• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.61-71
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• 2020

Purpose: To investigate the effect of collimator angle on plan quality of PAN-Pelvis Multi-isocenter VMAT plan, dose reproducibility at the junction and impact on set-up error at the junction. Material and method: 10 adult patients with whole pelvis cancer including PAN were selected for the study. Using Trubeam STx equipped with HD MLC, we changed the collimator angle to 20°, 30°, and 45° except 10° which was the default collimator angle in the Eclipse(version 13.7) and all other treatment conditions were set to be the same for each patient and four plans were established also. To evaluate these plans, PTV coverage, coverage index(CVI) and homogeneity index (HI) were compared and clinical indicators for each treatment sites in normal tissues were analyzed. To evaluate dose reproducibility at the junction, the absolute dose was measured using a Falmer type ionization chamber and dose changes at the junction were evaluated by moving the position of the isocenter in and out 1~3mm and setting up the virtual volume at the junction. Result: CVI mean value was PTV-45 0.985±0.004, PTV-55 0.998±0.003 at 45° and HI mean value was PTV-45 1.140±0.074, and PTV-55 1.031±0.074 at 45° which were closest to 1. V20Gy of the kidneys decreased by 9.66% and average dose of bladder and V30 decreased by 1.88% and 2.16% at 45° compared to 10° for the critical organs. The dose value at the junction of the plan and the actual measured were within 0.3% and within tolerance. At the junction, due to set-up error the maximum dose increased to 14.56%, 9.88%, 8.03%, and 7.05%, at 10°, 20°, 30°, 45°, and the minimum dose decreased to 13.18%, 10.91%, 8.42%, and 4.53%, at 10°, 20°, 30°, 45° Conclusion: In terms of CVI, HI of PTV and critical organ protection, overall improved values were shown as the collimator angle increased. The impact on set-up error at the junction by collimator angle decreased as the angle increased and it will help improve the anxiety about the set up error. In conclusion, the collimator angle should be recognized as a factor that can affect the quality of the multi-isocenter VMAT plan and the dose at the junction, and be careful in setting the collimator angle in the treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.89-97
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• 2021

Purpose: The purpose of this study is to compare and evaluate the dose change according to the gas volume variations in the rectum, which was not included in the treatment plan during radiation therapy for cervical cancer. Materials and methods: Static Intensity Modulated Radiation Therapy (S-IMRT) using a 9-field and Volumetric Modulated Arc Therapy (VMAT) using 2 full-arcs were established with treatment planning system on Computed Tomography images of a human phantom. Random gas parameters were included in the Planning Target Volume(PTV) with a maximum change of 2.0 cm in increments of 0.5 cm. Then, the Conformity Index (CI), Homogeneity Index (HI) and PTV D_max for the target volume were calculated, and the minimum dose (D_min), mean dose (D_mean) and Maximum Dose (D_max) were calculated and compared for OAR(organs at risk). For statistical analysis, T-test was performed to obtain a p-value, where the significance level was set to 0.05. Result: The HI coefficients of determination(R²) of S-IMRT and VMAT were 0.9423 and 0.8223, respectively, indicating a relatively clear correlation, and PTV D_max was found to increase up to 2.8% as the volume of a given gas parameter increased. In case of OAR evaluation, the dose in the bladder did not change with gas volume while a significant dose difference of more than D_mean 700 cGy was confirmed in rectum using both treatment plans at gas volumes of 1.0 cm or more. In all values except for D_mean of bladder, p-value was less than 0.05, confirming a statistically significant difference. Conclusion: In the case of gas generation not considered in the reference treatment plan, as the amount of gas increased, the dose difference at PTV and the dose delivered to the rectum increased. Therefore, during radiation therapy, it is necessary to make efforts to minimize the dose transmission error caused by a large amount of gas volumes in the rectum. Further studies will be necessary to evaluate dose transmission by not only varying the gas volume but also where the gas was located in the treatment field.

• Journal of the Society of Disaster Information
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• v.19 no.4
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• pp.976-983
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• 2023

Purpose: The dynamic behavior of a bridge structure under seismic loading depends on many uncertainties, such as the nature of the seismic waves and the material and geometric properties. However, not all uncertainties have a significant impact on the dynamic behavior of a bridge structure. Since probabilistic seismic performance evaluation considering even low-impact uncertainties is computationally expensive, the uncertainties should be identified by considering their impact on the dynamic behavior of the bridge. Therefore, in this study, a global sensitivity analysis was performed to identify the main parameters affecting the dynamic behavior of bridges with I-curved girders. Method: Considering the uncertainty of the earthquake and the material and geometric uncertainty of the curved bridge, a finite element analysis was performed, and a surrogate model was developed based on the analysis results. The surrogate model was evaluated using performance metrics such as coefficient of determination, and finally, a global sensitivity analysis based on the surrogate model was performed. Result: The uncertainty factors that have the greatest influence on the stress response of the I-curved girder under seismic loading are the peak ground acceleration (PGA), the height of the bridge (h), and the yield stress of the steel (fy). The main effect sensitivity indices of PGA, h, and fy were found to be 0.7096, 0.0839, and 0.0352, respectively, and the total sensitivity indices were found to be 0.9459, 0.1297, and 0.0678, respectively. Conclusion: The stress response of the I-shaped curved girder is dominated by the uncertainty of the input motions and is strongly influenced by the interaction effect between each uncertainty factor. Therefore, additional sensitivity analysis of the uncertainty of the input motions, such as the number of input motions and the intensity measure(IM), and a global sensitivity analysis considering the structural uncertainty, such as the number and curvature of the curved girders, are required.

