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Postoperative Radiotherapy in the Rectal Cancers Patterns of Care Study for the Years of $1998\~1999$ (직장암의 방사선치료에 대한 Patterns of Care Study: $1998{\sim}1999$년도 수술 후 방사선치료 환자들의 특성 및 치료내용에 대한 분석결과)

  • Kim, Jong-Hoon;Oh, Do-Hoon;Kang, Ki-Moon;Kim, Woo-Cheol;Kim, Won-Dong;Kim, Jung, Soo;Kim, June-Sang;Kim, Jin-Hee;Kil, Hak-Jae;Suh, Chang-Ok;Sohn, Seung-Chang;Ahn, Yong-Chan;Yang, Dae-Sik
    • Radiation Oncology Journal
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    • v.23 no.1
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    • pp.22-31
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    • 2005
  • Purpose : To conduct a nationwide survey on the principals in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. Materials and Methods : We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were Inputted to the web based PCS system by each investigators in 19 institutions. Results : Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum ($46\%$). Preoperative CEA was checked in $79\%$ of cases and its value was higher than 6 ng/ml in $32\%$. Pathologic stage were I in $1.5\%$, II in $32\%$, III in $53\%$, and IV in $1.6\%$. Low anterior resection was the most common type of surgery and complete resection was peformed in $95\%$ of cases. Distal resection margin was less than 2 cm in $30\%$, and number of lymph node dissected was less than 12 in $31\%$. Chemotherapy was peformed in $91\%$ and most common regimen was 5-FU and leucovorine ($59\%$). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique ($65.0\%$), and there was no AP-PA parallel opposing field used. Patient position was prone in $81.2\%$, and the boost field was used in $61.8\%$. To displace bowel outward, pressure modulating devices or bladder filling was used in $40.1\%$. Radiation dose was prescribed to isocenter in $45.3\%$ and to isodose line in 123 cases ($39.8\%$). Percent delivered dose over $90\%$ was achieved in $92.9\%$. Conclusion : We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.

Studies of the Effects of Acupuncture Stimulation at Huatuo Jiaji(EX B2) Points on Axonal Regeneration of Injured Sciatic Nerve in the Rats (화타협척혈 침자극에 의한 손상 말초신경의 재생효과에 관한 연구)

  • Kim, Dae-Feel;Park, Young-Hoi;Keum, Dong-Ho
    • Journal of Korean Medicine Rehabilitation
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    • v.18 no.4
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    • pp.39-61
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    • 2008
  • Objectives : The present study was performed to investigate whether acupuncture stimulation in the rats affected regeneration properties of the injured sciatic nerve. A differential effect of acupuncture stimulation on the one point near the spinal nerve root controlling sciatic nerve activity and the other point in the peripheral area subordinated by injured nerve was compared. Materials and Methods: Rat sciatic nerves were injured by crush, and the effects on axonal regeneration on injured sciatic nerves were evaluated by acupuncture stimulation at two different regions. In proximal acupuncture stimulation group, acupuncture stimulation was performed on Huatuo Jiaji(EX B2) points located from L5 to S1 vertebral levels to stimulate the nearest spinal nerve root that innervates sciatic nerves. In distal acupuncture stimulation group, acupuncture stimulation was performed on Zusanli(ST 36) and Weizhong(BL 40) points to stimulate at peripheral area dominated by injured sciatic nerves. Acupuncture stimulation was given every other days for 1 or 2 weeks. Sciatic nerve tissues collected from acupuncture stimulation experimental groups, injury control group, and intact animal group were used for protein analysis by Western blotting or Hoechst nuclear staining. To determine axonal regeneration, Dil fluorescence dye was injected into the sciatic nerve 0.5 cm distal to the injury site in individual animal groups and Dil-labeled cells by retrograde tracing were measured in the DRG at lumbar 5 or in the spinal cord. DRG sensory neurons prepared from individual animal groups were used to measure the extent of neurite outgrowth and for immunofluorescence staining with anti-GAP-43 antibody. Results : Animal groups given proximal or distal acupuncture stimulation showed upregulation of GAP-43 and Cdc2 protein levels in the sciatic nerve at 7 days after injury. Cdk2 protein levels were strongly induced by nerve injury, but did not show changes by acupuncture stimulation. Phospho-Erk1/2 protein levels were elevated by acupuncture stimulation above those present in the injury control animals. These increase in regeneration-associated protein levels appeared to be related with increase cell proliferation in the injured sciatic nerves. Hoechst 33258 staining of sciatic nerve tissue to visualize nuclei of individual cells showed increased Schwann cell number in the distal portion of the injured nerve 7 and 14 days after injury and further increases by acupuncture stimulation particularly at the proximal position. Measurement of axonal regeneration by retrograde tracing showed significantly increased Dil-labeled cells in proximal acupuncture stimulation group compared to distal acupuncture stimulation group and injury control group. Finally, an evaluation of axonal regeneration by retrograde tracing showed increased number of Dil labeled cells in the DRG at lumbar 5 or in the ventral horn of the spinal cord at lower thoracic level at 7 days after nerve injury. Conclusions : The present data show that the proximal acupuncture stimulation at Huatuo Jiaji(EX B2) points governing injured sciatic nerves was more effective for axonal regeneration than the distal acupuncture stimulation. Further studies on functional recovery or associated molecular mechanisms should be critical for developing animal models and clinical applications.

