• Title/Summary/Keyword: 영향

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The Expression of Vascular Endothelial Growth Factor (VEGF) is a Highly Significant Prognostic Factor in Stage IB Carcinoma of the Cervix (병기 IB 자궁경부암에서 혈관내피세포성장인자(VEGF)의 발현이 예후에 미치는 영향)

  • Lee Ik Jae;Park Kyung Ran;Lee Jong Young;Lee Kang Kyoo;Song Ji Sun;Lee Kwang Gil;Cha Dong Soo;Choi Hyun Il
    • Radiation Oncology Journal
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    • v.19 no.4
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    • pp.335-344
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    • 2001
  • Purpose : The aim of this study was to clarify the role of VEGF expression as an independent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Materials and methods : A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, n patients were treated with postoperative radiotherapy and/or chemotherapy. VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low VEGF expression and the patients with a score of +++ as high VEGF expression. Results : Of the 118 patients, 35 patients $(29.7\%)$ showed high VEGF expression. Strong correlations were found between the high VEGF expression and both deep stromal invasion (p=0.01) and the positive pelvic node (p=0.03). The 5-year overall and disease-free survival rates for all 118 patients were $95.5\%\;and\;93.8\%$. The 5-year overall (p=0.03) and disease-free survival (p<0.001) rates were $98.5\%\;and\;100%$ for low VEGF expression (0, +, and ++) and $85.5\%\;and\;79.7\%$ for high VEGF expression, respectively. Pelvic and distant failures for low versus high VEGF expression were $1.2\%$ versus $17.1\%$, (p=0.001) and $0\%$ versus $14.3\%$ (p<0.001), respectively. In a Cox multivariate analysis of survival, the high VEGF expression (p=0.02) and the bulky mass (p=0.02) were significant prognostic factors for overall survival. The high VEGF expression (p=0.002), and bulky mass (p=0.01) demonstrated as significant prognostic indicators for disease free survival. Conclusion : These results showed that VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage IB cervix cancer treated with radical surgery. We strongly suggest that the immune-histochemistry for VEGF expression be performed in a routine clinical setting in order to identify the patients at high risk for poor prognosis in early stage cervical cancer. Furthermore, postoperative and/or chemotherapy did not reduce the pelvic failure and distant metastasis. To improve the cure rate for the patients with high VEGF expression in stage IB cervical cancer, antiangiogenic therapy including anti-VEGF Ab may be new treatment option.

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Studies on the Estimation of Leaf Production in Mulberry Trees IV. Estimation of Spring Leaf Yield by the Measurement of Some Characters (상엽수확고 측정에 관한 연구 제 4보 추기상수각형질의 측정에 의한 익춘 상엽량의 예측)

  • 한경수;장권열;안정준
    • Journal of Sericultural and Entomological Science
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    • v.10
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    • pp.35-40
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    • 1969
  • Various formulae for estimation of spring leaf production in mulberry trees were calculated and obtained. Four varieties of mulberry trees were used as the materials, and four characters, namely branch length (X$_1$), node number (X$_2$), branch diameter (X$_3$) and branch number per stock (X$_4$) were studied. The formulae to estimate the leaf yield of spring mulberry trees are as follows: 1. $Y_1$v$_1$= -26.8939+50.3950X$_1$+1.1403X$_2$ $Y_1$v$_2$= -372.1091+116.6371X$_1$+0.1984X$_2$ $Y_1$v$_3$= 149.8203+90.5125X$_1$-0.9775X$_2$ $Y_1$v$_4$= 108, 1496+59.4533X$_1$+1.4965X$_2$ Where $Y_1$v$_1$, $Y_1$v$_2$, $Y_1$v$_3$, $Y_1$v$_4$, are showed the estimated yield of the each variety, namely Gaeryang Seuban, Ilchirye, Nosang, and Suwon Sang No. 4, respectively. X$_1$ and X$_2$ denote the measured values of branch length and node number, respectively. 2. $Y_{7}$v$_1$= -54.4411+32.9869c1.1127X$_2$+21.7600X$_3$ $Y_{7}$v$_2$= -494.1480-1.8756X$_1$+0.9788X$_2$+110.0039X$_3$ $Y_{7}$v$_3$= 143.2836+29.1779X$_1$+0.1644X$_2$+48.4135X$_3$ $Y_{7}$v$_4$= 1243.2549+1.9454X$_1$+2.7118X$_2$-75.6669X$_3$ Where $Y_{7}$v$_1$, $Y_{7}$v$_2$, $Y_{7}$v$_3$, $Y_{7}$v$_4$, are the estimated yield of the each variety, namely Gaeryang-Seuban, Ilchirye, Nosang, Suwon Sang No 4, respectively. X$_1$, X$_2$, X$_3$ denote the measured values of each character, branch length, node number, branch diameter and branch number per stock, respectively. 3. $Y_{11}$v$_1$=233.4780+74.3713X$_1$+1.2912X$_2$+39.0420X$_3$-148.9300X$_4$ $Y_{11}$v$_2$=-317.0150+15.l524X$_1$+1.0861X$_2$+156.7973X$_3$-148.3742X$_4$ $Y_{11}$v$_3$=178.7011+29.8664X$_1$-0.2562X$_2$+102.4632X$_3$-83.2693X$_4$ $Y_{11}$v$_4$= 264.0062+47.7742X$_1$+2.6996X$_2$+92.8882X$_3$-192.3464X$_4$ Where $Y_{11}$v$_1$, $Y_{11}$v$_2$, $Y_{11}$v$_3$, $Y_{11}$v$_4$, are the estimated yield values of four varieties, and X$_1$, X$_2$, X$_3$, X$_4$, denote the measured values of four characters, namely branch length, node number, branch diameter and branch number per stock, respectively. The estimation method of mulberry spring leaf yield by measurement of some characters, in autumn the year before, could be the better method to determine the leaf yield of mulberry trees without destroying the leaves and without weighting the leaves of mulberry trees than the other methods.

