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An Empirical Study in Relationship between Franchisor's Leadership Behavior Style and Commitment by Focusing Moderating Effect of Franchisee's Self-efficacy (가맹본부의 리더십 행동유형과 가맹사업자의 관계결속에 관한 실증적 연구 - 가맹사업자의 자기효능감의 조절효과를 중심으로 -)

  • Yang, Hoe-Chang;Lee, Young-Chul
    • Journal of Distribution Research
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    • v.15 no.1
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    • pp.49-71
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    • 2010
  • Franchise businesses in South Korea have contributed to economic growth and job creation, and its growth potential remains very high. However, despite such virtues, domestic franchise businesses face many problems such as the instability of franchisor's business structure and weak financial conditions. To solve these problems, the government enacted legislation and strengthened franchise related laws. However, the strengthening of laws regulating franchisors had many side effects that interrupted the development of the franchise business. For example, legal regulations regarding franchisors have had the effect of suppressing the franchisor's leadership activities (e.g. activities such as the ability to advocate the franchisor's policies and strategies to the franchisees, in order to facilitate change and innovation). One of the main goals of the franchise business is to build cooperation between the franchisor and the franchisee for their combined success. However, franchisees can refuse to follow the franchisor's strategies because of the current state of franchise-related law and government policy. The purpose of this study to explore the effects of franchisor's leadership style on franchisee's commitment in a franchise system. We classified leadership styles according to the path-goal theory (House & Mitchell, 1974), and it was hypothesized and tested that the four leadership styles proposed by the path-goal theory (i.e. directive, supportive, participative and achievement-oriented leadership) have different effects on franchisee's commitment. Another purpose of this study to explore the how the level of franchisee's self-efficacy influences both the franchisor's leadership style and franchisee's commitment in a franchise system. Results of the present study are expected to provide important theoretical and practical implications as to the role of franchisor's leadership style, as restricted by government regulations and the franchisee's self-efficacy, which could be needed to improve the quality of the long-term relationship between the franchisor and franchisee. Quoted by Northouse(2007), one problem regarding the investigation of leadership is that there are almost as many different definitions of leadership as there are people who have tried to define it. But despite the multitude of ways in which leadership has been conceptualized, the following components can be identified as central to the phenomenon: (a) leadership is a process, (b) leadership involves influence, (c) leadership occurs in a group context, and (d) leadership involves goal attainment. Based on these components, in this study leadership is defined as a process whereby franchisor's influences a group of franchisee' to achieve a common goal. Focusing on this definition, the path-goal theory is about how leaders motivate subordinates to accomplish designated goals. Drawing heavily from research on what motivates employees, path-goal theory first appeared in the leadership literature in the early 1970s in the works of Evans (1970), House (1971), House and Dessler (1974), and House and Mitchell (1974). The stated goal of this leadership theory is to enhance employee performance and employee satisfaction by focusing on employee motivation. In brief, path-goal theory is designed to explain how leaders can help subordinates along the path to their goals by selecting specific behaviors that are best suited to subordinates' needs and to the situation in which subordinates are working (Northouse, 2007). House & Mitchell(1974) predicted that although many different leadership behaviors could have been selected to be a part of path-goal theory, this approach has so far examined directive, supportive, participative, and achievement-oriented leadership behaviors. And they suggested that leaders may exhibit any or all of these four styles with various subordinates and in different situations. However, due to restrictive government regulations, franchisors are not in a position to change their leadership style to suit their circumstances. In addition, quoted by Northouse(2007), ssubordinate characteristics determine how a leader's behavior is interpreted by subordinates in a given work context. Many researchers have focused on subordinates' needs for affiliation, preferences for structure, desires for control, and self-perceived level of task ability. In this study, we have focused on the self-perceived level of task ability, namely, the franchisee's self-efficacy. According to Bandura (1977), self-efficacy is chiefly defined as the personal attitude of one's ability to accomplish concrete tasks. Therefore, it is not an indicator of one's actual abilities, but an opinion