel-yang-gun-tang'(滋血養筋湯), 'Ho-jam-hwan'(虎潛丸) are used for muscle dystropy. 15. The causes of myasthenia gravis are classified into 'insufficiency of middle warmer energy'(中氣不足), 'deficiency of qi and yin of spleen and kidney'(脾腎兩處), 'asthenia of qi of spleen'(脾氣虛弱), 'deficiency of qi and blood'(氣血兩虛), 'yang deficiency of spleen and kidney'(脾腎陽虛). 16. 'Bo-jung-ik-gi-tang-gagam'(補中益氣湯加減), 'Sa-gun-ja-tang-hap-gi-guk-yang-hyel-tang'(四君子湯合杞菊地黃湯), 'Sa-gun-ja-tang-hap-u-gyi-eum-gagam'(四君子湯合右歸飮加減), 'Pal-jin-tang'(八珍湯), 'U-gyi-eum'(右歸飮) are used for myasthenia gravis.

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Study on Tiangui(天癸)Focusing on the ${\ulcorner}$Neijing${\lrcorner}$(內經) commentators' views (천계(天癸)에 대한 연구 -내경(內經) 주석가(注釋家)들의 견해(見解)를 중심으로-)

  • Lee, Yong-Beom;Heo, Gi-Hoe
    • Journal of Korean Medical classics
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    • v.13 no.2 s.17
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    • pp.174-188
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    • 2000
  • The meaning of Tiangui(天癸) in $Suwen{\cdot}Shanggutianzhenlun\;素問{\cdot}上古天眞論$ is very important because it has the cause of 'having a child' and it shows the signs to being healthy. But until now there have been many arguments about what the correct meaning of Tiangui is. The most important thing in these arguments is to compare and analyze Neijing(內經) commentators' views, and to understand differences between their views. So I compared and analyzed by focusing on Neijing(內經) text, the other books with explanatory notes, and other commentators' views, and, after that. I got the following results. 1. On the meaning of Tian(天), Wangbing(王氷) and Mashi(馬蒔) considered that it is inborn. Zhangjiecong(張志聽) considered it as the Yang(陽) producing Yin(陰) Zhangjiebin(張介賓) regarded it as the Yang(陽) of Gua symbol. On the meaning of the Gui(癸). Zhangjiebin(張介賓) said that it is Yin qi(陰氣) which is the prior step to Xing(形). Mashi(馬蒔) and Zhangzhicong(張志聽) said that it is spirit or Jingxue(spiritual sanguine) which is the concrete constituents in our body. 2. On the relation bet ween Tian(天) and Gui(癸), Mashi(馬蒔) and Zhangzhicong(張志聽) said that Gui(癸) is made from Tian(天), and Zhangjiebin(張介賓) said that Tian is intrinsic in Gui(癸). 3. On the relation between Tiangui(天癸) and Jingxue(精血), Yangshangshan(楊上善). Wangbing(王氷), and Zhangjiebin(張介賓) regarded Tiangui(天癸) as a concrete matter which is the prior step to becoming Jingxue(精血). Mashi(馬蒔) and Zhangjiecong(張志聽) considered Tiangui(天癸) as a concrete matter. Mashi(馬蒔) considered Tiangui(天癸) as Jing(精)which is directly related to pregnancy. Zhangjiecong(張志聽) regarded Tiangui(天癸) as Jingxue(精血) which controls general physiology of men and women. 4. On the function of Tiangui(天癸), Yangshangshan(楊上善) and Wangbing(王氷) considered that Tiangui (天癸) has relation to menstruation. pregnancy. and, production and extinction of Jing(精). Zhangjiecong(張志聽) argued that Tiangui(天癸) strengthens and warms muscle and derma. and controls differential physiology between men and women, and said that the maintenance of its activity is based on the acquired spirit of food. A book of 『Huangti Neijing Yanjiu Dacheng(黃帝內經硏究大成)』 said that the function of Tiangui(天癸) is to promote generation, to develop the second sexual symbol, and to make growing and aging in body. It also said that Tiangui(天癸) has some relation to kidney and other organs, Chong Meridian, Ren Meridian, Du Meridian, and Dai Meridian. 5. Other commentators of 『Neijing(內經)』 accepted the meaning of Tiangui(天癸) as the prior step of both man's spiritual overflowing and woman's menstruation. 6. On the relation between Tiangui(天癸). and, Cheng and Ren Meridians, Yangshangshan(楊上善) and Zhangjiecong(張志聽) said that Tiangui(天癸) has direct relation with two meridians. Wangbing(王氷) said that Tiangui(天癸) and two meridians have no direct relation. Now I compared commentaors' views of Tiangui(天癸) and studied the differences between their views. I concluded that on the concept of Tiangui(天癸), Zhangjiebin(張介賓)'s explanations express well its connotative meaning. And on the function of Tiangui (天癸), Zhangjiecong(張志聽)'s explanations are excellent because he organized well his seniors' views, and extended its meaning by showing Neijing(內經)'s phrases related to Chong and Ren Meridians. Also, Mashi(馬蒔) suggested that if Tiangui(天癸) comes earlier than normal. people will die soon. But I think that more studies on male and female bodies are needed as to Mashi(馬蒔)'s argument.