Determination of Optimal Concentration of LPE (Lysophosphatidylethanolamine) for Postharvest Stability and Quality of Strawberry Fruit (딸기 수확 후 저장기간 연장 및 품질 개선을 위한 LPE (Lysophosphatidylethanolamine) 적정 처리농도 구명)

  • Choi, Ki-Young;Kim, Il-Seop;Yun, Young-Sik;Choi, Eun-Young
    • Journal of Bio-Environment Control
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    • v.25 no.3
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    • pp.153-161
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    • 2016
  • This study aims to determine the optimal maturity of strawberry fruits as affected by the application of lysophosphatidylethanolamine (LPE) and its optimal concentration for postharvest stability and quality. Prior to application of treatments, fruits that were classified into levels of maturity (0%, 50%, 70% and 100%) were air-dried for 40 minutes and stored in the refrigerator at $4^{\circ}C$ for 12 days. Fruits at 70% maturity were dipped into 0, 10, 50 and $100mg{\cdot}L^{-1}$ LPE solutions for 1 minute. A lower range of concentration (0, 2.5, 5, 10 and $25mg{\cdot}L^{-1}$) was applied to fruits at different maturity levels. Data on fresh weight, hardness at vertical and horizontal loading positions, color index and sugar content during storage were collected. Based on fruits with 70% maturity dipped in LPE concentrations, there were no significant differences found on fresh weight, color index and sugar content. However, the application of $10mg{\cdot}L^{-1}$ LPE gave the highest hardness at vertical loading position while $100mg{\cdot}L^{-1}$ had the lowest average. At lower range of LPE concentrations, fresh weight was not significantly affected by LPE application and maturity levels. Hardness of fruits was mainly based on the maturity of the fruits. Increased hardness was observed in the fruits with 70% maturity dipped into the $5mg{\cdot}L^{-1}$ of LPE solution. The hardness and Hunter's $L^*$ and $b^*$ value of 100% matured fruits gave lowest values despite the application of $25mg{\cdot}L^{-1}$ LPE 12 days after storage.

A Study on the Tree Surgery Problem and Protection Measures in Monumental Old Trees (천연기념물 노거수 외과수술 문제점 및 보존 관리방안에 관한 연구)

  • Jung, Jong Soo
    • Korean Journal of Heritage: History & Science
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    • v.42 no.1
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    • pp.122-142
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    • 2009
  • This study explored all domestic and international theories for maintenance and health enhancement of an old and big tree, and carried out the anatomical survey of the operation part of the tree toward he current status of domestic surgery and the perception survey of an expert group, and drew out following conclusion through the process of suggesting its reform plan. First, as a result of analyzing the correlation of the 67 subject trees with their ages, growth status. surroundings, it revealed that they were closely related to positional characteristic, damage size, whereas were little related to materials by fillers. Second, the size of the affected part was the most frequent at the bough sheared part under $0.09m^2$, and the hollow size by position(part) was the biggest at 'root + stem' starting from the behind of the main root and stem As a result of analyzing the correlation, the same result was elicited at the group with low correlation. Third, the problem was serious in charging the fillers (especially urethane) in the big hollow or exposed root produced at the behind of the root and stem part, or surface-processing it. The benefit by charging the hollow part was analyzed as not so much. Fourth, the surface-processing of fillers currently used (artificial bark) is mainly 'epoxy+woven fabric+cork', but it is not flexible, so it has brought forth problems of frequent cracks and cracked surface at the joint part with the treetextured part. Fifth, the correlation with the external status of the operated part was very high with the closeness, surface condition, formation of adhesive tissue and internal survey result. Sixth, the most influential thing on flushing by the wrong management of an old and big tree was banking, and a wrong pruning was the source of the ground part damage. In pruning a small bough can easily recover itself from its damage as its formation of adhesive tissue when it is cut by a standard method. Seventh, the parameters affecting the times of related business handling of an old and big tree are 'the need of the conscious reform of the manager and related business'. Eighth, a reform plan in an institutional aspect can include the arrangement of the law and organization of the old and big tree management and preservation at an institutional aspect. This study for preparing a reform plan through the status survey of the designated old and big tree, has a limit inducing a reform plan based on the status survey through individual research, and a weak point suggesting grounds by any statistical data. This can be complemented by subsequent studies.

