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The Clinical Characteristics of Lung Cancer in Patients with Idiopathic Pulmonary Fibrosis (특발성 폐섬유화증에 동반된 폐암 환자의 임상적 특정)

  • Park, Joo-Hun;Lee, Jin-Seong;Song, Koun-Sik;Shim, Tae-Sun;Lim, Chae-Man;Koh, Youn-Suck;Lee, Sang-Do;Kim, Woo-Sung;Kim, Won-Dong;Kim, Dong-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.674-684
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    • 1999
  • Background : It has been generally known that the incidence of lung cancer is higher in the patients with idopathic pumonary fibrosis (IPF) than those in general population. The reported incidence was variable from 4.8 to 43.2%. There were controversies on the most frequent cell type (squamous cell carcinoma vs. adenocarcinoma) and no study was done about the real concordance of cancer and the fibrotic lesion. And the pulmonary fibrosis may influence not only the development of cancer but also the treatment and prognosis of the cancer, but there was no report on that point. Method : Total 63 patients ($66.8{\pm}7.8$ year, M : F=61 : 2) were diagnosed as IPF combined with lung cancer (IFF-CA) at Asan Medical Center. A retrospective analysis was done about the risk factors of the lung cancer, pulmonary function test, the site of cancer(especially the relationship of the cancer with the fibrotic lesion), the histologic types, and the stage of cancer. The histologic types were compared with those of 2,660 patients with lung cancer who were diagnosed at the same institute for the same period. The effect of IPF on the treatment of the cancer was evaluated with the survival time after the detection of lung cancer. Results : The lung cancer was found in 63(22.9%) out of 281 patients with IPF. But in most of them(45 patients), lung cancer was detected at the same time with IPF and only in 18 patients, the cancer was diagnosed during the follow-up($25.2{\pm}17.7$ months) of IPF. So in our study, 6.7% of patients with IPF developed lung cancer during the course of the disease. The age ($66.8{\pm}7.84$ vs. $63.4{\pm}11.1$ years), percentage of smoker (88.9 vs. 67.2%), and the male gender (96.8 vs. 67.6%) were significantly higher in IPF-CA compared with lone IPF (p<0.05). The odds ratio of smoking was 4.7 compared with non smoking IPF controls. The lung cancer was located more frequently in the upper lobe and 55.5% was in the periphery of lung. The cancer was developed in the fibrotic lesion in 23 patients (35.9%), and in the majority of the patients, the cancer was separated from the fibrosis. The cell type of the lung cancer in IPF-CA was squamous cell carcinoma 34.9%, adenocarcinoma 30.2%, small cell carcinoma 19.0%, large cell undifferenciated carcinoma 6.3%, and others 9.5%. No significant difference in the distribution of histologic type of the lung cancer was found between IPF-CA and lone lung cancer. There was no significant difference in demographic features, cell types, location and the stage of the cancer between the group with concurrent IPF-CA and the group with cancer diagnosed during the follow up of IPF. There was a tendency (but statistically not significant : p=0.081) of higher incidence of adenocarcinoma among the cancers developed in the fibrotic area(43.5%) (F-CA) than in the cancers in non-fibrotic area (22.5%) (NF-CA). The prognosis of the patients with F-CA was poor (median survival : 4 months) compared with the patients with NF-CA (7 months, p=0.013), partly because the prevalence of severe IPF (the extent of fibrosis in HRCT 50%) was higher in F-CA group. Conclusion : These data suggest that the lung cancer in the patients with IPF has similar features to the ordinary lung cancer.

