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The Effect of Mutual Trust on Relational Performance in Supplier-Buyer Relationships for Business Services Transactions (재상업복무교역중적매매관계중상호신임대관계적효적영향(在商业服务交易中的买卖关系中相互信任对关系绩效的影响))

  • Noh, Jeon-Pyo
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.32-43
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    • 2009
  • Trust has been studied extensively in psychology, economics, and sociology, and its importance has been emphasized not only in marketing, but also in business disciplines in general. Unlike past relationships between suppliers and buyers, which take considerable advantage of private networks and may involve unethical business practices, partnerships between suppliers and buyers are at the core of success for industrial marketing amid intense global competition in the 21st century. A high level of mutual cooperation occurs through an exchange relationship based on trust, which brings long-term benefits, competitive enhancements, and transaction cost reductions, among other benefits, for both buyers and suppliers. In spite of the important role of trust, existing studies in buy-supply situations overlook the role of trust and do not systematically analyze the effect of trust on relational performance. Consequently, an in-depth study that determines the relation of trust to the relational performance between buyers and suppliers of business services is absolutely needed. Business services in this study, which include those supporting the manufacturing industry, are drawing attention as the economic growth engine for the next generation. The Korean government has selected business services as a strategic area for the development of manufacturing sectors. Since the demands for opening business services markets are becoming fiercer, the competitiveness of the business service industry must be promoted now more than ever. The purpose of this study is to investigate the effect of the mutual trust between buyers and suppliers on relational performance. Specifically, this study proposed a theoretical model of trust-relational performance in the transactions of business services and empirically tested the hypotheses delineated from the framework. The study suggests strategic implications based on research findings. Empirical data were collected via multiple methods, including via telephone, mail, and in-person interviews. Sample companies were knowledge-based companies supplying and purchasing business services in Korea. The present study collected data on a dyadic basis. Each pair of sample companies includes a buying company and its corresponding supplying company. Mutual trust was traced for each pair of companies. This study proposes a model of trust-relational performance of buying-supplying for business services. The model consists of trust and its antecedents and consequences. The trust of buyers is classified into trust toward the supplying company and trust toward salespersons. Viewing trust both at the individual level and the organizational level is based on the research of Doney and Cannon (1997). Normally, buyers are the subject of trust, but this study supposes that suppliers are the subjects. Hence, it uniquely focused on the bilateral perspective of perceived risk. In other words, suppliers, like buyers, are the subject of trust since transactions are normally bilateral. From this point of view, suppliers' trust in buyers is as important as buyers' trust in suppliers. The suppliers' trust is influenced by the extent to which it trusts the buying companies and the buyers. This classification of trust using an individual level and an organization level is based on the suggestion of Doney and Cannon (1997). Trust affects the process of supplier selection, which works in a bilateral manner. Suppliers are actively involved in the supplier selection process, working very closely with buyers. In addition, the process is affected by the extent to which each party trusts its partners. The selection process consists of certain steps: recognition, information search, supplier selection, and performance evaluation. As a result of the process, both buyers and suppliers evaluate the performance and take corrective actions on the basis of such outcomes as tangible, intangible, and/or side effects. The measurement of trust used for the present study was developed on the basis of the studies of Mayer, Davis and Schoorman (1995) and Mayer and Davis (1999). Based on their recommendations, the three dimensions of trust used for the study include ability, benevolence, and integrity. The original questions were adjusted to the context of the transactions of business services. For example, a question such as "He/she has professional capabilities" has been changed to "The salesperson showed professional capabilities while we talked about our products." The measurement used for this study differs from those used in previous studies (Rotter 1967; Sullivan and Peterson 1982; Dwyer and Oh 1987). The measurements of the antecedents and consequences of trust used for this study were developed on the basis of Doney and Cannon (1997). The original questions were adjusted to the context of transactions in business services. In particular, questions were developed for both buyers and suppliers to address the following factors: reputation (integrity, customer care, good-will), market standing (company size, market share, positioning in the industry), willingness to customize (product, process, delivery), information sharing (proprietary information, private information), willingness to maintain relationships, perceived professionalism, authority empowerment, buyer-seller similarity, and contact frequency. As a consequential variable of trust, relational performance was measured. Relational performance is classified into tangible effects, intangible