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Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer (초기 유방암의 유방보존수술과 방사선치료의 장기추적결과)

  • Kim, Jin-Hee;Byun, Sang-Jun
    • Radiation Oncology Journal
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    • v.27 no.3
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    • pp.153-162
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    • 2009
  • Purpose: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. Materials and Methods: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. Results: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ($\leq$6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conclusion: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

Noninvasive Prenatal Diagnosis using Cell-Free Fetal DNA in Maternal Plasma: Clinical Applications

  • Yang, Young-Ho;Han, Sung-Hee;Lee, Kyoung-Ryul
    • Journal of Genetic Medicine
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    • v.8 no.1
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    • pp.1-16
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    • 2011
  • Owing to the risk of fetal loss associated with prenatal diagnostic procedures (amniocentesis, chorionic villus sampling), noninvasive prenatal diagnosis (NIPD) is ultimate goal of prenatal diagnosis. The discovery of circulating cell-free fetal DNA (cffDNA) in maternal plasma in 1997 has opened up new probabilities for NIPD by Dr. Lo et al. The last decade has seen great development in NIPD. Fetal sex and fetal RhD status determination by cffDNA analysis is already in clinical use in certain countries. For routine use, this test is limited by the amount of cell-free maternal DNA in blood sample, the lack of universal fetal markers, and appropriate reference materials. To improve the accuracy of detection of fetal specific sequences in maternal plasma, internal positive controls to confirm to presence of fetal DNA should be analyzed. We have developed strategies for noninvasive determination of fetal gender, and fetal RhD genotyping using cffDNA in maternal plasma, using real-time quantitative polymerase chain reaction (RT-PCR) including RASSF1A epigenetic fetal DNA marker (gender-independent) as internal positive controls, which is to be first successful study of this kind in Korea. In our study, accurate detection of fetal gender through gestational age, and fetal RhD genotyping in RhD-negative pregnant women was achieved. In this assay, we show that the assay is sensitive, easy, fast, and reliable. These developments improve the reliability of the applications of circulating fetal DNA when used in clinical practice to manage sex-linked disorders (e.g., hemophilia, Duchenne muscular dystrophy), congenital adrenal hyperplasia (CAH), RhD incompatibility, and the other noninvasive pregnant diagnostic tests on the coming soon. The study was the first successful case in Korea using cffDNA in maternal plasma, which has created a new avenue for clinical applications of NIPD.

Summary and Conclusion Title :Oriental Nursing Management System (한방간호 관리체계 연구)

