• Title/Summary/Keyword: analysis of results

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The Role of Radiotherapy for Carcinomas of the Gall Bladder and Extrahepatic Biliary Duct: Retrospective Analysis (담낭 및 간외담도계 악성종양의 방사선치료결과)

  • Jeong Hyeon Ju;Lee Hyun Ju;Yang Kwang Mo;Suh Hyun Suk;Kim Re Hwe;Kim Sung Rok;Kim Hong Ryong
    • Radiation Oncology Journal
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    • v.16 no.1
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    • pp.43-49
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    • 1998
  • Purpose : Carcinomas arising in the gall bladder(GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5-year survival rates are less than $10\%$. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct. Materials and Methods : From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy(median 44.25Gy), and three Patients received additional intraluminal brachytherapy(range, 25Gy to 30Gy). Twenty-seven Patients received postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin. Results : Median follow up period was 8.5 months(range 2-97 months). The overall 2-year and 5-year survival rates in all patients were $29.9\%$ and $13.3\%$ respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were $34.5\%$ and $27.8\%$ respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation($43.8\%\;vs.\;20.7\%$), albeit statistically insignificant(p>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance(p<0.05). Patients with good performance status in the beginning showed significantly better survival rates than those with worse status(p<0.05). The 2-year survival rates in combined chemotherapy group and radiation group were $40.5\%$ and $22.0\%$ respectively. There was no statistical differences in two groups (p>0.05). Conclusion : The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical operation and/or chemotherapy, More radical treatment strategies, such as total resection with intensive radiation and/or chemotherapy may offer a better chance for cure in selective patients with carcinoma of gall bladder and extrahepatic biliary ducts.

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Serum 25-Hydroxy Vitamin $D_3$ Analysis of Korean People (한국인 일반인의 혈청 25-Hydroxy Vitamin $D_3$의 분석)

  • Kim, Bo-Kyung;Jung, Hyun-Mi;Kim, Yun-Kyung;Kim, So-Young;Kim, Jee-Hyun
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.133-137
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    • 2010
  • Purpose: The main function of vitamin D is the mineralization of the brain by increase of calcium and phosphorus, in case it is insufficient in children, lime deposition on cartilage cannot occur so it leads to rachitis, and in adults, it leads to osteomalacia or osteoporosis. It is also strongly believed in the academic world that vitamin D can restrict the growth of cancer cells and prevent heart diseases, which is also somewhat proven in epidemiological researches. While the right density of vitamin D is still being studied, 20-32 ng/mL is believed to be the most ideal density. Therefore, I wanted analyze how much density of 25-Hydroxyvitamin D3 that Koreans possess. Materials and Methods: From February 20th, 2008 to April 21st, 2009, the collection of 2800 serums, from medical examination treated subjects by Neodin Medical Institute, have been tested. The targets were tested by 25-Hydroxyvitamin D (125I Kit: Diasorin, USA), and were analyzed by dividing into many different categories (gender, age, season, region). Results: The average density of male were 20 ng/mL, female 17.08 ng/mL. Per age groups, the density of males were as follows: 10~20-18 ng/mL, 21~30-17 ng/mL, 31~40-19 ng/mL, 41~50-21 ng/mL, 51~60-22 ng/mL, 61~70-22 ng/mL, 71~80-22 ng/mL and 81~90-19.9 ng/mL. Average density of females per age groups, were as follows: 10~20-16 ng/mL, 20~30-15.26 ng/mL, 30~40-16 ng/mL, 40~50-17 ng/mL, 50~60-19 ng/mL, 60~70-19 ng/mL, 70~80-19 ng/mL, and 80~90-17 ng/mL. Per seasons, From December to May, the subjects showed the density of 15.97 ng/mL, while from June to November, it showed 21.60 ng/mL. On density of males from January to April regionally, Seoul+Gyeonggi-Do-15.52 ng/mL, Gangwon-Do-15.33 ng/mL, Choongchung-Do-18.03 ng/mL, Jeonla-Do-18.68 ng/mL, Gyungsang-Do-18.76 ng/mL and Cheju Do-21.23 ng/mL. Conclusions: The vitamin D of Koreans is has been insufficient compared to the suggested amount. Ultraviolet rays, which is the main source of vitamin D is critical, therefore it is suggested that more outdoor activities can definitely help.