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Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction (급성 심근경색증 환자에서 시행한 OPCAB의 수술시기와 검색의 정도에 따른 임상성적)

  • Youn Young-Nam;Yang Hong-Suk;Shim Yeon-Hee;Yoo Kyung-Jong
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.534-543
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    • 2006
  • Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

Minimally Invasive Coronary Artery Bypass Grafting (소침습적 관상동맥우회술)

  • Na, Chan-Young;Lee, Young-Tak;Park. Joong-Won;Chung, Do-Hyun;Jung, Ill-Sang;Jung, Yoon-Seup;Kim, Ok-Sung;Bang, Jung-Hyun;Lee, Sub;Chung, Chul-Hyun;KIM, Woong-Han;Park, Young-Kwan;Kim, Chong-Whan;Hong, Sung-Nok;Han, Jae-Jin;Lee, Gun
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.118-124
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    • 1998
  • Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.

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Inhibition of Neointima Formation and Migration of Vascular Smooth Muscle Cells by Anti-vascular Endothelial Growth Factor Receptor-1 (Flt-4) Peptide in Diabetic Rats (당뇨병 쥐에서 혈관내피 성장인자 수용체-1 차단 펩타이드를 이용한 신내막 형성과 혈관평활근세포 이동의 억제)

  • Jo, Min-Seop;Yoo, Ki-Dong;Park, Chan-Beom;Cho, Deog-Gon;Cho, Kue-Do;Jin, Ung;Moon, Kun-Woong;Kim, Chul-Min;Wang, Young-Pil;Lee, Sun-Hee
    • Journal of Chest Surgery
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    • v.40 no.4 s.273
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    • pp.264-272
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    • 2007
  • Background: Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis, including stimulating the proliferation and migration of vascular smooth muscle cells (VSMCs). It has been known that diabetes is associated with accelerated cellular proliferation via VEGF, as compared to that under a normal glucose concentration. We investigated the effects of selective blockade of a VEGF receptor by using anti-Flt-1 peptide on the formation and hyperplasia of the neointima in balloon injured-carotid arteries of OLETF rats and also on the in vitro VSMCS' migration under high glucose conditions. Material and Method: The balloon-injury method was employed to induce neointima formation by VEGF. For f4 days beginning 2 days before the ballon injury, placebo or vascular endothelial growth factor receptor-1 (VEGFR-1) specific peptide (anti-Flt-1 peptide), was injected at a dose of 0.5mg/kg daily into the OLETF rats. At 14 days after balloon injury, the neointimal proliferation and vascular luminal stenosis were measured, and cellular proliferation was assessed by counting the proliferative cell nuclear antigen (PCNA) stained cells. To analyze the effect of VEGF and anti-Flt-1 peptide on the migration of VSMCs under a high glucose condition, transwell assay with a matrigel filter was performed. And finally, to determine the underlying mechanism of the effect of anti-Flt-1 peptide on the VEGF-induced VSMC migration in vitro, the expression of matrix metalloproteinase (MMP) was observed by performing reverse transcription-polymerase chain reaction (RT-PCR). Result: Both the neointimal area and luminal stenosis associated with neointimal proliferation were significantly decreased in the anti-Flt-1 peptide injected rats, ($0.15{\pm}0.04 mm^2$ and $ 36.03{\pm}3.78%$ compared to $0.24{\pm}0.03mm^2\;and\;61.85{\pm}5.11%$, respectively, in the placebo-injected rats (p<0.01, respectively). The ratio of PCNA(+) cells to the entire neointimal cells was also significantly decreased from $52.82{\pm}4.20%\;to\;38.11{\pm}6.89%$, by the injected anti-Flt-1 peptide (p<0.05). On the VSMC migration assay, anti-Flt-1 peptide significantly reduced the VEGF-induced VMSC migration by about 40% (p<0.01). Consistent with the effect of anti-Flt-1 peptide on VSMC migration, it also obviously attenuated the induction of the MMP-3 and MMP-9 mRNA expressions via VEGF in the VSMCS. Conclusion: Anti-Flt-1 peptide inhibits the formation and hyperplasia of the neointima in a balloon-injured carotid artery model of OLETF rats. Anti-Flt-1 peptide also inhibits the VSMCs' migration and the expressions of MMP-3 and MMP-9 mRNA induced by VEGF under a high glucose condition. Therefore, these results suggest that specific blockade of VEGFR-1 by anti-Flt-1 peptide may have therapeutic potential against the arterial stenosis of diabetes mellitus patients or that occurring under a high glucose condition.

