식물공장 시스템내 광환경 제어가 청경채 생장에 미치는 영향

허정욱 ( Jeong Wook Heo ),김동억 ( Dong Eok Kim ),이공인 ( Gong In Lee ),윤정범 ( Jung Beom Yoon ),최규홍 ( Kyung Hong Choi ) 한국환경농학회 2013 한국환경농학회 학술대회집 Vol.2013 No.-

Closed-type plant factory system using artificial light sources instead of sunlight is an ultimated method for plant production without any pesticides comparing to conventional greenhouse structure. Control of the light environment such as a light quality or intensity in the plant factory system using artificial lights is an essential technique for improving the growth and development of plant species. It has been reported that the light environment significantly influences on growth in many kinds of leafy plants cultured under the plant factory system. In this experiment, effects of light quality and intensity under hydroponic culture system were mentioned on growth of green and red Pak Choi (Braccica rapa var. chinensis) seedlings. The Pak Choi seedlings which developed 2∼3 unfolded leaves were cultured in Yamazaki nutrient solution controlled at 1.4 ds m-1 EC and 5.6 pH, respectively on the plant factory of horizontal type. The seedlings were exposed by monochromic or mixture light-emitting diodes (LEDs) of blue+white (BW treatment), red (R treatment), or blue+red+white (BRW treatment) with 50, 100, or 250 μmol m-2 s-1 light intensity for 5 weeks. Increment of fresh and dry weights in the green and red Pak Choi was significantly affected by blue+red+white or red light qualities. However pigmentation was inhibited by the monochromic red light in both of the green and red Pak Choi seedlings. In BRW treatment, fresh weights per seedling of green and red Pak Choi grown under 250 μmol m-2 s-1 light intensity were 5.5 and 8.4 times promoted, respectively compared with fluorescent light considered as a control. Pigmentation in the Pak Choi seedlings increased under BRW treatment with higher light intensity than in lower treatment. From the results, it is suggested that the mixture radiation with higher light intensity gave the maximum growth of Pak choi seedlings with higher quality comparing with monochromic light. Optimum light intensity for leafy plant growth inside the plant factory system using artificial light sources should be decided for commercial production with a lower electric cost.

변산반도 연근해 표층 퇴적물의 특성과 퇴적환경

오재경,최규홍,Oh, Jae-Kyung,Choi, Kyu-Hong 한국해양학회 1999 바다 Vol.4 No.2

한반도 서해 중부 변산반도 연근해 표층 퇴적물의 퇴적작용 해저지형, 계절별 변화 등을 포함한 퇴적 환경을 연구하기 위해 여름 32 개, 겨울 29 개 표층 퇴적물을 채취하여 분석하였다. 지형적인 특성을 이해하기 위해 해도의 수심자료를 계수화했으며 음향측심기를 이용하여 동서방향을 따라 5 개 선상의 수심단면도를 얻었다. 표층 퇴적물의 퇴적상은 크게 모래(S), 사질니(sZ), 니질사(zS)로 나뉜다. 평균입도는 2.11~7.81 ${\Phi}$의 다양한 분포를 보인다. 전체적인 왜도값이 전반적으로 양의 분포를 보여 전형적인 조석 우세 환경임을 알 수 있다. 연구지역 북서쪽의 6 개의 정점에서는 중사에 해당하고 분급도는 0.5~1.4 ${\Phi}$의 분포를 보이며 그 외의 지역은 하천과 외해로부터 유입된 세립질 퇴적물과의 혼합에 의해서 외해에서 연안으로 갈수록 니질사부터 점차 사질니까지 분포한다. 겨울철에 하천 기원의 퇴적물이 재부유 하여 남쪽으로 이동 퇴적되는 것이 불량한 분급의 원인이 될 수 있다. C-M 다이아그램에 의하면 퇴적 기작은 크게 밑짐 이동(Mode A), 점이 부유와 지속적 부유의 혼합(Mode B), 그리고 지속적 부유(Mode C)로 각각 북서부의 사질, 중앙부의 니사질, 남부의 사니질 퇴적상과 밀접한 관계를 보인다. PCA 방법에 의한 통계분석에서도 유사한 결과가 나타났다. 결과적으로, 표층퇴적물의 퇴적상과 퇴적 기작은 밀접한 관계를 보이며 Type II에서 III의 퇴적상으로 갈수록 평균 입도는 세립해지고 분급이 점차 불량해지는 경향을 보인다. To study the characters of surface sediment and to describe the seasonal depositional environment as a result of sedimentation process off Byun-San Peninsula, a total 61 samples of surface sediment (32 samples in summer; 29 samples in winter) were collected and analysed. A digitized depth data from sea chart and echosounding profiles along five trans-sections were helpful for understanding the morphological factors. The types classified by the characters of surface sediment are type I (sand, S), type II (silty sand, zS), and type ill (sandy silt, sZ). Mean grain size varies from 2.11 to 7.81 ${\Phi}$. The positive-skewness shows the typical tide-dominated environment. The sediment type of the northwestern stations is medium sand and the sorting value is 0.5~1.4 ${\Phi}$ of well/moderately sorted. Meanwhile, other stations are composed of muddy sands and sandy muds transported from rivers and offshore. These sediment types toward inshore change gradually from silty sand to sandy silt. According to the C/M diagram, there are three major transport modes of sediment: bed load (Mode A), graded suspension (Mode B), and suspension (Mode C), correlating with north-eastern sandy area, middle part of silty-sand area, and southern sandy-silt area, respectively. The result of Principal Component Analysis shows also similar pattern of sediment types. In result, sediment texture of type III tends to be finer and more poorly-sorted than that of type II and sediment facies are correlateed with sedimentation process.