effects, and side effects. Tangible effects include financial performance; intangible effects include improvements in relations, network developing, and internal employee satisfaction; side effects include those not included either in the tangible or intangible effects. Three hundred fifty pairs of companies were contacted, and one hundred five pairs of companies responded. After deleting five company pairs because of incomplete responses, one hundred five pairs of companies were used for data analysis. The response ratio of the companies used for data analysis is 30% (105/350), which is above the average response ratio in industrial marketing research. As for the characteristics of the respondent companies, the majority of the companies operate service businesses for both buyers (85.4%) and suppliers (81.8%). The majority of buyers (76%) deal with consumer goods, while the majority of suppliers (70%) deal with industrial goods. This may imply that buyers process the incoming material, parts, and components to produce the finished consumer goods. As indicated by their report of the length of acquaintance with their partners, suppliers appear to have longer business relationships than do buyers. Hypothesis 1 tested the effects of buyer-supplier characteristics on trust. The salesperson's professionalism (t=2.070, p<0.05) and authority empowerment (t=2.328, p<0.05) positively affected buyers' trust toward suppliers. On the other hand, authority empowerment (t=2.192, p<0.05) positively affected supplier trust toward buyers. For both buyers and suppliers, the degree of authority empowerment plays a crucial role in the maintenance of their trust in each other. Hypothesis 2 tested the effects of buyerseller relational characteristics on trust. Buyers tend to trust suppliers, as suppliers make every effort to contact buyers (t=2.212, p<0.05). This tendency has also been shown to be much stronger for suppliers (t=2.591, p<0.01). On the other hand suppliers trust buyers because suppliers perceive buyers as being similar to themselves (t=2.702, p<0.01). This finding confirmed the results of Crosby, Evans, and Cowles (1990), which reported that suppliers and buyers build relationships through regular meetings, either for business or personal matters. Hypothesis 3 tested the effects of trust on perceived risk. It has been found that for both suppliers and buyers the lower is the trust, the higher is the perceived risk (t=-6.621, p<0.01 for buyers; t=-2.437, p<0.05). Interestingly, this tendency has been shown to be much stronger for buyers than for suppliers. One possible explanation for this higher level of perceived risk is that buyers normally perceive higher risks than do suppliers in transactions involving business services. For this reason, it is necessary for suppliers to implement risk reduction strategies for buyers. Hypothesis 4 tested the effects of trust on information searching. It has been found that for both suppliers and buyers, contrary to expectation, trust depends on their partner's reputation (t=2.929, p<0.01 for buyers; t=2.711, p<0.05 for suppliers). This finding shows that suppliers with good reputations tend to be trusted. Prior experience did not show any significant relationship with trust for either buyers or suppliers. Hypothesis 5 tested the effects of trust on supplier/buyer selection. Unlike buyers, suppliers tend to trust buyers when they think that previous transactions with buyers were important (t=2.913 p<0.01). However, this study did not show any significant relationship between source loyalty and the trust of buyers in suppliers. Hypothesis 6 tested the effects of trust on relational performances. For buyers and suppliers, financial performance reportedly improved when they trusted their partners (t=2.301, p<0.05 for buyers; t=3.692, p<0.01 for suppliers). It is interesting that this tendency was much stronger for suppliers than it was for buyers. Similarly, competitiveness was reported to improve when buyers and suppliers trusted their partners (t=3.563, p<0.01 for buyers; t=3.042, p<0.01 for suppliers). For suppliers, efficiency and productivity were reportedly improved when they trusted buyers (t=2.673, p<0.01). Other performance indices showed insignificant relationships with trust. The findings of this study have some strategic implications. First and most importantly, trust-based transactions are beneficial for both suppliers and buyers. As verified in the study, financial performance can be improved through efforts to build and maintain mutual trust. Similarly, competitiveness can be increased through the same kinds of effort. Second, trust-based transactions can facilitate the reduction of perceived risks inherent in the purchasing situation. This finding has implications for both suppliers and buyers. It is generally believed that buyers perceive higher risks in a highly involved purchasing situation. To reduce risks, previous studies have recommended that suppliers devise risk-reducing tactics. Moving beyond these recommendations, the present study uniquely focused on the bilateral perspective of perceived risk. In other words, suppliers are also susceptible to perceived risks, especially when they supply services that require very technical and sophisticated manipulations and maintenance. Consequently, buyers and suppliers must solve problems together in close collaboration. Hence, mutual trust plays a crucial role in the problem-solving process. Third, as found in this study, the more authority a salesperson has, the more he or she can be trusted. This finding is very important with regard to tactics. Building trust is a long-term assignment; however, when mutual trust has not been developed, suppliers can overcome the problems they encounter by empowering a salesperson with the authority to make certain decisions. This finding applies to suppliers as well.

