• 제목/요약/키워드: multistep methods

검색결과 28건 처리시간 0.025초

Management of endometriosis-related infertility: Considerations and treatment options

  • Lee, Dayong;Kim, Seul Ki;Lee, Jung Ryeol;Jee, Byung Chul
    • Clinical and Experimental Reproductive Medicine
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    • 제47권1호
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    • pp.1-11
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    • 2020
  • Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility. Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis. The severity of endometriosis is related to ovarian reserve. With regard to infertility treatment, medical therapy as a neoadjuvant or adjuvant to surgical therapy has no definite beneficial effect. Surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve. To overcome this disadvantage, a multistep technique has been proposed to minimize the reduction of ovarian reserve. When considering surgical treatment of endometriosis in patients experiencing infertility, it should be kept in mind that ovarian reserve can be reduced both due to endometriosis itself and by the process of removing endometriosis. In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy. In cases of severe endometriosis, the characteristics of the patient should be considered in a multidisciplinary manner to determine the prioritization of treatment modalities, including surgical treatment and assisted reproduction methods such as in vitro fertilization. The risk of cancer, complications after pregnancy, and infection during oocyte retrieval should also be considered when making treatment decisions.

Color stability of bulk-fill and incremental-fill resin-based composites polished with aluminum-oxide impregnated disks

  • Koc-Vural, Uzay;Baltacioglu, Ismail;Altinci, Pinar
    • Restorative Dentistry and Endodontics
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    • 제42권2호
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    • pp.118-124
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    • 2017
  • Objectives: This study aimed to evaluate the color stability of bulk-fill and nanohybrid resin-based composites polished with 3 different, multistep, aluminum-oxide impregnated finishing and polishing disks. Materials and Methods: Disk-shaped specimens (8 mm in diameter and 4 mm in thickness) were light-cured between two glass slabs using one nanohybid bulk-fill (Tetric EvoCeram, Ivoclar Vivadent), one micro-hybrid bulk-fill (Quixfil, Dentsply), and two nanohybrid incremental-fill (Filtek Ultimate, 3M ESPE; Herculite XRV Ultra, Kerr) resin-based composites, and aged by thermocycling (between $5-55^{\circ}C$, 3,000 cycles). Then, they were divided into subgroups according to the polishing procedure as SwissFlex ($Colt\grave{e}ne/Whaledent$), Optidisc (Kerr), and Praxis TDV (TDV Dental) (n = 12 per subgroup). One surface of each specimen was left unpolished. All specimens were immersed in coffee solution at $37^{\circ}C$. The color differences (${\Delta}E$) were measured after 1 and 7 days of storage using a colorimeter based on CIE Lab system. The data were analyzed by univariate ANOVA, Mann-Whitney U test, and Friedmann tests (${\alpha}=0.05$). Results: Univariate ANOVA detected significant interactions between polishing procedure and composite resin and polishing procedure and storage time (p < 0.05). Significant color changes were detected after 1 day storage in coffee solution (p < 0.05), except Quixfil/Optidisc which was color-stable after 7 days (p > 0.05). Polishing reduced the discoloration resistance of Tetric EvoCeram/SwissFlex, Tetric EvoCeram/Praxis TDV, Quixfil-SwissFlex, and all Herculite XRV Ultra groups after 7 days storage (p < 0.05). Conclusions: Discoloration resistance of bulk-fill resin-based composites can be significantly affected by the polishing procedures.

원자력시설 안전관리 법제의 문제점과 개선방안 연구 -수산물의 안전관리를 중심으로- (A Study on the Problems and Improvement of the Safety Management Law of Nuclear Facilities -Focused on Safety Management of Aquatic Products-)

