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A Study of Inter-observer Agreements of Spiral Chest Computed Tomography in Diagnosing Pulmonary Embolism (폐색전증에서 나선형 컴퓨터 전산화 단층촬영의 관찰자간의 일치도에 관한 연구)

  • Kim, Yang-Ki;Lee, Young Mok;Kim, Ki-up;Uh, Soo-taek;Kim, Yong Hoon;Park, Choon Sik;Hwang, Jung-Hwa;Kim, Dong Hun;Goo, Dong-Erk;Choi, Deuk-Lin
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.5
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    • pp.473-479
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    • 2005
  • Background : A pulmonary embolism often presents with nonspecific symptoms and signs. However, a delayed diagnosis can result in catastrophic outcome. The majority of preventable deaths associated with a pulmonary embolism can be ascribed to a missed diagnosis rather than to the failure of existing treatments. Therefore, accurate and rapid diagnostic methods are essential for the management of a pulmonary embolism. The recent generation of multidetector-row spiral CT scanners appears to outperform other imaging modalities in detecting a central and peripheral pulmonary embolism. However, there are some variations in the interpretations of the findings between observers. This study examined the inter-observer differences of the diagnoses in patients with a pulmonary embolism. Method : 64 patients who were diagnosed with a pulmonary embolism either clinically or with spiral chest CT from 2002 to 2004, were included. Two thoracic radiologists interpreted the multidetector-row spiral CT in terms of the diagnosis of a pulmonary embolism and the location of the thrombus independently. Among 64 patients, 14 patients were excluded because there was no evidence of a pulmonary embolism or there was different interpretation of the pulmonary embolism between radiologists. A clinical diagnosis was based on "Rules for predicting the probability of embolism". Results : The mean score of the patients according to the Wells method was $3.91{\pm}0.30$ (0-9). The accordance of the radiologists was 95% in the main, 85% in the lobar, 91.2% in the segmental, and 96% in the sub-segmental pulmonary arteries. After excluding the negative interpretation from both radiologists, their agreement was 76.2%(${\kappa}.$ 0.83) in the main, 57.6%(${\kappa}.$ 0.63) in the lobar, 51.5%(${\kappa}.$ 0.63) in the segmental, and 34.6%(${\kappa}.$ 0.49) in the sub-segmental pulmonary arteries. Conclusion : Chest CT has been recently applied to patients suspected of having a pulmonary embolism. It was found that spiral CT is a rapid test for diagnosing a thrombus, and there was reliable accordance between the observers from the area of the large pulmonary arteries. However, there was a lack of agreement between the observers in diagnosing thrombi located distal to the sub-segmental arteries.

Early Proterozoic Moyitic Series in Daqingshan, Inner Mongolia : Their Characteristics and Tectonis, Magmatic and Thermodynamic Model (내몽고 다큉샨내의 초기원생대 모이아이트계열 : 특성과 지구조, 마그마 그리고 열역학적 모델)

  • Lin CAO;Wei JIN
    • The Journal of the Petrological Society of Korea
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    • v.6 no.2
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    • pp.77-85
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    • 1997
  • The Early Proterozoic reworked rock association occurs within the Preacmbrian high grade metamorphic rocks in the area of Daqingshan, Inner Molgolia. In this association, the various large scale ductile deformation belts, form a nappe structure where the foliation steeply dips to north and the lineation ($340^{circ}-30^{\circ}$) plunges at $45^{\circ}55^{\circ}$. This result indicates the subduction/extension with northern part thrusting over the southern part at high angle. The southern subducted microlithon has the characteristics of prograde metamorphism. The northern thrusted microlithon shows the evidence of retrograde metamorphism with decreasing pressure and increasing temperature. The main rock types of Early Proterozoic Moyites are biotite adamellite and syenogranites occurring in the form of small batholiths or stocks and alkali-feldspar granites in veins. The biotite adamellites are progressively contacted with the Archean and Early Proterozoic rocks and contain a great deal of enclaves of metamorphosed rocks, suggesting an anatexis origin. The geochemical characteristics of moyites show the typical features of anatexis granite. At middle to late Early Proterozoic time, the continent-continent collision formed the large scale thrusting and imbrication of Archean basement rocks. According to the mineral assemblage and thermobarometer of Paria et al. (1988) give the following P-T condition : up-faulted block; $700-710^{\circ}C$, 0.72-0.78 Gpa (early stage) and $600^{\circ}C$, 0.44 Gpa (late stage), footwall block; $620^{\circ}C$, 0.8 Gpa (early stage), $620-840^{\circ}C$, 0.64-0.45 Gpa (peak) and $620-630^{\circ}C$, 0.35Gpa (late stage). These results suggest a clockwise P-T-t path (jin et al., 1991, 1994). According to the depth-temperature model in the comperature subduction zone and the experimental data of Wyllie et al. (1983), we propose a tectonic-magmatic-thermal model to account for metamorphism-anatexis of moyite occurring in subduction-shear zone.