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Shoulder Uptake in the Bone Scintigraphy in Patients with Hemiplegic Reflex Sympathetic Dystrophy Syndrome (반신마비성 반사성교감신경 이영양증후군 환자의 골스캔상 견관절 섭취)

  • Lee, Jong-Jin;Chung, June-Key;Lee, Dong-Soo;Hong, Joon-Beom;Han, Tai-Ryoon;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.4
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    • pp.288-293
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    • 2004
  • Purpose: increased uptake of wrist and hand joints in three phase bone scintigraphy (TPBS) have been used in the detection of reflex sympathetic dystrophy syndrome (RSDS). TPBS frequently shows increased shoulder uptake in the hemiplegic RSDS patients. We investigated the significance of the shoulder uptake in the detection of these patients. Materials and Methods: Twenty three patients who had hemiplegia due to brain stroke and diagnosed as RSD were enrolled in this study (M:F=16:7, R:L=11:12). The mean age was $63{\pm}10$ yrs. Ter normal volunteer (mean age: $60{\pm}5$, M:F=1:9) data was used as control group. TPBS was performed $59{\pm}32$ days after stoke (acute stage). We obtained the count ratios of bilateral hands by drawing a region of interest (ROI) in three phase images and compared to the count ratios of shoulders in the delayed image. Hand ROI included an ipsilateral wrist. Sensitivity of detecting the affected limb was defined using the right/left count ratio of normal control. Results: Sensitivities using count ratios of hand blood flow, blood pool and delayed image were 45%, 76% and 78%, respectively. Sensitivity of shoulder count ratio was 74%. Log of right/left counts of hand delayed image and that of shoulder delayed image were correlated well with statistical significance (Spearman's R=0.824, p<0.001). Conclusion: Shoulder uptake showed good correlation with hand uptake in the delayed image of TPBS. Shoulder uptake maybe helpful in the diagnosis of reflex sympathetic dystrophy syndrome in patients with hemiplegia.

The Clinical and Histopathological Study of Laryngeal mass (후두 종양의 임상적 및 병리조직학적 고찰)

