• Title/Summary/Keyword: Effective Management

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Detection of Brain Metastatses Using Limited Brain MR Imaging : Usefulness of Limited Contrast-Enhanced MR Imaging in Brain Metastasis (뇌전이암 진단을 위한 제한적 뇌 자기공명영상의 유용성에 관한 연구)

  • Kwon, Sun Jung;Lee, Yun Sun;An, Jin Yong;Park, Hee Sun;Jung, Sung Soo;Kim, Ju Ock;Kim, Jin Hwan;Song, Chang Joon;Kim, Sun Young
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.5
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    • pp.499-505
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    • 2003
  • Background : The brain is a common site of a metastasis in lung cancer patients. If left untreated, the patients succumb to progressive neurological deterioration with a lower survival rate than with other metastases sites. Contrast-enhanced MR imaging in the absence of symptoms or clinical signs is not recommended for identifying a cerebral metastasis in lung cancer patients because of management effectiveness. This pilot study was performed to estimate whether or not limited brain MR imaging, which has a lower cost, could be used to replace conventional brain MR imaging. Method : Between April 1999 and March 2001, 43 patients with a primary lung cancer and the others (breast cancer, stomach cancer, colon cancer, malignant melanoma etc), who had neurological symptoms and signs, were examined using conventional brain MR imaging to examine brain metastases. The control group involved four patients who had no evidence of brain metastases the sensitivity, specificity and correlation of limited brain MR imaging were compared with conventional brain MR imaging. Results : All the 43 patients who were examined with conventional brain MR imaging showed evidence of brain metastases, whereas limited brain MR imaging indicated that 42 patients had brain metastases(sensitivity=97.67%). One patient in whom limited brain MR imaging showed no brain metastasis had a metastasis in the cerebellum, as shown by the contrast-enhanced T1 weighted axial view using conventional brain MR imaging. The conventional brain MR imaging and the limited brain MI imaging of the 4 control patients both indicated no brain metastases (specificity=100 %). The Pearson Correlation of the two groups was 0.884(Confidence Interval : 99%) observed. Conclusion : Limited brain MR imaging can detect a brain metastasis with the same accuracy. In addition, it is cost-effective (229,000 won, 180)comparedtoconventionalbrainMRimaging(529,000won,480) when patients had neurological symptoms and signs or staging.

Targeted Therapies and Radiation for the Treatment of Head and Neck Cancer (두경부 암의 표적 지향적 방사선 치료)

  • Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.22 no.2
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    • pp.77-90
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    • 2004
  • Purpose: The purpose of this review Is to provide an update on novel radiation treatments for head and neck cancer Recent Findings: Despite the remarkable advances In chemotherapy and radiotherapy techniques, the management of advanced head and neck cancer remains challenging. Epidermal growth factor receptor (EGFR) Is an appealing target for novel therapies In head and neck cancer because not only EGFR activation stimulates many important signaling pathways associated with cancer development and progression, and importantly, resistance to radiation. Furthermore, EGFR overexpression Is known to be portended for a worse outcome in patients with advanced head and neck cancer. Two categories of compounds designed to abrogate EGFR signaling, such as monoclonal antibodies (Cetuxlmab) and tyrosine kinase inhibitors (ZD1839 and 051-774) have been assessed and have been most extensively studied In preclinical models and clinical trials. Additional TKIs In clinical trials include a reversible agent, Cl-1033, which blocks activation of all erbB receptors. Encouraging preclinical data for head and neck cancers resulted In rapid translation Into the clinic. Results from Initial clinical trials show rather surprisingly that only minority of patients benefited from EGFR inhibition as monotherapy or In combination with chemotherapy. In this review, we begin with a brief summary of erbB- mediated signal transduction. Subsequently, we present data on prognostic-predictive value of erbB receptor expression in HNC followed by preclinlcal and clinical data on the role of EGFR antagonists alone or in combination with radiation In the treatment of HNC. Finally, we discuss the emerging thoughts on resistance to EGFR biockade and efforts In the development of multiple-targeted therapy for combination with chemotherapy or radiation. Current challenges for investigators are to determine (1 ) who will benefit from targeted agents and which agents are most appropriate to combine with radiation and/or chemotherapy, (2) how to sequence these agents with radiation and/or cytotoxlc compounds, (3) reliable markers for patient selection and verification of effective blockade of signaling in vivo, and (4) mechanisms behind intrinsic or acquired resistance to targeted agents to facilitate rational development of multi-targeted therapy, Other molecuiar-targeted approaches In head and neck cancer were briefly described, Including angloenesis Inhibitors, farnesyl transferase inhibitors, cell cycle regulators, and gene therapy Summary: Novel targeted theraples are highly appealing in advanced head and neck cancer, and the most premising strategy to use them Is a matter of intense Investigation.

