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The Effect of Arthroscopic Medial Meniscectomy in Degenerative Arthritis of the Knee (슬관절 퇴행성 관절염에서 관절경적 내측 반월상 연골 절제술의 효과)

  • Kim, Do-Yeon;Choi, Yun-Jin;Lee, Seung-Joo;Ko, Min-Seok;Choi, Chong-Hyuk
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.9 no.2
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    • pp.79-84
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    • 2010
  • Purpose: In patients with meniscal tear with degenerative arthritis, controversy remains as to whether arthroscopic menisectomy is worthwhile or not. The purpose of this study was to evaluate the effect of arthroscopic medial meniscectomy in degenerative arthritis of the knee with meniscal tear. We also intended to identify pertinent indications and risk factors. Materials and Methods: 287 patients underwent arthroscopic medial meniscectomy from 2006 to 2008; 103 patients who had Kellgren-Lawrence grade II, III arthritis of the knee, were over 50 years old, and had minimum 1 year follow-up, were analyzed in this study. Clinical assessment was performed retrospectively using the arthroscopic surgery database, medical records, questionnires and interviews. Assessment included visual analogue scale (VAS) scores and Lysholm scores. Results: The mean Lysholm score increased from 69 to 85 after surgery. The mean VAS score improved from 7 to 3.1 after surgery. Kellgren-Lawrence grade II group and group with trauma history showed significant improvement of pain and function compared with grade III and group without trauma history. Outerbridge grade I showed significantly more improvement of pain than grade III and IV. Multiple regression analysis showed that trauma history and Outerbridge grade affect the improvement of Lysholm score. Conclusion: In one year follow-up, arthroscopic medial menisectomy can improve pain and function of patients in Kellgren-Lawrence grade II, III degenerative arthritis of the knee. We could expect good results especially in group with low Kellgren-Lawrence grade, trauma history, and mild articular cartilage lesion.

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The Functional and Genetic Defects of IFN-${\gamma}$ Receptor in the Patients with Tuberculosis (결핵환자에서 IFN-${\gamma}$ 수용체의 기능적 및 유전적 이상에 관한 연구)

  • Park, Gye-Young;Hwang, You-Jin;Lim, Young-Hee;An, Chang-Hyeok;Park, Jeong-Woong;Jeong, Seong-Hwan
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.5
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    • pp.497-505
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    • 2002
  • Background : INF-${\gamma}$ plays an important role in the host response to a mycobacterial infection. A complete IFN-${\gamma}$ receptor 1 deficiency is a life threatening condition because it renders patients highly susceptible to a mycobacterial infection. Several mutations in the IFN-${\gamma}$ receptor and STAT1 gene have been identified in the rare mycobacterial infections. These mutations have partial function of the IFN-${\gamma}$ receptor and similar pathologic features to clinical tuberculosis. Materials and Methods : The function of the IFN-${\gamma}$ receptor was evaluated in the patients with clinical tuberculosis. In addition, the DNA coding sequence of the IFNgR1 and STAT1 gene was also analyzed in disseminated tuberculosis patients who might have a defective IFN-${\gamma}$ receptor. Results : The cell surface expression levels of HLA-DR and CD64 in the PMBC after being stimulation with IFN-${\gamma}$ (100IU/ml, 1000IU/ml) were increased in both controls and patients. However, the rate of increase in both groups was similar. The production of TNF-${\alpha}$ in the response to stimulation with LPS was higher in the both groups ($850.7{\pm}687.8$ vs. $836.7{\pm}564.3$ pg/ml). Pretreatment with IFN-${\gamma}$ prior to LPS stimulation resulted in further increase in TNF-${\alpha}$ production between both groups ($2203.5{\pm}242.5$ vs. $2227.5{\pm}560.4$ pg/ml). However, the rate of the increase in TNF-${\alpha}$ production in the both groups was similar. The known mutations in the IFNgR1 and STAT1 coding sequences were not found in the genomic DNA of patients with disseminated tuberculosis. Conclusion : The functional and genetic defects of the IFN-${\gamma}$ receptor were not identified in clinical tuberculosis. This suggests the defective IFN-${\gamma}$ receptor that predispoe patients to a BCG or NTM infection can not alone account for the cases of clinical tuberculosis.