The Effect of Shading on Pedestrians' Thermal Comfort in the E-W Street (동-서 가로에서 차양이 보행자의 열적 쾌적성에 미치는 영향)

  • Ryu, Nam-Hyong;Lee, Chun-Seok
    • Journal of the Korean Institute of Landscape Architecture
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    • v.46 no.6
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    • pp.60-74
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    • 2018
  • This study was to investigate the pedestrian's thermal environments in the North Sidewalk of E-W Street during summer heatwave. We carried out detailed measurements with four human-biometeorological stations on Dongjin Street, Jinju, Korea ($N35^{\circ}10.73{\sim}10.75^{\prime}$, $E128^{\circ}55.90{\sim}58.00^{\prime}$, elevation: 50m). Two of the stations stood under one row street tree and hedge(One-Tree), two row street tree and hedge (Two-Tree), one of the stations stood under shelter and awning(Shelter), while the other in the sun (Sunlit). The measurement spots were instrumented with microclimate monitoring stations to continuously measure microclimate, radiation from the six cardinal directions at the height of 1.1m so as to calculate the Universal Thermal Climate Index (UTCI) from 24th July to 21th August 2018. The radiant temperature of sidewalk's elements were measured by the reflective sphere and thermal camera at 29th July 2018. The analysis results of 9 day's 1 minute term human-biometeorological data absorbed by a man in standing position from 10am to 4pm, and 1 day's radiant temperature of sidewalk elements from 1:16pm to 1:35pm, showed the following. The shading of street tree and shelter were mitigated heat stress by the lowered UTCI at mid and late summer's daytime, One-Tree and Two-Tree lowered respectively 0.4~0.5 level, 0.5~0.8 level of the heat stress, Shelter lowered respectively 0.3~1.0 level of the heat stress compared with those in the Sunlit. But the thermal environments in the One-Tree, Two-Tree and Shelter during the heat wave supposed to user "very strong heat stress" while those in the Sunlit supposed to user "very strong heat stres" and "exterme heat stress". The main heat load temperature compared with body temperature ($37^{\circ}C$) were respectively $7.4^{\circ}C{\sim}21.4^{\circ}C$ (pavement), $14.7^{\circ}C{\sim}15.8^{\circ}C$ (road), $12.7^{\circ}C$ (shelter canopy), $7.0^{\circ}C$ (street funiture), $3.5^{\circ}C{\sim}6.4^{\circ}C$ (building facade). The main heat load percentage were respectively 34.9%~81.0% (pavement), 9.6%~25.2% (road), 24.8% (shelter canopy), 14.1%~15.4% (building facade), 5.7% (street facility). Reducing the radiant temperature of the pavement, road, building surfaces by shading is the most effective means to achieve outdoor thermal comfort for pedestrians in sidewalk. Therefore, increasing the projected canopy area and LAI of street tree through the minimal training and pruning, building dense roadside hedge are essential for pedestrians thermal comfort. In addition, thermal liner, high reflective materials, greening etc. should be introduced for reducing the surface temperature of shelter and awning canopy. Also, retro-reflective materials of building facade should be introduced for the control of reflective sun radiation. More aggressively pavement watering should be introduced for reducing the surface temperature of sidewalk's pavement.