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Comparison of Heart Rate Variability Indices between Obstructive Sleep Apnea Syndrome and Primary Insomnia (폐쇄성 수면무호흡 증후군과 일차성 불면증에서 심박동률 변이도 지수의 비교)

  • Nam, Ji-Won;Park, Doo-Heum;Yu, Jaehak;Ryu, Seung-Ho;Ha, Ji-Hyeon
    • Sleep Medicine and Psychophysiology
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    • v.19 no.2
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    • pp.68-76
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    • 2012
  • Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=$41.50{\pm}13.16$ yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=$43.67{\pm}12.11$ yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age $44.93{\pm}12.38$ yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=$45.87{\pm}12.44$ yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were $991.1{\pm}27.1$ and $875.8{\pm}22.0$ ms (p=0.016), standard deviation of NN interval (SDNN) was $85.4{\pm}6.6$ and $112.8{\pm}5.4$ ms (p=0.022), SDNN index was $57.5{\pm}5.2$ and $87.6{\pm}4.2$ (p<0.001), total power was $11,893.5{\pm}1,359.9$ and $18,097.0{\pm}1,107.2ms^2$(p=0.008), very low frequency (VLF) was $7,534.8{\pm}1,120.1$ and $11,883.8{\pm}912.0ms^2$ (p=0.035), low frequency (LF) was $2,724.2{\pm}327.8$ and $4,351.6{\pm}266.9ms^2$(p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

Bone mineral density and nutritional state according to milk consumption in Korean postmenopausal women who drink coffee: Using the 2008~2009 Korea National Health and Nutrition Examination Survey (한국 폐경 후 여성 커피소비자에서 우유섭취여부에 따른 골밀도와 영양상태 비교 : 2008~2009년 국민건강영양조사 자료 이용)

  • Ryu, Sun-Hyoung;Suh, Yoon Suk
    • Journal of Nutrition and Health
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    • v.49 no.5
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    • pp.347-357
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    • 2016
  • Purpose: This study investigated bone mineral density and nutritional state according to consumption of milk in Korean postmenopausal women who drink coffee. Methods: Using the 2008~2009 Korean National Health & Nutrition Examination Survey data, a total of 1,373 postmenopausal females aged 50 yrs and over were analyzed after excluding those with diseases related to bone health. According to coffee and/or milk consumption, subjects were divided into four groups: coffee only, both coffee & milk, milk only, and none of the above. All data were processed after application of weighted values and adjustment of age, body mass index, physical activity, drinking, and smoking using a general linear model. For analysis of nutrient intake and bone density, data were additionally adjusted by total energy and calcium intake. Results: The coffee & milk group had more subjects younger than 65 yrs and higher education, urban residents, and higher income than any other group. The coffee only group showed somewhat similar characteristics as the none of the above group, which showed the highest percentage of subjects older than 65 and in a lower education and socio-economic state. Body weight, height, body mass index, and lean mass were the highest in coffee & milk group and lowest in the none of the above group. On the other hand, the milk only group showed the lowest values for body mass index and waist circumference, whereas percent body fat did not show any difference among the groups. The coffee and milk group showed the highest bone mineral density in the total femur and lumbar spine as well as the highest nutritional state and most food group intakes, followed by the milk only group, coffee only group, and none of the above group. In the assessment of osteoporosis based on T-score of bone mineral density, although not significant, the coffee and milk group and milk only group, which showed a better nutritional state, included more subjects with a normal bone density, whereas the none of the above group included more subjects with osteoporosis than any other group. Conclusion: Bone mineral density in postmenopausal women might not be affected by coffee drinking if their diets are accompanied by balanced food and nutrient intake including milk.

Relationships between Eating Behavior, Dietary Self-Efficacy, and Nutrition Knowledge of Elementary School Students by Food Service Type in Gangwon Province (강원지역 초등학생들의 급식유형(도시형, 농어촌형 및 도서벽지형) 별식행동과 식이자기효능감 및 영양지식과의 관계)

  • Won, Hyang-Rye;Shin, Gi-Beum
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.41 no.5
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    • pp.638-646
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    • 2012
  • The purpose of this study was to find a relationship between eating behavior, dietary self-efficacy and nutrition knowledge by comparing these items in elementary school students according to food service type. The survey was made through a questionnaire from 759 students in the 6th grade of elementary school in 39 Gangwon Province. The average score of eating behaviors according to food service type was highest for urban type, followed by agri-fishery type, and finally remote island and country type, for the questions asking about the application of nutrition knowledge and the frequency of eating out. The average score of nutrition knowledge according to food service type showed significant differences for the questions about eating snacks before going to sleep and weight increase as well as calorie comparisons between foods. For the correlation of eating behavior, dietary self-efficacy and nutrition knowledge, the agri-fishery type showed positive in all of the three items with significant differences. In the remote island and country type, there was a positive relationship between nutrition knowledge and dietary self-efficacy, and between eating behavior and dietary self-efficacy. However, there was no significant difference of correlation between nutrition knowledge and eating behavior. In order to confirm the predictable variables for eating behavior, a regression analysis was made by injecting variables in every stage with independent variables of dietary self-efficacy and nutrition knowledge, which showed a significant relationship with eating behavior. The results showed that, in the urban type, dietary self-efficacy and nutrition knowledge affected the eating behavior and, in the agriculture type and the remote island and country type, only dietary self-efficacy affected the eating behavior.