An Examination of Knowledge Sourcing Strategies Effects on Corporate Performance in Small Enterprises (소규모 기업에 있어서 지식소싱 전략이 기업성과에 미치는 영향 고찰)

  • Choi, Byoung-Gu
    • Asia pacific journal of information systems
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    • v.18 no.4
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    • pp.57-81
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    • 2008
  • Knowledge is an essential strategic weapon for sustaining competitive advantage and is the key determinant for organizational growth. When knowledge is shared and disseminated throughout the organization, it increases an organization's value by providing the ability to respond to new and unusual situations. The growing importance of knowledge as a critical resource has forced executives to pay attention to their organizational knowledge. Organizations are increasingly undertaking knowledge management initiatives and making significant investments. Knowledge sourcing is considered as the first important step in effective knowledge management. Most firms continue to make an effort to realize the benefits of knowledge management by using various knowledge sources effectively. Appropriate knowledge sourcing strategies enable organizations to create, acquire, and access knowledge in a timely manner by reducing search and transfer costs, which result in better firm performance. In response, the knowledge management literature has devoted substantial attention to the analysis of knowledge sourcing strategies. Many studies have categorized knowledge sourcing strategies into intemal- and external-oriented. Internal-oriented sourcing strategy attempts to increase firm performance by integrating knowledge within the boundary of the firm. On the contrary, external-oriented strategy attempts to bring knowledge in from outside sources via either acquisition or imitation, and then to transfer that knowledge across to the organization. However, the extant literature on knowledge sourcing strategies focuses primarily on large organizations. Although many studies have clearly highlighted major differences between large and small firms and the need to adopt different strategies for different firm sizes, scant attention has been given to analyzing how knowledge sourcing strategies affect firm performance in small firms and what are the differences between small and large firms in the patterns of knowledge sourcing strategies adoption. This study attempts to advance the current literature by examining the impact of knowledge sourcing strategies on small firm performance from a holistic perspective. By drawing on knowledge based theory from organization science and complementarity theory from the economics literature, this paper is motivated by the following questions: (1) what are the adoption patterns of different knowledge sourcing strategies in small firms (i,e., what sourcing strategies should be adopted and which sourcing strategies work well together in small firms)?; and (2) what are the performance implications of these adoption patterns? In order to answer the questions, this study developed three hypotheses. First hypothesis based on knowledge based theory is that internal-oriented knowledge sourcing is positively associated with small firm performance. Second hypothesis developed on the basis of knowledge based theory is that external-oriented knowledge sourcing is positively associated with small firm performance. The third one based on complementarity theory is that pursuing both internal- and external-oriented knowledge sourcing simultaneously is negatively or less positively associated with small firm performance. As a sampling frame, 700 firms were identified from the Annual Corporation Report in Korea. Survey questionnaires were mailed to owners or executives who were most erudite about the firm s knowledge sourcing strategies and performance. A total of 188 companies replied, yielding a response rate of 26.8%. Due to incomplete data, 12 responses were eliminated, leaving 176 responses for the final analysis. Since all independent variables were measured using continuous variables, supermodularity function was used to test the hypotheses based on the cross partial derivative of payoff function. The results indicated no significant impact of internal-oriented sourcing strategies while positive impact of external-oriented sourcing strategy on small firm performance. This intriguing result could be explained on the basis of various resource and capital constraints of small firms. Small firms typically have restricted financial and human resources. They do not have enough assets to always develop knowledge internally. Another possible explanation is competency traps or core rigidities. Building up a knowledge base based on internal knowledge creates core competences, but at the same time, excessive internal focused knowledge exploration leads to behaviors blind to other knowledge. Interestingly, this study found that Internal- and external-oriented knowledge sourcing strategies had a substitutive relationship, which was inconsistent with previous studies that suggested complementary relationship between them. This result might be explained using organizational identification theory. Internal organizational members may perceive external knowledge as a threat, and tend to ignore knowledge from external sources because they prefer to maintain their own knowledge, legitimacy, and homogeneous attitudes. Therefore, integrating knowledge from internal and external sources might not be effective, resulting in failure of improvements of firm performance. Another possible explanation is small firms resource and capital constraints and lack of management expertise and absorptive capacity. Although the integration of different knowledge sources is critical, high levels of knowledge sourcing in many areas are quite expensive and so are often unrealistic for small enterprises. This study provides several implications for research as well as practice. First this study extends the existing knowledge by examining the substitutability (and complementarity) of knowledge sourcing strategies. Most prior studies have tended to investigate the independent effects of these strategies on performance without considering their combined impacts. Furthermore, this study tests complementarity based on the productivity approach that has been considered as a definitive test method for complementarity. Second, this study sheds new light on knowledge management research by identifying the relationship between knowledge sourcing strategies and small firm performance. Most current literature has insisted complementary relationship between knowledge sourcing strategies on the basis of data from large firms. Contrary to the conventional wisdom, this study identifies substitutive relationship between knowledge sourcing strategies using data from small firms. Third, implications for practice highlight that managers of small firms should focus on knowledge sourcing from external-oriented strategies. Moreover, adoption of both sourcing strategies simultaneousiy impedes small firm performance.