Postoperative Radiation Therapy in the Management of Early Cervical Cancer (초기 자궁경부암의 수술 후 방사선치료의 효과)

  • Kim, Jae-Chul
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.164-170
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    • 2006
  • [ Purpose_ ]: This study identified the result of postoperative radiation therapy and the prognostic factors to affect survival rates in cancer patients. MaterialsandMethods_: One hundred and thirty three patients with cervical cancer who were treated with postoperative radiation therapy following surgery at our institution between June 1985 and November 2002 were retrospectively analyzed. One hundred and thirteen patients had stage IB disease, and 20 patients had stage IIA disease. Histological examination revealed 118 squamous cell carcinoma patients and 15 adenocarcinoma patients. Sixty seven patients were noted to have stromal invasion greater than 10 mm, and 45 patients were noted to have stromal Invasion 10 mm or less. Positive lymphovascular invasion was found in 24 patients, and positive pelvic lymph nodes were noted in 39 patients. Positive vaginal resection margin was documented in 8 patients. All of the patients were treated with external beam radiation therapy to encompass whole pelvis and primary surgical tumor bed. Intracavitary radiation therapy was added to 19 patients who had positive or close surgical margins. Results_: Actuarial overall and disease-free survival rates for entire group of the patients were 88% and 84% at 5 years, respectively. Five-year disease-free survival rates for patients with stromal invasion greater than 10 mm and 10 mm or less were 76% and 97%, respectively (p<0.05). Also there was a significantly lower survival in patients with positive pelvic lymph nodes compared with patients with negative pelvic lymph nodes (p<0.05). However, lymphovascular invasion, positive vaginal resection margins were not statistically significant prognostic factors. Addition of neoadjuvant chemotherapy or type of surgery did not affect disease-free survival. Conclusion_: Postoperative radiation therapy appears to achieve satisfactory local control with limited morbidity in cervical cancer patients with high pathologic risk factors. Distant metastasis was a dominant failure pattern to affect survival in cervical cancer patients after radical surgery and radiation and more effective systemic treatment should be investigated in these high-risk patients.

The Effect of CSR Activity on Customer's Behavioral Intention in Insurance Industry (보험산업에서의 기업의 사회적책임(CSR) 활동이 고객행동의도에 미치는 영향에 관한 연구)

  • Hong, SoonRan;Bae, JeongHo;Park, HyeonSuk
    • Journal of Service Research and Studies
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    • v.10 no.1
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    • pp.33-53
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    • 2020
  • The purpose of this study is to empirically examine the causal relationship of CSR activities, customer trust and CCID, customer behavior intention(B.I) in the relationship between CSR activities and customer behavior intention(B.I) in the insurance industry, thereby enable top management of insurance company to take it in their consideration that CSR activity help link to customer behavioral intention by customer trust in them and CCID. To achieve the purpose of the study, the hypothesis was established based on preceding research and theoretical background regarding CSR, trust, CCID, behavioral intention(B.I). And this study conducted AMOS statistical analysis based on effective 526 survey data collected from insurance customers across country through online research company. The result of this empirical study is as follows. First, insurance company's CSR activity has a positive impact on customer's trust and CCID, but it did not have a direct significant effect on the customer's behavioral intention(B.I). Second, both customer's trust and CCID have a positive and significant effect on customer's behavioral intention. Third, we have also found that both Trust and CCID played a mediating role between CSR activity and B,I. Fourth, it was found that authenticity did not moderate the enfluence relationship between CSR activity and Trust, CCID. The result of this study shows that insurance company's active CSR activity increase customer trust, thereby create a sense of unity between the customer and the company, In addition, it shows that when CSR activities are mediated by customer trust and CCID, it could lead to customer behavioral intention(B.I) such as repurchasing and positive word-of-mouth activities. to others. The result of this study will contribute to the future research on CSR literature and the marketing strategy of insurance companies.