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A Comparison of Segmental Gastrectomy and Distal Gastrectomy with Billroth I Reconstruction for Early Gastric Cancer That's Developed on the Gastric Body (위체부에 발생한 조기위암에서 위구획절제술과 Billroth I 재건술식의 비교)

  • Song, Min-Sang;Lee, Sang-Il;Sul, Ji-Young;Noh, Seung-Moo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.207-214
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    • 2009
  • Purpose: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. Materials and Methods: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. Results: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. Conclusion: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.

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CHANGES IN WATER USE AND MANAGEMENT OVER TIME AND SIGNIFICANCE FOR AUSTRALIA AND SOUTH-EAST ASIA

  • Knight, Michael J.
    • Proceedings of the Korean Society of Soil and Groundwater Environment Conference
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    • 1997.11a
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    • pp.3-31
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    • 1997
  • Water has always played a significant role in the lives of people. In urbanised Rome, with its million people. sophisticated supply systems developed and then fled with the empire. only to be rediscovered later But it was the industrial Revolution commencing in the eighteenth century that ushered in major paradigm shifts In use and altitudes towards water. Rapid and concentrated urbanisation brought problems of expanded demands for drinking supplies, waste management and disease. The strategy of using water from local streams, springs and village wells collapsed under the onslaughts of rising urban demands and pollution due to poor waste disposal practices. Expanding travel (railways. and steamships) aided the spread of disease. In England. public health crises peaks, related to water-borne typhoid and the three major cholera outbreaks occurred in the late eighteenth and early nineteenth century respectively. Technological, engineering and institutional responses were successful in solving the public health problem. it is generally accepted that the putting of water into pipe networks both for a clean drinking supply, as well as using it as a transport medium for removal of human and other wastes, played a significant role in towering death rates due to waterborne diseases such as cholera and typhoid towards the end of the nineteenth century. Today, similar principles apply. A recent World Bank report Indicates that there can be upto 76% reduction in illness when major water and sanitation improvements occur in developing countries. Water management, technology and thinking in Australia were relatively stable in the twentieth century up to the mid to late 1970s. Groundwater sources were investigated and developed for towns and agriculture. Dams were built, and pipe networks extended both for supply and waste water management. The management paradigms in Australia were essentially extensions of European strategies with the minor adaptions due to climate and hydrogeology. During the 1970s and 1980s in Australia, it was realised increasingly that a knowledge of groundwater and hydrogeological processes were critical to pollution prevention, the development of sound waste management and the problems of salinity. Many millions of dollars have been both saved and generated as a consequence. This is especially in relation to domestic waste management and the disposal of aluminium refinery waste in New South Wales. Major institutional changes in public sector water management are occurring in Australia. Upheveals and change have now reached ail states in Australia with various approaches being followed. Market thinking, corporatisation, privatisation, internationalisation, downsizing and environmental pressures are all playing their role in this paradigm shift. One casualty of this turmoil is the progressive erosion of the public sector skillbase and this may become a serious issue should a public health crisis occur such as a water borne disease. Such crises have arisen over recent times. A complete rethink of the urban water cycle is going on right now in Australia both at the State and Federal level. We are on the threshold of significant change in how we use and manage water, both as a supply and a waste transporter in Urban environments especially. Substantial replacement of the pipe system will be needed in 25 to 30 years time and this will cost billions of dollars. The competition for water between imgation needs and environmental requirements in Australia and overseas will continue to be an issue in rural areas. This will be especially heightened by the rising demand for irrigation produced food as the world's population grows. Rapid urbanisation and industrialisation in the emerging S.E Asian countries are currently producing considerable demands for water management skills and Infrastructure development. This trend e expected to grow. There are also severe water shortages in the Middle East to such an extent that wars may be fought over water issues. Environmental public health crises and shortages will help drive the trends.

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