of the extent of how one can use that ability. Thus, the judgment of maintain franchisee's commitment depends on the situation (e.g., government regulation and policy and leadership style of franchisor) and how it affects one's ability to mobilize resources to deal with the task, so even if people possess the same ability, there may be differences in self-efficacy. Figure 1 illustrates the model investigated in this study. In this model, it was hypothesized that leadership styles would affect the franchisee's commitment, and self-efficacy would moderate the relationship between leadership style and franchisee's commitment. Theoretically, quoted by Northouse(2007), the path-goal approach suggests that leaders need to choose a leadership style that best fits the needs of subordinates and the work they are doing. According to House & Mitchell (1974), the theory predicts that a directive style of leadership is best in situations in which subordinates are dogmatic and authoritarian, the task demands are ambiguous, and the organizational rule and procedures are unclear. In these situations, franchisor's directive leadership complements the work by providing guidance and psychological structure for franchisees. For work that is structured, unsatisfying, or frustrating, path-goal theory suggests that leaders should use a supportive style. Franchisor's Supportive leadership offers a sense of human touch for franchisees engaged in mundane, mechanized activity. Franchisor's participative leadership is considered best when a task is ambiguous because participation gives greater clarity to how certain paths lead to certain goals; it helps subordinates learn what actions leads to what outcome. Furthermore, House & Mitchell(1974) predicts that achievement-oriented leadership is most effective in settings in which subordinates are required to perform ambiguous tasks. Marsh and O'Neill (1984) tested the idea that organizational members' anger and decline in performance is caused by deficiencies in their level of effort and found that self-efficacy promotes accomplishment, decreases stress and negative consequences like depression and emotional instability. Based on the extant empirical findings and theoretical reasoning, we posit positive and strong relationships between the franchisor's leadership styles and the franchisee's commitment. Furthermore, the level of franchisee's self-efficacy was thought to maintain their commitment. The questionnaires sent to participants consisted of the following measures; leadership style was assessed using a 20 item 7-point likert scale developed by Indvik (1985), self-efficacy was assessed using a 24 item 6-point likert scale developed by Bandura (1977), and commitment was assessed using a 6 item 5-point likert scale developed by Morgan & Hunt (1994). Questionnaires were distributed to Korean optical franchisees in Seoul. It took about 20 days to complete the data collection. A total number of 140 questionnaires were returned and complete data were available from 137 respondents. Results of multiple regression analyses testing the relationships between the each of the four styles of leadership shown by the franchisor as independent variables and franchisee's commitment as the dependent variable showed that the relationship between supportive leadership style and commitment ($\beta$=.13, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.07, p<.001)were significant. However, when participants divided into high and low self-efficacy groups, results of multiple regression analyses showed that only the relationship between achievement-oriented leadership style and commitment ($\beta$=.14, p<.001) was significant in the high self-efficacy group. In the low self-efficacy group, the relationship between supportive leadership style and commitment ($\beta$=.17, p<.001),and the relationship between participative leadership style and commitment ($\beta$=.10, p<.001) were significant. The study focused on the franchisee's self-efficacy in order to explore the possibility that regulation, originally intended to protect the franchisee, may not be the most effective method to maintain the relationships in a franchise business. The key results of the data analysis regarding the moderating role of self-efficacy between leadership behavior style as proposed by path-goal and commitment theory were as follows. First, this study proposed that franchisor should apply the appropriate type of leadership behavior to strengthen the franchisees commitment because the results demonstrated that supportive and participative leadership styles by the franchisors have a positive influence on the franchisee's level of commitment. Second, it is desirable for franchisor to validate the franchisee's efforts, since the franchisee's characteristics such as self-efficacy had a substantial, positive effect on the franchisee's commitment as well as being a meaningful moderator between leadership and commitment. Third, the results as a whole imply that the government should provide institutional support, namely to put the franchisor in a position to clearly identify the characteristics of their franchisees and provide reasonable means to administer the franchisees to achieve the company's goal.