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One-year evaluation of the national health screening program for infants and children in Korea (영유아 건강검진 시행 초기 1년의 결과 분석)

  • Moon, Jin Soo;Lee, Soon Young;Eun, Baik-Lin;Kim, Seong Woo;Kim, Young Key;Shin, Son Moon;Lee, Hye Kyoung;Chung, Hee Jung
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.307-313
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    • 2010
  • Purpose : Results of the Korea National Health Screening Program for Infants and Children, which was launched in November 2007, were evaluated for future research and policy development. Methods : Data from a total of 2,729,340 cases were analyzed. Five visiting ages, such as 4, 9, 18, 30, and 60 months, were included. Several parameters such as stunting, obesity, and positive rate of developmental screening were also analyzed. Telephone survey was performed in 1,035 users. For the provider survey, 262 doctors participated in our study. Results : The overall participation rate of users was 35.3%. This participation rate showed a decrement tendency to old age and low income. Only 6.9% of users participated in oral screening. Health screening was performed mainly in private clinics (82.6%). The recall rate of 4 months program users at the age of 9 months was 57.3%. The positive rate of screening was 3.1%, and was higher in the low-income group. By telephone survey, users reported that questionnaires were not difficult (94%) and overall satisfaction was good (73%). Longer duration of counseling was related with more satisfied users. Counseling and health education were helpful to users (73.2%). Doctors agreed that this program was helpful to children (98.5%). Conclusion : Korea National Health Screening Program for Infants and Children was launched successfully. Participation rate should be improved, and a quality control program needs to be developed. More intensive support following this program for children of low-income families may lead to effective interventions in controlling health inequality. Periodic update of guidelines is also needed.

The current child and adolescent health screening system: an assessment and proposal for an early and periodic check-up program (현행 영유아 및 소아청소년 건강검진제도의 평가 및 대안)

  • Eun, Baik-Lin;Moon, Jin Soo;Eun, So-Hee;Lee, Hea Kyoung;Shin, Son Moon;Seong, In Kyung;Chung, Hee Jung
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.300-306
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    • 2010
  • Purpose : Recent changes in the population structure of Korea, such as rapid decline in birth rate and exponential increase in old-aged people, prompted us to prepare a new health improvement program in children and adolescents. Methods : We reviewed current health screenings applied for children and adolescents in Korea and other developed countries. We collected and reviewed population-based data focused on mortality and morbidity, and other health-related statistical data. We generated problem lists in current systems and developed new principles. Results : Current health screening programs for children and adolescents were usually based on laboratory tests, such as blood tests, urinalysis, and radiologic tests. Almost all of these programs lacked evidence based on population data or controlled studies. In most developed countries, laboratory tests are used only very selectively, and they usually focus on primary prevention of diseases and health improvement using anticipatory guidance. In Korea, statistics on mortality and morbidity reveal that diseases related to lifestyle, such as obesity and metabolic syndrome, are increasing in all generations. Conclusion : We recommend a periodic health screening program with anticipatory guidance, which is focused on growth and developmental surveillance in infants and children. We no longer recommend old programs that are based on laboratory and radiologic examinations. School health screening programs should also be changed to meet current health issues, such as developing a healthier lifestyle to minimize risk behaviors—or example, good mental health, balanced nutrition, and more exercise.

