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How Enduring Product Involvement and Perceived Risk Affect Consumers' Online Merchant Selection Process: The 'Required Trust Level' Perspective (지속적 관여도 및 인지된 위험이 소비자의 온라인 상인선택 프로세스에 미치는 영향에 관한 연구: 요구신뢰 수준 개념을 중심으로)

  • Hong, Il-Yoo B.;Lee, Jung-Min;Cho, Hwi-Hyung
    • Asia pacific journal of information systems
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    • v.22 no.1
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    • pp.29-52
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    • 2012
  • Consumers differ in the way they make a purchase. An audio mania would willingly make a bold, yet serious, decision to buy a top-of-the-line home theater system, while he is not interested in replacing his two-decade-old shabby car. On the contrary, an automobile enthusiast wouldn't mind spending forty thousand dollars to buy a new Jaguar convertible, yet cares little about his junky component system. It is product involvement that helps us explain such differences among individuals in the purchase style. Product involvement refers to the extent to which a product is perceived to be important to a consumer (Zaichkowsky, 2001). Product involvement is an important factor that strongly influences consumer's purchase decision-making process, and thus has been of prime interest to consumer behavior researchers. Furthermore, researchers found that involvement is closely related to perceived risk (Dholakia, 2001). While abundant research exists addressing how product involvement relates to overall perceived risk, little attention has been paid to the relationship between involvement and different types of perceived risk in an electronic commerce setting. Given that perceived risk can be a substantial barrier to the online purchase (Jarvenpaa, 2000), research addressing such an issue will offer useful implications on what specific types of perceived risk an online firm should focus on mitigating if it is to increase sales to a fullest potential. Meanwhile, past research has focused on such consumer responses as information search and dissemination as a consequence of involvement, neglecting other behavioral responses like online merchant selection. For one example, will a consumer seriously considering the purchase of a pricey Guzzi bag perceive a great degree of risk associated with online buying and therefore choose to buy it from a digital storefront rather than from an online marketplace to mitigate risk? Will a consumer require greater trust on the part of the online merchant when the perceived risk of online buying is rather high? We intend to find answers to these research questions through an empirical study. This paper explores the impact of enduring product involvement and perceived risks on required trust level, and further on online merchant choice. For the purpose of the research, five types or components of perceived risk are taken into consideration, including financial, performance, delivery, psychological, and social risks. A research model has been built around the constructs under consideration, and 12 hypotheses have been developed based on the research model to examine the relationships between enduring involvement and five components of perceived risk, between five components of perceived risk and required trust level, between enduring involvement and required trust level, and finally between required trust level and preference toward an e-tailer. To attain our research objectives, we conducted an empirical analysis consisting of two phases of data collection: a pilot test and main survey. The pilot test was conducted using 25 college students to ensure that the questionnaire items are clear and straightforward. Then the main survey was conducted using 295 college students at a major university for nine days between December 13, 2010 and December 21, 2010. The measures employed to test the model included eight constructs: (1) enduring involvement, (2) financial risk, (3) performance risk, (4) delivery risk, (5) psychological risk, (6) social risk, (7) required trust level, (8) preference toward an e-tailer. The statistical package, SPSS 17.0, was used to test the internal consistency among the items within the individual measures. Based on the Cronbach's ${\alpha}$ coefficients of the individual measure, the reliability of all the variables is supported. Meanwhile, the Amos 18.0 package was employed to perform a confirmatory factor analysis designed to assess the unidimensionality of the measures. The goodness of fit for the measurement model was satisfied. Unidimensionality was tested using convergent, discriminant, and nomological validity. The statistical evidences proved that the three types of validity were all satisfied. Now the structured equation modeling technique was used to analyze the individual paths along the relationships among the research constructs. The results indicated that enduring involvement has significant positive relationships with all the five components of perceived risk, while only performance risk is significantly related to trust level required by consumers for purchase. It can be inferred from the findings that product performance problems are mostly likely to occur when a merchant behaves in an opportunistic manner. Positive relationships were also found between involvement and required trust level and between required trust level and online merchant choice. Enduring involvement is concerned with the pleasure a consumer derives from a product class and/or with the desire for knowledge for the product class, and thus is likely to motivate the consumer to look for ways of mitigating perceived risk by requiring a higher level of trust on the part of the online merchant. Likewise, a consumer requiring a high level of trust on the merchant will choose a digital storefront rather than an e-marketplace, since a digital storefront is believed to be trustworthier than an e-marketplace, as it fulfills orders by itself rather than acting as an intermediary. The findings of the present research provide both academic and practical implications. The first academic implication is that enduring product involvement is a strong motivator of consumer responses, especially the selection of a merchant, in the context of electronic shopping. Secondly, academicians are advised to pay attention to the finding that an individual component or type of perceived risk can be used as an important research construct, since it would allow one to pinpoint the specific types of risk that are influenced by antecedents or that influence consequents. Meanwhile, our research provides implications useful for online merchants (both online storefronts and e-marketplaces). Merchants may develop strategies to attract consumers by managing perceived performance risk involved in purchase decisions, since it was found to have significant positive relationship with the level of trust required by a consumer on the part of the merchant. One way to manage performance risk would be to thoroughly examine the product before shipping to ensure that it has no deficiencies or flaws. Secondly, digital storefronts are advised to focus on symbolic goods (e.g., cars, cell phones, fashion outfits, and handbags) in which consumers are relatively more involved than others, whereas e- marketplaces should put their emphasis on non-symbolic goods (e.g., drinks, books, MP3 players, and bike accessories).