Distribution of Indicator Organisms and Influence of Storage Temperature and Period in Commercial Animal Foods (시판 동물성 식품의 오염지표세균 분포 및 저장온도, 기간별 오염지표세균의 변화)

  • 이용욱;박석기
    • Journal of Food Hygiene and Safety
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    • v.13 no.4
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    • pp.430-440
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    • 1998
  • The average number of total viable counts for the commercial pork tested was 19/g, coliform 1.8/g, psychrophilic bacteria 15/g, heterotrophic bacteria 12/g, fecal streptococcus 6.2/100 g, Pseudomonas aeruginosa 13/100 g and none of heat-resistant bacteria and Staphylococcus was detected. That for the commercial beef tested was 130/g, coliform 5.2/g, psychrophile 140/g, heterotroph 28/g, Staphylococcus 1.2/g, fecal streptococcus 9.5/100 g, Pseud. aeruginosa 1.9/100 g and heat-resistant bacteria was not detected. That for the commercial chicken tested was 8800/g, coliform 53/g, psychrophile 4600/g, heterotroph 4700/g, fecal streptococcus 9.9/100 g, Pseudo aeruginosa 2.5/100 g. That for milk was 4700/ml, psychrophile 120/ml, heterotroph 420/ml and the others were not detected. That for the commercial cheese was 3.2/g, psychrophile 2.3/g, heterotroph 1.6/g, Staphylococcus l/g, fecal streptococcus 9.1/g. That for fermented milk was $10^{7}/ml$, heatresistant bacteria $10^{6}/ml$, fecal streptococcus 2400/100 ml, lactobacillus $3.2{\times}10^{15}/ml$, in accordance with lactic acid bacteria and the others were not detected. There was not detected any indicator organisms from ham, sausage, butter, eggs and quails in the commercial fooods tested. SPC, coliform, psychrophile and heterotroph in commercial meats stored at $10^{\circ}C$ were increased rapidly as time goes on but heat-resistant bacteria, staphylococcus, fecal streptococcus and Pseudo aeruginosa were constant. At $20^{\circ}C$, SPC, coliform, psychrophile, heterotroph and fecal streptococcus were the highest at 7 days and heat-resistant bacteria, staphylococcus and Pseudo aeruginosa were increased a little. At $30^{\circ}C$, all indicators were increased rapidly for 3 and 7 days and then decreased rapidly. All indicator organisms were increased at the level of 10/g for 14 days in meat products stored at $10^{\circ}C$, but SPC, psychrophile and heterotroph in meat products stored at $20^{\circ}C$ were increased at the level of $lO^5/g$. It showed that the indicators in meat products stored at $30^{\circ}C$ had a tendency to increase at the level of $10^{2}/g$ relative to those stored at $20^{\circ}C$. SPC, psychrophile and heterotroph in milk stored at $10^{\circ}C$ increased up to the level of $10^4/ml$, but coliform, staphylococcus, fecal streptococcus and Pseudo aeruginosa were not detected. As stored at $20^{\circ}C$ and $30^{\circ}C$, they were increased rapidly for 1 or 3 days and then constant for a long time.

