• Title/Summary/Keyword: Multiple-regression

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A Study on the Relationships Among Learning Orientation, Innovativeness and Organizational Commitment of Entrepreneurs: Focusing on the Mediating Effect of Innovativeness and the Moderating Effect of Career Relevance (학습지향성 및 혁신성과 조직몰입 간의 관계에 관한 연구: 혁신성의 매개효과와 경력연관성의 조절효과를 중심으로)

  • Joo-Heon, Lee
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.6
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    • pp.159-174
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    • 2022
  • Entrepreneurs should continuously invest resource and capital for a long time to get tangible business results. In order to be successful, despite difficulties, it is essential for entrepreneurs to continue entrepreneurial businesses without giving up too early. Thus, it can be said that organizational commitment of entrepreneurs is essential for success. According to previous studies, the organizational commitment of entrepreneurs has a significant effect on organizing, establishments of new firms and new product developments. The purpose of this article is to examine the relationships among learning orientation, innovativeness and organizational commitment of entrepreneurs. Especially, we focus on the mediating effect of innovativeness in the relationship between learning orientation and organizational commitment and the moderating effect of career relevance among the relationships. Based on empirical analysis, we reported the following results. First, learning orientation, innovativeness and career relevance of entrepreneurs had significant positive effects on organizational commitment. Second, it was found that innovativeness of entrepreneurs has a partial mediating effect on the relationship between learning orientation and organizational commitment. Third, using Baron & Kenny's hierarchical multiple regression analysis, we examined the moderating effect of career relevance among the relationships of learning orientation, innovativeness and organizational commitment. Third, because the interaction term was found to be positively significant, it was concluded there is a moderating effect of career relevance between learning orientation and innovativeness. This means, when career relevance was higher than average, the influence of learning orientation on innovation increases even more. Fourth, it was also found there is a moderating effect of career relevance between learning orientation and organizational commitment. However, the results of the mediated moderating effect analysis showed the moderating effect of career relevance between learning orientation and organization commitment is an indirect effect of moderating effect of career relevance between learning orientation and innovativeness mediated by innovativeness.

Comparison of Inpatient Medical Use between Non-specialty and Specialty Hospitals: A Study Focused on Knee Replacement Arthroplasty (전문병원과 비전문병원 입원환자의 의료이용 비교 분석: 인공관절치환술(슬관절)을 대상으로)

  • Mi-Sung Kim;Hyoung-Sun Jeong;Ki-Bong Yoo;Je-Gu Kang;Han-Sol Jang;Kwang-Soo Lee
    • Health Policy and Management
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    • v.34 no.1
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    • pp.78-86
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    • 2024
  • Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use of inpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021-2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. The dependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable was whether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type, surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number of orthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospital showed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital, indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. In our study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the cost-effectiveness of specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals in metropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designating specialty hospitals in non-metropolitan areas, such as introducing "semi-specialty hospitals (tentative name)," will lead to a reduction in health disparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals' medical staff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriately allocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.

The Association of Dual Job on Dental Hygienists' Job Satisfaction (치과위생사의 직무만족도와 동시일자리(부업)의 관련성)