• Tuberculosis and Respiratory Diseases
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• v.39 no.2
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• pp.120-130
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• 1992

Background: Although there have been many studies on the pathogenetic mechanism of acute lung injury, it is still elusive. Recently interests have been focused on the role of oxygen free radicals. But the effect of hydroxyl radical on the neutrophil mobilization and the alveolar-capillary permeability is not clear especially in the endotoxin-induced acute lung injury model of rats. This investigation was performed to evaluate the pathogenetic role of hydroxyl radical on the neutrophil accumulation into the lung and the increased alveolar-capillary permeability in the endotoxin-induced acute lung injury in rats. Method: Fifty rats were divided into four groups: vehicle control group (n=5, 6hrs; n=5, 24hrs), endotoxin-treated group (n=10, 6hrs; n=10, 24hrs), Dimethylthiourea (DMTU)-pretreated group (n=10, 6hrs), and deferoxamine (DFX)-pretreated group (n=10, 6hrs). Thirty minutes before sacrifice, $^{125}I$-tagged bovine serum albumin was injected. Six and twenty four hours after endotoxin injection, the rats were sacrificed, and the radioactivity of lung tissue and peripheral blood was counted. Permeability index was defined as the ratio of radioactivity between lung tissue and peripheral blood. Another set of rats (n=52) were divided into the same four groups as before [vehicle control group (n=5, 6hrs; n=5, 24hrs), endotoxin·treated group (n=7, 6hrs; n=8, 24hrs), DMTU-pretreated group (n=6, 6hrs; n=9, 24hrs), and DFX-pretreated group (n=5, 6hrs; n=7, 24hrs)], and were sacrificed 6 and 24 hours after endotoxin injection. In these rats, cell profile of peripheral blood and bronchoalveolar lavage fluid was evaluated, and the pathologic examination of lung tissue was performed. Results: 1) Increased alveolar-capillary permeability was observed 6 hours after endotoxin injection, which was normalized after 24 hours, and this increase was attenuated by pretreatment with DMTU and DFX. 2) Neutrophil sequestration into the lung was observed 24 hours after endotoxin administration, but this was not influenced by DMTU and DFX pretreatment. Conclusion: These results suggest that hydroxyl radical would not be involved in the sequestration of neutrophils into the lung, but plays an important role in the increase of alveolar-capillary permeability in the endotoxin-induced acute lung injury in rats.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.15 no.1
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• pp.40-60
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• 2004

Introduction：Research on attachment in view point of the developmental perspective which began in the 1940s progressed during several decades. Many investigators focused mother-child separation in early attachment studies, and moved to the relationship with childhood psychopathology. Recently attachment theory and research are moving forward along the intergenerational transmission of attachment patterns, and adolescents and adult mental disorders in the developmental perspectives. Methods：We surveyed the research papers through Medline search, attachment-related monographs, and review or original papers published in Korean journal. Results：Developmental attachment researches have demonstrated convincingly that insecure attachment in infancy is associated with attachment disorder; several childhood psychopatholgy, such as institutional care and adoption, aggression and behavioral problems, childhood anxiety disorders and depressive disorders, gender identity disorder and feeding disorder, and child abuse and maltreatment; peer relationship and social competency, and parental behaviors. Recently the methodological advances including the Adult Attachment Interview that systematically assesses the adults' recollections of the earlier parent-child relationship they experienced could move beyond attachment researcher's initial concern with infancy to consider attachment processes throughout the life span. We could find that the quality of attachment was associated with several mental disorders in adolescents and adults significantly. Conclusion：Attachment theory would have focused on more specific parent-child relationship than general parental behavior. Recent attachment theory underscores its evolutionary origins to promote development of infant and contribute to human survival in psychobiological bases. Advances in attachment research could unite interests in evolutional biology and developmental psychology in understanding early parent-child relationship, and apply to clinical issues concerning mental health throughout the life span.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.257-264
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• 2014