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Application of a Single-pulsatile Extracorporeal Life Support System for Extracorporeal Membrane Oxygenation -An experimental study - (단일 박동형 생명구조장치의 인공폐 적용 -실험연구-)

  • Kim, Tae-Sik;Sun, Kyung;Lee, Kyu-Baek;Park, Sung-Young;Hwang, Jae-Joon;Son, Ho-Sung;Kim, Kwang-Taik;Kim. Hyoung-Mook
    • Journal of Chest Surgery
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    • v.37 no.3
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    • pp.201-209
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    • 2004
  • Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber, In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8∼2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47$\pm$ 10 and 41 $\pm$ 9 mmHg) than the nonpulsatile group 1 (17 $\pm$ 7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222 $\pm$ 8 mmHg in group 1, 739 $\pm$ 35 mmHg in group 2, and 470 $\pm$ 17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77 $\pm$ 41 mmHg in group 1, 96 $\pm$ 48 mmHg in group 2, and 97 $\pm$ 25 mmHg in group 3: p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7 $\pm$ 43.3, 162.8 $\pm$ 113.6, 82.5 $\pm$ 25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

The Evaluation of Hybrid-Volumetric Modulated Arc Therapy for Lung Cancer Radiation Therapy (폐암 방사선 치료 시 Hybrid-Volumetric Modulated Arc Therapy의 유용성 평가)

  • Lee, Geon Ho;Kang, Hyo Seok;Choi, Byoung Joon;Park, Sang Jun;Jung, Da Ee;Lee, Du Sang;Ahn, Min Woo;Jeon, Myeong Soo
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.2
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    • pp.19-26
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    • 2017
  • Objectives: In the Lung, the VMAT rotates continuously and examines radiation. That increases the low doses to normal lung. Due to that, the incidence of radiation pneumonia among radiation side effects may increase. The cause of radiation pneumonia is the lower dose area of the lungs. The H-VMAT was applied to patients who applied to reduce radiation in the lower doses of the lungs. We wanted to assess the usefulness of the H-VMAT by comparing the radiation doses to the low dose areas of the lungs and the normal organs. Materials and Methods: A total of 26 patients who applied for a H-VMAT procedure were applied to the patient. The prescription dose applied to total dose 44 Gy from 22 divisions. For each patient, a plan was implemented with Conventional RT, VMAT and H-VMAT. Conventional RT was carried out in four to five fields each, considering the size, location, shape, and location of the PTV. In the case of a VMAT plan, the two Half ARC, three Half ARC method and the two Full ARC were planned. The H-VMAT was planned by adding two Static fields in the VMAT, taking into account the dose of the lung and the tolerance dose of the organs. Results: In the NSCLC, the lung doses $V_5$ and $V_{10}$ of the lungs except for the treatment plan volume were the lowest with $55.40{\pm}13.39%$ and $32.05{\pm}11.37%$ of H-VMAT. And, in the SCLC, the lung doses of V5 and V10 were the lowest at $64.32{\pm}16.15%$ and $35.50{\pm}9.91%$, respectively. The spinal dose of VMAT in NSCLC was $21.15{\pm}4.02Gy$, which was 7.94 Gy lower than other treatment methods. The lowest spinal dose was delivered at $19.72{\pm}1.82Gy$ for SCLC. The mean dose delivered to the esophagus was also $17.44{\pm}2.04Gy$ and $17.84{\pm}9.20Gy$ in SCLC and NSCLC, respectively. Conclusion: When comparing the value of the surrounding normal organ dose, the VMAT showed that less doses were transmitted from the heart, esophagus and spinal cord than the rest of the treatment plan. However, it was similar to VMAT in normal organs except for the spinal cord. VMAT has increased doses of some normal organs but did not exceed the tolerance dose. It showed a low value in $V_5$, $V_{10}$. When comparing Conventional RT, VMAT, and H-VMAT, If the dose to the heart, esophagus and spinal cord is lower than the tolerance dose, it is thought to reduce the incidence of radiation pneumonia by applying H-VMAT that show the benefits of low doses of the lungs.

