• Title/Summary/Keyword: 재

Search Result 47,046, Processing Time 0.082 seconds

Division of the N2 Stage According to the Multiplicity of the Involved Nodal Stations May be Necessary in the N2-NSCLC Patients Who are Treated with Postoperative Radiotherapy (비소세포성 폐암으로 수술 후 방사선치료가 시행된 N2병기 환자들에서 다발 부위 종격동 림프절 전이 여부에 따른 N2병기 구분의 임상적 의미)

  • Yoon, Hong-In;Kim, Yong-Bae;Lee, Chang-Geol;Lee, Ik-Jae;Kim, Song-Yih;Kim, Jun-Won;Kim, Joo-Hang;Cho, Byung-Chul;Lee, Jin-Gu;Chung, Kyung-Young
    • Radiation Oncology Journal
    • /
    • v.27 no.3
    • /
    • pp.126-132
    • /
    • 2009
  • Purpose: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8~2 Gy. Results: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage ($\geq$T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size ($\geq$5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage ($\geq$T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. Conclusion: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

Clinical Implication of Cyclooxygenase-2 Expression for Rectal Cancer Patients with Lymph Node Involvement (림프절 전이를 동반한 직장암 환자들에서 Cyclooxygenase-2 발현의 임상적 의미)

  • Lee, Hyung-Sik;Choi, Young-Min;Hur, Won-Joo;Kim, Su-Jin;Kim, Dae-Cheol;Roh, Mee-Sook;Hong, Young-Seoub;Park, Ki-Jae
    • Radiation Oncology Journal
    • /
    • v.27 no.4
    • /
    • pp.210-217
    • /
    • 2009
  • Purpose: To assess the influence of cyclooxygenase-2 (COX-2) expression on the survival of patients with a combination of rectal cancer and lymph node metastasis. Materials and Methods: The study included rectal cancer patients treated by radical surgery and postoperative radiotherapy at the Dong-A university hospital from 1998 to 2004. A retrospective analysis was performed on a subset of patients that also had lymph node metastasis. After excluding eight of 86 patients, due to missing tissue samples in three, malignant melanoma in one, treatment of gastric cancer around one year before diagnosis in one, detection of lung cancer after one year of diagnosis in one, liver metastasis in one, and refusal of radiotherapy after 720 cGy in one, 78 patients were analyzed. The immunohistochemistry for COX-2 was conducted with an autostainer (BenchMark; Ventana, Tucson, AZ, USA). An image analyzer (TissueMine; Bioimagene, Cupertino, CA, USA) was used for analysis after scanning (ScanScope; Aperio, Vista, CA, USA). A survival analysis was performed using the Kaplan Meier method and significance was evaluated using the log rank test. Results: COX-2 was stained positively in 62 patients (79.5%) and negatively in 16 (20.5%). A total of 6 (7.7%), 15 (19.2%), and 41 (52.6%) patients were of grades 1, 2, and 3, respectively for COX-2 expression. No correlation was found between being positive of COX-2 patient characteristics, which include age (<60-year old vs. $\geq$60), sex, operation methods (abdominoperineal resection vs. lower anterior resection), degrees of differentiation, tumor size (<5 cm vs. $\geq$5 cm), T stages, N stages, and stages (IIIa, IIIb, IIIc). The 5-year overall and 5-year disease free survival rates for the entire patient population were 57.0% and 51.6%, respectively. The 5-year overall survival rates for the COX-2 positive and negative patients were 53.0% and 72.9%, respectively (p=0.146). Further, the 5-year disease free survival rates for the COX-2 positive and negative patients were 46.3% and 72.7%, respectively (p=0.118). The 5-year overall survival rates were significantly different (p<0.05) for the degree of differentiation, N stage, and stage, whereas the 5-year disease free survival rates were significant for N stage and stage. Conclusion: Being positive for and the degree of COX-2 expression did not have a significant influence on the survival of rectal cancer patients with lymph node metastasis. However, N stage and stage did significantly influence the rateof survival. Further analysis of a greater sample size is necessary for the verification of the effect of COX-2 expression on the survival of rectal cancer patients with lymph node involvement.