  • 김화성;한경수;이준기;정덕희;박재훈
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1981.05a
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    • pp.9.1-10
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    • 1981
  • The clinical study of 183 cases of laryngeal mass was observed and 88 cases of vocal nodule and polyp which is confirmed histopathologically, were clinically classified into 30 cases of vocal nodule, 48 cases of localized vocal polyp, 10 cases of diffuse vocal polyp, and the following results of microscopic examination were obtained. I. The clinical study of laryngeal mass 1. Among total cases of 183, vocal nodule is 82(45%) vocal polyp 53(29%) postintubation granuloma 3(1%) laryngeal papilloma 18(10%) tuberculosis 2(1%) cancer 25(14%). 2. The sex ratio of male to female is 3:4 in vocal nodule, 1:1 in vocal polyp, 1:2 in postintubation granuloma, 3:2 in laryngeal papilloma, 11:1 in cancer. 3. The age distribution is third-fourth decade in vocal nodule, fourth-fifth decade in vocal polyp, third decade in postintubation granuloma, second and fifth decade in laryngeal tuberculosis, sixth decade in laryngeal cancer. 4. The distribution of symptoms is 5 month. -1 year in vocal nodule and polyp, less than 1 year in laryngeal papilloma and postintubation granuloma, 1 year-3 year in laryngeal tuberculosis and cancer. 5. The location of the lesion is between the anterior 1/3 and middle 1/3 in vocal nodule and polyp and papilloma, middle 1/3 and posterior 1/3 in postintubation granuloma, and is diffusely spread on the entire vocal cord in laryngeal tuberculosis and cancer. 6. The side of the lesion is bilateral in vocal nodule and papilloma and the ratio of right to left is 5:3 in vocal polyp, 2:1 in postintubation granuloma. 7. The size is 1~2mm(67%) in vocal nodule, 3~5mm(42%) in vocal polyp, 6~10mm (67%) in postintubation granuloma, 1~2mm (39%) in papilloma, more than 10mm in tuberculosis and cancer. 8. Among the symptoms, the hoarseness is in more than 90% of disease entity, the sore-throat in tuberculosis and cancer, the dyspnea in postintubation granuloma and papilloma and tuberculosis and cancer. 9. In the past history, certain relationship with smoking is noted in cancer (40%) and tuberculosis(50%) and the history of frequent attack of URI is in papilloma(33%). 10. In occupation, certain statistical significance was not noted. II. The histopathological study of vocal nodule and polyp. 1. Most polyps and nodules were covered with stratified squamous epithelium, but focal hyperkeratosis, parakeratosis, acanthosis and atrophy were rather frequently observed. Hyperkeratosis and acanthosis was most frequently seen.

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Incidence and outcome of congenital anomalies of the kidney and urinary tract detected by prenatal ultrasonography: a single center study (산전 초음파로 발견된 선천성 신 요로 기형의 발생률과 임상 결과: 단일 기관 연구)

  • Lim, Gina;Lee, Joo Hoon;Park, Young Seo;Kim, Kun Seok;Won, Hye-Sung
    • Clinical and Experimental Pediatrics
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    • v.52 no.4
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    • pp.464-470
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    • 2009
  • Purpose : This study assessed the incidence and outcome of congenital anomalies of the kidney and urinary tract (CAKUT) detected by prenatal ultrasonography Methods : There were 906 cases of CAKUT detected by prenatal ultrasonography and postnatally confirmed at the Asan Medical Center from October 1989 to October 2007. We investigated the incidence and outcome of these cases by reviewing medical records retrospectively. Results : The order of incidence was hydronephrosis, multicystic dysplastic kidney (MCDK), duplex kidney, vesico-ureteral reflux (VUR), single kidney, hydroureteronephrosis, ectopic kidney, polycystic kidney, ureterocele, and posterior urethral valve (PUV). There were 520 cases (57.4%) of hydronephrosis, and 20% of these needed an operation due to significant obstruction. MCDK was associated with other CAKUT in 25.4% of all cases. Approximately 57.9% of duplex kidney cases needed surgical treatment due to ureterocele and VUR. VUR had a male: female ratio of 10:1. Two out of seven cases of autosomal recessive polycystic kidney had progressed to chronic renal failure. Patients with PUV were relatively uncommon, and one out of nine cases progressed to end-stage renal disease. Conclusion : CAKUTs detected by prenatal ultrasonography were composed of various anomalies, and almost all of them had a good outcome without any intervention. However, in some cases, recurrent urinary tract infection or renal failure occurred, especially in bilateral cases. For further management, a long-term multicenter study is needed to investigate the precise incidence and outcome of each anomaly in the general population.