Dismantling and Restoration of the Celadon Stool Treasure with an Openwork Ring Design (보물 청자 투각고리문 의자의 해체 및 복원)

  • KWON, Ohyoung;LEE, Sunmyung;LEE, Jangjon;PARK, Younghwan
    • Korean Journal of Heritage: History & Science
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    • v.55 no.2
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    • pp.200-211
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    • 2022
  • The celadon stools with an openwork ring design which consist of four items as one collection were excavated from Gaeseong, Gyeonggi-do Province. The celadon stools were designated and managed as treasures due to their high arthistorical value in the form of demonstrating the excellence of celadon manufacturing techniques and the fanciful lifestyles during the Goryeo Dynasty. However, one of the items, which appeared to have been repaired and restored in the past, suffered a decline in aesthetic value due to the aging of the treatment materials and the lack of skill on the part of the conservator, raising the need for re-treatment as a result of structural instability. An examination of the conservation condition prior to conservation treatment found structural vulnerabilities because physical damage had been artificially inflicted throughout the area that was rendered defective at the time of manufacturing. The bonded surfaces for the cracked areas and detached fragments did not fit, and these areas and fragments had deteriorated because the adhesive trickled down onto the celadon surface or secondary contaminants, such as dust, were on the adhesive surface. The study identified the position, scope, and conditions of the bonded areas at the cracks UV rays and microscopy in order to investigate the condition of repair and restoration. By conducting Fourier-transform infrared spectroscopy(FT-IR) and portable x-ray fluorescence spectroscopy on the materials used for the former conservation treatment, the study confirmed the use of cellulose resins and epoxy resins as adhesives. Furthermore, the analysis revealed the addition of gypsum(CaSO4·2H2O) and bone meal(Ca10 (PO4)6(OH)2) to the adhesive to increase the bonding strength of some of the bonded areas that sustained force. Based on the results of the investigation, the conservation treatment for the artifact would focus on completely dismantling the existing bonded areas and then consolidating vulnerable areas through bonding and restoration. After removing and dismantling the prior adhesive used, the celadon stool was separated into 6 large fragments including the top and bottom, the curved legs, and some of the ring design. After dismantling, the remaining adhesive and contaminants were chemically and physically removed, and a steam cleaner was used to clean the fractured surfaces to increase the bonding efficacy of the re-bonding. The bonding of the artifact involved applying the adhesive differently depending on the bonding area and size. The cyanoacrylate resin Loctite 401 was used on the bonding area that held the positions of the fragments, while the acrylic resin Paraloid B-72 20%(in xylene) was treated on cross sections for reversibility in the areas that provided structural stability before bonding the fragments using the epoxy resin Epo-tek 301-2. For areas that would sustain force, as in the top and bottom, kaolin was added to Epo-tek 301-2 in order to reinforce the bonding strength. For the missing parts of the ring design where a continuous pattern could be assumed, a frame was made using SN-sheets, and the ring design was then modeled and restored by connecting the damaged cross section with Wood epos. Other restoration areas that occurred during bonding were treated by being filled with Wood epos for aesthetic and structural stabilization. Restored and filled areas were color-matched to avoid the feeling of disharmony from differences of texture in case of exhibitions in the future. The investigation and treatment process involving a variety of scientific technology was systematically documented so as to be utilized as basic data for the conservation and maintenance.

The study on the cleft lip and/or palate patients who visited Dept. of Orthodontics, Seoul National University Dental Hospital during last 11 years (1988.3-1999.2) (최근 11년간 서울대학교병원 교정과에 내원한 순구개열 환자의 내원 현황에 관한 연구(1988.3 - 1999.2))