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The Effects of Environment-Friendly Agricultural Materials on Soil and the Quality of 'Niitaka' pear's Orchad (친환경농자재 처리가 배과수원 토양 및 과실품질에 미치는 영향)

  • Yoon, Seong-Tak;Xu, Zhen-Yu;Zhang, Qing-Yu;Kim, Tae-Ho;Nam, Jung-Chang;Park, Sang-Hun;Kwak, No-Il;Mun, Su-Hak;Lee, Hyuk-Jae;Choi, Jin-Ho
    • Korean Journal of Organic Agriculture
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    • v.18 no.4
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    • pp.613-626
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    • 2010
  • Coming with the well-being era, consumer's demand for safe agricultural products is increasing. It is urgent to develop an environment-friendly pear production system. Accordingly, this study was conducted to develop an environment-friendly pear production system by using several environment-friendly agricultural materials which is known to be effective in agricultural production. In the effects of environment-friendly agricultural materials on the soil chemical characteristics in pear orchard, the content of total carbon, organic matter, Ca and Mg increased a little respectively compared with those of 2008, and 2nd treatment showed the highest EC and Mg content in the soil among treatments. The content of leaf N, P and Ca in 2009 decreased compared with those of 2008, while Mg content showed no difference between 2008 and 2009 years. Average pear weight in 2009 was 31g higher than that of 2008 (682g) and 2nd treatment showed the highest pear weight (738g) among treatments. The average sugar content was higher in 2009 (12.6$^{\circ}Bx$) compared with that of 2008 (12.2$^{\circ}Bx$) and the plot of 2nd treatment highest sugar content (12.6$^{\circ}Bx$) among treatments. There were no difference in hunter value of L among treatments, but hunter value of a showed higher 1.62 in 2009 than that of 2008 (3.73). The highest of gumminess and cohesiveness of fruits were obtained from 1st treatment and adhesiveness and chewiness of fruits were obtained from 3rd and 1st treatment respectively. Firmness of fruit increased a little in 2009 compared with that of 2008, while the highest firmness was obtained from 3rd treatment with 1.63kg/5mm$\oint$ among treatments. Phosphate content in the peel of 'Niitaka' pear of fruit skin in 2009 (0.97g/kg) showed 0.06g/kg more content than that of 2008 (0.91g/kg), while the highest content was obtained from 3rd treatment (1.15g/kg). Potassium content in the peel of 'Niitaka' pear in 2009 was 8.20g/kg, which is 0.06g/kg more content than that of 2008 (7.82g/kg) and the highest content was obtained from 1st treatment (8.34g/kg) among treatments. The highest nitrogen content in the flesh of 'Niitaka' pear was obtained from 3rd treatment (4.32mg/g), while it was the lowest in control plot (3.10mg/g). Phosphate content in the flesh of 'Niitaka' pear in 2009 (8.20g/kg) showed 0.06g/kg more content than that of 2008 (7.82g/kg), while the highest content was obtained from 1st treatment (8.34g/kg). There were no difference of the potassium content in the fruit peel of 'Niitaka' pear between years, but 1st treatment showed the highest content (11.81g/kg) among treatments, while the lowest was obtained from the control plot (10.83g/kg).