Effect of Nasal Continuous Positive Airway Pressure after Early Surfactant Therapy in Moderate Respiratory Distress Syndrome (중등도 신생아 호흡 곤란 증후군에서 폐 표면 활성제 조기 투여 후 Nasal CPAP의 치료 효과)

  • Kim, Eun Ji;Kim, Hae Sook;Hur, Man Hoe;Lee, Sang Geel
    • Clinical and Experimental Pediatrics
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    • v.45 no.10
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    • pp.1204-1212
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    • 2002
  • Purpose : Early surfactant therapy with either gentle ventilation, high-frequency ventilation or aggressive weaning of mechanical ventilation are principles for the treatment of respiratory distress syndrome(RDS). We studied to determine the accessibility of noninvasive nasal continuous positive airway pressure(CPAP) rather than mechanical ventilation by invasive intubation after early surfactant therapy. Methods : The study group consisted of 14 infants who were born and diagnosed with moderate respiratory distress syndrome and received early surfactant therapy with nasal CPAP of PEEP 5-6 cm $H_2O$ within two hours after birth in the Fatima neonatal intensive care unit for two years from January 1999 to August 2001. The control group consisted of 15 infants who were diagnosed with the disease and could be weaned from mechanical ventilator within five days after birth during the same period. Results : The characteristics, the severity of clinical symptoms and laboratory findings in the two groups at birth showed no significant difference. Neither did the interim analysis of laboratory data in two groups. Of 14 infants in the study group who received nasal CPAP after early surfactant therapy, only two infants showed weaning failure with this therapy. In the response cases, duration of CPAP was five days and mean airway pressure was $5.4{\pm}0.5cm$ $H_2O$. Two had the complication of CPAP with abdominal distension. Final complications and outcomes in the two groups showed no signifcant difference(P>0.05). Conclusion : The clinical courses in the two groups showed no significant difference. Therefore, we suggest that early surfactant therapy with noninvasive nasal CPAP is a simple and safe method rather than aggressive weaning after invasive mechanical ventilation in moderate respiratory distress syndrome.

NO2 and SO2 Reduction Capacities and Their Relation to Leaf Physiological and Morphological Traits in Ten Landscaping Tree Species (조경수 10개 수종에 있어 NO2, SO2 저감 능력과 잎의 생리적, 형태적 특성과의 관계)

  • Kim, Kunhyo;Jeon, Jihyeon;Yun, Chan Ju;Kim, Tae Kyung;Hong, Jeonghyun;Jeon, Gi-Seong;Kim, Hyun Seok
    • Journal of Korean Society of Forest Science
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    • v.110 no.3
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    • pp.393-405
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    • 2021
  • With increasing anthropogenic emission sources, air pollutants are emerging as a severe environmental problem worldwide. Accordingly, the importance of landscape trees is emerging as a potential solution to reduce air pollutants, especially in urban areas. This study quantified and compared NO2 and SO2 reduction abilities of ten major landscape tree species and analyzed the relationship between reduction ability and physiological and morphological characteristics. The results showed NO2 reduction per leaf area was greatest in Cornus officinalis (19.81 ± 3.84 ng cm-2 hr-1) and lowest in Pinus strobus (1.51 ± 0.81 ng cm-2 hr-1). In addition, NO2 reduction by broadleaf species (14.72 ± 1.32 ng cm-2 hr-1) was 3.1-times greater than needleleaf species (4.68 ± 1.26 ng cm-2hr-1; P < 0.001). Further, SO2 reduction per leaf area was greatest in Zelkova serrata (70.04 ± 7.74 ng cm-2 hr-1) and lowest in Pinus strobus (4.79 ± 1.02 ng cm-2 hr-1). Similarly, SO2 reduction by broadleaf species (44.21 ± 5.01 ng cm-2 hr-1) was 3.9-times greater than needleleaf species (11.47 ± 3.03 ng cm-2 hr-1; P < 0.001). Correlation analysis revealed differences in NO2 reduction was best explained by chlorophyll b content (R2 = 0.671, P = 0.003) and SO2 reduction was best described by SLA and length of margin per leaf area (R2 = 0.456, P = 0.032 and R2 = 0.437, P = 0.001, R2 = 0.872, P < 0.001, respectively). In summary, the ability of trees to reduce air pollutants was related to photosynthesis, evapotranspiration, stomatal conductance, and leaf thickness. These findings highlight effective reduction of air pollutants by landscaping trees requires comprehensively analyzing physiological and morphological species characteristics.