  • Yang, Won-Sik;Baek, Seung-Hak
    • The korean journal of orthodontics
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    • v.29 no.4 s.75
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    • pp.467-481
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    • 1999
  • Cleft lip and/or palate is one of the most common congenital craniofacial anomalies. According to previous epidemiologic studies, incidence of cleft lip and/or palate has been increasing nowadays. However, there is no report about epidemiologic study of cleft lip and/or palate patients who visited dept. of orthodontics in Korea. So the purpose of this study was to provide the epidemiological characteristics and important basic clinical data for the diagnosis and the treatment of the cleft lip and/or palate patients. With the orthodontic and cleft charts, diagnostic models and X-ray films from 250 patients with cleft lip and/or palate who visited Dept. of Orthodontics, Seoul National University Dental Hospital during the last 11 years, the authors investigated patient's visiting yew, types of cleft, patient's gender, and Angle's classification of malocclusion, and surgery timing. The results were as follows ; 1. The number of cleft patients who visited Dept. of Orthodontics, SNUDH increased during 1988-1990 and then it declined until 1992. From 1993 to 1996, it showed a stationary trend. After 1997 it showed an overwhelmingly increasing trend. 2. In the cleft type, the ratio of cleft lip cleft lip and alveolus cleft palate : cleft lip and palate was 7.6:19.2:9.6:63.6. In cleft position, unilateral clefts were more than bilateral ones (cleft lip 79:21, cleft lip and alveolus 77:23, cleft lip and palate 75.5:24.5). In cleft side, left clefts were mote than right clefts (cleft lip 53.3:46.7 cleft lip and alveolus 59.5:40.5, cleft lip and palate 59.2:40.8). 3. In gender ratio, males were more than females in cleft lip (57.9:42.1), cleft lip and alveolus (68.8:31.2) and cleft lip and palate (76.1:23.9). But in cleft Palate females were more than males as 41.7: 58.3. 4. In the age groups, 7-12 year group was the most abundant as $52\%$, and then 0-6 year group ($20.4\%$), 13-18 year group ($17.2\%$), more than 18 yew group ($10.4\%$) were followed as descending order. 5. Most of the cleft lip repair surgeries were operated in 0-3 month ($60.3\%$) and 4-6 month ($17.9\%$). 6. The cleft palate repair surgeries were done in 1-2 year ($31.7\%$), 0-1 year ($25.6\%$), 2-3 year ($12.1\%$), more than 5 year ($11.6\%$) as descending order. 7. The lip scar revision surgeries were done before admission at elementary school in $60\%$. (4-6 you ($27.5\%$), 6-8 year ($19.6\%$), more than 10 year ($19.6\%$), 2-4 year ($13.7\%$) as descending order) 8. The rhinoplasties were done before admission at elementary school in $51.7\%$. (0-2 year ($7.1\%$), 2-4 year ($14.3\%$), 4-6 year ($21.4\%$), 6-8 year ($14.3\%$)). 9. The pharyngeal flap were done at 6 Y (72.5 months) after birth on average and there was even distribution of surgery timing. 10. In relationship between Angle's classification of malocclusion and cleft types, Class I was most abundant and Class III, Class II were followed as descending order in cleft lip group. But Class III was most abundant and Class I, Class II were followed as descending order in cleft lip and alveolus group, cleft palate group, and cleft lip and Palate group. The percentage of frequency in Class III malocclusion was overwhelmingly higher in cleft lip and palate group than any other groups. 11. Because the frequency of class III malocclusion was most prevalent in all age groups, anterior crossbite was the most common chief complaint of cleft patients.

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Usefulness of Stomach Extension after Drinking Orange Juice in PET/CT Whole Body Scan (PET/CT 전신 영상에서 오렌지 주스(Orange Juice)를 이용한 위장 확장 영상의 유용성)