The Comparision of Right Anterolateral Thoracotomy and Median Sternotomy in the Atrial Septal Defect Repair. (심방중격결손증 수술에서 우전측부개흉술과 정중흉골절개술의 비교)

  • Kim, Hyuck;Kim, Sang-Heon;Kim, Young-Hak;Chung, Won-Sang;Kang, Jung-Ho;Lee, Chul-Beom;Jee, Heng-Ok;Kim, Nam-Soo;Kim, Kyung-Soo
    • Journal of Chest Surgery
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    • v.36 no.1
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    • pp.1-6
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    • 2003
  • Currently, atrial septal defect repair has been considered low risk operation duo to the development of open heart surgery Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. Material and Method: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy(group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. Result: The mean weight of group A was 38.77$\pm$15.57kg and 38.21$\pm$21.82kg in group B. In group A, mean operation (OP) time was 197.6$\pm$61.40min, mean cardiopulmonary bypass(CPB) time was 48.66$\pm$13.02min and mean fibrillation time or aortic cross clamp(ACC) time was 30$\pm$11.64min. In group B, mean OP time was 212.33$\pm$31.95min, mean CPB time was 55$\pm$12.10min, and mean fibrillation or ACC time was 29.33$\pm$9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78$\pm$0.78 hours, mean postoperative ICU stay was 1.2$\pm$0.47 days and mean postoperative hospital stay was 10.20 41.08 days. In group B, mean mechanical ventilation time was 5.95$\pm$3.73 hours, mean post operative ICU stay was 1.41$\pm$0.61 days, and mean postoperative hospital stay was 12.20$\pm$3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33$\pm$90.54cc vs 352.33$\pm$239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block. Conclusion: Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument(p.0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.

Biodistribution of 3-[$^{131}I$]iodo-O-methyl-L-${\alpha}$-methyltyrosine in Tumor Bearing Rats: A Comparison Study with L-3-[$^{131}I$]iodo-${\alpha}$-methyltyrosine (종양 이식 백서에서 3-[$^{131}I$iodo-O-methyl-L-${\alpha}$-methyltyrosine의 체내 동태 연구: L-3-[$^{131}I$iodo-${\alpha}$-methyltyrosine와 비교)

  • Choi, Chang-Woon;Yang, Seung-Dae;Woo, Kwang-Sun;Chung, Wee-Sup;Lim, Soo-Jung;Suh, Yong-Sup;Chun, Kwon-Soo;Ahn, Soon-Hyuk;Lee, Jong-Doo;Hong, Sung-Woon;Lim, Sang-Moo
    • The Korean Journal of Nuclear Medicine
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    • v.32 no.3
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    • pp.290-297
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    • 1998
  • Purpose : The aim of this study was to evaluate the feasibility of 3-[$^{131}I$]iodo-O-methyl-L-${\alpha}$-methyltyrosine ([$^{131}I$]OMIMT) as an agent for tumor image. Materials and Methods : After synthesis of 4-O-methyl-L-${\alpha}$-methyltyrosine (OMAMT), OMAMT was labeled with [$^{131}I$] using Iodogen method. In vitro cellular uptake study was performed using 9 L gliosarcoma cells at various time points upto 4 hr. The biodistribution (five rats implanted with the 9 L gliosar-coma cells per group) was evaluated at 30 min, 2 hr, 24 hr after iv injection of 3.7 MBq [$^{131}I$]OMIMT or L-3-[$^{131}I$]iodo-${\alpha}$-methyltyrosine [$^{131}I$]IMT). Gamma camera images were obtained at 30 min, 2 hr and 24 hr. Results: [$^{131}I$]OMIMT uptake was 3.3 times and 2.5 times higher than [$^{131}I$]IMT uptake at 30 min and 60 min, respectively and same after 2 hr in in vitro study using 9L gliosarcoma cells. Maximum accumulation in tumor occurred at 30 min for both [$^{131}I$]OMIMT and [$^{131}I$]IMT in tumor bearing rats. The tumor uptake of [$^{131}I$]OMIMT was significantly higher than that of [$^{131}I$]IMT at early time point studied ($3.74{\pm}0.48$ vs $0.38{\pm}0.17%$ ID/g at 30 min and $2.40{\pm}0.17$ vs $0.24{\pm}0.03%$ ID/g at 2 hr, respectively, p<0.01). However, the tumor uptake of both radiolabels were not significantly different at 24 hr ($0.04{\pm}0.01$ vs $0.05{\pm}0.01%$ ID/g). Tumor was visualized as early as at 30 min in gamma camera images. Conclusion: These data suggested that [$^{131}I$]OMIMT might be a useful tumor imaging agent and has more advantage for the tumor imaging compared to [$^{131}I$]IMT