  • Mi-Sook Yoon;Go-eun Kim;Han-A Cho
    • Journal of Korean Dental Hygiene Science
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    • v.6 no.2
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    • pp.51-64
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    • 2023
  • Background: This study was conducted to determine the association with dual jobbing on dental hygienists' job satisfaction and to identify the factors that lead to dual jobs. Methods: This study was an online survey of 110 currently employed dental hygienists conducted during the month of May 2022. To determine job satisfaction, we used the 20-item Korea-Minnesota Satisfaction Questionnaire (K-MSQ). Survey questions related to dual job were adapted and supplemented from the dual job survey instrument for dental hygienists to identify intention to dual job and future intention to dual job. Descriptive statistics, independent t-test, ANOVA and Scheffe's post hoc analysis, and multiple logistic regression were performed. Results: The dual job rate and future dual job rate of the participants in this study were about 27% and 47%, respectively. The means for Intrinsic job satisfaction, Extrinsic job satisfaction, and job satisfaction were 3.44, 3.15, and 3.36, respectively. It was statistically significant that extrinsic job satisfaction increased with increasing position, and intrinsic job satisfaction, extrinsic job satisfaction, and job satisfaction increased with increasing salary. Those currently working dual jobs cited "self-actualization" as a reason for doing so, and those who intended to work dual jobs in the future cited "not being paid enough in their primary job" as a reason. We found that a one-unit increase in intrinsic job satisfaction and job satisfaction increases the odds of future intention to dual job by about 1.07 and 1.05 times, respectively (p<0.05). Conclusion: This study confirmed the influence of dental hygienists' job satisfaction on intention to dual job and future intention to dual job, and self-actualization was found to be the main factor. Therefore, the consideration of dual jobs in the future will affect the improvement of dental hygienists as professionals and the reduction of turnover through better working conditions.

The Effects of Technological Competitiveness by Country on The Increase of Unicorn Companies (국가별 기술경쟁력이 유니콘기업 증가에 미치는 영향에 관한 연구)

  • Kyu Hoon Cho;Dong Woo Yang
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.19 no.1
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    • pp.55-73
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    • 2024
  • Unicorn companies are attracting attention around the world as they are recognized for their high corporate value in a short period of time as an innovative business models. Their growth process presents good lessons for the startup ecosystem and have a positive impact on national economic development and job creation. However, previous studies related to unicorn companies are focused on 'event studies' and 'case studies' such as characteristics of founders, environmental factors, business models and success/failure cases of companies already recognized as unicorns rather than a multifaceted approach. The occurrence of unicorn companies and Macroscopic analysis of related factors is lacking. Against this background, this study are considering the characteristics of unicorns examined through previous research and the current status unicorns with a high proportion of technology companies, the purpose was to analyze the impact of the country's technological competitiveness, such as 'technology human resource index', 'R&D index', and 'technology infrastructure index', on the increase in unicorn companies. For statistical analysis, data published by various international organizations, the Bank of Korea, and Statistics Korea from 2017 to 2020 and unicorn company data compiled by CB Insights were used as panel data for 44 countries to be tested by multiple regression analysis. As a result of the study, it was confirmed that the number of science majors had a positive (+) effect on the increase of unicorn companies in the case of technology human resource index, and in the case of R&D index, the total amount of R&D investment had a positive (+) effect on the increase of unicorn companies, while the number of Triad Patents Families and the number of scientific and technological papers published had a negative (-) effect on the increase of unicorn companies. Finally, in the case of technology infrastructure index, it was confirmed that the number of the world's 500th-ranked universities had a positive (+) effect on the increase of unicorn companies. This study is the first to reveal the causal relationship between national technological competitiveness and unicorn company growth based on country-specific and time-series empirical data, which were insufficiently covered in previous studies. and compared to the UN's ranking of the global industrial competitiveness index and the OECD's total R&D investment by country, Korea is considered to have technological and growth potential, while the number of unicorn companies driving growth as leaders of the innovative economy is relatively small, so the research results can be used when establishing policies to discover and foster unicorn companies in the future.

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The association between COVID-19 and changes in food consumption in Korea: analyzing the microdata of household income and expenditure from Statistics Korea 2019-2022 (코로나19와 한국 식품 소비 변화의 관계: 2019-2022년 통계청 소비자 가계동향조사를 활용하여)