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A Prospective Randomized Comparative Clinical Trial Comparing the Efficacy between Ondansetron and Metoclopramide for Prevention of Nausea and Vomiting in Patients Undergoing Fractionated Radiotherapy to the Abdominal Region (복부 방사선치료를 받는 환자에서 발생하는 오심 및 구토에 대한 온단세트론과 메토클로프라미드의 효과 : 제 3상 전향적 무작위 비교임상시험)

  • Park Hee Chul;Suh Chang Ok;Seong Jinsil;Cho Jae Ho;Lim John Jihoon;Park Won;Song Jae Seok;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.19 no.2
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    • pp.127-135
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    • 2001
  • Purpose : This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy of ondansetron $(Zofran^{\circledR})$ 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg lid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Materials and Methods : Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tablets including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Results : Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was $52.9{\pm}11.2$ in group M, $46.5{\pm}9.5$ in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly score for all three symptoms. Ondansetron $(Zofran^{\circledR})$ 8 mg bid dose and metoclopramide 5 mg lid dose were well tolerated without significant side effects. There were no clinically important changes In vital signs or clinical laboratory parameters with either drug. Conclusion : Concerning the fact that patients with younger age have higher emetogenic potential, there are possibilities that age difference between two treatment groups lowered the statistical power of analysis. There were significant difference favoring ondansetron group with respect to the severity of nausea, vomiting and loss of appetite. We concluded that ondansetron is more effective anti-emetic agents in the control of radiotherapy-induced nausea, vomiting, loss of appetite without significant toxicity, compared with commonly used drug, i.e., metoclopramide. However, there were patients suffering emesis despite the administration of ondansetron. The possible strategies to improve the prevention and the treatment of radiotherapy-induced emesis must be further studied.

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Effect of Retrovirus Mediated TNF-$\alpha$ Gene Transfer to Tumor Necrosis Factor(TNF) Sensitive Tumor Cell Lines on Sensitivity to TNF (Retroviral Vector를 이용한 TNF-$\alpha$ 유전자의 이입이 암세포의 종양괴사인자(TNF) 감수성에 미치는 효과)

  • Oh, Yeon-Mok;Park, Kyeo-Yeong;Jung, Man-Pyo;Yoo, Chul-Gyu;Kim, Young-Whan;Han, Sung-Goo;Sim, Young-Soo;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.2
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    • pp.87-96
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    • 1994
  • Background : Since tumor necrosis factor was discovered in 1975, TNF has been well known about its cytotoxic effect on tumor cells in vivo and in vitro. According to the recent improvement of molecular biological techinques, it is possible that exogenous TNF gene is transferred to tumor cells and is expressed in theirs. By virtue of TNF gene transfer, we have expected that TNF expressed in TNF-gene-transferred tumor cells would kill tumor cells in vivo without systemic side effect. The expected mechanisms in which antitumor effects of TNF expressed in TNF-gene-transferred tumor cells are working would be as followings. In the first mechanism, TNF expressed in TNF-gene-transferred tumor cells would kill tumor cells around(like homicide). In the second mechanism, TNF expressed in TNF-gene-transferred tumor cells would kill themselves(like suicide). In the third mechanism, TNF expressed in TNF-gene-transferred tumor cells would recruit immune effector cells and kill tumor cells indirectly. In the last mechanism, TNF expressed in TNF-gene-transferred tumor cells would augment cytokine such as interferon-$\gamma$ to kill tumor cells. Among these four mechanisms of antitumor effect, only the second mechanism has not been established yet. Therefore, to elucidate the second mechanism, We performed this study. Method : We transferred TNF-$\alpha$ gene to NCI-H2058, a human mesothelioma cell line and WEHI164, a murine fibrosarcoma cell line by using retroviral vector(pLT12SNTNF). And, We determined by using MTT assay whether TNF expressed in TNF-gene-transferred tumor cell lines would kill themselves like suicide or not. Then, if TNF-gene-transferred tumor cell lines would not suicide themselves, I would know more about the TNF sensitivity of TNF-gene-transferred tumor cell lines to exogenous TNF also by MTT assay. Result : NCI-H2058 and WEHI164 which were sensitive to TNF, became far less sensitive to endogenous and exogenous TNF after being transferred TNF-$\alpha$ gene to. Conclusion : TNF-gene-transfer to NCI-H2058 and WEHI164 gave them resistance to TNF.