Effect of Eddy on the Cycle of 210Po and 234 in the central Region of Korean East Sea (동해 중부해역에서 210Po과 234Th의 순환에 대한 소용돌이의 영향)

  • YANG, HAN SOEB;KIM, SOUNG SOO;LEE, JAE CHUL
    • 한국해양학회지
    • /
    • v.30 no.4
    • /
    • pp.279-287
    • /
    • 1995
  • The vertical profiles of natural 210Pb, 210Po and 234Th activities were measured for the upper 100 m of water column at three stations in the middle region of the Korean East Sea during May 1992. And the distribution of these radionuclides was discussed associated with the formation of warm eddy or water mass. The main thermocline was maintained between the depth of 50 and 100 m at the southern station (Sta. A1), and between the depth of 10 to 50 m at the coastal station of Sockcho (Sta. B10). Contrastingly, a main thermocline at Sta. A10, which locates near the center of warm eddy, was observed below 230 m depth. Between 50 and 220 m depth of Sta. A10 is there a relatively homogeneous water mass of 10.1${\pm}$0.5$^{\circ}C$, which is significantly higher in temperature and lower in nutrient than the other two stations. It seems to be due to sinking of the warm surface water in which nutrients were completely consumed. Both 210Pb and 210Po show the highest concentration at Sta. A1 and the lowest at Sta. B10 among the three stations. Also, the 210Pb activity is generally higher in the upper layer than in the lower layer, while 210Po activity represents the reversed pattern at all three stations. At Sta. A1 and Sta. B10, the activities of 210Po relative to its parent 210Pb were deficient in the water column above the main thermocline, but were excess below the thermocline. However, the station near the center of warm eddy(Sta. A10), shows no excess of 210Po in the depths below 50 m, although its defficiency is found in the upper layer like the other stations. At Sta. A1 and b10. 234Th activities are slightly lower in the surface mixed layer than in the deeper region However, at Sta. A10, 234Th activity in the upper 30 m is higher than below 50 m or in the same depth of the other stations, probably because of the high concentration of particulate matter. The residence time of 210Po in the surface mixed layer at Sta. A10 is 0.4 year, much shorter than at the other two stations(about one year). Above 100 m depth, the residence times of 234Th range from 18 to 30 other two stations(about on year). Above 100 m depth, the residence times of 234Th range from 18 to 30 days at all stations, without significant regional variation. The percentages of recycled 210Po within the thermocline are 39% and 92% at Sta. A1 and Sta. B10, respectively. Much higher value at Sta. B10 may be due to a thin thickness of the mixed layer as well as the slower recycling rate of 210Po in the main thermocline.

  • PDF

Comparison of Blood and Urine Renal Indices Between Hypercalciuric and Non-hypercalciuric Hematuria Patients (혈뇨 환아에서 고칼슘뇨군과 비고칼슘뇨군의 혈액 및 소변화학검사와 신기능 지표들의 비교)