  • Haram Eom;Kyounghee Kim;Seonghwan Cho;Junghoon Moon
    • Journal of Nutrition and Health
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    • v.57 no.1
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    • pp.153-169
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    • 2024
  • Purpose: The main goal of this study was to identify the impact of coronavirus disease 2019 (COVID-19) on grocery purchases (i.e., fresh and processed foods by grain, vegetable, fruit, seafood, and meat categories) in Korea. To understand the specific impact of COVID-19, the study period was divided into 3 segments: PRE-COVID-19, INTER-COVID-19, and POST-COVID-19. Methods: We used the microdata of household income and expenditure from Statistics Korea (KOSTAT), representing households across the country. The data comprised monthly grocery expenditure data from January 2019 to September 2022. First, we compared the PRE-COVID-19 period to INTER-COVID-19 and then INTER-COVID-19 to POST-COVID-19 and used multiple regression analysis. The covariates used were the gender and age of the head of the household, the household's monthly income, the number of family members, the price index, and the month (dummy variable). Results: The expenditures on all grocery categories except fresh fruit increased from PRE-COVID-19 to INTER-COVID-19. From INTER-COVID-19 to POST-COVID-19, almost all grocery category spending declined, with processed meat being the only exception. Most purchases of protein sources, increased during INTER-COVID-19 compared to PRE-COVID-19, while ham/sausage/bacon for meat protein, fish cakes and canned seafood for seafood protein, and soy milk for plant-based protein did not decrease during POST-COVID-19 compared to INTER-COVID-19. Conclusion: These results show an overall increase in in-home grocery expenditure during COVID-19 due to an increase in eating at home, followed by a decrease in this expenditure in the POST-COVID-19 period. Among the trends, the protein and highly processed convenience food categories did not see a decline in spending during the POST-COVID-19 period, which is a reflection of the preferences of consumers in the post-COVID-19 period.

The Influence of Self-Leadership of Research and Development Practitioners on Innovative Behavior via Job Satisfaction : A Comparison between Manufacturing and ICT Industries (국내 기업 연구개발 종사자의 셀프리더십이 직무만족을 매개로 혁신행동에 미치는 영향 : 제조업과 정보통신업 비교)

  • Choi, Min-seog;Hwang, Chan-gyu
    • Journal of Venture Innovation
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    • v.7 no.1
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    • pp.91-110
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    • 2024
  • In this study, we compared and analyzed the influence of self-leadership on innovative behavior and the mediating effect of job satisfaction among R&D practitioners in manufacturing and information communication technology (ICT) industries. To accomplish this, we conducted an online survey using random sampling methods and collected data from 209 respondents. We employed exploratory factor analysis, reliability analysis, correlation analysis, multiple regression analysis, and mediation analysis using SPSS 20.0 software to analyze the data and to compare differences between the manufacturing and ICT sectors. The research findings are as follows: Firstly, both in manufacturing and ICT sectors, self-leadership showed significant positive correlations with job satisfaction and innovative behavior. Secondly, in the analysis of the impact of self-leadership on innovative behavior, in the manufacturing sector, only natural reward strategy and constructive thought strategy showed significant positive effects, while in the ICT sector, behavioral-oriented strategy, natural reward strategy, and constructive thought strategy all showed significant positive effects. Thirdly, in the analysis of the impact of self-leadership on job satisfaction, in the manufacturing sector, only natural reward strategy and constructive thought strategy showed significant positive effects, while in the ICT sector, behavioral-oriented strategy and natural reward strategy showed significant positive effects. Fourthly, in the analysis of the impact of job satisfaction on innovative behavior, significant positive effects were observed in both manufacturing and ICT sectors, with manufacturing sector having relatively greater impact than ICT sector. Lastly, the results of the analysis on the mediating effect of job satisfaction indicate that in the manufacturing sector, only a constructive thinking strategy significantly influences, showing partial mediating effects. However, in the ICT sector, no mediating effects of job satisfaction were observed for any sub-factors of self-leadership. These research findings highlight differences in the mechanisms of action of self-leadership on innovative behavior and its mediating effects between the manufacturing and ICT sectors. Furthermore, the results suggest the importance of improving organizational strategies and culture towards promoting leadership, job design, and job satisfaction, considering the characteristics of each industry and research and development organization.