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A Prospective Randomized Trial Comparing the Seciuence of Adiuvant Chemotherapy and Radiotherapy following Curative Resection of Stage II, III Rectal Cancer (직장암의 근치적 수술 루 방사선치료와 화학요법의 순서에 대한 고찰 -전향적 무작위 3상 임상연구 중간 결과 보고-)

  • Kim Kyoung Ju;Kim Jong Hoon;Choi Eun Kyung;Chang Hyesook;Ahn Seung Do;Lee Je Hwan;Kim Jin Cheon;Yu Chang Sik
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.17-25
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    • 2000
  • Purpose : To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and III rectal cancer who had undergone curative resection were randomized to 'early radiotherapy group (arm I)' or' late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. Materials and Methods . From January 1996 to March 1999, 313 patients with curatively resected stages II and III rectal cancer have been randomized to' early' or' late' radiation therapy group and received combined chemotherapy (5-FU 375 mg/m$^{2}$/day, ieucovorin 20 mg/m$^{2}$, IV bolus daily Dl-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/s weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was peformed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. Results :Local recurrence occurred in 11 patients (9.7$\%$) for arm I and 9 patients (8$\%$) for arm 11. There was no significant difference between both groups ( p=0.64). However, distant metastasis was found in 22 patients (19.5$\%$) for arm I and 35 patients (31.0$\%$) for arm II and which showed statistically significant difference between the two groups ( p=0.046). And neither 3-year disease-free survival (70.2$\%$ vs 59.2$\%$, p=0.2) nor overall survival (89.4$\%$ vs 88.0$\%$, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3$\%$ and 79.9$\%$ respectively but leukopenia more than RTOG grade 3 was only 2.1$\%$ and 6.0$\%$ respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2$\%$ vs 41.6$\%$, p=0.02) but this complication was controlled with supportive cares. Conclusion : Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy after curative resection for rectal cancer, local recurrence rate was low with combined chemoradlotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.

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Air Cavity Effects on the Absorbed Dose for 4-, 6- and 10-MV X-ray Beams : Larynx Model (4-, 6-, 10-MV X-선원에서 공기동이 흡수선량에 미치는 효과 : 후두모형)

  • Kim Chang-Seon;Yang Dae-Sik;Kim Chul-Yong;Choi Myung-Sun
    • Radiation Oncology Journal
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    • v.15 no.4
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    • pp.393-402
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    • 1997
  • Purpose : When an x-ray beam of small field size is irradiated to target area containing an air cavity, such as larynx, the underdosing effect is observed in the region near the interfaces of air and soft tissue. With a larynx model, air cavity embedded in tissue-equivalent material, this study is intonded for examining Parameters, such as beam quality, field size, and cavity size, to affect the dose distribution near the air cavity. Materials and Methods : Three x-rar beams, 4-, 6- and 10-MV, were employed to Perform a measurement using a 2cm $(width){\times}L$ (length in cm, one side of x-ray field used 2cm (height) air cavity in the simulated larynx. A thin window parallel-plate chamber connected to an electrometer was used for a dosimetry system. A ratio of the dose at various distances from the cavity-tissue interface to the dose at the same points in a homogeneous Phantom (ebservedlexpected ratio, O/E) normalized buildup curves, and ratio of distal surface dose to dose at the maximum buildup depth were examined for various field sizes. Measurement for cavity size effect was performed by varying the height (Z) of the air cavity with the width kept constant for several field sizes. Results : No underdosing effect for 4-MV beam for fields larger than $5cm\times5cm$ was found For both 6- and 10-MV beams, the underdosing portion of the larynx at the distal surface was seen to occur for small fields, $4cm\times4cm\;and\;5cm\times5cm$. The underdosed tissue was increased in its volume with beam energy even for similar surface doses. The relative distal surface dose to maximum dose was changed to 0.99 from 0.95, 0.92, and 0.91 for 4-, 6-, and 10-MV, respectively, with increasing field size, $4cm\times4cm\;to\;8cm\times8cm$, For 6- and 10-MV beams, the dose at the surface of the cavity is measured less than the predicted by about two and three percent. respectively. but decrease was found for 4-MV beam for $5cm\times5cm$ field. For the $4cm\timesL\timesZ$ (height in cm). varying depth from 0.0 to 4.8cm, cavity, O/E> 1.0 was observed regardless of the cavity size for any field larger than about $8cm\times8cm$. Conclusion : The magnitude of underdosing depends on beam energy, field size. and cavity size for the larynx model. Based on the result of the study. caution must be used when a small field of a high quality x-ray beam is irradiated to regions including air cavities. and especially the region where the tumor extends to the surface. Low quality beam. such as. 4-MV x-ray, and larger fields can be used preferably to reduce the risk of underdosing, local failure. In the case of high quality beams such as 6- and 10-MV x-rays, however. an additional boost field is recommended to add for the compensation of the underdosing region when a typically used treatment field. $8cm\times8cm$, is employed.