The Relation between Collateral Circulation and $^{99m}Tc$-MIBI Heart SPECT (심근경색에서 측부순환 유무에 따른 $^{99m}Tc$-MIBI 심근 SPECT 소견)

  • Kim, Jae-Man;Na, Deug-Young;Park, Eun-Kyung;Yang, Hyung-In;Kim, Deog-Yoon;Kang, Heung-Sun;Choue, Chung-Whee;Kim, Kwon-Sam;Kim, Myung-Shick;Song, Jung-Sang;Bae, Jong-Hoa
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.1
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    • pp.37-43
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    • 1994
  • The coronary collateral vessels have revealed their significance in terms of reduction of infarct size, preservation left ventricular function, and prevention of left ventricular aneurysm in patients with myocardial infarction. The purpose of this study were to evaluated the relation between collateral circulation and $^{99m}Tc$-MIBI Heart SPECT in patient with acute myocardial infarction and their clinical significance. The fifty six MI patients with antegrade TIMI perfusion grade 0 and 1 were studied. The patients were classified into two groups; Group I inclueded 30 patients with grade 2, 3 Collateral flow. Group II inclueded 26 patients with grade 0, 1 Collateral flow. Collateral filling were graded from 0 to 3: 0- none, 1- Filling of side branch only, 2- Partial filling of the epicardial segment, 3- Complete filling of epicardial segment. Clinical variables, left ventricular function, $^{99m}Tc$-MIBI Heart SPECT were analyzed with angiographic finding. Results were following: 1) Collateral visualization was found to be greater in patient with involvement of right coronary artery (RCA). The collateral development site of infarct related artery was RCA 15 cases, left anterior descending artery (LAD) 10 cases, left circumflex artery (LCX) 5 cases, and the collateral circulation from LAD to RCA was 13 cases (40.6%). 2) There was a tendency to be decreased in peak CK activity with group I. 3) The presence of good collateral channels was more frequently $^{99m}Tc$-MIBI reversible perfusion defect (83.4% vs 15.3%, p<0.05). 4) No differences of left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), ejection fraction (EF) were noted between group I and group II. The presence of good collateral channels did affect the frequency of occurrence of $^{99m}Tc$-MIBI reversible perfusion defect.

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A Study on Measures to Strengthen National Authorized Qualification (국가공인 민간자격 활용성 강화 방안 연구)

  • Kim, Sang-Jin;Park, Jong-Sung;Jung, Hyang-Jin
    • Journal of Engineering Education Research
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    • v.12 no.1
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    • pp.3-16
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    • 2009
  • The purpose of this study is to prepare diverse measures to enhance the utilization of national authorized qualification. The detail objectives of this study are first, to re-establish the utilization scope and range of national authorized qualification through analysis of advance research and theory in various fields of learning on the function of qualification; and second, to set the direction to strengthen the utilization of national authorized qualification. Based on discussions on the various fields of learning on the function of qualification, this study divided the utilization scope of qualification into personal utilization for the benefit of the qualification acquirer him or herself and public utilization for the social and economic benefits. And according to this distinction, we prepared measures to strengthen the utilization of national authorized qualification. First of all, as a way to strengthen personal utilization of the national authorized qualification, we prepared measures to enhance accessibility and facilitate further improvement. As a means to enhance accessibility, we proposed restriction on setting the application condition, diversification of qualification authorization method, facilitation of partial qualification system and minimization of expense required to acquire qualification. Also for the further improvement, we proposed creation of job-level centered grade system and development of job-level centered qualification item by stage. For strengthening the public utilization of national authorized qualification, we come up with ways of strengthening flexibility, transparency, public trust and compatibility. As a way to strengthen flexibility, we proposed establishment of qualification demand monitoring system, expansion of direct participation of users on qualification management, establishment of qualification expiration period and its renewal. For the strengthening of transparency, we proposed to build general qualification information system and to utilize qualification recommendation system. To strengthen public trust, we proposed to strengthen the management of qualification management regulation, secure independency, establish internal audit system and strengthen post management of national authorized qualification. And lastly, we suggested that compatibility comparison standard between qualification and qualification level standard be developed for the strengthening of compatibility.