An Empirical Study on Influencing Factors of Venture Firm's CSR: Focusing on Slack Resources and Growth Strategy (벤처기업의 사회적책임(CSR)활동의 영향요인에 관한 연구: 기업의 여유자원과 성장전략을 중심으로)

  • Jang, Dong-Hyun;Yeon, Ju-Han;Kim, Chun-Kyu
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.19 no.3
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    • pp.27-40
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    • 2024
  • This study empirically derives the factors affecting the practice of corporate social responsibility (CSR) of venture firms in Korea from the perspective of Slack Resource Theory and the company's growth strategy, and provides implications for future expansion of venture firm's CSR activities. In Korea, venture firms have grown into important players in the national economy since the late 1990s through social contributions such as economic value creation, job creation, and technological development. As venture companies grow in status, positive relationships with stakeholders and responsibility for environmental and social values are required. Now, CSR is becoming an important strategic choice for SMEs and venture firms. However, until now, CSR-related academic research has mainly focused on large or listed corporations, and there is not much research on SMEs or venture firms. In particular, research on the factors that lead venture companies to make important business decisions of participating in CSR activities is not there yet. This study applied logistic multiple regression analysis using the '2023 Survey on Venture Firms' conducted by the Ministry of SMEs and Startups. As a result of this study, operating profit, which is an available resources of venture companies, and government support, which is a potential resource, have a positive impact on venture firms's CSR activities. Also, business relationships with large corporations and expectation for future cooperation also have a positive impact on CSR activities as the determinants. On the other hand, it was analyzed that in venture firms where ownership and management are not separated, the higher the CEO's shareholding ratio, the more negatively it affects CSR activities. This study contributes academically as the first empirical study on the determinants of CSR activities of venture firms in Korea and provides implications that government policy support and collaboration between large corporations and venture firms are important in order to expand CSR activities of venture firms.

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The Marketing Effect of Loyalty Program on Relational Market Behavior : Focusing in Franchise Membership Fitness Club (로열티 프로그램이 고객 참여와 소비자-브랜드 관계에 기초한 관계형 시장 행동에 미치는 영향 : 프랜차이즈 회원제 휘트니스클럽을 대상으로)