The Diagnosis for Educational Behavioral Strategies of Community Health Nurse-Community Health Worker for Control of Hypertensive Urban Young Black Men in America (간호사-지역사회건강상담자팀의 미국 도시지역 젊은 흑인 남자 집단의 고혈압 관리를 위한 전략 활동의 교육-행위진단)

  • Park, Kyung-Min
    • Research in Community and Public Health Nursing
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    • v.7 no.1
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    • pp.80-99
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    • 1996
  • Young black men(YBM) have the most severs levels of high blood pressure(HBP) and, in all reports but one, the lowest of HBP control of any age /sex /race group. To increase entry into care, remaining in care, and BP control for young(18-49 years) Black men, It is needed to review socio-demographic, medical characteristics, and behaviors(importance of and difficulty with HBP control behaviors, or worry about mdication) for experimental intervention study(educational- behavior strategies) of hypertensive urban young black men. The 204 participants had an average age of 38.8+7.0 years and an average educational level of $11.0{\pm}2.4$ years; only 23.1% were employed full- or part-time while 26% were on disability ; and 6% were married. Only 35.3% had an MD for HBP care and 37.3% had some form of health insurance. The average BP of those men currently being in care on medication(35.3%) was $148.2/95.1{\pm}19.5/11.3$ compared to those men not taking HBP care $153.7/99.1{\pm}14.0/9.8(p<.05)$. The average creatinine level was 1.3(excluding 3 marked elevations of 15.9, 9.6, and 7.7) for the 163 men consenting to have their blood drawn. Self-reported co-morbidity induded heart disease 7.8%, diabetes 8.9%, high cholesterol 18.2%, CVA 3.4%, alcohol and drug related problems 27.9% and 22.5% respectively. The kidney disease of those men currently being in care & on medication was 9.7 compared to those men not taking HBP care 0.8(p<.05). The problems of with sex life, physicl activity and dearly thinking of those men currently being in care & on medication was higher compared to those men not taking HBP care(p<.05). Questions of 'during the past month, on how many days did you have 5 or more drinks (bottles) of any alcoholic beverag?' and smoking of those men currently being in care & on medication was 18.1% and 72.2% compared to those men not taking HBP care 27.3 and 82.6%, respectively. HBP control behaviors was assessed with 1-5 point Likert subscales(5=extreme, 1-none at all), In general, th men reportd low levels of perceived psychological barrier to HBP care and control behaviors; importance of and difficulty with HBP control behaviors, or worry about mdication. For example, on a five point scale(1=none at all, 5=extreme), average ratings for perceived important and difficulty with BP care and behaviors were 2.8(SD=1.2) and 2.5(SD=1.1). Average ratings for perceived benefit with BP care and behaviors worry about medication of those men currently being in care on medication was 4.0(SD=0.9) and 2.2(SD=1.1) compared to those men not taking HBP care 3.6(SD=0.8), 2.8 (SD=1.6) respectively(p<.05). These data support the need for educational-behavioral strategies of community health nurse to improve high blood pressure control in this high risk group through perceived barriers to treatment, health care skills and use of resources, and social support.

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Mutations of katG and inhA in MDR M. tuberculosis (국내에서 분리된 다제 내성 결핵균의 katG 와 inhA 변이 다양성 및 그 빈도)