A study on simple nursing activities for the registered nurses and nurse aides in the hospital (단순간호활동에 관한 간호사 및 간호조무사의 태도조사연구)

  • Lee Jung-Hee
    • Journal of Korean Public Health Nursing
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    • v.4 no.1
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    • pp.37-55
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    • 1990
  • Every country in the world has been trying to expand the basic health right for the peoples as W.H.O has established the goal 'health for AU' by the year of 2000. Related to this goal, our government authority has establish the policy 'the insurance of health for all' into effect from July 198\). Recently hospitalshave been making a ceaseless effort for the plan for the rationalization of its management the academic World is making it a subject of discussion by doing the secure of manpower at a resonable level and the increase of productivity by the manpower. As a result of the efforts the study was established to secure the numbers of nursing manpower at a resonable level and use the unskilled persons at the utilizing field and seek the possible area of their activity for more efficient service through the investigation of ablity of simple nursing activities of regiestered nurses and nurse aides for rational function according to the educational levels and talents. The method of study was established by the registered nurses and nurse and nurse aides(R.N 229, N.A 226) who are working in 15 hospitals with over 200 beds. This surrey was conducted from Mar 29, 1989 to April 8, 1989. The method to test the degree of importance, difficulties, and the abillity of performance of a simple nursing activities was classified into 35 activities on the basis of references on this field. The degree of importance was composed from point l(Not so important) to 5(Very important). the degree of difficulties. was composed as follows; very easy - Point 1 very difficult and complicated - Point 5. and the ability of performance was composed from point 1 to 5. The materials gathered through the survey were analyzed with frequency, mean standard deviation, percentage. t-test, Anova, pearson's coefficient of correlation, stepwise multiple regression. factor analysis, discriminant analysis. The obtained results are summarized as follows: 1. The recognition values of the simple nursing activities of each group of registered nurse and nurse aides show; The degree of importance; 4.04 and 4.26 The degree of difficulties; 2.72 and 2.94 The ability of performance; 2.07 and 2.38 The brief summary shows there are little differences between who two groups the simple nursing activities turned out to be easy and simple work. 2. Regardless of the degree of importance, and difficulties, the ability of performance the important in fluencing of the degree of the simple nursing activities between the registered nurses and nurse aides was the order of educational level, hospital career, working career in wards and ages of the registered nurses and ages and hospital creer of nurse aides. The result was that the simple nursing activities could easily be familiar through the training of their working environment and period of experience. 3. Among the 35 simple nursing activities the items capable of resonable entrusting to the nurse aides are 5 that is helping bed-bathing, 8itz Bath, using bed pan, care while delivering patient, accompaying patient when visitor's check. There wasn't and differences between RN and nurse aides in performing the above 5 items. In anywhere. so we can say obviosuly that this nursing activities should be performed under the nursing system of which chief of nurse are supposed to supervise nurse aides as a possible function to be entrusted. In view of the above mentioned results, therefore, this partial functional job of the simple nursing activities can able be entrusted to the nurse aides through the regular training course. In case of these functional activities could be entrusted under, the responsibility of registered nurse, we can able suggest to for that there are the following advantages: 1.. In the nursing activities-affairs, the qualified guarantee of the nursing services can be kept and increased or promotoed with accommodation of the required nursing service and roles being expanded presently. 2. In the productivity of the hospital manpower, therefore, we have comt to view and consider in favourly that when an automational administration times would be come in the near future time to hospital affairs as a reality, to utilize the existing nures aides is better rather than investing so as to develop the other source manpowers or seek its for the efficient business management in the operational strategy or its policy.