  • Yoon, Kyung-Goo;Shin, Geon-Cheol
    • Journal of Distribution Research
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    • v.17 no.2
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    • pp.1-28
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    • 2012
  • I. Introduction : The purpose of this study is to test empirically hypothetical causality among constructs used in previous studies to build the model of relational market behavior on customers' participation and consumer-brand relationship after introducing theories of relationship marketing, loyalty program, consumer-brand relationship, customers' participation in service marketing as previous studies with regard to relational market behavior, which Bagozzi(1995) and Peterson(1995) commented on constructs and definition suggested by Sheth and Parvatiyar (1995). For this purpose, loyalty program by the service provider, customers' participation and consumer-brand relationship as preceding variables explain relational market behavior defined by Sheth and Parvatiyar(1995). This study proposes that loyalty program as a tool of relationship marketing will be effective in that consumers' participation in marketing relationship results in a narrow range of choice(Sheth and Parvatiyar, 1995) because consumers think that their participation motive result in benefits(Peterson, 1995). Also, it is proposed that the quality of consumer-brand relationship explain the performance of relationship as well as the intermediary effect because the loyalty program could be evaluated based on relationship with customers. We reviewed the variables with regard to performance of relationship based on relation maintain in marketing literature, and then tested our hypotheses related to several performance variables including loyalty and intention of relation maintain based on the previous studies and constructs(Bendapudi and Berry, 1997 ; Bettencourt, 1997 ; Palmatier, Dant, Grewal and Evans, 2006 ; You Jae Yi and Soo Jin Lee, 2006). II. Study Model : Analyses about hypothetical causality were proceeded. The marketing effect of loyalty program on relational market behavior was empirically tested in study regarding a service provider. The research model in according to the path hypotheses (loyalty program ${\rightarrow}$ customers' participation ${\rightarrow}$ consumer-brand relationship ${\rightarrow}$ relational market behavior and loyalty program ${\rightarrow}$ consumer-brand relationship, and loyalty program ${\rightarrow}$ relational market behavior and customers' participation ${\rightarrow}$ consumer-brand relationship, and customers' participation ${\rightarrow}$ relational market behavior) proceeded as an activity for customer relation management was suggested. The main purpose of study is to see if relational market behavior could be brought as a result of developing relationship between consumers and a corporate into being stronger and more valuable when a corporate or a service provider try aggressively to build the relationship with customers (Bettencourt, 1997; Palmatier, Dant, Grewal and Evans, 2006; Sheth and Parvatiyar, 1995). III. Conclusion : The results of research into the membership fitness club, one of service areas with high level of customer participation (Bitner, Faranda, Hubbert and Zeithaml, 1997; Chase, 1978; Kelley, Donnelly, Jr. and Skinner, 1990) are as follows: First, causalities in according to path hypotheses were tested, after the preceding variables affecting relational market behavior and conceptual frame were suggested. In study, all hypotheses were supported as expected. This result confirms the proposition suggested by Sheth and Parvatiyar(1995), who claimed that intention of consumer and corporate to participate in marketing relationship brings high level of marketing productivity. Also, as a corporate or a service provider try aggressively to build relationship with customers, the relationship between consumers and a corporate can be developed into stronger and more valuable one (Bettencourt, 1997; Palmatier, Dant, Grewal and Evans, 2006). This finding supports the logic of relationship marketing. Second, because the question regarding the path hypothesis of consumer-brand relationship ${\rightarrow}$ relational market behavior are still at issue, the further analyses were conducted. In particular, there existed the mediating effects of consumer-brand relationship toward relational market behavior. Also, multiple regressions were conducted to see if which one strongly influences relational market behavior among specific question items with regard to consumer-brand relationship. As a result, the influence between items composing consumer-brand relationship and ones composing relational market behavior was different. Among items composing consumer-brand relationship, intimacy was an influence of sustaining relationship, word of mouth, and recommendation, intimacy and interdependence were influences of loyalty, intimacy and self-connection were influences of tolerance and advice. Notably, commitment among items measuring consumer-brand relationship had the negative influence with relational market behavior. This means that bringing relational market behavior is not consumer-brand relationship without personal commitment, but effort to build customer relationship like intimacy, interdependence, and self-connection. This finding confirms the results of Breivik and Thorbjornsen(2008). They reported that six variables composing the quality of consumer-brand relationship have higher explanation in regression model directly affecting performance of consumer-brand relationship. As a result of empirical analysis, among the constructs with regard to consumer-brand relationship, intimacy(B=0.512), interdependence(B=0.196), and quality of partner(B=0.153) had the effects on relation maintain. On the contrary, self-connection, love and passion, and commitment had little effect and did not show the statistical significance(p<0.05). On the other hand, intimacy(B=0.668) and interdependence(B=0.181) had the high regression estimates on word of mouth and recommendation. Regarding the effect on loyalty, explanation level of the model was high(R2=0.515), intimacy(0.538), interdependence(0.223), and quality of partner(0.177) showed the statistical significance(p<0.05). Furthermore, intimacy(0.441) had the strong effect as well as self-connection(0.201) and interdependence (0.163) had the effect on tolerance and forgive. And these three variables showed effects even on advice and suggestion, intimacy(0.373), self-connection(0.270), interdependence (0.155) respectively. Third, in study with regard to the positive effect(loyalty program ${\rightarrow}$ customers' participation, loyalty program ${\rightarrow}$ consumer-brand relationship, loyalty program ${\rightarrow}$ relational market behavior, customers' participation ${\rightarrow}$ consumer-brand relationship, customers' participation ${\rightarrow}$ relational market behavior, consumer-brand relationship ${\rightarrow}$ relational market behavior), the path hypothesis of customers' participation ${\rightarrow}$ consumer-brand relationship, was supported. The fact that path hypothesis of customers' participation ${\rightarrow}$ consumer-brand relationship was supported confirms assertion by Bitner(1995), Fournier(1994), Sheth and Parvatiyar(1995) about consumer relationship to participate in marketing relationship.