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Short-Term Efficacy of Steroid and Immunosuppressive Drugs in Patients with Idiopathic Pulmonary Fibrosis and Pre-treatment Factors Associated with Favorable Response (특발성폐섬유화증에서 스테로이드와 면역억제제의 단기 치료효과 및 치료반응 예측인자)

  • Kang, Kyeong-Woo;Park, Sang-Joon;Koh, Young-Min;Lee, Sang-Pyo;Suh, Gee-Young;Chung, Man-Pyo;Han, Jung-Ho;Kim, Ho-Joong;Kwon, O-Jung;Lee, Kyung-Soo;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.685-696
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    • 1999
  • Background : Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the short-term efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. Method : Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednisolone (0.25mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders : (1) improvement of more than one grade in dyspnea index, (2) improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. Result : One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid ($23.8{\pm}16.3%$ vs $7.8{\pm}3.6%$, p<0.05), and less honeycombing in chest HRCT findings (0% vs $9.2{\pm}2.3%$, p<0.001). Conclusion : Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables.

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A Study on the Curriculum for Record Management Science Education - with focus on the Faculty of Cultural Information Resources, Surugadai University; Evolving Program, New Connections (기록관리학의 발전을 위한 교육과정연구 -준하태(駿河台)(스루가다이)대학(大學)의 경우를 중심(中心)으로-)

  • Kim, Yong-Won
    • Journal of Korean Society of Archives and Records Management
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    • v.1 no.1
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    • pp.69-94
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    • 2001
  • The purpose of this paper is to provide an overview of the current status of the records management science education in Japan, and to examine the implications of the rapid growth of this filed while noting some of its significant issues and problems. The goal of records management science education is to improve the quality of information services and to assure an adequate supply of information professionals. Because records management science programs prepare students for a professional career, their curricula must encompass elements of both education and practical training. This is often expressed as a contrast between theory and practice. The confluence of the social, economic and technological realities of the environment where the learning takes place affects both. This paper reviews the historical background and current trends of records management science education in Japan. It also analyzes the various types of curriculum and the teaching staff of these institutions, with focus on the status of the undergraduate program at Surugadai University, the first comprehensive, university level program in Japan. The Faculty of Cultural Information Resources, Surugadai University, a new school toward an integrated information disciplines, was opened in 1994, to explore the theory and practice of the management diverse cultural information resources. Its purpose was to stimulate and promote research in additional fields of information science by offering professional training in archival science, records management, and museum curatorship, as well as librarianship. In 1999, the school introduced a master program, the first in Japan. The Faculty has two departments and each of them has two courses; Department of Sensory Information Resources Management; -Sound and Audiovisual Information Management, -Landscape and Tourism Information Management, Department of Knowledge Information Resources Management; -Library and Information Management, -Records and Archives Management The structure of the entire curriculum is also organized in stages from the time of entrance through basic instruction and onwards. Orientation subjects which a student takes immediately upon entering university is an introduction to specialized education, in which he learns the basic methods of university education and study, During his first and second years, he arranges Basic and Core courses as essential steps towards specialization at university. For this purpose, the courses offer a wide variety of study topics. The number of courses offered, including these, amounts to approximately 150. While from his third year onwards, he begins specific courses that apply to his major field, and in a gradual accumulation of seminar classes and practical training, puts his knowledge grained to practical use. Courses pertaining to these departments are offered to students beginning their second year. However, there is no impenetrable wall between the two departments, and there are only minor differences with regard requirements for graduation. Students may select third or fourth year seminars regardless of the department to which they belong. To be awarded a B.A. in Cultural Information Resources, the student is required to earn 34 credits in Basic Courses(such as, Social History of Cultural Information, Cultural Anthropology, History of Science, Behavioral Sciences, Communication, etc.), 16 credits in Foreign Languages(including 10 in English), 14 credits on Information Processing(including both theory and practice), and 60 credits in the courses for his or her major. Finally, several of the issues and problems currently facing records management science education in Japan are briefly summarized below; -Integration and Incorporation of related areas and similar programs, -Curriculum Improvement, -Insufficient of Textbooks, -Lack of qualified Teachers, -Problems of the employment of Graduates. As we moved toward more sophisticated, integrated, multimedia information services, information professionals will need to work more closely with colleagues in other specialties. It will become essential to the survival of the information professions for librarians to work with archivists, record managers and museum curators. Managing the changes in our increasingly information-intensive society demands strong coalitions among everyone in cultural Institutions. To provide our future colleagues with these competencies will require building and strengthening partnerships within and across the information professions and across national borders.