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Effect of Cooking Processes on the Amount of Salmonella typhimurium in Pork and Korean Japchae and Identification of Critical Control Point in the Processes (조리과정에 따른 살모넬라(Salmonella typhimurium) 식중독균수의 변화 및 중점 관리점 (CCP)의 관찰 - 돼지고기와 잡채를 중심으로 -)

  • 김종규
    • Journal of Food Hygiene and Safety
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    • v.13 no.4
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    • pp.441-447
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    • 1998
  • This study was performed to investigate the changes of amount of S. typhimurium during cooking processes using pork and japchae (a Korean food which is made from meat, vegetables and noodles), and to support a practical application to develop a hazard analysis critical control point (HACCP) model. The pork was purchased in a retail shop, cut ($0.5\;cm\;{\times}\;10\;cm\;{\times}\;10\;cm$, 25 g), tested for Salmonella contamination (results: negative), inoculated with S. typhimurium ($10^{7}\;CFU/g$), then treated in various conditions related to cooking. Mter thawing for 24 hours in various conditions, the number of S. typhimurium was increased to $10^{10}\;CFU/g$ at a refrigerated temperature ($4~10^{\circ}C$), and to $10^{21}\;CFU/g$ at room temperature ($22~29^{\circ}C$). Mter thawing in a microwave oven for 40 seconds, the number of S. typhimurium increased to $10^{8}\;CFU/g$. During the thawing period, the number of S. typhimurium increased over time. At the refrigerated temperature, the number of the bacteria was $10^{10}\;CFU/g$ after 24 hours, $10^{13}\;CFU/g$ after 48 hours, and $10^{20}\;CFU/g$ after 72 hours. At room temperature the number of bacteria reached $10^{11}\;CFU/g$ in 2 hours, $10^{15}\;CFU/g$ in 4 hours, $10^{16}\;CFU/g$ in 8 hours, $10^{18}\;CFU/g$ in 12 hours, and $10^{21}\;CFU/g$ in 24 hours. Mter cooking in a frying pan (150{\pm}7^{\circ}C$) for 3 minutes, the bacterial count was $10^{16}\;CFU/g$. After cooking in hot water for 20 minutes, the bacterial count was $10^{7}\;CFU/g\;at\;60^{\circ}C,\;10^{6}\;CFU/g\;at\;63^{\circ}C,\;and\;10^{4}\;CFU/g\;at\;65^{\circ}C$. The fried pork was mixed with cooked vegetables, noodles, sesame oil, sesame seeds, and seasonings to make Korean japchae. This process took $10{\pm}2$ minutes. The bacterial count in the japchae increased to $10^{7}\;CFU/g$ from the count of $10^{6}\;CFU/g$ of the fried pork before it was mixed with the other ingredients. These results indicate that the amount of S. typhimurium is effected by various different cooking processes. This study can suggest that pork should be cooked in water at over $65^{\circ}C$ for 20 minutes in order to prevent food poisoning, if the pork is contaminated with S. typhimurium. The presence of S. typhimurium in the raw pork is identified in an HA for japchae, and the primary CCP for japchae is inadequate cooking (cooking method and time/temperature). We need to standardize time-temperature-size and amount of pork in cooking japchae, because pork is usually cooked in ordinary frying pans when we make this food.

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Status of Tuberculosis Control in Rural Area (일부 농촌지역 결핵환자들의 관리 양상)