양성 자궁병변에 대한 세 가지 다른 자궁적출술 접근 방법

한호섭 ( Ho Suap Hahn ),최규홍 ( Kyu Hong Choi ),김주명 ( Joo Myung Kim ),이현주 ( Hyun Joo Lee ),최노미 ( No Mi Choi ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김남숙 ( Nam Sook Kim ),조수희 ( Soo Hee Jo ),홍준식 ( Jun Sh 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 자궁의 양성병변으로 자궁적출술시에 세 가지 다른 수술방법인 복식 자궁적출술, 복강경식 자궁적출술, 질식 자궁적출술의 시행비율과 임상적 결과를 비교하고자 하였다. 연구 방법: 2004년 3월부터 2006년 4월까지 세 가지 수술에 익숙한 한명의 집도의에 의하여 시행된 236예의 자궁적출술을 대상으로 하였다. 일차적인 결과로 각 수술의 시행비율을 알아보았고 이차적인 결과로서 수술전후의 결과를 알아보았다. 결과: 세 연구군 간에 평균나이, 체중, 신장, 체질량 지수, 분만력에 차이는 없었다. 연구대상에 합당한 222건의 자궁적출술은 복식이 13.5%, 복강경식 34.2%, 질식이 52.3%의 비율로 시행되었다. 복식, 복강경식, 질식 자궁적출술의 수술전후의 결과는 다음과 같다 : 수술시간 (83.2±27.1 min, 94.2±25.2 min, 50.8±15.5 min), 수술전후 혈색소 변화 (2.3±1.5 g/dL, 2.0±0.9 g/dL, 1.3±1.1 g/dL), 방광 도뇨관 유치일 (2.0±0.2 days, 1.0±0.0 days, 1.0±0.4 days), 수술 후 입원기간 (5.7±1.2 days, 4.7±0.9 days, 4.3±1.0 days), 자궁 무게 (733±665 g, 340±213 g, 300±156 g). 자궁의 무게는 복식이 복강경식이나 질식에 비하여 의미 있게 무거웠다 (p<0.05). 복강경식은 복식에 비하여 수술 후 입원기간과 도뇨관 유치기간에서 유리하였다 (p<0.05). 질식은 복식에 비하여 수술시간, 낮은 혈색소변화, 도뇨관 유치기간, 수술 후 입원기간에서 유리하였다 (p<0.05). 복식, 복강경식, 질식 자궁적출술의 합병증에서는 유의한 차이를 보이지 않았다 (13.3%, 10.5%, 9.5%, p=0.825). 결론: 질식이나 복강경식 자궁적출술은 86.5%에서 가능하였다. 질식과 복강경식 수술 방법을 적절히 사용하면 합병증의 증가 없이 복식 자궁적출술을 줄일 수 있다. Objective: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). Methods: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. Results: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2±27.1 min, 94.2±25.2 min, and 50.8±15.5 min, respectively), change in hemoglobin (2.3±1.5 g/dL, 2.0±0.9 g/dL, and 1.3±1.1 g/dL, respectively), duration of urinary catheterization (2.0±0.2 days, 1.0±0.0 days, and 1.0±0.4 days, respectively), postoperative hospitalization (5.7±1.2 days, 4.7±0.9 days, and 4.3±1.0 days, respectively), uterine weight (733±665 g, 340±213 g, and 300±156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). Conclusions: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.