Broadening the Understanding of Sixteenth-century Real Scenery Landscape Painting: Gyeongpodae Pavilion and Chongseokjeong Pavilion (16세기(十六世紀) 실경산수화(實景山水畫) 이해의 확장 : <경포대도(鏡浦臺圖)>, <총석정도(叢石亭圖)>를 중심으로)

  • Lee, Soomi
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.18-53
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    • 2019
  • The paintings Gyeongpodae Pavilion and Chongseokjeong Pavilion were recently donated to the National Museum of Korea and unveiled to the public for the first time at the 2019 special exhibition "Through the Eyes of Joseon Painters: Real Scenery Landscapes of Korea." These two paintings carry significant implications for understanding Joseon art history. Because the fact that they were components of a folding screen produced after a sightseeing tour of the Gwandong regions in 1557 has led to a broadening of our understanding of sixteenth-century landscape painting. This paper explores the art historical meanings of Gyeongpodae Pavilion and Chongseokjeong Pavilion by examining the contents in the two paintings, dating them, analyzing their stylistic characteristics, and comparing them with other works. The production background of Gyeongpodae Pavilion and Chongseokjeong Pavilion can be found in the colophon of Chongseokjeong Pavilion. According to this writing, Sangsanilro, who is presumed to be Park Chung-gan (?-1601) in this paper, and Hong Yeon(?~?) went sightseeing around Geumgangsan Mountain (or Pungaksan Mountain) and the Gwandong region in the spring of 1557, wrote a travelogue, and after some time produced a folding screen depicting several famous scenic spots that they visited. Hong Yeon, whose courtesy name was Deokwon, passed the special civil examination in 1551 and has a record of being active until 1584. Park Chung-gan, whose pen name was Namae, reported the treason of Jeong Yeo-rip in 1589. In recognition of this meritorious deed, he was promoted to the position of Deputy Minister of the Ministry of Punishments, rewarded with the title of first-grade pyeongnan gongsin(meritorious subject who resolved difficulties), and raised to Lord of Sangsan. Based on the colophon to Chongseokjeong Pavilion, I suggest that the two paintings Gyeongpodae Pavilion and Chongseokjeong Pavilion were painted in the late sixteenth century, more specifically after 1557 when Park Chung-gan and Hong Yeon went on their sightseeing trip and after 1571 when Park, who wrote the colophon, was in his 50s or over. The painting style used in depicting the landscapes corresponds to that of the late sixteenth century. The colophon further states that Gyeongpodae Pavilion and Chongseokjeong Pavilion were two paintings of a folding screen. Chongseokjeong Pavilion with its colophon is thought to have been the final panel of this screen. The composition of Gyeongpodae Pavilion recalls the onesided three-layered composition often used in early Joseon landscape paintings in the style of An Gyeon. However, unlike such landscape paintings in the An Gyeon style, Gyeongpodae Pavilion positions and depicts the scenery in a realistic manner. Moreover, diverse perspectives, including a diagonal bird's-eye perspective and frontal perspective, are employed in Gyeongpodae Pavilion to effectively depict the relations among several natural features and the characteristics of the real scenery around Gyeongpodae Pavilion. The shapes of the mountains and the use of moss dots can be also found in Welcoming an Imperial Edict from China and Chinese Envoys at Uisungwan Lodge painted in 1557 and currently housed in the Kyujanggak Institute for Korean Studies at Seoul National University. Furthermore, the application of "cloud-head" texture strokes as well as the texture strokes with short lines and dots used in paintings in the An Gyeon style are transformed into a sense of realism. Compared to the composition of Gyeongpodae Pavilion, which recalls that of traditional Joseon early landscape painting, the composition of Chongseokjeong Pavilion is remarkably unconventional. Stone pillars lined up in layers with the tallest in the center form a triangle. A sense of space is created by dividing the painting into three planes(foreground, middle-ground, and background) and placing the stone pillars in the foreground, Saseonbong Peaks in the middle-ground, and Saseonjeong Pavilion on the cliff in the background. The Saseonbong Peaks in the center occupy an overwhelming proportion of the picture plane. However, the vertical stone pillars fail to form an