  • Moon, Heui-Ja
    • Journal of East-West Nursing Research
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    • v.10 no.1
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    • pp.11-26
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    • 2004
  • The purpose of this study is to investigate the present conditions of nursing investment contents, its conversion process, and output in Oriental University Medical Center, Korea to get good qualified Oriental nursing result which is the ultimate purpose of the Oriental nursing management, and to develope a matrix of Oriental nursing management system on the basis of that project. The subjects for nursing investment and output contents were eighteen nursing directors in eleven Oriental University Medical Center and two hundred thirty-nine nurses with three years and over experience in Oriental medical center. The subjects for Oriental nursing organization, human affair management, and control function were nineteen Oriental medical center in Oriental University Medical Center, Korea. Data were collected from November, 2002 to February, 2003 with questionnaire. Data analysis was done by SPSS PC+ 12 program. Frequency, percentage, and minimum/maximum values were used for investment contents, and frequency and percentage were used for conversion process and output contents. 1. The input factors of oriental nursing management system The objective's western hospital career was over five years of one hundred and seventy-five(73.2%) persons. Nursing in-service education was performed in fourteen hospitals(77.8%). Two hundreds(83.7%) were pro to oriental nurse system. Only four hospitals(22.2%) had independent budget in nursing division. Nursing staff allocation to the bed was from 2.8:1 to 9.06:1 respectively, with a big gap of the rate following the hospitals. 2. The conversion factors of oriental nursing system 1) Oriental nursing system Oriental hospital nursing system was organized independently in ten hospitals among eighteen hospitals. The recruitment of nurses which was a vital role of the nursing division of the hospital was mostly(79%) opened. The education to develope nursing personnels was through in-service one in 97.4%. Education for oriental nursing and management was performed in 42.1%(eight hospitals) and that for reserves was done in 36.8%(seven hospitals). Administration for nursing education by nursing division was 68.5%(thirteen hospitals). The post education evaluation was performed by report submission in 36.8%(seven hospitals), by written examination in 26.3%, by questionnaires in 21.1%, and by lecture presentation in 15.8% subsequently. The directorial meeting for the nursing directors was attended by 84.2%(sixteen hospitals), and the meeting type was the medical executive and support division executive meeting in 55.6%(ten hospitals) and the personnel management in 39.6%(seven hospitals). 2) The actual conditions of oriental nursing personnel management The reason of working in oriental hospital was by voluntary in 67.1%(a hundred and sixty persons), by nursing department order in 28.0%(sixty-seven persons), and by others in 5.0%(twelve persons) respectively. The shift form was a three-shifts one in 94.7%(eighteen hospitals), a two-shift one in only one hospital. Duty assignment was functional in 52.6%(ten hospitals), team and functional in 26.3%(five hospitals) and no team alone. Promotion manual was present at 68.4%(thirteen hospitals) and the competency essentials comprised of performance evaluation in 79%, interview, written examination, training result, study result subsequently. No labor union existed in 79%(fifteen hospitals) 3) Oriental nursing preceptor system There were five oriental hospitals(27.7%) administering the preceptor utilization model, which showed lower rate than the twenty-two medical university hospitals in Seoul in which fifteen hospitals (72.7%) were having the system. To the question of necessity of oriental nurse system asked to the objectives of two hundred and thirty-nine with more than three year-experience in oriental hospital, two hundred persons(83.7%) answered positively. 4) The control of oriental nursing The evaluation results from the target hospitals were mostly not opened in 89.4% of oriental hospitals. Thirteen hospitals(68.3%) had evaluation system of direct managers and the next were three hospitals(15.8%) of direct managers and selves. There was one hospital(5.3% each) where fellows and superiors, fellows, and inferiors' evaluation was performed and no hospital where superiors, fellows, inferiors and selves, and superiors, fellows and selves' evaluation was performed. The QI activity of nursing was 42.1%(eight hospitals) for nursing service evaluation, 36.8% for survey of ECSI, 26.3% for survey of ICSI, 15.8% for medical visit rate, 10% for hospital standardization inspection in sequence. 3. The output factors of oriental nursing management system The job satisfaction appeared good in general, indicating very good in thirty-seven persons (15.7%), good in one hundred and fourteen persons (48.3%) and fair in eighty-five persons(36.0%).

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Value of Health, Multidimensonal Health Locus of Control and Level of Self-esteem in Low Income Mothers (도시빈곤여성의 건강가치, 건강통제위성격 및 자아존중감과의 관계)