Mitral Valve Reconstruction in Patients with Moderate to Severe Left Ventricular Dysfunction (중등도 이상의 좌심기능부전 환자에서 승모판성형술)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Sae;Kim, Woong-Han;Whang, Sung-Wook;Kim, Soo-Cheol;Lim, Cheong;Kim, Wook-Sung;Lee, Young-Tak;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.11
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    • pp.812-819
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    • 2003
  • Background: Left ventricular dysfunction is one of the important prognostic factors of early mortality and long-term survival after valve operation. We studied the intermediate term results of mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction. Material and Method: Forty four patients who underwent mitral valve reconstruction with a left ventricular ejection fraction (EF) of <45% or less (20∼45%) from April 1995 through July 2001 were reviewed retrospectively. Ages ranged from 10 to 67 years (46∼14 years) and 32 patients were in NYHA class III-IV. The mitral valve diseases were regurgitation (MR) in 28 patients, stenosis(MS) in 10, and mixed lesion in 5. The etiologies of mitral valve disease were rheumatic in 20 patients, degenerative in 14, ischemic in 5, annular dilatation in 2, congenital in 2, and endocarditis in 1. Operatively, all patients had annuloplasty and/or various valvuloplasty techniques, and a total of 52 procedures were concomitantly performed. Total cardiopulmonary bypass and aortic crossclamp time were 160±57 minutes and 112±45 minutes respectively. Result: Two operative deaths occurred as a result of left ventricular failure (4.5%). After the mean follow-up of 39 months (range, 10∼83 months), there was no late death. Transthoracic echocardiography revealed no or grade I of MR in 29 patients (72.5%) and no or mild MS in 35 patients (87.5%). The actuarial survival at 5 years was 100%. Four patients required mitral valve replacement due to progressive mitral valvular disease. The actuarial freedom from valve-related reoperation at 5 years was 84±9%. Conclusion: This study suggests that mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction offers good early and intermediate survival and acceptable freedom from valve-related reoperation, and it is the strategy for effective management for these patients.

Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy (부적절한 수술루 침윤성 자궁경부암의 방사선치료 결과)

  • Choi Doo Ho;Kim Eun Seog;Nam Kae Hyun;Huh Seung Jae
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.211-219
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    • 1996
  • Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Materials and Methods : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcinoma in situ (38 cases), severe dysplasia (2), myoma (6), uterine bleeding (4), uterine prolapse (2). and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy from August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients received ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate werer 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cancer (stage IA) had no treatment related failure Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy Survivals for patients with gross disease remained after inappropriate hysterectomy was poor, So, early cancer detection and Proper management with precise pretreatment s1aging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.

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Results of Postoperative Radiation Therapy of Rectal Cancers - with the Emphasis of the Overall Treatment Time - (직장암의 수술 후 방사선치료의 성적 - 예후 인자와 전체 치료기간이 미치는 영향에 관한 고찰 -)

  • Kim Joo-Young;Lee Myung-Hag;Lee Kyu-Chan
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.303-310
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    • 1998
  • Purpose : To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors. especially with the emphasis on the treatment time factor. Materials and Methods : There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94% of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. Results : Five-year overall survival, disease-free survival were 58.8% and 57%, respectively. Two-year local control rate was 76.6%. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. Conclusion : The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'c' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen of chemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment. radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period trout definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.

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Physico-chemical and Microbial Properties of Sausages Affected by Plant Scale and Cooking Treatments during Refrigerated Storage (가열조건 및 공장 규모에 따른 소시지의 냉장저장 중 이화학적 및 미생물적 품질특성)

  • Choi, Yun-Sang;Ku, Su-Kyung;Jeon, Ki-Hong;Park, Jong-Dae;Lim, Sang-Dong;Kim, Hee-Ju;Kim, Ji-Ho;Kim, Young-Boong
    • Korean journal of food and cookery science
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    • v.32 no.4
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    • pp.390-399
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    • 2016
  • Purpose: The objective of this study was to examine the effect of plant scale and cooking conditions on the quality characteristics of sausages during refrigerated storage. Methods: Sausages used in this study were classified into two groups: those submitted to 1st cooked treatments and those submitted to 2nd cooked treatments. The pH, volatile basic nitrogen (VBN), gas production ratio, and microorganisms were measured in triplicate. Results: The change of quality in the products was assessed every 7 days by measuring pH, VBN levels, total microbes, coliform bacteria, Escherichia coli, and pathogenic bacteria in the products. Pathogenic bacteria such as Staphylococcus aureus, Listeria monocytogenes, Clostridium perfringens, and E. coli were not detected in the sausages with 1st cooked treatments. The results showed that the pH of the sausages decline as storage time increased. The pH value of the sausages with 2nd cooked treatments changed gradually. VBN levels were generally lower in products with 2nd cooked treatments than in those with 1st cooked treatments, but they varied with the type of products. On the 35th day, the number of total microbes ranged between 6.13-7.12 log CFU/g in products with 1st cooked treatments and 3.44-6.92 log CFU/g in products with 2nd cooked treatments, showing fewer bacteria in the latter products. Conclusions: 1st cooked treatments were effective in microbial control, but 2nd cooked treatments could prolong the shelf life of the sausages, indicating a need for differential management of each product.