  • Cho, Seok-Won;Chung, Seok;Oh, Shin-Hyun;Park, Hoon-Hee;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.13 no.1
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    • pp.86-92
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    • 2009
  • Purpose: The PET/CT has a clear distinction on the lesion of the functional image by adding anatomical information. It also could reduce the examination time using CT data as the attenuation-correction. When the stomach was contracted from a fast, it could bring a misinterpretation of the cancer of the lesion with a presence of physiological $^{18}F$-FDG uptake in stomach and it occasionally would bring an additional scan to confirm. To complement this shortcoming, the method that the patients had water before the examination to extend the stomach had been attempted. However, a short excretion time of the stomach did not give sufficiently extended image of the stomach. Then the patients had additional water and had the examination again. Therefore, the noticed fact is that the stomach excretion time depends on calories, protein content, and the level of carbohydrate. In this study, we use an orange juice to evaluate the extension of the stomach and usefulness of it. Materials and Methods: PET/CT scan were obtained on total 150 of patient from February 2008 to October2008, There were 3 groups in this study and each group had 50 patients. First group drank nothing, Second group drank water and third group drank orange juice. The patients (man 25, female 25) not drinking are the age of 30~71 years old (average: 54), the patients (man: 25, female: 25) drinking water (400 cc) are the age of 28~71 years old (average: 54) and the patients (man: 25, female: 25) drinking orange juice (400 cc) are the age of 32~74 years old (average: 56). The patients were fasted in 6-8 hours before the test, the patients were not diabetic. $^{18}F$-FDG 370~555 MBq were injected intravenously. The patients were in stable position for 1 hour, than the image was obtained. The patients drank water and other patients drank orange juice before Whole body scan. The image scan started from mid-femur to skull base. The emission scan acquired for three minutes per bed and the images were reconstructed. Stomach extension analysis is measured from vertical and horizontal length. Results: Stomach Extension was described as the vertical length of the Non Drink Group was $1.20{\pm}0.50\;cm$, horizontal length was $1.4{\pm}0.53\;cm$, the vertical length of the Water Drink Group was $1.67{\pm}0.63\;cm$, horizontal length was $1.65{\pm}0.77\;cm$, the vertical length of Orange juice Drink Group was $3.48{\pm}0.77\;cm$, horizontal length was $3.66{\pm}0.77\;cm$ in coronal image. Stomach Extension was described the vertical length of the Non Drink Group was $2.03{\pm}0.62\;cm$, horizontal length was $1.69{\pm}0.68\;cm$, the vertical length of Water Drink Group was $5.34{\pm}1.62\;cm$, horizontal length was $2.45{\pm}0.72\;cm$, the vertical length of Orange juice Drink Group was $7.74{\pm}1.62\;cm$, horizontal length was $3.57{\pm}0.77\;cm$ in transverse image. The Stomach Extension has specific differences (p<0.001). The SUVs shows the Non Drink Group were measured as Liver $2.52{\pm}0.42$, Lung $0.51{\pm}0.14$, the Water Drink Group were measured as Liver $2.47{\pm}0.38$, Lung $0.50{\pm}0.14$, Orange juice Drink Group were measured as Liver $2.47{\pm}0.38$, Lung $0.50{\pm}0.14$. The SUVs did not have specific differences (p>0.759). Conclusions: There was not a large difference of SUV in three groups. When the patients drank Orange juice and water, the range extension of stomach was higher than without drinking nothing and it was possible to acquire fully extended images. Therefore, it will be possible that unnecessary additional stomach scans will be reduced by drinking orange juice before the examination so that the patients' claim from uncomfortable and long period of fast will be minimized.

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Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength (경추부의 후관절 나사못 고정술에서 단피질삽입법과 양피질 삽입법 간의 특성에 관한 비교)

  • Park, Choon-Keun;Hwang, Jang-Hoe;Ji, Chul;Lee, Jae Un;Sung, Jae Hoon;Choi, Seung-Jin;Lee, Sang-Won;Seybold, Eric;Park, Sung-Chan;Cho, Kyung-Suok;Park, Chun-Kun;Kang, Joon-Ki
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1210-1219
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    • 2001
  • Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

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The Effect of Corporate Association on the Perceived Risk of the Product (소비자의 제품 지각 위험에 대한 기업연상과 효과: 지식과 관여의 조절적 역활을 중심으로)