  • Lin, Hai Hua;Kim, Hee-Youn;Yun, Yeo-Jun;Park, Chan Geun;Kim, Bum-Joon;Park, Young-Gil;Kook, Yoon-Hoh
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.2
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    • pp.128-138
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    • 2007
  • Backgrounds: Mutations of katG and inhA (ORF and promoter) are known to be related to isoniazid (INH) resistance of Mycobacterium tuberculosis. Because reports on these mutations in Korean isolates are limited (i.e. only the frequency of katG codon 463 was evaluated.), we tried to know the kinds of mutations of two genes and their frequencies in INH resistant Korean M. tuberculosis strains. Methods: PCR was performed to amplify katG (2,223 bp), inhA ORF (-77~897, 975 bp), and inhA promoter (-168~80, 248 bp) from 29 multidrug resistant M. tuberculosis (MDR-TB) DNAs prepared by bead beater-phenol method. Their sequences were determined and analyzed by ABI PRISM 3730 XL Analyzer and MegAlign package program, respectively. Results: All of the isolates had more than one mutation in katG or inhA gene. Twenty seven (93%) of 29 tested strains had katG mutations, which suggests that katG is a critical gene determining INH resistance of M. tuberculosis. Amino acid substitutions, such as Arg463Leu and Ser315Thr, due to point mutations of the katG were the most frequent (62.1% and 55.2%) mutations. In addition, deletion of the katG gene was frequently observed (17.2%). Analyzed Korean MDR-TB isolates also had variable inhA mutations. Point mutation of inhA promoter region, such as -15 ($C{\rightarrow}T$) was frequently found. Substitution of amino acid (Lsy8Asn) due to point mutation ($AAA{\rightarrow}AAC$) of inhA ORF was found in 1 isolate. Interestingly, 14 point mutated types that were not previously reported were newly found. While four types resulted in amino acid change, the others were silent mutations. Conclusions: Although it is not clear that the relationship of these newly found mutations with INH resistance, they show marked diversity in Korean MDR-TB strains. It also suggests their feasibility as a molecular target to supplement determining the INH resistance of clinical isolates because of the possible existence of low-level INH resistant strains.

Devonian Strata in Imjingang Belt of the Central Korean Peninsula: Imjin System (임진강대의 중부 고생대층: 임진계)

  • Choi, Yong-Mi;Choh, Suk-Joo;Lee, Jeong-Hyun;Lee, Dong-Chan;Lee, Jeong-Gu;Kwon, Yi-Kyun;Cao, Lin;Lee, Dong-Jin
    • The Journal of the Petrological Society of Korea
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    • v.24 no.2
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    • pp.107-124
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    • 2015
  • The 'Imjin System' (or Rimjin System) was established in 1962 as a new stratigraphic unit separated from the Upper Paleozoic Pyeongan System based on the discovery of brachiopods and echinoderms of possible Devonian age. Subsequent discoveries of the Middle Devonian charophytes confirmed the Devonian age of the system. The Imjin System is distributed in the Imjingang Belt between the Pyongnam Basin and the Gyeonggi Massif, spans from the eastern areas including Cholwon-gun of the Gangwon Province, Gumchon-gun, Phanmun-gun, and Tosan-gun of the Hwanghaebuk Province, to the western areas of Gangryong-gun and Ongjin-gun of the Hwanghaenam Province, and includes the Yeoncheon Group (metamorphic complex) to the south. Unlike the lower Paleozoic strata in the Pyongnam Basin which solely produce marine invertebrate fossils, the Imjin System yields diverse non-marine plant and algal fossils. Brachiopods of the system are similar to those from the Devonian of the South China Block and include taxa endemic to the platform, implying a close paleogeographic affinity to the South China Block. The Imjin System is generally considered as of Middle to Late Devonian in age, although there have been suggestions that the system is of the Middle Devonian to Carboniferous in age. North Korean workers postulated that the Imjin System was deposited in the current geographic position, where the "Imjin Sea" (an extension of the South China Platform) was located during the Devonian. The Imjin System displays strong local variations in stratigraphy and its thickness. It has recently been reported that the strata are repeated and overturned by thrust faults in many exposures. The Yeoncheon Group a southward extension of the Imjin System, also experienced intense tight folding and contractional deformation. Northward decrease in metamorphic grade within the system suggests that the northern part of the Gyeonggi Massif and the Imjingang Belt are probably an extension of the Dabie-Sulu Belt between the South China and Sino-Korean blocks, and the Imjin System is an remnant of accretion resulted from the collision between the two blocks. In order to understand tectonic evolution and Paleozoic paleogeography of eastern Asia, further studies on stratigraphic, sedimentologic and tectonic evolution of the Imjin System involving scientists from the two Koreas are urgently needed.