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LONGEVITY AND FAILURE ANALYSIS OF FIXED RESTORATIONS SERVICED IN KOREA (국내에서 제작된 고정성 보철물의 수명과 실패 요인 및 양상)

  • Shin Woo-Jin;Jeon Young-Sik;Lee Keun-Woo;Lee Ho-Yong;Han Dong-Hoo
    • The Journal of Korean Academy of Prosthodontics
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    • v.43 no.2
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    • pp.158-175
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    • 2005
  • Statement of problem. Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however desired level of development has not to be made in this field yet. Purpose. This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of flxed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows : Results. 1. Length of service of fixed restorations serviced in Korea was 6.86$\pm$0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51$\pm$0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21$\pm$0.66) and that of the teen age group(3.39$\pm$0.28) was shortest (p<0.05). 4. Longevity of fixed restorations of women (7.38$\pm$0.18 years) was longer than that of men (6.00$\pm$0.26) (p<0.05). 5. As for the provider factor (such as unlicensed performers, university hospitals, and private clinic), there was no statistically significant difference in longevity of fixed restorations. 6. Defective margin (34.78%). periodontal disease (12.15%), periapical involvement (11.73%), was the most frequent causes of failure and poor esthetics group showed the longest life above all (p<0.05). Actual frequent causes of failure after removing old prosthetics were defective margin, periapical involvement, periodontal disease and uncemented restoration. In 75.67% of the cases, abutment state after removing old prosthetics was good enough for loading another prosthetics. 7. There was found to have statistically significant influence between longevity of single crown (6.35$\pm$0.20 yr) and that of 3 unit fixed restorations (7.60$\pm$0.30 y) (p<0.05). In each case the most frequent cause of failure was defective margin. 8. The number of cantilever pontic, pontic/abutment ratio, oral hygiene status were found to have no statistically significant influence on longevity of fixed restorations in all groups (p>0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60$\pm$0.40 yr) semi precious and precious trailing behind(p<0.05). 10. Group function group (37.04%) and partial group function group (44.62%) were predominant in frequency but showed no correlation between them and among different types of occlusal plane and different types of occlusal surface (p>0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35$\pm$0.62) (p<0.05) among different types of occlusal interference. Conclusion. We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of axed restorations, unified research design. overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

Development of Korean Version of Heparin-Coated Shunt (헤파린 표면처리된 국산화 혈관우회도관의 개발)

  • Sun, Kyung;Park, Ki-Dong;Baik, Kwang-Je;Lee, Hye-Won;Choi, Jong-Won;Kim, Seung-Chol;Kim, Taik-Jin;Lee, Seung-Yeol;Kim, Kwang-Taek;Kim, Hyoung-Mook;Lee, In-Sung
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.97-107
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    • 1999
  • Background: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. Material and Method: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. Result: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. Conclusion: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).

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Relationships on Magnitude and Frequency of Freshwater Discharge and Rainfall in the Altered Yeongsan Estuary (영산강 하구의 방류와 강우의 규모 및 빈도 상관성 분석)

  • Rhew, Ho-Sang;Lee, Guan-Hong
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.16 no.4
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    • pp.223-237
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    • 2011
  • The intermittent freshwater discharge has an critical influence upon the biophysical environments and the ecosystems of the Yeongsan Estuary where the estuary dam altered the continuous mixing of saltwater and freshwater. Though freshwater discharge is controlled by human, the extreme events are mainly driven by the heavy rainfall in the river basin, and provide various impacts, depending on its magnitude and frequency. This research aims to evaluate the magnitude and frequency of extreme freshwater discharges, and to establish the magnitude-frequency relationships between basin-wide rainfall and freshwater inflow. Daily discharge and daily basin-averaged rainfall from Jan 1, 1997 to Aug 31, 2010 were used to determine the relations between discharge and rainfall. Consecutive daily discharges were grouped into independent events using well-defined event-separation algorithm. Partial duration series were extracted to obtain the proper probability distribution function for extreme discharges and corresponding rainfall events. Extreme discharge events over the threshold 133,656,000 $m^3$ count up to 46 for 13.7y years, following the Weibull distribution with k=1.4. The 3-day accumulated rain-falls which occurred one day before peak discharges (1day-before-3day -sum rainfall), are determined as a control variable for discharge, because their magnitude is best correlated with that of the extreme discharge events. The minimum value of the corresponding 1day-before-3day-sum rainfall, 50.98mm is initially set to a threshold for the selection of discharge-inducing rainfall cases. The number of 1day-before-3day-sum rainfall groups after selection, however, exceeds that of the extreme discharge events. The canonical discriminant analysis indicates that water level over target level (-1.35 m EL.) can be useful to divide the 1day-before-3day-sum rainfall groups into discharge-induced and non-discharge ones. It also shows that the newly-set threshold, 104mm, can just separate these two cases without errors. The magnitude-frequency relationships between rainfall and discharge are established with the newly-selected lday-before-3day-sum rainfalls: $D=1.111{\times}10^8+1.677{\times}10^6{\overline{r_{3day}}$, (${\overline{r_{3day}}{\geqq}104$, $R^2=0.459$), $T_d=1.326T^{0.683}_{r3}$, $T_d=0.117{\exp}[0.0155{\overline{r_{3day}}]$, where D is the quantity of discharge, ${\overline{r_{3day}}$ the 1day-before-3day-sum rainfall, $T_{r3}$ and $T_d$, are respectively return periods of 1day-before-3day-sum rainfall and freshwater discharge. These relations provide the framework to evaluate the effect of freshwater discharge on estuarine flow structure, water quality, responses of ecosystems from the perspective of magnitude and frequency.