초음파를 이용한 정상 태아의 임신 주수에 따른 신체 각 부위의 표준 평균치 측정

최준식 ( June Seek Choi ),양재혁 ( Jae Hyug Yang ),류현미 ( Hyun Mee Ryu ),김문영 ( Moon Young Kim ),한정열 ( Jung Yeol Han ),안현경 ( Hyun Kyung Ahn ),정상희 ( Sang Hee Jung ),최규홍 ( Kyu Hong Choi ),이지영 ( Jee Young Lee ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

목적 : 초음파 기기의 발달로 임신 중의 태아 임신 주수에 따른 발육 상태를 태아의 아두 대횡경, 대퇴골 길이, 복부 둘레 등을 측정함으로써 예측할 수 있게 되었다. 그러나 아직 정확한 한국의 태아 신체 각 부분의 평균 표준치가 없다는 것은 빨리 해결해야 할 과제라 생각된다. 따라서 본 연구는 정상 태아의 평균치 및 제태 연령을 예측할 수 있는 회귀 방정식을 구하고자 하였다. 연구 방법 : 1996년 6월부터 1998년 3월까지 삼성제일병원에서 산전 검사를 받은 300명의 산모 중, 태아 성장에 영향을 줄 수 있는 요인을 가진 29명을 제외한 총 271명의 산모를 대상으로 하였다. 이들에서 태아의 전둔장 (CRL), 아두 대횡경 (BPD), 머리 둘레 (HC), 복부 둘레 (AC), 대퇴골 길이 (HL), 경골 길이 (TL)를 측정하였으며, 제태 연령을 예측하는 회귀 방정식은 선형 회귀 분석을 통해 구하였다. 결과 : 임신 11주에서 29주 사이의 태아의 전둔장, 아두 대횡경, 머리 둘레, 복부 둘레, 대퇴골 길이, 경골 길이의 백분율을 산출하였으며, 제태 연령을 예측하는 이차 방정식을 추론하였다. 결론 : 본 연구는 정상 태아의 생체 계측의 평균치 및 백분율을 구하였다. 많은 수의 산모를 전향적으로 측정하였고, 측정자 수를 제한함으로써 계측자간의 오차를 최소화하였다. 또한 한국 태아의 경골의 평균치 및 백분율을 처음으로 산출함으로써 임신 연령 측정에 좀더 정확한 자료를 제시하였다. Objective : The purpose of this study was to assess the mean fetal biometry and to create a formulae for estimation of gestational week using sonographic biometry measurement. Methods : A total 271 women of singleton gestation were involved in this study of ultrasonographic fetal biometry. During the period from June 1996 to March 1998, the length of CRL (Crown Rump Length), BPD (Biparietal Diameter), HC (Head Circumference), AC (Abdominal Circumference), HL (Humerus Length) and TL (Tibia Length) of fetuses in normal pregnancy were measured by ultrasonography at Samsung Cheil Hospital & Women`s Healthcare Center. The gestational age prediction equations were derived form sigletons with the use of liner regression analysis. Results : We present the percentile ranks of fetal CRL, BPD, HC, AC, HL and TL measurement from 11 to 39 week`s gestation and mean value of fetal size at each week. These data were analyzed and several second grade equations were derived from the data. Conclusion : We created these authentic equations and tables for mean value of fetal biometry in normal pregnancy at each gestation week with minimal intervariable errors.