  • Lee, Jin-Hee;Lee, Hyun-Seung;Lee, Keun-Young;Jang, Pil-Sang;Lee, Kyung-Yil;Kim, Dong-Un
    • Childhood Kidney Diseases
    • /
    • v.11 no.2
    • /
    • pp.168-177
    • /
    • 2007
  • Purpose : The purpose of this study was to investigate whether hypercalciuria patients with hematuria show different renal indices compared to non-hypercalciuria patients with hematuria. Methods : We retrospectively reviewed the medical records of patients with gross or microscopic hematuria whose blood chemistry and 24 hour urine chemistry were examined. After excluding the patients with more than $4 mg/m^2/day$ proteinuria or the patients with urinary calcium excretion between 3 and 4 mg/kg/day, we divided the patients into two groups: a hypercalciuria group whose calcium excretion was more than 4 mg/kg/day(n=30) and a non hypercalciuria group whose calcium excretion was less than 3 mg/kg/day(n=41). The urinary excretion, clearance, and fractional excretion(FE) of Na, K, Cl, Ca, P, urea, and creatinine were calculated and compared between the two groups. Results : The hypercalciuria group had more calcium excretion($6.1{\pm}2.9$ vs $1.5{\pm}0.9 mg/kg/day$), more urea excretion($341{\pm}102$ vs $233{\pm}123 mg/kg/day$), greater glomerular filtration rate(GFR) ($93.7{\pm}31.1$ vs $79.5{\pm}32.0 mL/min$) but lower FENa($1.0{\pm}0.4%$ vs $1.3{\pm}0.6%$) than the nonhyper-calciuria group, although the urinary sodium excretion was similar between the two groups. Conclusion : The greater urea excretion and GFR in hypercalciuric patients suggest that they might be on a higher protein diet than the non-hypercalciuria group. The increased glomerular filtration of sodium and calcium induced by the higher GFR in hypercalciuria would have increased their delivery to the distal tubule, where sodium is effectively reabsorbed but calcium is not, which is suggested by the lower FENa but higher FECa in hyercalciuria. It is recommended that the diet of hematuria patients be reviewed in detail at initial presentation and during treatment.

  • PDF

Neuroprotective Effect of Cyclosporin A on Spinal Cord Ischemic Injury in Rabbits (토끼를 이용한 척수 허혈 손상 모델에서 Cyclosporin A의 척수 손상에 대한 보호 효과)

  • Shin Yoon-Cheol;Choe Ghee-Young;Kim Won-Gon
    • Journal of Chest Surgery
    • /
    • v.39 no.10 s.267
    • /
    • pp.739-748
    • /
    • 2006
  • Background: The purpose of this study is to ascertain the neuroprotective effect of cyclosporin A on the 25-min surgical ischemia model in the spinal cords of rabbits with neuropathological correlation and histoimmunochemical analyses, Material and Method: Thirty-two New Zealand white rabbits were randomly divided into four groups: Rabbits were randomly divided into four groups: the control 12 group (n=8), the control 17 group (n=8), the cyclosporin Cs2 group (n=8), and the cyclosporin Cs7 group (n=8). The 12 group underwent a 25-min aortic cross- clamp without intervention and were sacrificed on the 2nd day postoperatively, while the 17 group underwent a 25- min of aortic cross-clamp without intervention and were sacrificed on the 7th day postoperatively. The Cs2 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25-min cross-clamp and were sacrificed on the End day postoperatively, while the Cs7 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25-min cross-clamp and were sacrificed on the 7th day postoperatively. The rabbits underwent 25-min surgical aortic cross-clamp. Neurologic functions were evaluated on the 2nd day and 7th postoperative day using Tarlov scoring system. After scoring neurologic function, all rabbits were sacrificed for histopathologic observation. Result: All rabbits survived the experimental procedure. The values of Tarlov score did not show any differences between the control and cyclosporin groups on the 2nd day. The scores of group Cs7 ($2.75{\pm}0.89$) were significantly higher than those of group 17 ($1.25{\pm}1.39$) on the 7th day (p<0,05). On the histologic exanminations, specimens of the spinal cord showed necrosis and apoptosis. The pathologic scores of group Cs7 ($1,0{\pm}0.53$) was less than those of group 17 ($2.13{\pm}1.36$, p<0.05). TUNEL staing showed apoptosis of the specimen in group 12 and Cs2 but there was no stastically significant difference between groups on the score. There were more overexpression of HSP70 and nNOS in cyclosporine group than in control group. Conclusion: We think that cyclosporin A may decrease neuronal cell death with induced upregulation of HSP70 against 25-min ischemia of the spiral cord in the rabbit.

