• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.523-531
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• 2004

Background : Bronchoscopy in patients on mechanical ventilation is being performed much more frequently. However, there is little data on the changes in physiologic parameters and no established mechanical ventilation protocol during bronchoscopy. A decreasing or the removal of positive end-expiratory pressure (PEEP) during bronchoscopy may precipitate severe hypoxemia and/or derecruitment. Methods : Our standardized mechanical ventilation protocol, without changing the PEEP level, was used during bronchoscopy. The physiological parameters were measured during the bronchoscopic procedure. Results : During bronchoscopy, respiratory acidosis, elevation of peak pressure, elevation of heart rate and auto-PEEP were developed, but were reversible changes. Procedure-related gross barotraumas or other severe complications did not developed. Conclusion : No serious complications developed during bronchoscopy under our standardized mechanical ventilation protocol when the PEEP level remained unchanged. The procedure time should be kept to a minimum to decrease the exposure time to undesirable physiological changes.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.87-94
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• 2008

Background: Surveillance of TB drug resistance (DR) is essential for providing information on the magnitude and trends in resistance, for developing treatment guidelines and for monitoring the effect of interventions. Up to now national surveys of drug resistance of M. tuberculosis have been conducted four times since 1994 among patients registered at health centers. The purpose of this study is to estimate the prevalence of primary drug resistance among new cases identified in private sector, and to compare it with the previous national drug resistance surveys. Methods: The study collected results of drug susceptibility testing (DST) performed at the Korean Institute of Tuberculosis by the request of private sector from January 2003 to December 2005, and then finally selected new cases for the analysis from the database of Korean TB Surveillance (KTBS) by matching patients' name and social identification numbers. Results: Of the 5,132 new patients included in the study, 689 (13.4%) patients were found to have drug resistance at least one drug, 530 patients (10.3%) were isoniazid resistant, 195 patients (3.8%) were multi-drug resistant (MDR), and 21 patients (0.4%) were extensively drug resistant (XDR). The rate of drug resistance tended to decrease annually but it was not statistically significant. When compared with previous national DR surveys in 2003 and in 2004 respectively, they were not significantly different. Conclusion: The prevalence of DR among new cases managed in the private sector did not show significant difference from that of new patients registered in the public sector in the same year.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.102-108
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• 2008

Background: Recently, multidrug-resistant (MDR) A. baumannii has been implicated for a significant proportion of nosocominal pneumonia in many intensive care units (ICUs), and its acquisition may increase mortality and the length of stay in the ICU. Aerosolized colistin has been successfully used in patients with cystic fibrosis, but there is a lack of data regarding the use of aerosolized colistin in patients with nosocomial pneumonia. Methods: We conducted the present study to assess the effectiveness of aerosolized colistin for the treatment of MDR A. baumannii nosocomial pneumonia. We retrospectively reviewed the medical records of 10 patients who had been hospitalized in the medical ICU and had received aerosolized colistin as a therapy for MDR A. baumannii pneumonia. Results: The mean duration of aerosolized colistin therapy was $12.7{\pm}2.4$ days. Nine (90%) of 10 patients showed a favorable response to the therapy. Follow-up cultures were available for all patients, and the responsible pathogen was completely eradicated. One patient suffered from bronchospasm, which resolved after treatment with nebulized salbutamol. Conclusion: Our results corroborate previous reports that aerosolized colistin may be an effective and safe choice for the treatment of nosocomial pneumonia caused by MDR A. baumannii. Larger prospective controlled clinical studies are warranted to validate further the effectiveness and safety of aerosolized colistin therapy.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.134-140
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• 2005

Purpose: We evaluated the effectiveness of temporary using the extendible external fixator (EF) for lengthening of soft tissue that contracture caused by tumor prosthesis removal in the treatment of complications after limb salvage surgery like deep infection and loosening. Materials and Methods: Five patients six cases were included who underwent extendible EF (Dyna-extor(r)). EF was applied after insertion of half pin to the proximal and distal bone of defect area. EF lengthening started at third day of post-operation, above 2-3 mm per day in the range of no neurological sign. Results: The treatment area was three in femur and two in tibia. Mean age when the time of EF apply was 22.2 years old (range 15-29), but its primary limb salvage operation had done in 13.4 years old (range 9-19), therefore mean times of interval between initial tumor prosthesis reconstruction and temporary EF apply was 8.8 years (range 3-14). One patient had EF for 150 days with 7.2 cm lengthening. Others 5 cases of 4 patients had EF for mean 37 days (range 25-50) and mean soft tissue lengthening was 5.8 cm. Three patients underwent re-insertion of tumor prosthesis and two patients underwent knee fusion as final operation and showed no evidence of infection through mean 22 months follow up period. Conclusion: Temporary using of extendible EF is an effective method for correction of leg shortening which occurred by soft tissue contracture in the complications of limb salvage operation or their treatment process, and it could be provide easily application of tumor prosthesis and knee fusion as final operation.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.71-78
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• 2004