결혼이주여성의 농촌 사회참여활동 실태 및 이에 따른 생활만족도 변화 -농업,지역사회,취업활동 중심으로-

양순미 ( Soon Mi Yang ),최규홍 ( Kyu Hong Choi ),강경하 ( Kyung Ha Kang ) 한국농촌지도학회 2009 농촌지도와 개발 Vol.16 No.4

In the near future, the multicultural families are expected to be the majority of population living in the rural area, which is an aged and small-scaled society. Moreover, they are expected to have an important role in sustaining the culture of agriculture and a rural community. Therefore, it is very important for them to adjust and settle urgently as well as to develop a policy and social services for the adjustment and settlement. The purpose of this study is to identify different aspects of the participation in agricultural, social, and job activities of married immigrant women in a Korean rural area as well as to investigate the change of life satisfaction resulting from the l activities. The following findings were established from this study. First, married immigrant women participate in local social and agricultural activities in a Korean rural area more frequently than in their own country. However, the frequency of their participation in job activity in a Korean rural area is lower than in their own country. Second, the main factor that prevents married immigrant women from participating in agricultural activity in a Korean rural area is to carry out childcare, household chores, and farming at the same time. Their low participation in social activity and job activity mostly results from their lack of fluency in Korean. Third, married immigrant women score higher in the change of life satisfaction after participating in social activity and job activity than in agricultural activity.

인간정자의 처리에 있어서 Percoll과 Sil-Select 방법의 비교

문신용,류범용,신현아,오선경,서창석,김석현,최영민,김정구,최규홍,이진용,Moon, Shin-Yong,Ryu, Buom-Yong,Shin, Hyun-Ah,Oh, Sun-Kyung,Suh, Chang-Suk,Kim, Seok-Hyun,Choi, Young-Min,Kim, Jung-Gu,Choi, Kyu-Hong,Lee, Jin-Yong 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.4

Objective: To evaluate silane-coated silica particles (Sil-select) as an alternative to polyvinylpyrrolidone-coated particles (Percoll) for gradient separation of spermatozoa, for use in assisted reproduction. Methods: 20 normal semen based on WHO criteria were included in this study. Recovery of motile and morphologically normal spermatozoa after using two-layer Percoll and Sil-select gradient respectively was recorded. Motility, HOST (hypoosmotic swelling test) and the detection of malondialdehyde for LPO (lipid peroxidation) after 24 h of incubation at $37^{\circ}C$ in a 5% $CO_2$ incubator were compared. Results: Percoll (78.5%) and Sil-select (79.1%) showed a significant increase in the motility compared to ejaculate (60.9%) but no difference between Percoll and Sil-select. Normal sperm morphology significantly increased after Percoll (57.6%) and Sil-select (53.7%) compared to ejaculate (35.8%) but no difference between Percoll and Sil-select. No differences in the recovery of motile spermatozoa and motility, HOST and the production of malondialdehyde after 24 h incubation were found when comparing the use of Percoll and Sil-select. Conclusion: Sil-select seems to be an attractive alternative to Percoll for sperm separation in assisted reproduction.

자궁내막증에 의한 골반 통증을 호소하는 불임환자에서 골반경하 자궁천골인대 소작술 ( laparoscopic uterosacral nerve ablation ) 의 임상적 효용성

문명진(Myoung Jin Moon),김대곤(Dae Kon Kim),윤경호(Kyung Ho Yoon),홍준식(Jun Sig Hong),김연주(Yon Ju Kim),김혜옥(Hye Ok Kim),양광문(Kwang Moon Yang),최규홍(Kyu Hong Choi),유근재(Keun Jai Yoo) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

N/A Objective : The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. Method : Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). Result : The pelvic pain score of pre-operation was 3.72±1.07 (mean±SD) and it was significantly decreased to 1.83±0.85 at 1 month later and 1.93±0.92, 1.69±0.60, 1.56±0.62, 1.56±0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). Conclusion : Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

신생아 예후와 태아심박동 제변수들에 대한 통계적 고찰

한우하 ( Woo Ha Han ),정후연 ( Hoo Yoen Chung ),최규홍 ( Kyu Hong Choi ),신동열 ( Dong Yul Shin ),이정한 ( Jung Han Lee ),박문일 ( Moon Il Park ),김준 ( Joon Kim ),차경준 ( Kyung Joon Cha ) 대한주산의학회 1999 大韓周産醫學會雜誌 Vol.10 No.3

생쥐배아의 부화와 탈각에 미치는 Pronase의 영향

문신용,최성미,김희선,류범용,오선경,서창석,김석현,최영민,김정구,최규홍,이진용,Moon, Shin-Yong,Choi, Sung-Mi,Kim, Hee-Sun,Ryu, Buom-Yong,Oh, Sun-Kyung,Suh, Chang-Suk,Kim, Seok-Hyun,Choi, Young-Min,Kim, Jung-Gu,Choi, Kyu-Hong,Lee, Jin-Y 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.4