Postoperative Echocardiographic Hemodynamic Comparison between Recently Available Bileaflet Mechanical Valves (수종의 기계판막치환후 초음파심음향도를 이용한 판막간의 혈류역학적 비교)

  • Kang Joon Kyu;Hong Joon Hwa;Kim Hyung Tai;Park In Duk;Lee Cheol Joo
    • Journal of Chest Surgery
    • /
    • v.38 no.7 s.252
    • /
    • pp.496-500
    • /
    • 2005
  • There was no difference between the bileaflet mechanical valves on the midterm and longterm clinical outcome. We reviewed the hemodynamic comparison between recently available mechanical valves by Doppler Echocardiography. Material and Method: We retrospectively reviewed 396 postoperative hemodynamic datas (EOA, MDPG, and MSPG) by doppler echocardiography in 345 patients. Mechanical valves from 5 venders (Sorin Bicarbon, SJM, ATS, On-X, and Edward MIRA) were compared. There were 232 valves in mitral position, 162 in aortic, and 2 in tricuspid. Result: There were 178 men (mean age; $50.6\pm13.9$ years old) and 167 women $(52.6\pm,4.6)$. MDPG/EOA of 27 mm in mitral position was Sorin; $4.2\pm1.5 mmHg/3.0\pm0.9cm^2,\;SJM;\;2.3\pm1.2/3.5\pm0.6$. In 29mm, Sorin, SJM, ATS, On-X, MIRA revealed $3.4\pm1.2/3.1\pm0.6,\;3.3\pm1.1/2.7\pm0.4,\;3.8\pm0.8/3.2\pm0.6,\;4.0\pm3.0/3.1\pm0.9,\;2.9\pm0.9/3.0\pm0.8$ In 31mm, Sorin, SJM, ATS, MIRA revealed $3.9\pm1.9/2.9\pm0.6,\;3.5\pm1.2/3.0\pm0.6,\;3.4\pm0.8/2.8\pm0.2,\;3.7\pm1.5/2.7\pm0.7$. In 33mm, Sorin, SJM, MIRA revealed $4.4\pm0.9/2.5\pm0.4,\;3.4\pm1.5/3.3\pm0.5,\;4.7\pm2.4\3.0\pm0.3$. MSPG/EOA of 19mm aortic position was Sorin, SJM, ATS, On-X, MIRA $18.0 mmHg/1.2cm^2,\;25.6\pm8.7/1.1\pm0.3,\;25.9\pm12.6/1.2\pm0.3,\;23.0/1.3,\;27.9\pm7.1/1.2\pm0.1$ in that order. In 21mm, SJM, ATS, On-X, MIRA revealed $18.3\pm6.7/1.5\pm0.5,\;13.7\pm2.1/1.7\pm0.3,\;17.0/1.4,\;17.1\pm5.5/1.8\pm0.5$. In 23mm Sorin, SJM, ATS, On-X, MIRA revealed $14.0\pm4.6/1.7\pm0.6,\;12.8\pm3.2/2.0\pm0.2,\;16.8\pm12.2/2.1\pm0.9,\;14.0/1.5,\;15.0\pm5.5/1,8\pm0.5$. In 25mm, SJM and MIRA revealed $14.0\pm5.1/1.8\pm1.0,\;11.0/2.3$. There was no statistically significant difference in these values between the venders given the same position and size. 2 redo valve replacements were performed, 1 due to severe hemolysis in ATS and 1 due to leaflet immobilization in SJM. Conclusion: Postoperative hemodynamic comparison by doppler echocardiography shows no statistically significant difference between recently available mechanical valves in this country.

Stomata Variation of Rice and Weeds (수도(水稻) 및 잡초(雜草)의 기공형태(氣孔形態)와 분포(分布))