  • 이우도
    • 수산경영론집
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    • 제50권2호
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    • pp.23-40
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    • 2019
  • The main purpose of this study is to analyze and examine the problems of the law systems of the safety and maintenance of nuclear facilities and to propose the improvements with respect to the related problems especialy focused on safety management of aquatic products. Therefore, the results of the paper would be helpful to build an effective management law system of safety and maintenance of nuclear facilities and fisheries products. The research methods are longitudinal and horizontal studies. This study compares domestic policies with foreign policies of nuclear plants and aquatic products. Using the above methods, examining the current system of nuclear-related laws and regulations, we have found that there exist 13 Acts including "Nuclear Safety Act", etc. Safety laws related on nuclear facilities have seven Acts including "Nuclear Safety Act", "the Act on Physical Protection and Radiological Emergency", "Radioactive waste control Act", "Act on Protective Action Guidelines against Radiation in the Natural Environment", "Special Act on Assistance to the locations of facilities for disposal low and intermediate level radioactive waste", "Korea Institute of Nuclear Safety Act". "Act on Establishment and Operation of the Nuclear Safety and Security Commission". The seven laws are composed of 119 legislations. They have 112 lower statute of eight Presidential Decrees, six Primeministrial Decrees and Ministrial Decrees, 92 administrative rules (orders), 6 legislations of local self-government aself-governing body. The concluded proposals of this paper are as follows. Firstly, we propose that the relationship between the special law and general law should be re-established. Secondly, the terms with respect to law system of safety and maintenance of nuclear plants should be redefined and specified. Thirdly, it is advisable to re-examine and re-establish the Law System for Safety and Maintenance of Nuclear Facilities. and environmental rights like the French Nuclear Safety Legislation. Lastly, inadequate legislation on the aquatic pollution damage should be re-established. It is necessary to ensure sufficient transparency as well as environmental considerations in the policy decisions of the Korean government and legislation of the National Assembly. It is necessary to further study the possibilities of accepting the implications of the French legal system as a legal system in Korea. In conclusion, the safety management of nuclear facilities is not only focused on the secondary industry and the tertiary industry centering on power generation and supply, but also on the primary industry, which is the food of the people. It is necessary to prevent damage to be foreseen. Therefore, it is judged that there should be no harm to the people caused by contaminated marine products even if the "Food Safety Law for Prevention of Radiation Pollution Damage" is enacted.

Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

  • Ulas, Arife;Silay, Kamile;Akinci, Sema;Dede, Didem Sener;Akinci, Muhammed Bulent;Sendur, Mehmet Ali Nahit;Cubukcu, Erdem;Coskun, Hasan Senol;Degirmenci, Mustafa;Utkan, Gungor;Ozdemir, Nuriye;Isikdogan, Abdurrahman;Buyukcelik, Abdullah;Inanc, Mevlude;Bilici, Ahmet;Odabasi, Hatice;Cihan, Sener;Avci, Nilufer;Yalcin, Bulent
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권5호
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    • pp.1699-1705
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    • 2015
  • Background: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. Materials and Methods: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Results: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Conclusions: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

Salivary Her2/neu Levels in Differentiation of Oral Premalignant Disorders and Oral Squamous Cell Carcinomas

  • Varun, Chopra;Dineshkumar, Thayalan;Jayant, VS;Rameshkumar, Annasamy;Rajkumar, Krishnan;Rajashree, Padmanaban;Mathew, Jacob;Arunvignesh, Rajendran K
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권14호
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    • pp.5773-5777
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    • 2015
  • Background: Oral squamous cell carcinoma (OSCC) is thought to develop from precancerous dysplastic lesions through multistep processes of carcinogenesis involving activation of oncogenes and loss of tumor suppressor genes. The human epidermal growth factor receptor 2 (Her-2/neu [erbB-2]), a cell membrane glycoprotein, is a growth factor receptor that has receptor tyrosine kinase activity. Her2/neu activation plays a central role in cell proliferation and survival. It has been shown that overexpression of Her2/neu increases the rate of cell division and growth, leading to precancerous changes. The aim of the present study was to compare the serum and salivary Her2/neu levels between cases with premalignant and malignant oral lesions. Materials and Methods: Fasting blood samples and unstimulated saliva by passive drooling were collected from three groups of healthy control (n=20), premalignant disorder (PMD) (n=20) and OSCC (n=25) subjects. The HER2 extracellular domain (HER2 ECD) levels were measured using ELISA. Results: The levels of serum Her2/neu showed no significant differences between any of the groups but on the other hand salivary Her2/neu levels were found to be significantly (p<0.05) higher when compared between control (median 68.7 pg/ml, range: 21.5 - 75.8) and OSCC (median 145.6 pg/ml, range: 45.1-191.1). A similar trend was observed when comparing between PMD (median 43.3, range: 22.1 -94.7) and OSCC with a statistical significance of p<0.05. Conclusions: Our study provided evidence of increased salivary Her2/neu in OSCC when compared to PMD and control which was not the case for serum levels. This suggests that probably Her2/neu is not highly amplified as in breast cancer so as to be reflected in serum. Since saliva is in local vicinity of the OSCC, even a mild increase might be mirrored. On the whole, this study proposes Her2/neu as marker for distinguishing premalignant and malignant conditions.