Objective: Hatching of the blastocyst from the zona pellucida (ZP) is a key event in mammalian implantation. In vivo, two factors have been identified as possible mediators of hatching: lysis of the ZP by substances elaborated either from the embryo or female reproductive tract and pressure exerted on the zona by expansion of the blastocyst. Two methods of zona manipulation were already in use to enhance the ability of embryos to hatch: mechanical PZD and chemical ZD by acidic Tyrode's solution. But several controversies of each method have been reported. The purpose of this study was to investigate the effect of pronase for mouse embryo hatching. Methods: Mouse embryos were obtained following ovulation induction of $F_1$ animals. Fresh and cryo-thawed morula embryos were exposed to 0.5, 1.0, 2.0, 5.0 ${\mu}g/ml$ pronase in Ham's F10 for 72 hrs. Main outcome measures were the rates of partial hatching and completely hatched blastocysts, and cell number of it. Results: In fresh and cryo-thawed group, the rates of completely hatched blastocyst were significantly higher in 5 ${\mu}g/ml$ pronase treatment group than control group. There was no difference in completely hatched blastocyst total cell number between pronase treatment group and control group. This suggest that pronase treatment did not harmful in mouse embryo development. In pronase treatment group, zona pellucida were thinner than control group. Conclusion: The addition of pronase to culture media may accelerate the hatching of embryo. So, enzymatic treatment of the zona may provide a valuable and effective assisted hatching technique for human in-vitro fertilization-embryo transfer.

자궁근종으로 진단된 환자의 치료 선호도 및 치료방법에 관한 고찰

조수희 ( Soo Hee Jo ),김주명 ( Joo Myung Kim ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김미라 ( Mi La Kim ),최규홍 ( Kyu Hong Choi ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ),주관영 ( Kwan Young Joo ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11

목적: 외래 내원 환자 중 자궁근종을 가진 환자의 치료 방법에 대한 선호도를 확인하고, 진단 이후의 치료방법에 대해 알아보고자 하였다. 방법: 2006년 1월 1일부터 12월 31일까지 외래를 내원한 환자 중 초음파상 자궁근종으로 진단된 577명의 환자를 대상으로, 진단 후 치료방법에 대해 후향적으로 의무기록을 확인하였다. 또한, 외래 초진시 근종으로 진단받은 환자 100명에서의 치료 방법에 대한 설문지 선호도 조사 자료를 분석하였다. 결과: 자궁근종을 가진 환자에서 가장 흔하게 나타나는 증상은 통증으로 58.6%에서, 출혈과 관련된 증상은 51.3%, 압박증상은 30.2%에서 보였다. 특별한 약물치료 없이 정기적 추적관찰은 31.7%의 환자에서 시행되었으며, NSAID와 같은 비호르몬제 약물은 27.1%에서, 미레나를 포함한 호르몬제는 41.9%에서 사용되었다. 수술을 시행받은 환자는 총 182명으로 31.5%에서 시행되었으며, 그 중 104명은 자궁근종절제술을 시행받았으며, 아전자궁적출술은 36명, 전자궁적출술은 42명에서 시행되었다. 출혈관련 증상을 가진 환자의 42.6%, 통증관련은 34.6%, 압박증상 관련은 50.6%에서 수술을 시행하였다. 근종으로 진단된 초진 환자 100명을 대상으로 한 설문지 조사에서는 우선적으로 약물치료를 원하는 환자가 78명, 수술적 치료를 원하는 환자가 22명이었다. 수술을 시행받아야 한다면 우선적으로 근종절제술을 시행받기를 원한 환자가 94명, 자궁적출술을 받기를 원한 환자는 6명이었다. 결론: 출혈이나 통증과 관련된 증상을 가진 자궁근종 환자에서는 일차적으로 약물치료가 효과적이며, 환자의 선호도 역시 비침습적인 약물치료를 우선 시행받는 것을 원하는 것으로 나타났다. Objective: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. Methods: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients` characteristics, treatment methods and questionnaires for patient preference were evaluated. Results: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. Conclusions: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.