• Radiation Oncology Journal
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• v.17 no.2
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• pp.91-99
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• 1999

Propose : This study was performed to find out the prognostic factors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. Materials and Methods : We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70$\%$) patients was male. Histological types were composed of 3 (6$\%$) keratinizing, 30 (64$\%$) nonkeratinizing squamous cell carcinoma and 13 (28$\%$) undifferentiated carcinoma. Histoiogicai type was not known in 1 patient (2$\%$). We restaged according to the staging system of 1997 American Joint Committee on Cancer Forty seven patients were recorded as follows: 71: 11 (23$\%$), T2a; 6 (13$\%$), T2b; 9 (19$\%$), 73; 7 (15$\%$), 74: 14 (30$\%$), and NO; 7 (15$\%$), Nl: 14 (30$\%$), N2; 21 (45%), N3: 5 (10%). Clinical staging was grouped as follows: Stage 1; 2 (4$\%$), IIA: 2 (4$\%$), IIB; 10 (21$\%$), III; 14 (30$\%$), IVA; 14 (30$\%$) and IVB; 5 (11$\%$). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the Iymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was from 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin +5-fluorouracil (25 patients) or cisplatin+pepleomycin (17 patients) with one to three cycles. Five patients did not received chemotherapy. Local control rate, survival and disease free suwival rate were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. Results: Local control rate was 81$\%$ in 5 year. Five year survival rate was 60$\%$ (median survival; 100 months). We included age, sex, cranial nerve deflicit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial none deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were significant prognostic factors in survival (P=0.000, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. Conclusion : In our study, cranial none deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemotherapy and radiotherapy used in our patients were effective without any serious complication.

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.8-17
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• 2006

Purpose : We describe the changes of rat glomerular epithelial cells when exposed to high levels of glucose and advanced glycosylation endproducts(AGE) in the in vitro diabetic condition. We expect morphological alteration of glomerular epithelial cells and permeability changes experimentally and we may correlate the results with a mechanism of proteinuria in DM. Methods : We made 0.2 M glucose-6-phsphate solution mixed with PBS(pH 7.4) containing 50 mg/mL BSA and pretense inhibitor for preparation of AGE. As control, we used BSA. We manufactured and symbolized five culture dishes as follows; B5 - normal glucose(5 mM) + BSA, B30 - high glucose(30 mM) + BSA, A5 - normal glucose(5 mM) + AGE, A30 - high glucose(30 mM) + AGE, A/B 25 - normal glucose(5 mM) + 25 mM of mannitol(osmotic control). After the incubation period of both two days and seven days, we measured the amount of heparan sulfate proteoglycan(HSPG) in each dish by ELISA and compared them with the B5 dish at 2nd and 7th incubation days. We observed the morphological changes of epithelial cells in each culture dish using scanning electron microscopy(SEM). We tried the permeability assay of glomerular epithelial cells using cellulose semi-permeable membrane measuring the amount of filtered BSA through the apical chamber for 2 hours by sandwich ELISA. Results : On the 2nd incubation day, there was no significant difference in the amount of HSPG between the 5 culture dishes. But on the 7th incubation day, the amount of HSPG increased by 10% compared with the B5 dish on the 2nd day except the A30 dish(P<0.05). Compared with the B5 dish on the 7th day the amount of HSPG in A30 and B30 dish decreased to 77.8% and 95.3% of baseline, respectively(P>0.05). In the osmotic control group (A/B 25) no significant correlation was observed. On the SEM, we could see the separated intercellular junction and fused microvilli of glomerular epithelial cells in the culture dishes where AGE was added. The permeability of BSA increased by 19% only in the A30 dish on the 7th day compared with B5 dish on the 7th day in the permeability assay(P<0.05). Conclusion: We observed not only the role of a high level of glucose and AGE in decreasing the production of HSPG of glomerular epithelial cells in vitro, but also their additive effect. However, the role of AGE is greater than that of glucose. These results seems to correlate with the defects in charge selective barrier. Morphological changes of the disruption of intercellular junction and fused microvilli of glomerular epithelial cells seem to correlate with the defects in size-selective barrier. Therefore, we can explain the increased permeability of glomerular epithelial units in the in vitro diabetic condition.