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Clinical Outcomes of Off-pump Coronary Artery Bypass Grafting (심폐바이패스 없는 관상동맥우회술의 임상성적)

  • Shin, Je-Kyoun;Kim, Jeong-Won;Jung, Jong-Pil;Park, Chang-Ryul;Park, Soon-Eun
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.34-40
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    • 2008
  • Background: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary by. pass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. Material and Method: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of $62{\pm}10$ years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean $56.7{\pm}11.6%$). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). Result: The mean number of grafts was $2.7{\pm}1.2$ per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial in-farctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was $20{\pm}35$ hours and the mean duration of stay in the intensive care unit was $68{\pm}47$ hours. The mean amounts of blood transfusion were $4.0{\pm}2.6$ packs/patient. Conclusion: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.

Structural and Compositional Characteristics of Skarn Zinc-Lead Deposits in the Yeonhwa-Ulchin Mining District, Southeastern Taebaegsan Region, Korea Part II : The Yeonhwa II Mine (연화(蓮花)-울진광산지대(蔚珍鑛山地帶) 스카른연(鉛)·아연광상(亞鉛鑛床)의 구조적(構造的) 및 성분적(成分的) 특징(特徵) 기이(其二) : 제2연화광산(第二蓮花鑛山))

  • Yun, Suckew
    • Economic and Environmental Geology
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    • v.12 no.3
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    • pp.147-176
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    • 1979
  • The Yeonhwa II zinc-lead mine is characterized by a dozen of moderately dipping tabular orebodies of skarn and zinc-lead sulfides, developed in accordance with the ENE-trending bedding thrusts and bedding planes of the Pungchon Limestone and underlying Myobong Formation, mostly along the contacts of a ENE-trending sill and a NW-trending dike of quartz mononite porphyry. The orebodies occur in three groups: (1) the footwall Wolgok orebodies with respect to the sill, (2) the hangingwall Wolgok orebodies, and (3) the Seongok orebodies extended from dike contacts into carbonate beds. Mineral compositions of these orebodies are dominated by calc-silicates (skarn) associated with ore minerals of sphalerite, galena, and chalcopyrite, as well as sulfide gangue of pyrrhotite. A pair of exo- and endo-skerns in the Wolgok footwall contact aureole between the Pungchon Limestone and quartz monzonite porphyry on the -120 level represents a well-developed symmetrical pattern of mineral zoning: a garnet/quartz zone in the center of exoskarn, two zones of pyroxene with ore minerals on both sides of the garnet/quartz zone, further outwards-an epidote/chlorite-bearing hornfelsic zone in the Myobong slate beyond a zone of unaffected limestone, and an epidote-dominated zone of endo skarn on the opposite side toward fresh quartz monzonite porphyry. These features indicate a combination of two effects on the skarn formation: (1) differences in composition of the host rocks(sedimentary and ignous), and (2) progressive outward migration of inner zones on outer zones on the course of metasomatic replacement of the pre-existing minerals. Microprobe analyses of garnet, pyroxene, pyroxenoids, epidote, and chlorite for nine major elements on a total of 23 mineral grains revealed that: the pyroxenes are hedenbergitic, in most zones, with a gradual decrease of Fe- and Mn-contents toward the central zone, whereas the garnets are andraditic in outer zones, but are grossularitic in the central zone. This indicates a reverse relationship of Fe-contents between pyroxene and garnet across the exoskarn zones. Pyroxenoids are lacking in wollastonite but are dominated by pyroxmangite, rhodonite and bustamite, indicating a Mn-rich nature in bulk chemistry. Pseudomorphic fluorite after garnet occurs abundantly reflecting a fluorine-enhanced evidence of the skarn-forming fluids. Epidote contains 0.19-0.25mole fraction of pistacite, and chlorite is Mn-rich but is Mg-poor. Sulfide mineralization took place with the most Fe-rich pyroxene rather than with garnet as indicated by the fact that the highest value of hedenbergite mole fraction occurs in the ore-bearing pyroxene zone. The Yeonhwa II ores are characterized by high zinc and low lead in metal grade, with minor quantity of copper content in almost constant grade. The hangingwall Wolgok and Seongok orebodies, that formed in a more open environment with respect to their local configurations of geologic setting, are more variable in metal grades and ratios, than are the footwall Wolgok orebodies formed in a more closed condition in a narrow interval of sedimentary beds.