Purpose: The purpose of this study is to investigate the characteristic of recurred giant cell tumor after bony curettage and cementation, and to review a way to prevent the recurrence. Materials and Methods : Thirty seven cases were analyzed, which were pathologically diagnosed giant cell tumor after diagnostic biopsy or surgical excision, followed by curative curettage, burring and cementation. Location, character, and time interval to recurrence were reviewed. Results: Thirteen out of thirty seven analyzed cases(35%) showed recurrence after primary curettage and cementation. The mean interval to recurrence was sixteen months(5 months to 43 months). Most of recurrence happened within the first two years except two cases. Among the recurred cases, eleven showed recurrence in the vicinity of window area. Two cases recurred in the depth of bone marrow, where cementation was made. The advantage of curettage and cementation is the immediate stability of the operation site, early rehabilitation, and early detection of recurrence. Furthermore, cementation is beneficial in that the cement-producing heat can eradicate the residual tumor burden. In this study, 85% of cases with insufficient curettage (for example, in cases where too small surgical window was made, or where there were anatomical difficulty in approaching the target tumor burden) showed recurrence. Conclusion: Bony curettage, burring and cementation is widely used as the primary curative modality for giant cell tumor. A few other modalities such as chemical cautery using phenol and $H_2O_2$; cryotherapy; and anhydroalcohol have also been introduced, but the benefit of these are still questionable. For some cases that relatively small surgical window was made due to anatomically complicated structures (such as ligament insertion or origin site) over the target tumor burden, unsatisfactory curettage and burring was made. This study showed high chance of recurrence after unsatisfactory curettage, and 85% of recurrence developed in the vicinity of the small window area. Most of the recurrence occurred within the first two years. It is concluded that sufficient window opening, extensive curettage and eradicative burring are key factors to prevent recurrence. Also, it should be reminded that careful and close observation should be made for at least the first two years after initial treatment for early detection of recurrence.

• The Korean Journal of Elementary Counseling
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• v.6 no.1
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• pp.141-169
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• 2007

One of the most common feelings in everyday life is anger. Anger plays an important role in activating emotional energy and increasing intolerance when confronted with hardships, frustration and improper treatments. And it provides us with controlling interpersonal behavior, organizing internal, physiological, psychological process and various adaptive functions. If anger is not properly expressed, it brings about offensive attitude, leading to not only physical impairment but also anxiety in interpersonal relations and maladaptive to everyday life. For elementary school students, frequent quarrels, abusive words and defiant attitude toward adults are also caused by students' anger. Therefore, students' anger is one of the most difficult problems to be dealt with not only psychologically but also in elementary schools. In this respect, after investigating frequently experienced anger- inducing situations and inventing anger-inducing situation questionnaire, we postulated specific situations changing irrational belief into rational one. Based on these situations, we accounted for how to cope with anger inducing factors and change irrational belief into rational one, introducing several strategies needed to control anger, invented cognitive behavioral anger control program and tried to clarify the relationship between anger inducing experience and anger regulation ability. In order to derive usual anger-inducing situations, we made 180 students with fifth and sixth grade to record the reason why he/she got angry, mood, thought, behavior and result. Through this process, we could derive 47 situations bringing about anger and prepared anger-inducing situation questionnaire. It can be divided into 3 anger inducing situations by using factor analysis into 500 elementary students of fifth and sixth grade. Cognitive behavioral anger control program used in this study consists of 13 sessions. From first to fifth session, it is composed of 10 anger control methods to make students be aware of and control their anger. From sixth through thirteenth session, the relationship between irrational belief and anger inducing is introduced is focused on how irrational belief is changed into rational one. To examine the effects of the program, high anger students and the students lacking anger control are selected. Thirty students through pre-test using anger-inducing questionnaire and anger control ability questionnaire are taught the goals and procedures. Volunteer students and students with parents' consent allocated to experimental group (12 students) and the rest of the students are control group (12 students). Cognitive Behavioral Anger Control Program are applied every 50 minutes twice a week for 7 weeks and 4 weeks before and after this program, anger-inducing situation questionnaire and anger control ability questionnaire are practiced. Data collected in this study analyzed by SPSS and Kwakstat. In the middle of this program, quarterly reports and satisfaction measuratings were evaluated to examine whether there is verbal and non-verbal behavior change and students feel satisfied with the program. The results of this study are as follows: First, Cognitive-behavioral anger control program used in this study effectively reduced anger experience and lasted for 4 weeks. Second, cognitive behavioral anger control program increased students' ability to control anger inducing situations and also effective for 4 weeks. And its effect on verbal and non-verbal behaviour was very impressive Students come to realize that irrational belief is the cause of their anger and actively apply cognitive-behavioral anger control technique to themselves as well. Students became improved in their peer relations and felt confident in everyday life. The overall evaluation of this program can be listed as follows; "very satisfactory (91.67%)", "satisfactory (8.33%)", "very helpful (91.67%)", "helpful (8.33%). In this study we first investigated several anger-inducing situations and invented anger-inducing situation questionnaire and then applied cognitive behavioral anger control program in order to control their. anger and not to experience it. By creating workbooks and manuals this method can easily be used in school education settings.