organic relation and are segmented and flat. The painter of Chongseokjeong Pavilion had not yet developed a three-dimensional or natural spatial perception. The white lower and dark upper portions of the stone pillars emphasize their loftiness. The textures and cracks of the dense stone pillars were rendered by first applying light ink to the surfaces and then adding fine lines in dark ink. Here, the tip of the brush is pressed at an oblique angle and pulled down vertically, which shows an early stage of the development of axe-cut texture strokes. The contrast of black and white and use of vertical texture strokes signal the forthcoming trend toward the Zhe School painting style. Each and every contour and crack on the stone pillars is unique, which indicates an effort to accentuate their actual characteristics. The birds sitting above the stone pillars, waves, and the foam of breaking waves are all vividly described, not simply in repeated brushstrokes. The configuration of natural features shown in the above-mentioned Gyeongpodae Pavilion and Chongseokjeong Pavilion changes in other later paintings of the two scenic spots. In the Gyeongpodae Pavilion, Jukdo Island is depicted in the foreground, Gyeongpoho Lake in the middle-ground, and Gyeongpodae Pavilion and Odaesan Mountain in the background. This composition differs from the typical configuration of other Gyeongpodae Pavilion paintings from the eighteenth century that place Gyeongpodae Pavilion in the foreground and the sea in the upper section. In Chongseokjeong Pavilion, stone pillars are illustrated using a perspective viewing them from the sea, while other paintings depict them while facing upward toward the sea. These changes resulted from the established patterns of compositions used in Jeong Seon(1676~1759) and Kim Hong-do(1745~ after 1806)'s paintings of Gwandong regions. However, the configuration of the sixteenth-century Gyeongpodae Pavilion, which seemed to have no longer been used, was employed again in late Joseon folk paintings such as Gyeongpodae Pavilion in Gangneung. Famous scenic spots in the Gwandong region were painted from early on. According to historical records, they were created by several painters, including Kim Saeng(711~?) from the Goryeo Dynasty and An Gyeon(act. 15th C.) from the early Joseon period, either on a single scroll or over several panels of a folding screen or several leaves of an album. Although many records mention the production of paintings depicting sites around the Gwandong region, there are no other extant examples from this era beyond the paintings of Gyeongpodae Pavilion and Chongseokjeong Pavilion discussed in this paper. These two paintings are thought to be the earliest works depicting the Gwandong regions thus far. Moreover, they hold art historical significance in that they present information on the tradition of producing folding screens on the Gwandong region. In particular, based on the contents of the colophon written for Chongseokjeong Pavilion, the original folding screen is presumed to have consisted of eight panels. This proves that the convention of painting eight views of Gwangdong had been established by the late sixteenth century. All of the existing works mentioned as examples of sixteenth-century real scenery landscape painting show only partial elements of real scenery landscape painting since they were created as depictions of notable social gatherings or as a documentary painting for practical and/or official purposes. However, a primary objective of the paintings of Gyeongpodae Pavilion and Chongseokjeong Pavilion was to portray the ever-changing and striking nature of this real scenery. Moreover, Park Chung-gan wrote a colophon and added a poem on his admiration of the scenery he witnessed during his trip and ruminated over the true character of nature. Thus, unlike other previously known real-scenery landscape paintings, these two are of great significance as examples of real-scenery landscape paintings produced for the simple appreciation of nature. Gyeongpodae Pavilion and Chongseokjeong Pavilion are noteworthy in that they are the earliest remaining examples of the historical tradition of reflecting a sightseeing trip in painting accompanied by poetry. Furthermore, and most importantly, they broaden the understanding of Korean real-scenery landscape painting by presenting varied forms, compositions, and perspectives from sixteenth-century real-scenery landscape paintings that had formerly been unfound.