• Asia Marketing Journal
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• v.14 no.1
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• pp.131-157
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• 2012

Despite the voluminous research on switching barriers, the notion that they can generate negative responses has not been investigated. Further, a critical question is what determines the strength of such negative responses. To address this question, the classic theory of psychological reactance is briefly reviewed, and the idea of switching barrier is advanced. This study attempts to suggest a model on the negative effects of switching- frustrated situation, based on the studies on psychological reactance. According to psychological reactance theory(Brehm 1966), whenever a freedom is threatened or removed, individuals are motivated, at least temporarily, to restore their freedom. For example, if individuals think they are free to engage in behaviors .v, y, or z, then threatening their freedom to engage in x would cause psychological reactance. This reactance could be reduced by an increase in the perceived attractiveness of engaging in, the threatened behavior(Kivetz 2005). This investigation seeks to extend existing switching barrier research in three important ways. First, while the past research has emphasized only positive role of switching barrier, this study address negative role of it by applying psychological reactance theory. Second, to find negative results of switching barrier, I suggest negative psychological response including regret to the past choice, resentment to the present provider, and strong desire to the alternative provider. Third, I suggest the perceived severity of the switching barriers, the attractiveness of the alternative as switching-frustrated situation which can lead to negative results. And, in addition to these relationships, I added moderated effects of perceived justice for better explanation. So this study includes the following hypotheses. H1-1 ~ H1-3: The attractiveness of the alternative has a positive effect regret to the past choice (h1-1), resentment to the present provider (h1-2), and strong desire to the alternative provider (h1-3). H2-1 ~ H2-3 : The perceived severity of the switching barrier has a positive effect regret to the past choice (h2-1), resentment to the present provider (h2-2), and strong desire to the alternative provider (h2-3). H3-1 ~ H3-3 : The positive relationships between the attractiveness of the alternative and consumer' negative responses will be stronger at low level of perceived justice than at high level of perceived justice. H4-1 ~ H4-3 : The positive relationships between the perceived severity of the switching barrier and consumer' negative responses will be stronger at low level of perceived justice than at high level of perceived justice. Survey research is employed to test hypotheses involving perceived severity of the switching barrier(Hess 2008), attractiveness of the alternative(Anderson and Narus 1990; Ohanian 1990),regret(Glovich and Medvec 1995), resentment, strong desire(Alcohol Urge Questionaire: Bohn et al. 1995), perceived justice(Bies and Moag 1986; Clemmer 1993; Lind and Tyler 1998). Previous researches, such as reactance theory, emotion and service failure, have been referenced to measure constructs. All items were measured on a 7-point Likert scale ranging from "strongly disagree" to "strongly agree". We collected data involving various service field, and used 249 respondents to analyze these data using the moderated regression. The results of our analysis suggest, as expected, that the perceived severity of the switching barrier had positive effects on regret to the past choice(b = .197, p< .01), resentment to the present provider(b = .214, p< .01), and strong desire to the alternative provider(b = .254, p< .001). And the attractiveness of the alternative had positive effects on regret to the past choice(b = .353, p<.001), resentment to the present provider(b = .174, p< .01), and strong desire to the alternative provider(b = .265, p< .001). However, our findings indicate perceived justice partly moderates relationship between switching-frustrated situation and psychological negative response. The study has brought to light a number of insights between switching barriers and consumer' negative responses that have been subject to little prior research. In particular, this study adds to the existing understanding of the psychological responses to switching barriers in switching- frustrated situation. This research therefore has significance to marketers for strategic marketing programs, particularly in terms of customer retention and switching barrier strategies. Since consumers could exhibit negative responses to switching barrier, companies would be able to lose their customer when they thoughtlessly use switching barrier for remaining customer. Although the study has these contributions, there are several limitations including unsupported hypotheses and research method. So, we need to make up for these limitations in the future researches.