• The Korean Journal of Elementary Counseling
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• v.11 no.1
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• pp.71-91
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• 2012

The purpose of this study is investigate what effects of counseling program using children's poem on maladapted children in school on the children's self-esteem and school adjustment. For this, counseling programs using children's poem was developed and this counseling sessions were implemented to maladapted children in school and the research question to analyze the effect is as follows. First, what effect does the counseling program using children's poem have on the improvement of self-esteem of the maladapted children in school? Secondly, what effect does the counseling program using children's poem have on the school life of the maladapted children in school? The research target were maladapted children in school who are enrolled in the 4th grade in Elementary school. Through two different case studies, these students were selected after reflecting the opinions of the students' current homeroom teacher, parents, and friends. The counseling program using children's poem were conducted from June 2010 to July 2010, twice a week for a total number of 12 sessions. Each session consisted of 40 minutes and client's change process was explored. Through the counseling program using children's poem, this study collected data and examined the effectiveness of the program through comparing the results of the evaluated results of the language and behavior the target children responded, depth interviews with parents, friends, and teachers, behavior observation checklist, and the pre and post test results of the measurement tools. The results of this study is as follows. First, the counseling program using children's poem improved the self-esteem of the maladjusted child in school. Especially, among the sub-region of self-esteem, it was able to improve the domestic, social and academic self-esteem. Secondly, the counseling program using children's poem had a positive effect on the school adjustment of the maladjusted child in school. Among the sub-region of school adjustment, it had a positive change in the teacher relationships, peer relationships, and attitude. In addition, children's poem which was the reading material for the counseling program using children's poem was proven to work effectively in the counseling progress. Recitation and content of the children's poem promoted self-open of the client and as a result, it had a positive effect on improving relations with the counselor and this became the media that led to a successful counseling session. Therefore, I anticipate that this counseling program using children's poem will be actively used in counseling sessions through applying the results of this study and after revising the program so the counseling program could have a more efficient effect on self-esteem and school adjustment.

• The Korean Journal of Elementary Counseling
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• v.11 no.1
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• pp.51-69
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• 2012

This research is a fundamental research to provide the foundation that psychological test can be utilized efficiently. It investigated and studied the reality of the psychological test used in elementary school, teacher's degrees of understanding and utilization of psychological test, requirements for improving the psychological test that is performed currently, and the direction of the testing tools that are required by elementary school. First, the main purpose of psychological test was different. The tests that were usually utilized in elementary schools were career inventory test and aptitude test, followed by personality test, learning test, creativity test and intelligence test in order. Second, it showed that teachers read the testing manual before carrying out the psychological test and understood it individually, the degree of understanding of T score showed to be the lowest. As a factor that hampered elementary school teacher's understanding of the psychological test, there was insufficiency of the teacher's professional knowledge, and it showed that the preparatory training for teachers about the tools of psychological test was necessary in order to improve this. Teacher's degree of utilization of psychological test showed to be lower than that of understanding. As a factor that influenced this kind of utilization by teachers, the lack of methodical understanding in afterwards guidance after the testing was the biggest factor. To increase the teacher's degree of utilization of psychological test, it was investigated that advice for more specific methods of guidance after the testing was necessary. Third, cross analysis was executed to find out if there was difference in the degree of understanding and utilization of psychological test according to whether a teacher completed the education course regarding counseling or not, and as a result, there was difference in the degree of understanding regarding some tests, but there was no difference found in the degree of utilization. Besides these, the point to be complemented in psychological test that was currently executed elementary schools and the direction of the testing tools that elementary schools require were investigated.