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Comparison of Single-Breath and Intra-Breath Method in Measuring Diffusing Capacity for Carbon Monoxide of the Lung (일산화탄소 폐확산능검사에서 단회호흡법과 호흡내검사법의 비교)

  • Lee, Jae-Ho;Chung, Hee-Soon;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.555-568
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    • 1995
  • Background: It is most physiologic to measure the diffusing capacity of the lung by using oxygen, but it is so difficult to measure partial pressure of oxygen in the capillary blood of the lung that in clinical practice it is measured by using carbon monoxide, and single-breath diffusing capacity method is used most widely. However, since the process of withholding the breath for 10 seconds after inspiration to the total lung capacity is very hard to practice for patients who suffer from cough, dyspnea, etc, the intra-breath lung diffusing capacity method which requires a single exhalation of low-flow rate without such process was devised. In this study, we want to know whether or not there is any significant difference in the diffusing capacity of the lung measured by the single-breath and intra-breath methods, and if any, which factors have any influence. Methods: We chose randomly 73 persons without regarding specific disease, and after conducting 3 times the flow-volume curve test, we selected forced vital capacity(FVC), percent of predicted forced vital capacity, forced expiratory volume within 1 second($FEV_1$), percent of forced expiratory volume within 1 second, the ratio of forced expiratory volume within 1 second against forced vital capacity($FEV_1$/FVC) in test which the sum of FVC and $FEV_1$ is biggest. We measured the diffusing capacity of the lung 3 times in each of the single-breath and intra-breath methods at intervals of 5 minutes, and we evaluated which factors have any influence on the difference of the diffusing capacity of the lung between two methods[the mean values(ml/min/mmHg) of difference between two diffusing capacity measured by two methods] by means of the linear regression method, and obtained the following results: Results: 1) Intra-test reproducibility in the single-breath and intra-breath methods was excellent. 2) There was in general a good correlation between the diffusing capacity of the lung measured by a single-breath method and that measured by the intra-breath method, but there was a significant difference between values measured by both methods($1.01{\pm}0.35ml/min/mmHg$, p<0.01) 3) The difference between the diffusing capacity of the lung measured by both methods was not correlated to FVC, but was correlated to $FEV_1$, percent of $FEV_1$, $FEV_1$/FVC and the gradient of methane concentration which is an indicator of distribution of ventilation, and it was found as a result of the multiple regression test, that the effect of $FEV_1$/FVC was most strong(r=-0.4725, p<0.01) 4) In a graphic view of the difference of diffusing capacity measured by single-breath and intra-breath method and $FEV_1$/FVC, it was found that the former was divided into two groups in section where $FEV_1$/FVC is 50~60%, and that there was no significant difference between two methods in the section where $FEV_1$/FVC is equal or more than 60% ($0.05{\pm}0.24ml/min/mmHg$, p>0.1), but there was significant difference in the section, less than 60%($-4.5{\pm}0.34ml/min/mmHg$, p<0.01). 5. The diffusing capacity of the lung measured by the single-breath and intra-breath method was the same in value($24.3{\pm}0.68ml/min/mmHg$) within the normal range(2%/L) of the methane gas gradient, and there was no difference depending on the measuring method, but if the methane concentration gradients exceed 2%/L, the diffusing capacity of the lung measured by single-breath method became $15.0{\pm}0.44ml/min/mmHg$, and that measured by intra-breath method, $11.9{\pm}0.51ml/min/mmHg$, and there was a significant difference between them(p<0.01). Conclusion: Therefore, in case where $FEV_1$/FVC was less than 60%, the diffusing capacity of the lung measured by intra-breath method represented significantly lower value than that by single-breath method, and it was presumed to be caused largely by a defect of ventilation-distribution, but the possibility could not be excluded that the diffusing capacity of the lung might be overestimated in the single-breath method, or the actual reduction of the diffusing capacity of the lung appeared more sensitively in the intra-breath method.