Dentofacial changes of non-orthodontically treated female patients with TMJ disk displacement: a longitudinal cephalometric study (교정 치료를 받지 않은 측두하악관절원반변위가 있는 여성 환자의 두부계측방사선사진을 이용한 안모 및 치열 변화 연구)

  • Han, Jung-Woo;Kim, Tae-Woo
    • The korean journal of orthodontics
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    • v.40 no.6
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    • pp.398-410
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    • 2010
  • Objective: The purpose of this study was to investigate the changes in dentofacial morphology of non-orthodontically treated female patients with TMJ disk displacement. Methods: The sample consisted of 25 Korean female patients with bilateral TMJ disk displacement who visited the Department of Orthodontics, Seoul National University Dental Hospital from 1996 to 2006. Disk displacements were diagnosed using the magnetic resonance imaging (MRI) of both TMJs. Baseline (T1) and follow-up (T2) lateral cephalograms were analyzed. The mean age of samples at T1 was $18.1{\pm}3.5$ years (range 14.2 - 25.8 years) and at T2, $21.1{\pm}3.5$ years (range 16.2 - 28.0 years). The mean observation period was $3.0{\pm}1.9$ years. Descriptive statistics for each variable were calculated at baseline (T1) and follow-up (T2) stages, and during the observation period (T2-T1). Results: Skeletal changes were found in 64% of the non-orthodontically treated female patients with TMJ disk displacement during the observation period. The L1 to Mandibular plane distance (mm) increased significantly by 0.8 mm (p < 0.01). But there were no significant differences in the other dental relationship variables (overjet, overbite, U1 to palatal plane) during the observation period. Most patients with skeletal changes showed a backward rotation of the mandible. The ratio of the rotation was a decrease of SNB by $0.43^{\circ}$ for every $1^{\circ}$ increase of FMA (Spearman rho = -0.660, P < 0.01). A few patients showed a distal shift of the mandible without rotation or significant changes in the vertical dimension. Conclusions: During observation periods without orthodontic treatment, non-growing patients with TMJ disk displacement showed dentoskeletal changes, mainly backward rotation of the mandible.

Effects of Soy Isoflavone Intake on Urinary and Fecal Excretion of Daidzein and Genistein in Ovariectomized Rats (대두 이소플라본 섭취수준이 난소절제한 흰쥐에서 Daidzein과 Genistein의 뇨와 변 중 배설에 미치는 영향)

  • Nam, Hae-Kyung;Kim, Sun-Hee
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.34 no.1
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    • pp.27-35
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    • 2005
  • This study was performed to determine the effect of three different concentrations of soy-isoflavones on excretions through urine and feces in either sham-operated or ovariectomized female rats. Seventy-two 16-week old Sprague-Dawley rats underwent sham operation or bilateral ovariectomy. They were provided diets containing different levels of soy isoflavones for 6 weeks: 50 ppm (low isoflavone intake; LI), 250 ppm (medium isoflavone intake; MI) and 500 ppm (high isoflavone intake; HI). The subsequent fecal and urinary excretions of daidzein and genistein were then measured. In the sham operated rats, body weight gains and food efficiency ratio of the MI and HI groups were significantly lower than control group, while food intake was not different. However, there was no significant difference in ovariectomized rats. The fecal excretion of daidzein was significantly higher in the HI group than the LI and MI groups, and that of genistein increased as dietary isoflavone intakes increased in both the sham operation and ovariectomy. The reverse tendency of fecal recovery was shown with dietary isoflavone dose only in genistein among ovariectomized rats. When dietary isoflavones were increased from 50 ppm to 500 ppm, the amounts of daidzein and genistein in the urine increased dose-dependently. The higher intakes of isoflavones leaded to lower recovery rates of daidzein and genistein in the urine in the sham-operated rats but not in the ovariectomized rats. The urinary recovery was significantly higher in the LI group than the MI and HI groups in the sham-operated rats. The excreted amounts and recovery of the two isoflavones in the urine were higher in the sham operated groups than in the ovariectomized groups, which implied an increased bioavailability of isoflavones by ovariectomy. Therefore, the results suggest that a more efficient use of soy isoflavones in ovariectomized conditions may occur, which indicates that a higher dose of soy isoflavones is necessary for the postmenopausal states.