  • Lee, Kwang-Ok;Yang, Soon-Ok
    • Research in Community and Public Health Nursing
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    • v.7 no.1
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    • pp.52-68
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    • 1996
  • As a product of poverty, health means the physical, mental and social instability caused by poverty. High mortality, high morbidity, and unsatisfied needs for medical care indicate the health condition of poor people. These indicators are related to the social and psychological property. This study is to develop an effective method of nursing in the poor family which is an essential unit in the nursing field of the community and to which a fundamental approach is need as a top priority. We can make such a study, though partially, by revealing the relationship among the Health-value, Health Locus of Contol, and the Level of Self esteem. We randomly sampled 243 women who are participating in the nursing department of the comnnity nursing centers in Seoul. We investigated by using questionaries and made an analysis on the result by SAS program. The result of this investigation can summarized as follows : 1. The average age of the subjects investigated is 43.4 and the participation rate in the economic activity is as high as 49.4%. Most of them are paid daily. The average members of the family are 4.28 persons, and 80.2% of which are nuclear families. The type of housing is as follows:51.4% are monthly-rent houses. Rent houses represent 23.5%. And 43.6% of the subjects graduate the high schools 2. The level of self-esteem possessed by the subjects is 37.17. The quality of task performance(3.46) and the morality(3.53) are low as compared with the other qualities. 3. In relation to the locus of control, internality is 22.39, the influence of powerrful others represents 20.24, and the effect of chance occurance is 16.41. 4. The orderings of value scale are the physical and mental health, comfortable life, happiness, mental peace, and pleasure. The lowest order is social recognition. 5. Considering in relation to the self-esteem and the locus of control, we found out that there is a negative relationship among the self-esteem, the influence of powerful others. The lower the level of self-esteem is, the higher the influence of powerful others is. There is also a negative relationship among the detailed items such as the qualities, and the positive attitude. 6. In a significant test in the general characters of the subjects and in the level of self-esteem, we can obtain the follwing results. The higher the economic level is, the higher the level of self-esteem is. And the higher the level of satisfaction with life is, the higher the level of self-esteem is. 7. In the locus of control, the higher the economic level is, the higher the internality is. 8. In the health-level, 75.72% represent the high health -level. And the group which has the low satisfaction with life represents the high level of health-value(81.6%). With these results, we can conclude that the level of self-esteem possessed by the poor women living in the city is high and that they have the multi-dimemsional health-value even though they are living in the poor condtions. Traditionally, the poverty has been recognized as an unfavorale factor in the health care. But this study shows that the poverty is no longer an unfavorale factor and, on the contrary, it has a potential power with which people can improve their health by possessing the high self-esteem and the high health value. The ultimate purpose which the nursing task of the community has is to make the patients keep and improve their own health. So, when the nurses approach the poor patients, the nurses should put an emphasis on the individual responsibilities of the patients, and respect their own health value.

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The Effect of Safflower Seed Extract on the Bone Formation of Calvarial Bone Model in Sprague Dawley rat (백서 두개골 결손부에서 홍화씨 추출물의 골조직 재생 유도 효과)

  • Kim, Sung-Tae;Jhon, Gil-Ja;Lim, So-Hyoung;Cho, Kyoo-Sung;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.30 no.4
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    • pp.835-852
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    • 2000
  • The ultimate goal of periodontal therapy is the regeneration of periodontal tissue and repair of function. For more than a decade there have been many efforts to develop materials and methods of treatment to promote periodontal wound healing. Recently many efforts are concentrated on the regeneration potential of material used in oriental medicine. In some in vitro and in vivo experiments, there have been many evidences that these materials have an effect on bone regeneration. The purpose of this study was to evaluate histologically and radiologically in Sprague-Dawley rats the effects of safflower seed extracts on the regeneration of the calvarial defects surgically produced. So in this study, the critical size defects were surgically produced in the calvarial bone of 30 Sprague-Dawley rats using the 8mm trephine bur. The safflower seed extract was applied into the defect of each rat in experimental group, whereas nothing was applied into the defect of each rat in control group. Rats were sacrificed at 2, 4, 8 weeks following operation and histomorphometric and radiodensitometric analysis were performed. 1. The newly formed bone length was $102.91{\pm}22.05$, $178.29{\pm}24.40$ at 2 week in the each control, experimental group, $130.95{\pm}39.24$, $242.62{\pm}50.33$ at 4 week and $181.53{\pm}76.35$, $240.36{\pm}22.00$ at 8 week($unit,{\mu}m$). In the 2, 4 week, there were statistically significant difference between control and experimental group(P<0.05). 2. The newly formed bone area was $2962.06{\pm}1284.48$, $10648.35{\pm}1284.48$ at 2 week, $5103.25{\pm}1375.88$, $9706.78{\pm}1481.81$ at 4 week, $8046.02{\pm}818.99$, $12057.06{\pm}740.47$ at 8 week($unit,{\mu}m^2$). In every week, there were statistically significant difference between control and experimental group(P<0.05). 3. The radiopacity was $14.26{\pm}.33$, $25.47{\pm}4.33$ at 2 week, $20.06{\pm}9.07$, $26.61{\pm}2.78$ at 4 week, $22.99{\pm}3.76$, $27.29{\pm}1.54$ at 8 week(unit, %). In the 2 week, there was statistically significant difference between control and experimental group(P<0.05). In conclusion, the results of the present study suggest that safflower seed extract initially has an effect on the newly formed bone area, length and radiopacity when it is applied to the calvarial defect of Sprague - Dawley rat. Then. the material has an effect on newly formed bone area and length.