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Optimum Harvest Stage of Italian Ryegrass 'Kowinearly' According to One and Two Harvests During Spring Season (이탈리안 라이그라스 '코윈어리'의 봄철 1회 및 2회 이용에 따른 수확적기 구명)

  • Seo, Sung;Kim, Meing Jooung;Kim, Won Ho;Lee, Sang Hak;Jung, Min Woong;Kim, Ki Yong;Ji, Hee Chung;Park, Hyung Soo;Kim, Jong Geun;Choi, Gi Jun
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.33 no.1
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    • pp.15-20
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    • 2013
  • This study was carried out to determine the optimum harvest stage of Italian ryegrass (Lolium multiflorum Lam., IRG) for maximum forage production during the spring season in Suwon, 2010. The variety of IRG was the early maturity type, 'Kowinearly', and six harvest stages (treatments) were first heading (T1), heading (T2), late heading to early bloom (T3), bloom to late bloom (T4), ripeness (T5), and late ripeness stage (T6). The dates of the first heading and heading of 'Kowinearly' were seen on 4 to 5 May, and 14 May, respectively. Plant length and dry matter (DM) percentage at first harvest were from 69 cm and 14.8% at T1 stage to 103 cm and 35.0% at T6 stage, respectively. The content of crude protein (CP) and in vitro DM digestibility (IVDMD) of T1, T2, T3, T4, T5 and T6 at first harvest were 15.6%, 10.6%, 10.1%, 8.1%, 7.3% and 5.4%, and 81.8%, 72.1%, 64.8%, 63.8%, 61.4% and 59.0%, respectively. The content of neural detergent fiber (NDF) and acid detergent fiber (ADF) were increased continuously with delayed harvest. A significantly higher yield of DM, CP and in vitro digestible DM (IVDDM) were observed for T3, and T4 (p<0.05). DM yield of 3,526 kg, 6,278 kg, 7,842 kg, 8,984 kg, 8,346 kg and 8,008 kg/ha, CP yield of 549 kg, 665 kg, 795 kg, 725 kg, 608 kg and 430 kg/ha, and IVDDM of 2,883 kg. 4,526 kg, 5,083 kg, 5,728 kg, 5,124 kg and 4,722 kg/ha at first harvest were recorded in T1, T2, T3, T4, T5 and T6, respectively. Regrowth yield of DM, CP and IVDDM were shown to be higher at T1 and T2 (p<0.05). However, no significant differences were observed between the two stages. Daily DM and DDM production of regrowth IRG were higher at T2, followed by T1. The total yield (at first and at regrowth) of DM, CP and IVDDM were significant higher for T2, followed by T3, T4 and T1 in order. At T2 stage, the yield was 11,089 kg, 1,254 kg, and 7,669 kg/ha in DM, CP, and IVDDM. In conclusion, the late heading to bloom stage was determined to be the optimum harvest stage for a single harvest, while the heading stage was a suitable stage of first harvest of 'Kowinearly' where two harvests were sought in a single year.

A Survey on Physical Complaints Related with Farmers' Syndrome of Vinylhouse and Non-vinylhouse Farmers (비닐하우스 재배농민과 일반농민의 농부증 관련 신체증상 호소율 조사)