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REPORT OF EXPERIENCE WITH KIMURA'S DISEASE (기무라씨 질환, 5 예 보고)

  • Seel David J.;Park Yoon-Kyu;Lee Kwang-Min
    • Korean Journal of Head & Neck Oncology
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    • v.5 no.1
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    • pp.39-46
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    • 1989
  • Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vase 비 ar proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE I. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years' duration and with inguinal swelling of 7 years' duration. The submental mass measured 5x5cm. and the inguinal mass was 8x4cm. in size. Peripheral eosinophilia varying from 14% to 40% was found. On August 20, 1982, the submental mass was removed and a superficial groin dissection was done. In May 1983 an intraoral lesion of the palate was removed. The patient is free of disease. CASE II. A 23-year-old unemployed man visited this hospital for the first time in July, 1984, with swelling of the right cheek present for 6 years. The mass was soft and ill-defined but measured 10x20cm. and extended from the submandibular upper neck to the zygomatic arch, and from the mastoid to the cheek, over the parotid gland. Eosinophilia varying from 27% to 29% was noted in the peripheral blood. On March 21, 1986, the lesion was resected. The procedure comprised an extended superficial parotidectomy from the temporalis fascia to the upper neck. Post-operatively radiotherapy 3000 rad tissue dose was administered using the 6 MeV linear accelerator. The patient remains free of disease. CASE III. A 19-year-old student came to the clinic with masses over both mastoid areas, present 3 years. On the right there were two adjacent lesions, one over the mastoid, the other in the upper jugular level of the neck. On the left it was a single mass over the mastoid. Eosinophilia varied from 13 to 32% in the peripheral blood, and 11.6% in the bone marrow. Incisional biopsy revealed 'eosinophilic granuloma' and a trial of predisolone was employed. The mass increased in size so a small dose of radiation (600 rads) was used, with substantial regression,. The lesion on the left was excised and follwed by 1000 rads radiotherapy. Finally recurrent tumor on the right side was removed on November 5, 1985. The patient remains free of disease. CASE N. A 29-year-old local merchant had had swelling of both upper necks since childhood. At the time of his first visit on March 17, 1986, the right submandibular mass measured 5x3.5cm. and the ,right upper neck and parotid tail mass measured 2.5cm. On the left there were masses in the upper neck, the largest of which measured 2.5cm, and of the parotid tail, 2.0cm. in size.(See Fig. 1) Peripheral eosinophilia of 39% was recorded. Left side partial parotidectomy and resection of the upper neck and subdigstric mases was done on May 2, 1986. The mass involving the right parotid tail and upper neck nodes was removed on Angust 7,1986. Postoperatively the patient was placed on prednisolone 30 mg. per day. No definite masses are palpable. CASE V. A 66-year-old housewife informed us, at the time of her first visit in May, 1986, that she had had multiple neck masses since 10 years ago. On the right side there was a 2.5cm. subcutaneous mass of the upper neck, over the upper jugular chain. On the left there was a 9x4.5cm. mass involving the entire parotid, the post-auricular area and the upper neck. A third mass presented in the submental area and measured 3.5cm. (See Fig. 2) Eosinophilia of 51% was noted in the peripheral blood. partial excision of the left upper neck lesion and complete excision of the submental mass were performed on june 6, 1986. post-operatively she was placed on 20 mg. of prednisolone daily, but when the mass re-grew after two months she was referred to Radiation Therapy for a 2500 rad course of treatment. A barely palpable thickening remains.

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