  • Park, Chan-Byoung;Chun, Byung-Yeol;Yeh, Min-Hae
    • Journal of agricultural medicine and community health
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    • v.18 no.2
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    • pp.141-151
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    • 1993
  • This study was done about 371 tuberculosis(TB) patients composed 195 newly registered at Kyungju Gun Health Center from May 1989 to April 1990 (Group A) and 176 being treated at hospitals or private clinics from January 1988 to November 1989(Group B). When Group A patients visited and newly registered at Health Center, data was obtained by interviewing with a prepared questionnaire paper. And well trained inquirer visited Group B patients and obtained data by the same method from February 1990 to April 1990. The results are as follows ; Group A was generally lower than Group B in socioeconomic status and in family history of TB, the rate of Group A was 24.1% and higher than 11.9% in Group B(p<0.05). Knowledge about TB was improved more than past, but those who answered that TB is 'a communicable disease' were 59.5% in Group A and 51.7% in Group B(p<0.05). Those answered that TB is 'a inherited disease' were 9.2% and 11.4% each. And 1.7% of Group B answered that TB is 'a incurable disease'. Knowledge about TB treatment also was improved more than past, but in the rate of those who answered that TB is a curable disease provided by well treatment Group B(77.8%) was worse than Group A(91.3%). The rate of those who answered that TB were been able to cure by regularly anti-TB medication were 98.0% in Group A and 89.8% in Group B. Its difference was statistically significant. The rate that patients took the first diagnosis and wanted to receive treatments at the same organ were 34.9% of Group A at Health Center and 72.2% of Group B at hospitals or private clinics. And its difference was statistically significant. In the reasons that Group B knew Health Center treated pulmonary TB but they was treated at hospitals or private clinics, unreliability to Health Center was 48.1%. The reasons that Group A was treated at Health Center were 'because of trust' 63.1%, 'because of low cost' 50.3%, 'because of low cost except trust' 9.3%, 'no specific reasons' 27.7%. In the courses of knowing that TB was controlled at Health Center, 'by neighborhood, health worker and doctors' were 84.9% in Group A and 69.0% in Group B. But 'by TV or radio' were 8.2% in Group A and 14.7% in Group B, 'by school education' 2.5% in Group A and 6.2% in Group B. Conclusively, Group A patients were lower than Group B in socioeconomic status, but better than in knowledge about TB. Its reasons was suggested that Health Center had controlled TB patients better than hospitals and private clinics. But considering, that difference in the rate of the same organ for the first diagnosis and treatment, that the only 63.0% of Group A have treated due to 'reliability to Health Center', and that 48.1% of Group B knew that Health Center treated pulmonary TB but didn't visit it due to 'unreliability to Health Center', that public relations(PR) about use Health Center for pulmonary TB and health education for TB was thought to have to strengthened.

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A study on the gratification of the patient in the Dental Hospital (치과병원 내원환자의 만족도 조사분석)

  • Kim, Min-Young;Lee, Keun-Woo;Moon, Hong-Suk;Chung, Moon-Kyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.1
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    • pp.65-82
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    • 2008
  • Statement of problem : Today's market economy has been changed more and more to consumer concerned. It is owing to not only consumers ' rising standard of living and education, but also purchasers' easy accessibilities to products through various mass media. The consumer centered market system, where customer can choose items with diverse alternatives to satisfy their self esteem, is also applied to the field of medical business, and accelerated by an increasing income level of shoppers and introducing the whole nations' medical insurance system. Today, the medical industry has become competitive due to increasing number of medical institutions and medical personnel, and this offers wide choices to consumers in the medical market place. At this point of time, it is essential to survey on the primary factor of gratification for the patient in the Dental clinic, as well as on the problems and suggestions in medical service. Purpose : The analysis in this study shows essential factors and expected influential elements in satisfaction of the patient in the Dental Hopsital, and strategic suggestions for the provider of dental service, which can be of benefit to the prospective customer as well as can make improvement in the quality of dental treatment service. Material and method : This study had been researched by collecting and analyzing the organized questionnaires, which were filled in directly from 784 patients, who visit Dental Hospital, Yonsei University in Seoul, from January 23rd to April 15th. Result : It can be summarized like the followings. 1. The social and demographical peculiarities of respondents are as follows. Samples of gender and marital status are adequately extracted, but data on occupation and treatment are are under a bias toward students, undergraduates and graduate students, and orthodontics. 2. 74% of patients who answer the questionnaire were highly satisfied with the service of dental clinic in the section of overall satisfaction. 3. The survey result about specific service of dental treatment, within sections of independent variables, is like the followings; Patients are highly gratified with service system, kindness, explanation, explanation on expected waiting hours, reservation system, emergency measures, expert treatment, existence of knowledge of dentistry, size of hospital, disinfection, equipment and parking, but lowly satisfied with expense of treatment, preparatory hours for treatment, waiting hours, treatment hours and the period of subscription. 4. The correlation analysis showed that there is no significant linear relationship between the independent variables. 5. The probit regression analysis showed that 8 out of 34 independent variables explained the dependent variables at the level of 0.01. 6. It shows that 8 independent variables, which can affect customers 'satisfaction, are clearing up of inconvenience, service system, kindness, explanation, treatment hours per attendance, reservation system, existence of knowledge of dentistry, and contentment of equipment in the hospital. Conclusion : The consumer's satisfaction totally relies on subjective evaluations of customers. Providing appropriate service, which can meet the criteria for the customer who demands various wares, pursues luxury goods, and expects high quality of medical service, is essential to fulfill patients' satisfaction. Many medical institutions do their best to satisfy their customer, touch their consumer, and offer patience centered services, and it is also applied to the field of dentistry. Establishing brand new strategic managements and elevating the quality of dental service based on this survey are required to improve the satisfaction of patience in the Dental Hospital.