  • Kim, S.C.;Lee, S.K.;Chung, G.S.
    • Korean Journal of Weed Science
    • /
    • v.9 no.1
    • /
    • pp.46-55
    • /
    • 1989
  • Stomatal variation was observed at the Yeongnam Crop Experiment Station in 1988 using 42 rice cultivars and 30 weed species. The shape, density or size of stomata was varied depending on the species. Two general trends, however, were found that more number of stomata was found at lower leaf epidermis than upper leaf epidermis and stomata number was negatively correlated with stomata size. Aneilema japonica and Portulaca oleracea had the least number of stomata having 17-20 stomata per $m^2$ for upper leaf epidermis and 17-54 stomata for lower leaf epidermis while Polygonum conspicuum had the greatest number of stomata (449 for upper leaf epidermis and 511 for lower leaf epidermis). Soybean, Aeschynomene indica, Ludwigia prostrata and Lactuca indica had the smallest in stomata size while the biggest stomata was found at P. oleracea and A. Japonica that had the least number of stomata. Cyperus species such as C. difformis, C. iria and C. serotinus had no stomata at upper leaf epidermis. The stomata were distributed only at lower leaf epidermis for these species. Potamogeton distinctus, on the other hand, had stomata almost at upper leaf epidermis and thus, hardly found the stomata at lower leaf epidermis. Among rice cultivars, Tongil-type had the greatest number of stomata followed by Indica-type and Japonica-type, in order. Cultivars released after 1960 had more stomata than cultivars released before 1960 for Japonica-type cultivars while stomata size had reversed trend. Jinheung had the least number of stomata (${\fallingdotseq}$ 150 per $mm^2$) while Yushin had the greatest number of stomata (350 for upper and 449 for lower leaf epidermis, respectively) among rice cultivars. Other cultivars having more than 350 stomata per $mm^2$ were Samgangbyeo, Milyang 23, Woonbongbyeo, etc.

  • PDF

Studies on Characteristics of Sprouting and Occurrence on paddy field of Water Chestnut(Eleocharis Kuroguwai Ohwi) (올방개 괴경(塊莖)의 맹아(萌芽) 특성(特性)과 본답(本畓)에서의 발생(發生)에 관한 연구(硏究))

  • Kim, H.D.;Park, J.S.;Park, K.Y.;Choi, Y.J.;Yu, C.J.;Rho, Y.D.;Kwon, Y.W.
    • Korean Journal of Weed Science
    • /
    • v.16 no.4
    • /
    • pp.264-281
    • /
    • 1996
  • As a consequence of wide use of herbicides, Eleocharis kuroguwai Ohwi became a dorminant problem weed for rice cultivation in Korea. To understand the establishment of the weed, experiments on physio-ecological characteristics were carried out sprouting and occurrence, the results could be summarized as follows: Sprouting percentage remained 68 to 73% until the time of field emergence, indicating many of the them are still dormant. The proportion of the dormant tubers were greater for the smaller than the bigger tubers. Apical dominance was apparent in sprouting, with 84% of tuber sprouted from only one of the apical buds. Tubers sprouted from 2 or 3 buds were less than 20%, and were mostly from the bigger tubers. When the shoot growth was compared, by controlling the others, ones from apical and the next 3 buds showed similar vigorous growth, but the later ones showed poorer growth. For the longevity of tubers, deep soil storage appeared to be better than storage in temperature controlled room to 2~$3^{\circ}C$. Emergence of E. kuroguwai was better in clay soil than in sand, and the possible depth for emergence in clay soil appeared to be up to 21cm, but was 15cm in sand. When tubers were exposed to salt solutions before emergence tests, E. kuroguwai appeared to be much sensitive to salts than S.planiculmis. Among the tubers formed in previous year, 12.7% remained still viable until the end of next crop season, but with relatively strong dormancy. The first emergence was about 10 days after planting at ordinary cropping seasons, and the days to the maximum shoot number stage were 60~90 from planting. The duration was extended at early transplanting, and shoot number, leaves per shoot, and tubers developed per plant were also greater at early plantings. The 6th order offshoots were developing when E. kuroguwai was planted at early season. When planted at later seasons, generation and the number of offshoots was reduced planted at early season. When planted at later seasons, generation and the number of offshoots was reduced and the number of tubers, runner and rhizome lengths was also reduced.