Clinical Characteristics of Pulmonary Cryptococcosis (국내 폐효모균증의 임상적 특징)

  • Moon, Doo-Seop;Yoo, Jeong-Soo;Kim, Chung-Mi;Kim, Yeon-Soo;Kim, Seung-Min;Oh, Kwang-Taek;Sohn, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo;Lee, Jung-Hee;Hahm, Shee-Young
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.5
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    • pp.1083-1093
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    • 1997
  • Background : So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. Method : The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. Results : Cryptococcosis occurred frequently over sixth decade and the male to female ratio was 3.6 : 1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnasis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case. and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture, serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. Conclusion : Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnosic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.

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Clinical Characteristics and Prognostic Factors of Severe Community-Acquired Pneumonia (중증 지역사회획득 폐렴의 임상상 및 예후 예측인자에 관한 연구)

  • Oh, Heung-Kook;Seo, Ji-Young;Kim, Dong-Kyu;Choi, Jeong-Eun;Mo, Eun-Kyung;Park, Myung-Jae;Lee, Myung-Goo;Hyun, In-Gyu;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.5
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    • pp.1072-1082
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    • 1997
  • Background : To characterize the clinical features and determine the prognostic factors of severe community-acquired pneumonia. This study is the first of its kind in Korea. Methods : Recruited were 40 patients diagnosed as severe community-acquired pneumonia in Hallym University Hospital from January 1, 1989 through July 31, 1996. Patients were analysed retrospectively for age, sex, underlying disease, respiration rate, hypoxemia, requirement of mechanical ventilation, involvement on chest radiograph, shock, and the serum concentration of BUN and albumin. All parameters were compared between survived and dead group. Results : Male to female ratio was 2.07 : 1. The mean age was $63.1{\pm}17.5$years(range 25~90years) with 65% of patients aged equal to or more than 60. The major underlying diseases were old pulmonary tuberculosis(12.5%), chronic obstructive pulmonary disease(7.5%), bronchial asthma(5%), bronchiectasis(2.5%), and diabetes mellitus(22.5%). Microbiologic diagnosis was made in 26 out of 40 patients(65%). The most common causative organism was S. pneumoniae(17.5%, 7/40) followed by S. aureus(15.0%, 6/40), K. Pneumoniae(12.5%, 5/40), M. tuberculosis(7.5%, 3/40), H. influenzae(2.5%, 1/40), coagulase negative staphylococcus(2.5%, 1/40), P. aeruginosa(2.5%. 1/40), E. cloaceae(2.5%, 1/40), and E. coli(2.5%, 1/40). M. pneumoniae was detected in no patient. The most frequent drugs administered in single or combination therapy were aminoglycosides(75%, 30/40), second- and third-generation cephalosporin(40%, 16/40 and 27.5%, 11/40), macrolides(27.5%, 11/40), and amoxicillin/clavulanic acid(22.5%, 9/40). Of the 40 patients, 14 died of severe community-acquired pneumonia(37.5%). Among them, seven patients (50%) expired within 72h of hospital arrival. According to multivariate analysis, mortality was significantly associated with requirement of mechanical ventilation, bilateral pulmonary involvement, and serum albumins$\leq$3.0g/dl. Conclusion : An understanding of the clinical characteristics and prognostic factors in severe community-acquired pneumonia identified in this study will optimize therapeutic approach in this disease and help decreasing its notorious mortality rate.

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Antithrombin-III as an early prognostic factor in children with acute lung injury (급성 폐손상 소아 환자에서 조기 예후 인자로서의 antithrombin-III)