A Study on Gardening Theories of Li, Yu in 'Xian Qing Ou Ji' (한정우기(閑情偶寄)를 통해 본 이어(李漁)의 조원(造園) 이론)

  • Zhang, Lin;Jung, Woo-Jin;Sung, Jong-Sang
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.36 no.3
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    • pp.137-148
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    • 2018
  • Li Yu's Xian Qing Ou Ji was written during the late Ming and early Qing Dynasty when material culture flourished due to the development of the commercial economy. Xian Qing Ou Ji is considered a retrospective work that reflects the rich material society at that time. This study focuses on his gardening theories through the interpretation and analysis of these two texts of 'Jushibu(居室部)' and 'Zhongzhibu(種植部)' in Xian Qing Ou Ji. The results are summarized as follows. First, he explained the method of garden configuration and orientation according to the topography utilizing the theory of 'suiting one's measures to local conditions(因地制宜)'. He emphasized the detailed understanding of topography as the starting point for all the gardening theories. It stated that he tried to adjust the height of the terrain artificially to create an ideal form of 'anterior high and posterior low(前低後高)'. The successful arrangement of houses, pavilions, rockery and waterways et al. was able to be achieved because of his accurate understanding of topography. Second, 'borrowing scenery(取景在借)' means 'borrowing the outside scenery to the inside'. He applied this theory by 'viewing in motion(動觀)' and 'viewing in repose(靜觀)'. 'Viewing in motion' is seen as a positive methodology for landscape enjoyment. For example, the view through a window changes with movements of the boat, and it can portray thousands of landscape paintings which can be seen through the windows. In the case of 'viewing in repose', the window is regarded as a means of attracting outside garden views to the inside. Third, he emphasized 'the firmness of objects(制體宜堅)', where the design of windows and railings must be considered ahead of others. Fourth, he interpreted the contents of 'the pursuit of novelty(創異標新)'. This generalizes the characteristics of his gardening theory. The contents included 'hall wall(廳壁)', 'variable sun visor(活?)', 'hanging boards and couplets(聯?)' and 'method of supporting vines with bamboo screen(竹屛扶植法)'.

Expression of Growth Factors and Secretory Leukocyte Protease Inhibitor (SLPI) in RAW264.7 Cells after Lipopolysaccharide (LPS) Stimulation (대식세포주 (RAW264.7)에서 박테리아성 지질다당류 (LPS) 자극에 의한 분비백혈구단백분해효소억제제 (SLPI)와 성장인자들의 발현)

  • Son, Wook-Hee;Choi, Baik-Dong;Jeong, Soon-Jeong;Wang, Guan-Lin;Hwang, Ho-Keel;Jeong, Moon-Jin
    • Applied Microscopy
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    • v.37 no.2
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    • pp.93-102
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    • 2007
  • Secretory leukocyte protease inhibitor (SLPI) was known as one of bacterial lipopolysaccharide (LPS)-induced products of macrophage. Macrophages play an important role in the development of inflammatory responses by secreting an array of cytokines and chemokines in a tissue microenvironment. To identify the function and relationship between potent growth factors and SLPI after LPS stimulation, we conducted reverse transcriptase polymerase chain reaction (RT-PCR) and Western blots for the detection of mRNA and protein expression of SLPI and growth factors such as VEGF, PDGF, bFGF after 100 ng LPS stimulation on the RAW264.7 cells. The result of RT-PCR was showed SLPI mRNA expression was increased from 60 min to 48h in RAW 264.7 cells after incubation with LPS. VEGF and PDGF mRNA was expressed highly at initial stage by LPS stimulation. The mRNA of bFGF and type I collagen was very weakly expressed after LPS stimulation. SLPI protein level was increased likely the mRNA levels in RAW 267.7 cells. Additionally, phase contrast and scanning electron microscopic observation demonstrated that the LPS induce the change of morphology of the RAW264.7 cells. From these results, it suggest that expression of SLPI by LPS treatment may associate with VEGF and PDGF expression in RAW264.7 cells.