  • Lee, Ju-Young;Park, Jung-Han;Kim, Doo-Hie
    • Journal of Preventive Medicine and Public Health
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    • v.27 no.2 s.46
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    • pp.258-273
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    • 1994
  • To compare the physical complaints of vinylhouse farmers with those of non-vinylhouse farmers, a personal interviews on 250 vinylhouse and 142 non-vinylhouse farmers were conducted in Sungjoo county in Kyungpook province selected by a random sampling from July 5 to July 10, 1993. Blood pressure of the subjects was also measured. Vinylhouse farmers had a higher average age, larger family size, shorter experience of farming, more working hours per day and working days per year and higher annual income than the non-vinylhouse farmers. The frequency of pesticide spray of the vinylhouse farmers was 3.4 times on the average in June 1993 as compared with 2.0 times of non-vinylhouse farmers, and 16.7 times for the vinylhouse farmers during the last one year while it was 8.3 times for the non-vinylhouse farmers in the same period. While 39.6% of vinylhouse farmers experienced pesticide intoxication symptoms such as headache, nausea, vomiting, dizziness, itching, and skin irritation, etc. during the month of June, 25.4% of non-vinylhouse farmers experienced such symptoms. The most frequent symptoms among eight symptoms that constitute the farmers' syndrome were lumbago, numbness of hand or foot, shoulder pain and dizziness regardless of sex and type of farming. Prevalence of the farmers' syndrome in male and female among vinylhouse farmers were 22.1%, 43.4%, respectively, and the prevalence in non-vinylhouse farmers was 23.2% for male and 50.7% for female. There was no statistically significant difference in the prevalence of farmers' syndrome between vinylhouse and non-vinylhouse farmers. However, the prevalence in female was about 2 times higher than that of male. When the effects of other factors were adjusted by multiple logistic regression for farmers' syndrome, the prevalence in female was 3.0 times higher than that of male. The prevalence of farmers' syndrome was increased as the age of farmers increased in both vinylhouse and non-vinylhouse farmers, and adjusted odds ratio of farmers' syndrome increased by 3% as the age increased by 1 year. Adjusted odds ratio for Farmers' syndrome in farmers who experienced pesticide intoxication during the month of June was 3.1 times higher than that of farmers who did not have such experience. While the prevalence of hypertension in male and female non-vinylhouse farmers were 22.4%, 13.7%, respectively, the prevalence in vinylhouse farmers were 13.5% for male and 12.0% for female. However, there was no association between farmers' syndrome and hypertension. It was found in this study that the vinylhouse farmers are at a high risk of pesticide intoxication, which is associated with tile common physical complaints. To reduce such risk it is necessary to develop farming methods which do not require the pesticide or may use less pesticide, a safer method of pesticide spraying, and the protective equipments which can be worn at a high temperature and have a better protective effect. Also education of farmers for the correct methods of ventilation after pesticide spraying in the vinylhouse and wearing the protective equipments may be considered as a supportive method. Since inappropriate posture at work and intensive labor may cause farmers' syndrome, it is recommended to develop farming tools which reduce physical burden and take a rest and exercise periodically during work. It is necessary to strengthen the hypertension management program of the Kyungpook province, because the prevalence of hypertension was as high as about 15%.

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Lead Level in Blood, Scalp Hair and Toenail of Elementary Schoolchildren (국민학교 학생들의 혈액, 두발 및 조갑 내의 연농도 비교)

  • Kim, Jae-Uk;Lee, Jung-Jeung;Kim, Chang-Yoon;Chung, Jong-Hak
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.1 s.49
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    • pp.73-84
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    • 1995
  • This study was conducted to measure the lead level in the blood, scalp hair and toenail of the elementary schoolchildren and assess the relationship among those samples. Lead concentration of the blood, scalp hair and toenail was measured for 100(male 50, female 50) fourth grade elementary schoolchildren in Taegu city. The mean lead level in the blood, scalp hair and toenail was $6.00{\pm}2.44{\mu}g/dl,\;6.68{\pm}3.54{\mu}g/g,\;and\;7.33{\pm}3.18{\mu}g/g. The mean lead level in the blood of schoolboys was $6.43{\pm}2.77{\mu}g/dl$, and that of schoolgirls was $5.59{\pm}2.01{\mu}g/dl$. The mean lead level in the scalp hair of schoolboys was $7.66{\pm}2.97{\mu}g/g$ and that of schoolgirls was $6.88{\pm}3.54{\mu}g/g$. The mean lead level in the toenail of schoolboys was $8.19{\pm}3.5{\mu}g/g$ and that of schoolgirls was $6.47{\pm}2.52{\mu}g/g$ and their difference was statistically significant. In schoolboys, the correlation coefficient between the lead level in the blood and scalp hair was 0.4909, and the data were fitted best by the regression equation Y = 0.5255X+4. 2810, where Y and X are scalp hair and blood concentration. In schoolgirls the correlation coefficient between the lead level in the blood and scalp hair was 0.3778, and the data were fitted best by the regression equation Y = 0.6655X+2.9632, where Y and X are scalp hair and blood concentration. In schoolboys, the correlation coefficient between the lead level in the blood and in the toenail was 0.5533, and the data were fitted best by the regression equation Y = 0.7076X+3. 6472, where Y and X are toenail and blood concentration. In schoolgirls the correlation coefficient between the lead level in the blood and in the toenail was 0.2738, and the data were fitted best by the regression equation Y = 0.3431X+4.5570, where Y and X are toenail and blood concentration In schoolboys, the correlation coefficient between the lead level in the scalp hair and in the toenail, in the schoolboys was 0.4148, and the data were fitted best by the regression equation Y = 0.4956X+4.3986, where Y and X are toenail and scalp hair concentration. In schoolgirls, the correlation coefficient between the lead level in the scalp hair and in the toenail was 0.1159, and the data were fitted best by the regression equation Y = 0.0825X+5. 9214, where Y and X are toenail and scalp hair concentration. Correlation among lead concentration in the blood, scalp hair and toenail of schoolchildren were statistically significant except between scalp hair and toenail in schoolgirls. These finding suggest that blood, scalp hair and toenail can be used as substitutive samples between each others.