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A Study of the Application of 'Digital Heritage ODA' - Focusing on the Myanmar cultural heritage management system - (디지털 문화유산 ODA 적용에 관한 시론적 연구 -미얀마 문화유산 관리시스템을 중심으로-)

  • Jeong, Seongmi
    • Korean Journal of Heritage: History & Science
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    • v.53 no.4
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    • pp.198-215
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    • 2020
  • Official development assistance refers to assistance provided by governments and other public institutions in donor countries, aimed at promoting economic development and social welfare in developing countries. The purpose of this research is to examine the construction process of the "Myanmar Cultural Heritage Management System" that is underway as part of the ODA project to strengthen cultural and artistic capabilities and analyze the achievements and challenges of the Digital Cultural Heritage ODA. The digital cultural heritage management system is intended to achieve the permanent preservation and sustainable utilization of tangible and intangible cultural heritage materials. Cultural heritage can be stored in digital archives, newly approached using computer analysis technology, and information can be used in multiple dimensions. First, the Digital Cultural Heritage ODA was able to permanently preserve cultural heritage content that urgently needed digitalization by overcoming and documenting the "risk" associated with cultural heritage under threat of being extinguished, damaged, degraded, or distorted in Myanmar. Second, information on Myanmar's cultural heritage can be systematically managed and used in many ways through linkages between materials. Third, cultural maps can be implemented that are based on accurate geographical location information as to where cultural heritage is located or inherited. Various items of cultural heritage were collectively and intensively visualized to maximize utility and convenience for academic, policy, and practical purposes. Fourth, we were able to overcome the one-sided limitations of cultural ODA in relations between donor and recipient countries. Fifth, the capacity building program run by officials in charge of the beneficiary country, which could be the most important form of sustainable development in the cultural ODA, was operated together. Sixth, there is an implication that it is an ODA that can be relatively smooth and non-face-to-face in nature, without requiring the movement of manpower between countries during the current global pandemic. However, the following tasks remain to be solved through active discussion and deliberation in the future. First, the content of the data uploaded to the system should be verified. Second, to preserve digital cultural heritage, it must be protected from various threats. For example, it is necessary to train local experts to prepare for errors caused by computer viruses, stored data, or operating systems. Third, due to the nature of the rapidly changing environment of computer technology, measures should also be discussed to address the problems that tend to follow when new versions and programs are developed after the end of the ODA project, or when developers have not continued to manage their programs. Fourth, since the classification system criteria and decisions regarding whether the data will be disclosed or not are set according to Myanmar's political judgment, it is necessary to let the beneficiary country understand the ultimate purpose of the cultural ODA project.

Service Quality, Customer Satisfaction and Customer Loyalty of Mobile Communication Industry in China (중국이동통신산업중적복무질량(中国移动通信产业中的服务质量), 고객만의도화고객충성도(顾客满意度和顾客忠诚度))