Nutritional Status and Health Risks of Low Income Elderly Women in Gwangju Area (광주지역 저소득층 여자노인의 영양상태와 건강위험요인에 관한 연구)

  • Yang, Eun-Ju;Bang, Hee-Myung
    • Journal of Nutrition and Health
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    • v.41 no.1
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    • pp.65-76
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    • 2008
  • This study was performed to identify association between nutritional status and health risks of the elderly. This was a cross-sectional study involving low income elderly women in Gwangju, Korea (${\geq}$65y, n = 92). Socio-demographics, life style characteristics, health conditions, dietary intakes based on 24h-recall method, anthropometric measures, and clinical biochemistry parameters were examined. Anthropometric and clinical parameters included wt, ht, waist, hip, body protein, body fat, abdominal fat, total cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, hemoglobin, hematocrit, fasting blood glucose, ferritin, IL-2, IL-6, TNF-${\alpha}$, CRP, TAS, TBARS, systolic blood pressure, and diastolic blood pressure. The subjects were divided into three groups based on age (65-74y, 75-84y, 85y${\leq}$) and were divided into two groups according to the sum of the Nutrition Screening Initiative (NSI) checklist score (adequate nutritional status, NSI score ${\leq}$3; at risk of malnutrition, NSI score >3). Mean and frequency of variables were estimated. Analysis of Variance, Tukey test, Chi-square test, and Multiple linear regression analyses were performed. Mean BMI and body fat were 25.1 $kg/m^2$ and 40.0%, respectively. However, for over 80% of subjects, the intakes of energy, fiber, thiamin, riboflavin, niacin, folate, Ca, K, and Zn were less than the Korean DRI (EAR or AI). The subjects who had lower NSI score tended to have better health status, eat meals frequently, have less depression, and exercise regularly. The subjects who had higher NSI score tended to have tooth problems, to eat alone most of time, and to be physically unable to cook or feed. Serum IL-6 and TNF-${\alpha}$ were significantly related with nutritional status which suggested higher tendency of inflammatory response. Serum IL-2, TAS, and glucose were significantly correlated with body fat (%) or abdominal fat (%). These results suggest that improving the nutritional status, increasing regular exercise, maintaining normal weight are beneficial to health care of low income elderly women.

Changes in Biochemical Components of Several Tissues of the Hard Clam, Meretrix petechialis, in Relation to Gonad Developmental Phases (말백합, Meretrix petechialis의 생식소 발달단계에 따른 일부 조직의 생화학적 성분 변화)

  • Kim, Yong-Min;Park, Kwan-Ha;Chung, Ee-Yung;Kim, Jong-Bae;Lee, Chang-Hoon
    • The Korean Journal of Malacology
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    • v.22 no.2
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    • pp.125-134
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    • 2006
  • We investigated the reproductive cycle of the hard clam, Meretrix petechialis with its gonadal development by histological observations. The seasonal changes in biochemical component of the adductor muscle, visceral mass, foot muscle and mantle of the clam were studied by biochemical analysis, from January to December, 2002. The reproductive cycle of this species can be divided into five successive stages: early stage (January to March), late active stage (February to May), ripe stage (April to August), partially spawned stage (July to August) and spent/inactive stage (September to January). Total protein content in the visceral mass was over two times higher than that in the adductor muscle. Monthly changes of total protein content in the adductor muscle were not statistically significant (ANOVA, p = 0.071), while the changes in the visceral mass were significant (p < 0.001). Total protein content in visceral mass was higher during the early active, late active, and ripe stages (from January to May), while the lowest in July. Glycogen content in the adductor muscle was higher than that in the visceral mass. Monthly changes in glycogen contents were statistically significant in both adductor muscle (F = 237.2, p < 0.001) and the visceral mass (F = 64.04, p < 0.001). Glycogen content in the adductor muscle was the highest in the ripe stage (April). Its content was lower in the partially spawned and the spent/inactive stages (June-September). Glycogen contents in the visceral mass were relatively lower until the early active stage, while the highest in the late active stage. RNA content was higher in visceral mass than that in the adductor muscle. Monthly changes in RNA contents were significant in both adductor muscle (F = 195.2, p < 0.001) and visceral mass (F = 78.85, p < 0.001). RNA content in the adductor muscle was high in the early active stage (January-February), and then it decreased rapidly in the late active stage (March-April), thereafter, slightly increased during the partially spawned stage (June-July). RNA content in the visceral mass reached a maximum during the ripe stage (May), and then it decreased rapidly during the partially-spawned stage (June-July). There was significant positive correlation in total protein contents between adductor muscle and visceral mass (r = 0.715, p = 0.020). However, there was no correlation between adductor muscle and visceral mass in glycogen (p = 0.550), while a negative correlation was found between the adductor muscle and visceral mass in RNA (p = 0.518) contents. Especially, changes in RNA content showed a negative correlation between the adductor muscle tissue and visceral mass. Therefore, these results suggest that the nutrient content of the adductor muscle, visceral muscle and foot muscle changed in response to gonadal energy needs.