  • Cho, Hyun-Chul;Kang, Suk-Hou;Kim, Jin-Yong
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.1-32
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    • 2008
  • Brown and Dacin (1997) have investigated the relationship between corporate associations and product evaluations. Their study focused on the effects of associations with a company's corporate ability (CA) and its corporate social responsibility (CSR) on consumers' product evaluations. Their study has found that both of CA and CSR influenced product evaluation but CA association has a stronger effect than CSR associations. Brown and Dacin (1997) have, however, claimed that there are few researches on how corporate association impacts product responses. Accordingly, some of researchers have found the variables to moderate or to mediate the relationship between the corporate association and the product responses. In particular, there has been existed a few of studies that tested the influence of the reputation on the product-relevant perceived risk, but the effects of two types of the corporate association on the product-relevant perceived risk were not identified so far. The primary goal of this article is to identify and empirically examine some variables to moderate the effects of CA association and CSR association on the perceived risk of the product. In this articles, we take the concept of the corporate associations that Brown and Dacin (1997) had proposed. CA association is those association related to the company's expertise in producing and delivering its outputs and CSR association reflected the organization's status and activities with respect to its perceived societal obligations. Also, this study defines the risk, which is the uncertainty or loss of the product and corporate that consumers have taken in a particular purchase decision or after having purchased. The risk is classified into product-relevant performance risk and financial risk. Performance risk is the possibility or the consequence of a product not functioning at some expected level and financial risk is the monetary loss one perceives to be incurring if a product does not function at some expected level. In relation to consumer's knowledge, expert consumers have much of the experiences or knowledge of the product in consumer position and novice consumers does not. The model tested in this article are shown in Figure 1. The model indicates that both of CA association and CSR association influence on performance risk and financial risk. In addition, the effects of CA and CSR are moderated by product category knowledge (product knowledge) and product category involvement (product involvement). In this study, the relationships between the corporate association and product-relevant perceived risk are hypothesized as the following form. For example, Hypothesis 1a($H_{1a}$) is represented that CA association has a positive influence on the performance risk of consumer. Also, the hypotheses that identified some variables to moderate the effects of two types of corporate association on the perceived risk of the product are laid down. One of the hypotheses of the interaction effect is Hypothesis 3a($H_{3a}$), it is described that consumer's knowledges of the product moderates the negative relationship between CA association and product-relevant performance risk. A field experiment was conducted in order to examine our model. The company tested was not real but imagined to meet the internal validity. Water purifiers were used for our study. Four scenarios have been developed and described as the imaginary company: Type A with both of superior CA and CSR, Type B with superior CSR and inferior CA, Type C with superior CA and inferior CSR, and Type D with both inferior of CA and CSR. The respondents of this study were classified into four groups. One type of four scenarios (Type A, B, C, or D) in its questionnaire was given to the respondent who filled out questions. Data were collected by means of a self-administered questionnaire to the respondents, chosen in convenience. A total of 300 respondents filled out the questionnaire but 207 were used for further analysis. Table 1 indicates that the scales in this study are reliable because the range of coefficients of Cronbach's $\alpha$ are from 0.85 to 0.92. The composite reliability is in the range of 0,85 to 0,92 and average variance extracted is in 0.72-0.98 range that is higher than the base level of 0.6. As shown in Table 2, the values for CFI, NNFI, root-mean-square error approximation (RMSEA), and standardized root-mean-square residual (SRMR) are acceptably close to the standards suggested by Hu and Bentler (1999):.95 for CFI and NNFI,.06 for RMSEA, and.08 for SRMR. We also tested discriminant validity provided by Fornell and Larcker (1981). As shown in Table 2, we found strong evidence for discriminant validity between each possible pair of latent constructs in all samples. Given that these batteries of overall goodness-of-fit indices were accurate and that the model was developed on theoretical bases, and given the high level of consistency across samples, this enables us to proceed the previously defined scales. We used the moderated hierarchical regression analysis to test the influence of the corporate association(CA and CSR associations) on product-relevant perceived risk(performance and financial risks) and to identify the variables moderating the relationship between the corporate association and product-relevant performance risk. In this study, dependent variables are performance and financial risk. CA and CSR associations are described the independent variables. The moderating variables are product category knowledge and product category involvement. The results are, as expected, found that CA association has statistically a significant influence on the perceived risk of the product, but CSR association does not. Product category knowledge and involvement moderate the relationship between the CA association and the perceived risk of the product. However, the effect of CSR association on the perceived risk of the product is not moderated by the consumers' knowledge and involvement. For this result, it is necessary for a corporate to inform its customers CA association more than CSR association so that they could be felt to be the reduction of the perceived risk. The important theoretical contribution of this research is the meanings that two types of corporate association that Brown and Dacin(1997), and Brown(1998) have proposed replicated the difference of the effects on product evaluation. According to Hunter(2001), it was an important affair to accomplish the validity of a particular study and we had to take about ten studies to deduce a strict study. Next, there is the contribution of the this study to find that the effects of corporate association on the perceived risk of the product are varied by the moderator variables. In particular, the moderating effect of knowledge on the relationship between corporate association and product-relevant perceived risk has not been tested in Korea. In the managerial implications of this research, we suggest the necessity to stress the ability that corporate manufactures the product well(CA association) than the accomplishment of corporate's social obligation(CSR association). This study suffers from various limitations that imply future research directions. The moderating effects of product category knowledge and involvement on the relationship between corporate association and perceived risk need to be replicated. Next, future research could explore whether the mediated effects of the perceived risk has the relationship between corporate association and consumer's product purchase. In addition, to ensure the external validity of the study will be needed to use realistic company, not artificial.

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