한 농촌지역 주민에서 성, 연령 및 Helicobacter pylori 감염 여부에 따른 위축성 위염과 장상피화생 유병률 (The Prevalence of Atrophic Gastritis and Intestinal Metaplasia according to Gender, Age and Helicobacter Pylori Infection in a Rural Population)

  • 김현자;최보율;변태준;은창수;송규상;김용성;한동수
    • Journal of Preventive Medicine and Public Health
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    • 제41권6호
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    • pp.373-379
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    • 2008
  • Objectives ; The objective of this study was to evaluate the prevalence of atrophic gastritis and intestinal metaplasia according to gender, age and Helicobacter pylori infection in a rural population in Korea. Methods: Between April 2003 and January 2007, 713 subjects (298 men and 415 women, age range: 18-85) among the 2,161 adults who participated in a population-based survey received gastrointestinal endoscopy. All the subjects provided informed consent. Multiple biopsy specimens were evaluated for the presence of atrophic gastritis and intestinal metaplasia. The presence of Helicobacter Pylori was determined using CLO and histology testing. Results ; The age-adjusted prevalence of atrophic gastritis was 42.7% for men and 38.1% for women and the prevalence of intestinal metaplasia was 42.5% for men and 32.7% for women. The prevalence of atrophic gastritis and intestinal metaplasia increased significantly with age for both men and women (p for trend<0.001). The age-adjusted prevalence of Helicobacter pylori was similar for men (59.0%) and women (56.7%). The subjects with Helicobacter pylori infection showed a significantly higher prevalence of intestinal metaplasia (44.3%) compared with that (26.8%) of the noninfected subjects (p<0.001). However, the prevalence of atrophic gastritis was not statistically different between the Helicobacter pylori-infected subjects and the noninfected individuals. Conclusions : Our findings suggest that the prevalence of atrophic gastritis and intestinal metaplasia is higher for a Korean rural population than that for a Western population; this may be related to the high incidence of gastric cancer in Koreans. Especially, the prevalence of intestinal metaplasia was high for the subjects with Helicobacter pylori infection. The multistep process of gastric carcinogenesis and the various factors contributing to each step of this process need to be determined by conducting future follow-up studies.

기관지 천식을 의심하는 성인환자에서 등탄산 찬공기 과호흡의 진단적 유용성 (The Diagnostic Value of Isocapnic Hyperventilation of Cold Air in Adults with Suspected Asthma)

  • 조재화;류정선;이지영;곽승민;이홍렬;조철호
    • Tuberculosis and Respiratory Diseases
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    • 제51권3호
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    • pp.232-239
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    • 2001
  • 연구 배경 : 기관지 천식에서 찬 공기와 연관된 기침 및 호흡기계 증상유발은 흔히 관찰된다. 임상에서 천식이 의심되는 환자를 대상으로 다단계 등탄산 찬공기 과호흡법(isocapnic hyperventilation of cold air, 이하 IHCA)의 민감도, 특이도 및 정확도를 구하고 진단적 유용성에 대하여 알아보고자 하였다. 대상 및 방법 : 1999년 7월부터 2000년 12월까지 전향적으로 인하대학교 의과대학 부속병원에 내원한 임상적으로 천식을 의심하는 환자에서 폐기능검사, 기관지유발검사와 IHCA를 시행하였다. 결 과 : 기관지 천식환자는 50예, 증상 대조군이 79예이었고 양 군간 남녀 비, 나이, 흡연의 차이는 없었다 (p>0.05). 검사 전 $FEV_1$과 FVC에서 정상 범주였으나 천식군이 증상 대조군보다 통계적으로 낮았다(p<0.05). IHCA에 대한 $FEV_1$ 감소는 천식 환자군($-10.0{\pm}6.8%$)에서 증상 대조군($-2.3{\pm}2.5%$)보다 유의하게 낮았다(p<0.01). IHCA의 $FEV_1$ 감소반응과 연관된 인자들은 $FEV_1$/FVC(r=0.36, p<0.05), $FEF_{25-75%}$/FVC (r=0.33, p<0.05), $FEF_{25-75%}$ (r=0.32, p<0.05), 검사 전 $FEV_1$ 정상 예측치의 백분율(r=0.28, p<0.05)이었다. IHCA후 감소한 $FEV_1$ 백분율 6%, 7%, 8%, 9%, 10%로 계산한 민감도는 각각 80%, 76%, 69%, 52%, 43%이었고, 특이도는 각각 92%, 96%, 96%, 96%, 99%이었으며, 정확도는 각각 87%, 88%, 85%, 78%, 71%이었다. 결 론 : 다단계 등탄산 찬공기 과호흡법은 천식환지에서 민감도는 낮으나 높은 특이도를 갖으므로 선별검사보다는 특이검사로 이용하여야 하고, 검사 방법에 대한 기준과 그 방법에 따른 결정치에 대해 연구가 있어야 할 것이다.