• Journal of Environmental Policy
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• v.5 no.1
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• pp.45-70
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• 2006

China has achieved great economic growth above 9% annual since it changed to more of a market economy system by its reform and open-door policy. At the same time, China has experienced severe ecological deterioration, such as air and water pollutions caused by its rapid urbanization and industrialization. China is now confronted with environmental pollution and ecological deterioration at a critical point, at which economic development in China is limited. Moreover, environmental problems in China have become a lit fuse for social fluctuation beyond pollution problems. The root and background of environmental problems in China, firstly, are its government's lack of understanding of these problems and incorrect economic policies affected by political and ideological prejudice. Secondly, the plundering of resources, 'the principle of development first' which didn't consider environmental sustainability is another source of environmental deterioration in China. In addition, a huge population and poverty in China have increased the difficulty in solving its environmental problems, and in fact have accelerated them. The Chinese government has established many environmental laws and institutions, increased environmental investments, and is enlarging the participation of NGOs and the general public in some limited scale to solve its environmental problems. However, it has not obtained effective results because of the lack of environmental investments owing to the government's limit of the development phase, a structural limit of law enforcement and local protectionism, and the limit of political independency in NGOs and the lack of public participation in China. It seems that China remains in the stage of 'economic development first, environmental protection second', contrary to its catch-phrase of 'the harmony between economic development and environmental protection'. China is now confronted with dual pressure both domestically and abroad because of deepening environmental problems. There are growing public's protests and demonstrations in China in response to the spread of damage owing to environmental pollution and ecological deterioration. On the other hand, international society, in particular neighboring countries, regard China as a principal cause of ecological disaster. In the face of this dual pressure, China is presently contemplating a 'recycling economy' that helps sustainable development through the structural reform of industries using too much energy and through more severe law enforcement than now. Therefore, it is desirable to promote regional cooperation more progressively and practically in the direction of building China's ability to solve environmental problems.

• Asian-Australasian Journal of Animal Sciences
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• v.22 no.6
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• pp.819-826
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• 2009

An in vitro study was conducted to investigate the effect of malate or fumarate on fermentation characteristics, and production of conjugated linoleic acid (CLA) and methane ($CH_4$) by rumen microbes when incubated with linolenic acid (${\alpha}-C_{18:3}$). Sixty milligrams of ${\alpha}-C_{18:3}$ alone (LNA), or ${\alpha}-C_{18:3}$ with 24 mM malic acid (M-LNA) or ${\alpha}-C_{18:3}$ with 24 mM fumaric acid (F-LNA) were added to the 150 ml culture solution consisting of 75 ml strained rumen fluid and 75ml McDougall's artificial saliva. Culture solution for incubation was also made without malate, fumarate and ${\alpha}-C_{18:3}$ (Control). Two grams of feed consisting of 70% concentrate and 30% ground alfalfa (DM basis) were also added to the culture solution of each treatment. In vitro incubation was made anaerobically in a shaking incubator up to 12 h at $39^{\circ}C$. Supplementation of malate (M-LNA) or fumarate (F-LNA) increased pH at 6 h (p<0.01) and 12 h (p<0.001) incubation times compared to control and linolenic acid (LNA) treatments. Both malate and fumarate did not influence the ammonia-N concentration. Concentration of total VFA in culture solution was higher for M-LNA and F-LNA supplementation than for control and LNA treatments from 6 h (p<0.040) to 12 h (p<0.027) incubation times, but was not different between malate and fumarate for all incubation times. Molar proportion of $C_3$ was increased by F-LNA and M-LNA supplementation from 6 h (p<0.0001) to 12 h (p<0.004) incubation times compared to control and LNA treatments. No differences in $C_{3}$ proportion, however, were observed between M-LNA and F-LNA treatments. Accumulated total gas production for 12h incubation was increased (p<0.0002) by M-LNA or F-LNA compared to control or LNA treatment. Accumulated $CH_4$ production for 12 h incubation, however, was greatly reduced (p<0.0002) by supplementing malate or fumarate compared to the control, and its production from M-LNA or F-LNA treatment was smaller than that from LNA treatment. Methane production from LNA, M-LNA or F-LNA treatment was steadily lower (p<0.01 - p<0.001) from 3 h incubation time than that from the control, and was also lower for M-LNA or F-LNA treatment at incubation times of 6 h (p<0.01) and 9 h (p<0.001) than for LNA treatment. Methane production from LNA, however, was reduced (p<0.01 - p<0.001) from 3 h to 9 h incubation times compared to the control. Both malate and fumarate increased concentration of trans11-$C_{18:1}$ from 3 h to 12 h incubation (p<0.01), cis9,trans11-CLA up to 6 h incubation (p<0.01 - p<0.01), trans10,cis12-CLA at 3 h (p<0.05) and 12 h (p<0.01), and total CLA for all incubation times (p<0.05) compared to corresponding values for the ${\alpha}-C_{18:3}$ supplemented treatment (LNA). In conclusion, malate and fumarate rechanneled the metabolic $H_2 pathway to production of propionate and CLA, and depressed the process of biohydrogenation and methane generation. Linolenic acid alone would also be one of the optimistic alternatives to suppress the $CH_4$ generation.