A Study of Industrial Patients from Selected General in the Kyung Pook and Taegu City areas (일부지역 산업재해환자 실태 조사 연구 -대구${\cdot}$경북지역 일부 종합병원 중심으로-)

  • Huh, Choon-Bok
    • The Journal of Korean Physical Therapy
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    • v.3 no.1
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    • pp.151-174
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    • 1991
  • The purpose of this study is to research the actual conditions of industrial accident patients and to produce worker satisfaction and a rational and effective counter measure plan. Direct interviews with 179 cases (in and out patients) were carried out during a three month period from April to July 1990, at six hospitals : two general hospitals Sun Lin and Sung Mo in Po Hang, and four general hospitals in Taegu : Kyung pooh University Hospital, Dong San Medical Center, Young Nam Medical Center and Catholic Hospital. The results of this study are summarized as fellows : 1. Among the 179 cases, $51.6\%$ were male and $48.4\%$ were female. The two largest age groups were 30-39, $31.8\%$ and 20-29, $27.4\%$. Among the 179 cases, $51.6\%$ were married, the largest family number was 2 to 3, $41.1\%$ and 4 to 5, $25.6\%$. Educationally, graduation from high school was the largest group, $46.4\%$ among ,the patients, followed by middle school and primary school. The largest group income level was from 40-69 만원, $45.2\%$. The largest group of patients who worked over 50 hrs. a week was $52.0\%$. The largest group of patients who worked less than 1 year was $44.7\%$, of the patients in work places of less than 100 people, $60.3\%$ were injured and in work places of 100-299 people, $20.1\%$ were injured. In manufacturing, the largest group injured was $55.3\%$, the next group was transport, storage, communication. The largest group of production workers injured was $40.2\%$. 2. The cause of injury in the largest group was facility problems, $33.5\%$. The next group was unsafe habits, $30.2\%$ ; a lack of safety knowledge, $17.9\%$ ; and insufficient supervision, $12.3\%$. The 30-39 year age group head the highest number of injuries, $40.4\%$ ; work places with more than 10 years of work, $44.4\%$ ; work places with more than 1000 people, $56.3\%$ and mining accidents, $80.0\%$. Among. these groups the highest cause of injury was due to facility problems. 3. The accident pattern showed machinery injuries $28.5\%$ as the largest group, followed by falls & falling objects $17.3\%$, fire & electric $15.1\%$, strucke by an object $14.5\%$, followed by overaction and vehicular accidents. The accident pattern showed $46.4\%$ among workers over the 50 year age group, workers in the 5-10 year group, $50.0\%$ ; places employing more than 1000 workers, $35.3\%$ ; construction $73.7\%$, and construction workers $57.1\%$, among these fall & falling objects caused the greatest number of injuries. 4. The largest group of injuries was fractures $54.8\%$, trauma $14.5\%$, amputation $11.7\%$, open wound, and burns. The largest number of fractures occurred in people in the 30-39 year age group, $63.2\%$ : over 10 years of work, $55.0\%$ ; in work places of 300-490 people, $63.6\%$ ; construction $63.2\%$ and general workers $57.2\%$. 5. The largest group of injuries was upper extremity $45.3\%$, lower extremity $24.0\%$, trunk $18.5\%$ and head or neck $12.2\%$. Of these groups, upper extremity injuries were the highest in those less than 20 years old $75.0\%$, less than 1 year or work $59.5\%$, in work places of 500-999 people $60.0\%$, manufacturing $56.6\%$ and production workers $55.6\%$. 6. Periods of injury showed 34 people injured in September, to be the largest followed by October, 32 ; August, 22 people : July, 19 people and the lowest December, 2 people. During the week, Friday had the largest group injured, 35 people ; followed by Saturday, 26 people and the lowest was Wednesday, 17 people, During the day 1400 hours had the largest group injured, 38 people ; followed by 800 hours, 31 people. 7. On a basis of 5 as the highest mark, the average, according to worker satisfaction showed facility safety 3.55, work environment 3.47, income 3.44, job 3.21 and treatment 2.98. 8. The correlation between general characteristics and injury showed that age was directly correlated to the duration of work (r=2591) p<0.01, age was directly correlated to industry (r=2311) p<0.01, and the duration was directly correlated to occupation (r=4372) p<0.001.

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