A Study of Upper Airway Resistance Syndrome : Clinical and Polysomnographic Characteristics (상기도저항 증후군에 대한 연구 : 임상 및 수면다원검사 특징)

  • Yang, Chang-Kook;Clerk, Alex
    • Sleep Medicine and Psychophysiology
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    • v.3 no.2
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    • pp.32-42
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    • 1996
  • Objectives : Upper airway resistance syndrome(UARS) is a sleep-related breathing disorder characterized by abnormal negative intrathoracic pressure during sleep. Abnormally increased negative intrathoracic pressure results in microarousal and sleep fragmentation which underlay UARS-associated complaints of daytime fatigue and sleepiness. Although daytime dysfunction in patients with UARS is comparable to that of sleep apnea syndrome, UARS has been relatively unnoticed in clinical setting. That is why UARS is apt to be excluded in diagnosing of sleep-related breathing disorders since its respiratory disturbance index and arterial oxygen saturation are within normal limits. The current study presents a summary of clinical and polysomnographic characteristics found in patients with UARS. The present study aims (1) to explore characteristics of patients diagnosed with UARS, (2) to characterize the polysomnographic findings of UARS patients, and (3) to enhance the understanding of UARS through those clinical and laboratory characteristics. Methods : This was a retrospective study of 20 UARS patients (male 15, female 5) and 30 obstructive sleep apnea (OSA) patients (male 21, female 9) at the Stanford Sleep Disorders Clinic. We diagnosed patients as having UARS when they met critenia, RDI < 5 characteristic findings of an elevated esophageal pressure($<-10\;cmH_2O$), frequent arousals secondary to an elevated esophageal pressure, and symptoms of daytime fatigue and sleepiness. We used polysomnographic value, which is standardized by Williams et al(1974), as normal control. Statiotical test were done with student t-tests. Results : (1) Mean age of UARS was $41.0\;{\pm}\;14.8$ years and OSA was $50.9\;{\pm}\;12.0$ years. UARS subject was significantly younger than OSA subject (p<0.05). (2) The total score of Epworth Sleepiness Scale (ESS) was UARS $9.7\;{\pm}\;6.3$ and OSAS $11.2\;{\pm}\;6.3$. There was no significant difference between two groups. (3) The mean body mass index was UARS $28.1\;{\pm}\;5.7\;kg/m^2$ and OSAS $32.9\;{\pm}\;7.0\;kg/m^2$. UARS had significantly lower meen body man index than OSAS subjects (p<0.05). (4) The polysomnographic parameters of UARS were not significantly different from those of OSA except RDI(p<0.001), $SaO_2$ (p<0.001) and slow wave sleep latency (p<0.05). (5) Compared with normal control, Total sleep time in UARS subjects was significantly shorter (p<0.001), sleep efficiency index was significantly lower (p<0.001), total awakening percentage was significantly higher (p<0.001), and sleep stage 1 (p<0.001) were significantly higher. (6) OSA patients showed poor sleep quality and distinct abnormal sleep architectures compared with normal control. Conclusions : Conclusions from the above results are as follows : (1) UARS patients were younger and had lower body mass index when umpared with OSA patients. (2) The quality of sleep and sleep architectures of the UARS and OSA patients are significantly different from those of normal control. (3) ESS scores and awakening frequencies of UARS are similar with those of OSA, suggesting that daytime dysfunction of UARS patients may be comparable to those of OSA patients. (4) The RDI and the $SaO_2$ which are important indicators in diagnosing sleep-related breathing disorders, of UARS subjects are close to normal value. (5) According to the the above results, we unclude that despite the absence of $SaO_2$ drops and the absence of an elevated number of apnea and hypopnea, subjects developed clinical complaints which were associated with laborious breathing, elevated Pes nadir, and frequently snoring. (6) Accordingly, we suggest including LIARS in the differential diagnosis list when sleep related breathing disorder is suspected clinically and overnight polysomnographic findings except snoring and frequent microarousal are within normal limits.

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