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The Ability of Anti-tumor Necrosis Factor Alpha(TNF-${\alpha}$) Antibodies Produced in Sheep Colostrums

  • Yun, Sung-Seob
    • 한국유가공학회:학술대회논문집
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    • 2007.09a
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    • pp.49-58
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    • 2007
  • Inflammatory process leads to the well-known mucosal damage and therefore a further disturbance of the epithelial barrier function, resulting abnormal intestinal wall function, even further accelerating the inflammatory process[1]. Despite of the records, etiology and pathogenesis of IBD remain rather unclear. There are many studies over the past couple of years have led to great advanced in understanding the inflammatory bowel disease(IBD) and their underlying pathophysiologic mechanisms. From the current understanding, it is likely that chronic inflammation in IBD is due to aggressive cellular immune responses including increased serum concentrations of different cytokines. Therefore, targeted molecules can be specifically eliminated in their expression directly on the transcriptional level. Interesting therapeutic trials are expected against adhesion molecules and pro-inflammatory cytokines such as TNF-${\alpha}$. The future development of immune therapies in IBD therefore holds great promises for better treatment modalities of IBD but will also open important new insights into a further understanding of inflammation pathophysiology. Treatment of cytokine inhibitors such as Immunex(Enbrel) and J&J/Centocor(Remicade) which are mouse-derived monoclonal antibodies have been shown in several studies to modulate the symptoms of patients, however, theses TNF inhibitors also have an adverse effect immune-related problems and also are costly and must be administered by injection. Because of the eventual development of unwanted side effects, these two products are used in only a select patient population. The present study was performed to elucidate the ability of TNF-${\alpha}$ antibodies produced in sheep colostrums to neutralize TNF-${\alpha}$ action in a cell-based bioassay and in a small animal model of intestinal inflammation. In vitro study, inhibitory effect of anti-TNF-${\alpha}$ antibody from the sheep was determined by cell bioassay. The antibody from the sheep at 1 in 10,000 dilution was able to completely inhibit TNF-${\alpha}$ activity in the cell bioassay. The antibodies from the same sheep, but different milkings, exhibited some variability in inhibition of TNF-${\alpha}$ activity, but were all greater than the control sample. In vivo study, the degree of inflammation was severe to experiment, despite of the initial pilot trial, main trial 1 was unable to figure out of any effect of antibody to reduce the impact of PAF and LPS. Main rat trial 2 resulted no significant symptoms like characteristic acute diarrhea and weight loss of colitis. This study suggested that colostrums from sheep immunized against TNF-${\alpha}$ significantly inhibited TNF-${\alpha}$ bioactivity in the cell based assay. And the higher than anticipated variability in the two animal models precluded assessment of the ability of antibody to prevent TNF-${\alpha}$ induced intestinal damage in the intact animal. Further study will require to find out an alternative animal model, which is more acceptable to test anti-TNF-${\alpha}$ IgA therapy for reducing the impact of inflammation on gut dysfunction. And subsequent pre-clinical and clinical testing also need generation of more antibody as current supplies are low.

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