Variation of Inflow Density Currents with Different Flood Magnitude in Daecheong Reservoir (홍수 규모별 대청호에 유입하는 하천 밀도류의 특성 변화)

  • Yoon, Sung-Wan;Chung, Se-Woong;Choi, Jung-Kyu
    • Journal of Korea Water Resources Association
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    • v.41 no.12
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    • pp.1219-1230
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    • 2008
  • Stream inflows induced by flood runoffs have a higher density than the ambient reservoir water because of a lower water temperature and elevated suspended sediment(SS) concentration. As the propagation of density currents that formed by density difference between inflow and ambient water affects reservoir water quality and ecosystem, an understanding of reservoir density current is essential for an optimization of filed monitoring, analysis and forecast of SS and nutrient transport, and their proper management and control. This study was aimed to quantify the characteristics of inflow density current including plunge depth(dp) and distance(Xp), separation depth(ds), interflow thickness(hi), arrival time to dam(ta), reduction ratio(β) of SS contained stream inflow for different flood magnitude in Daecheong Reservoir with a validated two-dimensional(2D) numerical model. 10 different flood scenarios corresponding to inflow densimetric Froude number(Fri) range from 0.920 to 9.205 were set up based on the hydrograph obtained from June 13 to July 3, 2004. A fully developed stratification condition was assumed as an initial water temperature profile. Higher Fri(inertia-to-buoyancy ratio) resulted in a greater dp,Xp,ds,hi, and faster propagation of interflow, while the effect of reservoir geometry on these characteristics was significant. The Hebbert equation that estimates dp assuming steady-state flow condition with triangular cross section substantially over-estimated the dp because it does not consider the spatial variation of reservoir geometry and water surface changes during flood events. The β values between inflow and dam sites were decreased as Fri increased, but reversed after Fri>9.0 because of turbulent mixing effect. The results provides a practical and effective prediction measures for reservoir operators to first capture the behavior of turbidity inflow.

Reevaluation of Clinical Efficacy of Peripheral Vasodilator: Ethaverine HCl (말초혈관(襪梢血管) 확장제(擴張劑) Ethaverine HCl의 임상효과(臨床效果)의 재평가(再評價))

  • Kim, Yoon-Young;Cho, Young-W.
    • The Korean Journal of Pharmacology
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    • v.11 no.1 s.17
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    • pp.33-38
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    • 1975
  • The clinical efficacy of Ethaverine, a peripheral vasodilator, was studied according to a double-blind, non-cross over method in 29 diabetic patients with peripheral arterial diseases. The clinical improvement was assessed from the history of patients including the incidence and frequency of intermitten claudication. Ethaverine, after 4 weeks of therapy, was not effective in improving clinical symptoms compared to placebo. Ethaverine, however, was an efective vasodilator than placebo. The quality of vasodilation induced by Ethaverine, was similar to that of alcohol. A new clinical method of studying peripheral vasodilator was presented. The clinical symptoms of peripheral vascular arterial disease in the lower extrimities include reduced intensity of palpable pulses, coldness, and discoloration of the skin. Intermittent claudication may be present. Pathologic changes in vessel architecture precede the symptoms, and recognition of impending vascular insufficiency is a determining factor in selecting vasodilating therapy or surgical management. Also, post-operative patients who have chronic peripheral vascular arterial disease may be candidates for subsequent vasodilating therapy. Peripheral vasodilators, according to the series of reports, may be indicated in vasospastic peripheral vascular condition rather than an occlusive vascular disease and the vessel responds best when a relatively large vascular beds are involved rather than a small, capillary beds. Recently, the clinical efficacy of peripheral vasodilators have been challanged by many clinical investigators and clinicians. In this study, we have re-evaluated the efficacy of Ethaverine HCl as peripheral vasodilator in patients with vasospastic peripheral arterial disease. Ethaverine is claimed to be two to four times as potent a spasmolytic agent as papaverine in a variety of laboratory and clinical work.

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