Role of Postoperative Conventional Radiation Therapy in the Management of Supratentorial Malignant Glioma - with respect to survival outcome and prognostic factors - (천막상부 악성 신경교종에서 수술 후 방사선 치료의 역할 - 생존율과 예후인자 분석 -)

  • Nam Taek Keun;Chung Woong Ki;Ahn Sung Ja;Nah Byung Sik
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.389-398
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    • 1998
  • Purpose : To evaluate the role of conventional postoperative adjuvant radiotherapy in the management of supratentorial malignant glioma and to determine favorable prognostic factors affecting survival. Materials and Methods : From Sep. 1985 to Mar. 1997, the number of eligible patients who received postoperative radiotherapy completely was 69. They ranged in age from 7 to 66 years (median, 47). Forty-two (61$\%$) patients were glioblastoma multiforme and the other 27 (39$\%$) were anaplastic astrocytoma. Twenty patients (29$\%$) had Karnofsky score equal or more than 80 preoperatively. Forty-three patients (62$\%$) had symptom duration equal or less than 3 months. Twenty-four patients (35$\%$) had gross total resection and forty patients(58$\%$) had partial resection, the remaining five patients (7$\%$) had biopsy only. Radiotherapy dose ranged from 50.4 Gy to 61.2 Gy (median, 55.8; mode, 59.4) with fraction size of 1 8 Gy-2.0 Gy for 33-83 days(median, 48) except three patients delivered 33, 36, 39 Gr, respectively with fraction size of 3.0 Gy due to poor postoperative performance status. Follow-up rate was 93$\%$ and median follow-up period was 14 months. Results : Overall survival rate at 2 and 3 years and median survival were 38$\%$, 20$\%$, and 16 months for entire patients; 67$\%$, 44$\%$, and 34 months for anaplastic astrocytoma; 18$\%$, 4$\%$, and 14 months for glioblastoma multiforme, respectively (p=0.0001). According to the extent of surgery, 3-year overall survival for gross total resection, partial resection, and biopsy only was 38$\%$, 11$\%$, and 0$\%$, respectively (p=0.02) The 3-year overall survival rates for patients age 40>, 40-59, and 60< were 52$\%$, 8$\%$, and 0$\%$, respectively (p=0.0007). For the variate of performance score 80< vs 80>, the 3-year survival rates were 53$\%$ and 9$\%$, respectively (p=0.008). On multivariate analysis including covariates of three surgical and age subgroups as above, pathology, extent of surgery and age were significant prognostic factors affecting overall survival. On another multivariate analysis with covariates of two surgical (total resection vs others) and two a9e (50> vs 50<) subgroups, then, pathology, extent of surgery and performance status were significant factors instead of age and 3-year cumulative survival rate for the five patients with these three favorable factors was 100$\%$ without serious sequela. Conclusion : We confirmed the role of postoperative conventional radiotherapy in the management of supratentorial malignant glioma by improving survival as compared with historical data of surgery only. Patients with anaplastic astrocytoma, good performance score, gross total resection and/or young age survived longest. Maximum surgical resection with acceptable preservation of neurologic function should be attempted in glioblastoma patients, especially in younger patients. But the survival of most globlastoma patients without favorable factors is still poor, so other active adjuvant treatment modalities should be tried or added rather than conventional radiation treatment alone in this subgroup.

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