  • Zhang, Ruijin;Li, Xiangyang;Zhang, Yunchang
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.3
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    • pp.269-277
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    • 2010
  • Previous studies have shown that the most important factor affecting customer loyalty in the service industry is service quality. However, on the subject of whether service quality has a direct or indirect effect on customer loyalty, scholars' views apparently vary. Some studies suggest that service quality has a direct and fundamental influence on customer loyalty (Bai and Liu, 2002). However, others have shown that service quality not only directly affects customer loyalty, it also has an indirect impact on customer loyalty by influencing customer satisfaction and perceived value (Cronin, Brady, and Hult, 2000). Currently, there are few domestic articles that specifically address the relationship between service quality and customer loyalty in the mobile communication industry. Moreover, research has studied customer loyalty as a whole variable, rather than breaking it down further into multiple dimensions. Based on this analysis, this paper summarizes previous study results, establishes an effect mechanism model among service quality, customer satisfaction, and customer loyalty in the mobile communication industry, and presents a statistical test on model assumptions by using customer investigation data from Heilongjiang Mobile Company. It provides theoretical guidance for mobile service management based on the discussion of the hypothesis test results. For data collection, the sample comprised mobile users in Harbin city, and the survey was taken by random sampling. Out of a total of 300 questionnaires, 276 (92.9%) were recovered. After excluding invalid questionnaires, 249 remained, for an effective rate of 82.6 percent for the study. Cronbach's ${\alpha}$ coefficient was adapted to assess the scale reliability, and validity testing was conducted on the questionnaire from three aspects: content validity, construct validity. and convergent validity. The study tested for goodness of fit mainly from the absolute and relative fit indexes. From the hypothesis testing results, overall, four assumptions have not been supported. The ultimate affective relationship of service quality, customer satisfaction, and customer loyalty is demonstrated in Figure 2. On the whole, the service quality of the communication industry not only has a direct positive significant effect on customer loyalty, it also has an indirect positive significant effect on customer loyalty through service quality; the affective mechanism and extent of customer loyalty are different, and are influenced by each dimension of service quality. This study used the questionnaires of existing literature from home and abroad and tested them in empirical research, with all questions adapted to seven-point Likert scales. With the SERVQUAL scale of Parasuraman, Zeithaml, and Berry (1988), or PZB, as a reference point, service quality was divided into five dimensions-tangibility, reliability, responsiveness, assurance, and empathy-and the questions were simplified down to nineteen. The measurement of customer satisfaction was based mainly on Fornell (1992) and Wang and Han (2003), ending up with four questions. Based on the study’s three indicators of price tolerance, first choice, and complaint reaction were used to measure attitudinal loyalty, while repurchase intention, recommendation, and reputation measured behavioral loyalty. The collection and collation of literature data produced a model of the relationship among service quality, customer satisfaction, and customer loyalty in mobile communications, and China Mobile in the city of Harbin in Heilongjiang province was used for conducting an empirical test of the model and obtaining some useful conclusions. First, service quality in mobile communication is formed by the five factors mentioned earlier: tangibility, reliability, responsiveness, assurance, and empathy. On the basis of PZB SERVQUAL, the study designed a measurement scale of service quality for the mobile communications industry, and obtained these five factors through exploratory factor analysis. The factors fit basically with the five elements, indicating the concept of five elements of service quality for the mobile communications industry. Second, service quality in mobile communications has both direct and indirect positive effects on attitudinal loyalty, with the indirect effect being produced through the intermediary variable, customer satisfaction. There are also both direct and indirect positive effects on behavioral loyalty, with the indirect effect produced through two intermediary variables: customer satisfaction and attitudinal loyalty. This shows that better service quality and higher customer satisfaction will activate the attitudinal to service providers more active and show loyalty to service providers much easier. In addition, the effect mechanism of all dimensions of service quality on all dimensions of customer loyalty is different. Third, customer satisfaction plays a significant intermediary role among service quality and attitudinal and behavioral loyalty, indicating that improving service quality can boost customer satisfaction and make it easier for satisfied customers to become loyal customers. Moreover, attitudinal loyalty plays a significant intermediary role between service quality and behavioral loyalty, indicating that only attitudinally and behaviorally loyal customers are truly loyal customers. The research conclusions have some indications for Chinese telecom operators and others to upgrade their service quality. Two limitations to the study are also mentioned. First, all data were collected in the Heilongjiang area, so there might be a common method bias that skews the results. Second, the discussion addresses the relationship between service quality and customer loyalty, setting customer satisfaction as mediator, but does not consider other factors, like customer value and consumer features, This research will be continued in the future.