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비소세포 폐암에서 EGFR의 발현률과 생존률에 미치는 영향 (Expression of EGFR in Non-small Cell Lung Cancer and its Effects on Survival)

  • 김학렬;정은택
    • Tuberculosis and Respiratory Diseases
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    • 제44권6호
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    • pp.1285-1295
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    • 1997
  • 연구배경 : 종양형성다단계 과정중의 하나인 EGFR(epidermal growth factor receptor)은 170KDa의 당단백질로서 세포막의 안팎에 걸친 수용체로서 EGF, TGF alph 의 자극에 의해서 신호전달체계의 시작을 담당한다. EGFR은 정상세포에도 존재가능하나 종양에서는 발현이 증가되어 있으며, EGFR의 발현이 높을수록 종양의 예후가 불량하리라 예측된다. 이에 저자들은 비소세포 폐암에서 EGFR의 발현을 확인하고 EGFR의 임상적 의의 특히 생존률과의 관계를 검색 하였다. 방 법 : 원발성 비소세포 폐암으로 확진받고, 외과적 절제술후 paraffin에 보관된 57례의 병리조직에서 면역 조직화학법으로 EGFR의 발현을 확인하고, EGFR과 암세포형, TNM 병기, 세포분화도, 유식세포 분석법에 의한 S 및 $G_1$ 주기비율 그리고 생존 기간과의 관계를 분석하였다. 결 과 : 1) 57례중 남녀비는 43 : 14였고, 중간 연령은 62세였다. EGFR과 생존기간과의 경향을 파악하기 위해, 종양세포중 EGFR 양성 세포가 20% 이상인 경우만을 발현군으로 하였을 때 56%에서 발현되었다. 2) EGFR의 발현은 병리조직형에 따른 차이는 없었고, TNM병기 그리고 세포의 분화도에 따른 차이도 없었다. 3) EGFR 발현군과 비발현군에서의 S-주기비율은 22.3(${\pm}10.5$)%, 18.0(${\pm}10.9$)% 였고, $G_1$-주기비율은 68.4(${\pm}11.6$)%, 71.1(${\pm}12.8$)%로서 모두 양군간의 유의한 차이는 없었다. 4) EGFR 발현군과 비발현군에서의 1년 생존률은 66%, 96%, 2년 생존률은 53%, 84%, 3년 생존률은 38%, 66%였고 중간 생존기간은 26개월, 53개월로서 유의한 차이가 있었다. 결 론 : 비소세포 폐암에서 EGFR은 56%에서 발현되었으며, 조직병리형, TNM 병기, 세포분화도에 따른 발현의 차이는 없었다. 발현군과 비발현군에서의 S 및 $G_1$ 주기비율은 차이가 없었다. EGFR 발현군과 비발현군의 2년 생존률은 53%, 84%였으며, 중간 생존기간은 26개월, 53개월이었다 (p<0.05). 즉 결과적으로 EGFR 발현이 높을수록 생존기간은 불량하여 예후추정인자로서의 이용이 가능하리라 판단된다.

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