  • Lee, Young Seung;Kim, Seonguk;Kang, Eun Kyeong;Park, June Dong
    • Clinical and Experimental Pediatrics
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    • v.50 no.5
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    • pp.443-448
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    • 2007
  • Purpose : To evaluate the potential prognostic value of the antithrombin-III (AT-III) level in the children with acute lung injury (ALI), we analyzed several early predictive factors of death including AT-III level at the onset of ALI and compared the relative risk of them for mortality. Methods : Over a 18-month period, a total of 198 children were admitted to our pediatric intensive care unit and 21 mechanically ventilated patients met ALI criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and $PaO_2/FiO_2$ lower than 300 without left atrial hypertension. Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as Pediatric Risk of Mortality-III (PRISM-III) scores and Lung Injury Score (LIS) at admission were collected. AT-III levels were measured within 3 hours after admission. These variables were compared between survivors and non-survivors and entered into a multiple logistic regression analysis to evaluate their independent prognostic roles. Results : The overall mortality rate was 38.1% (8/21). Non-survivors showed lower age, lower lung compliance, higher PEEP, higher oxygenation index (OI), lower arterial pH, lower $PaO_2/FiO_2$, higher PRISM-III score and LIS, and lower AT-III level. PRISM-III score, LIS, OI and decreased AT-III level (less than 70%) were independently associated with a risk of death and the odds ratio of decreased AT-III level for mortality is 2.75 (95% confidence interval; 1.28-4.12) Conclusion : These results suggest that the decreased level of AT-III is an important prognostic factor in children with ALI and the replacement of AT-III may be considered as an early therapeutic trial.

Normal MR Spectroscopic Findings of the Cerebellum and Pons: Comparison of the Results between Intra-Unit and Inter-Unit Studies (소뇌와 뇌교의 정상 자기공명분광 소견: 같은 장비내 및 다른 장비간의 결과 비교)

  • 최준일;장기현;송인찬;도강현;이준우
    • Investigative Magnetic Resonance Imaging
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    • v.5 no.2
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    • pp.123-129
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    • 2001
  • Purpose: The purposes of this study are to evaluate normal MR spectroscopy (MRS) data of the cerebellum and pons, and to evaluate intra-unit and inter-unit differences of the results. Materials and methods: Nine normal volunteers (mean age 23 years) were studied with two 1.5 Tesla MR units (A and B units). A total of four sessions of MRS study were performed with two sessions in ea.ch MR unit in each volunteer. In each session, MRS data were obtained from bilateral cerebellar hemisphere and pons. MRS was performed using spin-echo single voxel technique with repetition time of 2000 ms, echo time of 288ms and 128 averagings. Voxel size was $2{\;}{\times}{\;}2{\;}{\times}{\;}1.5{\;}cm$ in the cerebellum and $1.5{\;}{\times}{\;}1.5{\;}{\times}{\;}1.5{\;}cm$ in the pons. Metabolite ratios of NAA/Cho, NAAcCr, NAAc(Cho+Cr) and Cr/Cho (both peak heights and the peak areas) were compared among the results of four sessions of MRS for evaluation of intra-unit and inter-unit differences. Results: In the cerebellum, mean (SO values of peak height NAA/Cho, NAA/Cr, NAA/(Cho+Cr) and Cr/Cho ratios obtained in the first session of A unit were $1.08{\pm}O.16,{\;}1.44{\pm}O.286,{\;}0.61{\pm}O.09{\;}and{\;}O.76{\pm}0.13$, respectively. Comparing with the results of the second session, intra-unit differences were 3-7%. In B unit intra-unit differences were 1-9%, except for 22% of Cr/Cho ratio. Inter-unit differences between A and B units were 1-26%. In the pons, mean ISD values of peak height NANCho, NANCr, NANICho + Cr) and Cr/Cho ratios obtained in the first session of A unit were $1.51{\pm}O.35,{\;}3.35{\pm}O.78,{\;}1.02{\pm}0.16{\;}and{\;}0.47{\pm}O.14$, respectively. Mean NAAfCho, NANCr and NAAI(Cho+ Cr} ratios of the pons were significantly higher than those of the cerebellum. Intra-unit differences were 2-21 % in A unit and 4-18 % in B unit. Inter-unit differences between A and B units were 1-18%. The mean values obtained by using peak area were generally higher and wider in range than those of peak height in both units. Conclusion: Mean NAAfCho, NAAlCr and NAAf(Cho+Cr) ratios of the cerebellum were significanHy lower than those of the pons. Intra-unit differences of most metabolites ratios were generally not significant, whereas inter-unit differences were greater than intra-unit differences in more metabolite ratios. Therefore, normal MRS data of the cerebellum and the pons should be obtained in every MR unit, before MRS applications in the diseases of the cerebellum and the pons.

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