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The Effects of Pergola Wisteria floribunda's LAI on Thermal Environment (그늘시렁 Wisteria floribunda의 엽면적지수가 온열환경에 미치는 영향)

  • Ryu, Nam-Hyong;Lee, Chun-Seok
    • Journal of the Korean Institute of Landscape Architecture
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    • v.45 no.6
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    • pp.115-125
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    • 2017
  • This study was to investigate the user's thermal environments under the pergola($L\;7,200{\times}W\;4,200{\times}H\;2,700mn$) covered with Wisteria floribunda(Willd.) DC. according to the variation of leaf area index(LAI). We carried out detailed measurements with two human-biometeorological stations on a popular square Jinju, Korea($N35^{\circ}10^{\prime}59.8^{{\prime}{\prime}}$, $E\;128^{\circ}05^{\prime}32.0^{{\prime}{\prime}}$, elevation: 38m). One of the stations stood under a pergola, while the other in the sun. The measurement spots were instrumented with microclimate monitoring stations to continuously measure air temperature and relative humidity, wind speed, shortwave and longwave radiation from the six cardinal directions at the height of 0.6m so as to calculate the Universal Thermal Climate Index(UTCI) from $9^{th}$ April to $27^{th}$ September 2017. The LAI was measured using the LAI-2200C Plant Canopy Analyzer. The analysis results of 18 day's 1 minute term human-biometeorological data absorbed by a man in sitting position from 10am to 4pm showed the following. During the whole observation period, daily average air temperatures under the pergola were respectively $0.7{\sim}2.3^{\circ}C$ lower compared with those in the sun, daily average wind speed and relative humidity under the pergola were respectively 0.17~0.38m/s and 0.4~3.1% higher compared with those in the sun. There was significant relationship in LAI, Julian day number and were expressed in the equation $y=-0.0004x^2+0.1719x-11.765(R^2=0.9897)$. The average $T_{mrt}$ under the pergola were $11.9{\sim}25.4^{\circ}C$ lower and maximum ${\Delta}T_{mrt}$ under the pergola were $24.1{\sim}30.2^{\circ}C$ when compared with those in the sun. There was significant relationship in LAI, reduction ratio(%) of daily average $T_{mrt}$ compared with those in the sun and was expressed in the equation $y=0.0678{\ln}(x)+0.3036(R^2=0.9454)$. The average UTCI under the pergola were $4.1{\sim}8.3^{\circ}C$ lower and maximum ${\Delta}UTCI$ under the pergola were $7.8{\sim}10.2^{\circ}C$ when compared with those in the sun. There was significant relationship in LAI, reduction ratio(%) of daily average UTCI compared with those in the sun and were expressed in the equation $y=0.0322{\ln}(x)+0.1538(R^2=0.8946)$. The shading by the pergola covered with vines was very effective for reducing daytime UTCI absorbed by a man in sitting position at summer largely through a reduction in mean radiant temperature from sun protection, lowering thermal stress from very strong(UTCI >$38^{\circ}C$) and strong(UTCI >$32^{\circ}C$) down to strong(UTCI >$32^{\circ}C$) and moderate(UTCI >$26^{\circ}C$). Therefore the pergola covered with vines used for shading outdoor spaces is essential to mitigate heat stress and can create better human thermal comfort especially in cities during summer. But the thermal environments under the pergola covered with vines during the heat wave supposed to user "very strong heat stress(UTCI>$38^{\circ}C$)". Therefore users must restrain themselves from outdoor activities during the heat waves.