  • PDF

Development of Dual Reporter System of Mutant Dopamine 2 Receptor ($D_2R$) and Sodium Iodide Symporter (NIS) Transgenes (변이 도파민 2 수용체와 나트륨 옥소 공동 수송체 이입유전자의 이중 리포터시스템 개발)

  • Hwang, Do-Won;Lee, Dong-Soo;Kang, Joo-Hyun;Chang, Young-Soo;Kim, Yun-Hui;Jeong, Jae-Min;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
    • /
    • v.38 no.4
    • /
    • pp.294-299
    • /
    • 2004
  • Purpose: Both human NIS and mutant $D_2R$ transgenes are proposed as reporting system in transplanted cell tracking. Using hepatoma cell lines, we constructed a dual reporter system containing human sodium-iodide symporter (hNIS) and dopamine 2 receptor ($D_2R$) and compared its characteristics. Materials and Methods: The recombinant plasmid ($pIRES-hNIS/D_2R$) was constructed with IRES (internal ribosome entry site) under control of the CMV promoter $pIRES-hNIS/D_2R$ was transfected to human hepatoma SK-Hep1 cell line with lipofectamine. HEP-ND ($SK-Hep1-hNIS/D_2R$) cells stably expressing hNIS and $D_2R$ was established by selection with G418 for two weeks. RT-PCR was performed to investigate the expression of both hNIS and $D_2R$ genes. The expressions of hNIS and $D_2R$ were measured by $^{125}I$ uptake assays and receptor binding assays. Specific binding of $D_2R$ to $[^3H]spiperone$ was verified by Scatchard plot with (+) butaclamol as a specific inhibitor. $K_d\;and\;B_{max}$ values were estimated. The correlation between hNIS and $D_2R$ expression was compared by using each clone. Results: Similar quantities of hNIS and $D_2R$ genes were expressed on HEP-ND as RT-PCR assays. HEP-ND cells showed 30 to 40 fold higher radioiodine uptakes than those of parental SK-Hep1 cells. $^{125}I$ uptake in HEP-ND cells was completely inhibited by $KClO_4$, a NIS inhibitor Specific binding to HEP-ND cells was saturable and the $K_d\;and\;B_{max}$ values for HEP-ND cells were 2.92 nM, 745.25 fmol/mg protein and 2.91nM, 1323 fmole/mg protein in two clones, respectively. The radioiodine uptake by hNIS activity and $D_2R$ binding was highly correlated. Conclusion: We developed a dual positron and gamma imaging reporter system of hNIS and $D_2R$ in a stably transfected cell line. We expect that $D_2R$ and hNIS genes can complement mutually as a nuclear reporting system or that $D_2R$ can be used as reporter gene when hNIS gene were used as a treatment gene.

The study of food habit and degree of depression in nursing home and privite home living elderly (시설노인과 재가노인의 식습관과 정신건강 상태에 관한 실태조사)

  • Han, Myung-Joo;Koo, Sung-Ja;Lee, Young-Soon
    • Journal of the Korean Society of Food Culture
    • /
    • v.13 no.5
    • /
    • pp.475-486
    • /
    • 1998
  • The dietary habit, health condition and the cognition concerning the health food have been surveyed with the help of the 151 old people living in In-Cheon and Seoul. In this study, the old are classified as an institution for the aged and the old in their own home. The preference and mental health condition influenced on dietary habits have been surveyed as wall. Their dietary habits such s three meals a day and a regular meal time have show) that they have generally good eating habits. Psychologically, the old in an institution for the aged think their health condition is not so good in comparison with the old in their own home. The old in their own home have good condition in that they can go up the stairs, exercise often and walk relatively well. Moreover, men's health condition is better than women. The old generally like meats(especially beef) and prefer sesame oil, perilla oil, soy been oil to Western oil. They like sweat flavor the most and hot, salty taste in order. Thier favorite cooking method is a pot stew, soup and season. The difference between dietary habit and mental health based on an academic career, an allowance and a residential condition shows that the old who live alon have relatively terrible eating habit and the more learned, the better. The more pocket money they have, the better dietary habits they have. The old feel glommy in general and the old in an institution are more depressed and it is statistically significant.

  • PDF