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Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.343-352
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    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.

The Analysis of Dose in a Rectum by Multipurpose Brachytherapy Phantom (근접방사선치료용 다목적 팬톰을 이용한 직장 내 선량분석)

  • Huh, Hyun-Do;Kim, Seong-Hoon;Cho, Sam-Ju;Lee, Suk;Shin, Dong-Oh;Kwon, Soo-Il;Kim, Hun-Jung;Kim, Woo-Chul;K. Loh John-J.
    • Radiation Oncology Journal
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    • v.23 no.4
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    • pp.223-229
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    • 2005
  • Purpose: In this work we designed and made MPBP(Multi Purpose Brachytherapy Phantom). The MPBP enables one to reproduce the same patient set-up in MPBP as the treatment of the patient and we tried to get an exact analysis of rectal doses in the phantom without need of in-vivo dosimetry. Materials and Methods: Dose measurements were tried at a point of rectum 1, the reference point of rectum, with a diode detector for 4 patients treated with tandem and ovoid for a brachytherapy of a cervix cancer. Total 20 times of rectal dose measurements were made with 5 times a patient. The set-up variation of the diode detector was analyzed. The same patient set-ups were reproduced in self-made MPBP and then rectal doses were measured with TLD. Results: The measurement results of the diode detector showed that the set-up variation of the diode detector was the maximum $11.25{\pm}0.95mm$ in the y-direction for Patient 1 and the maximum $9.90{\pm}4.50mm,\;20.85{\pm}4.50mm,\;and\;19.15{\pm}3.33mm$ in the z-direction for Patient 2, 3, and 4, respectively. Un analyzing the degree of variation in 3 directions the more variation was showed in the z-direction than x- and y-direction except Patient 1. The results of TLD measurements in MPBP showed the relative maximum error of 8.6% and 7.7% at a point of rectum 1 for Patient 1 and 4, respectively and 1.7% and 1.2% for Patient 2 and 3, respectively. The doses measured at R1 and R2 were higher than those calculated except R point of Patient 2. this can be thought to related to the algorithm of dose calculation, whcih corrects for air and water but is guessed not to consider the correction for the scattered rays, but by considering the self-error (${\pm}5%$) TLD has the relative error of values measured and calculated was analyzed to be in a good agreement within 15%. Conclusion: The reproducibility of dose measurements under the same condition as the treatment could be achieved owing to the self-made MPMP and the dose at the point of interest could be analyzed accurately. If a treatment is peformed after achieving dose optimization using the data obtained in the phantom, dose will be able to be minimized to important organs.

Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment (수모세포종의 방사선치료 후 전두엽하방 재발된 환자에서 원인 분석 및 구제 치료)

  • Cho Jae Ho;Koom Woong Sub;Lee Chang Geol;Kim Kyoung Ju;Shim Su Jung;Bak Jino;Jeong Kyoungkeun;Kim Tae_Gon;Kim Dong Seok;Choi oong-Uhn;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.165-176
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    • 2004
  • Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.