Purpose : Photoneutron dose in high-energy photon radiotherapy at linear accelerator increase the risk for secondary cancer. The purpose of this investigation is to evaluate the dose variation of photoneutron with different treatment method, flattening filter, dose rate and gantry angle in radiation therapy with high-energy photon beam ($E{\geq}8MeV$). Materials and Methods : TrueBeam $ST{\time}TM$(Ver1.5, Varian, USA) and Korea Tissue Equivalent Proportional Counter (KTEPC) were used to detect the photoneutron dose out of the high-energy photon field. Complex Patient plans using Eclipse planning system (Version 10.0, Varian, USA) was used to experiment with different treatment technique(IMRT, VMAT), condition of flattening filter and three different dose rate. Scattered photoneutron dose was measured at eight different gantry angles with open field (Field size : $5{\time}5cm$). Results : The mean values of the detected photoneutron dose from IMRT and VMAT were $449.7{\mu}Sv$, $2940.7{\mu}Sv$. The mean values of the detected photoneutron dose with Flattening Filter(FF) and Flattening Filter Free(FFF) were measured as $2940.7{\mu}Sv$, $232.0{\mu}Sv$. The mean values of the photoneutron dose for each test plan (case 1, case 2 and case 3) with FFF at the three different dose rate (400, 1200, 2400 MU/min) were $3242.5{\mu}Sv$, $3189.4{\mu}Sv$, $3191.2{\mu}Sv$ with case 1, $3493.2{\mu}Sv$, $3482.6{\mu}Sv$, $3477.2{\mu}Sv$ with case 2 and $4592.2{\mu}Sv$, $4580.0{\mu}Sv$, $4542.3{\mu}Sv$ with case 3, respectively. The mean values of the photoneutron dose at eight different gantry angles ($0^{\circ}$, $45^{\circ}$, $90^{\circ}$, $135^{\circ}$, $180^{\circ}$, $225^{\circ}$, $270^{\circ}$, $315^{\circ}$) were measured as $3.2{\mu}Sv$, $4.3{\mu}Sv$, $5.3{\mu}Sv$, $11.3{\mu}Sv$, $14.7{\mu}Sv$, $11.2{\mu}Sv$, $3.7{\mu}Sv$, $3.0{\mu}Sv$ at 10MV and as $373.7{\mu}Sv$, $369.6{\mu}Sv$, $384.4{\mu}Sv$, $423.6{\mu}Sv$, $447.1{\mu}Sv$, $448.0{\mu}Sv$, $384.5{\mu}Sv$, $377.3{\mu}Sv$ at 15MV. Conclusion : As a result, it is possible to reduce photoneutron dose using FFF mode and VMAT method with TrueBeam $ST{\time}TM$. The risk for secondary cancer of the patients will be decreased with continuous evaluation of the photoneutron dose.

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.246-259
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• 2000

Background: As one of the etiologies of acute respiratory distress syndrome(ARDS), sepsis is one of the morbid causes of this cryptogenic malady. Even though many documents on the role of endotoxin(ETX) in the pathogenesis of ARDS have been issued, still the underlying mechanism associated with oxidative stress and activation of $PLA_2$ has been controversial. In the present study, the role of phospholipase $A_2(PLA_2)$ in the neutrophilic respiratory burst, which is presumed to cause acute lung injury during sepsis, was probed. Method: In glutathione-depleted Sprague-Dawley rats, lung leak, infiltration of neutrophils, $PLA_2$ activity and lipid peroxidation in the lung were measured after intratracheal instillation of endotoxin(delete). In addition, gamma glutamyl transferase(GGT) activity and the amount of pulmonary surfactant were measured. Morphologically, the changes in ultrastructure and cytochemical demonstration of oxidants were presented to confirm the neutrophilic oxidative stress and to elucidate the effects of $PLA_2$ activation on(delete) oxidative stress. Results: Instillation of ETX to glutathione-depleted rats intensified lung leak and lipid peroxidation when compared with non-glutathione depleted rats treated with the endotoxin. Moreover, oxidative stress was confirmed by the assay of GGT and malondialdehyde. Functionally, the depletion of glutathione altered the secretion of pulmonary surfactant from alveolar type II cells. Ultrastructurally and cytochemicaliy, oxidative stress was also confirmed after treatment of with ETX and diethylmaleate(DEM). Conclusion: The endotoxin-induced acute lung injury was mediated by oxidative stress, which in turn was provoked by the neutrophilic respiratory burst. The activation of $PLA_2$ in the lung seems to playa pivotal role in the oxidative stress of the lung.

• Geotechnical Engineering
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• v.13 no.3
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• pp.101-122
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• 1997

A spiting reinforcement system is composed of a series of radially installed reinforcing spites along the perimeter of the tunnel opening ahead of excavation. The reinforcing spill network is extended into the in-situ soil mass both radially and longitudinally The sailing reinforcement system has been successfully used for the construction of underground openings to reinforce weak rock formations on several occasions. The application of this spiting reinforcement system is currently extended to soft ground tunneling in limited occasions because of lack of reliable analysis and design methods. A method of threetimensional limit equilibrium stability analysis of the smile-reinforced shallow tunnel in soft ground is presented. The shape of the potential failure wedge for the case of smile-reinforced shallow tunnel is assumed on the basis of the results of three dimensional finite element analyses. A criterion to differentiate the spill-reinforced shallow tunnel from the smile-reinforced deep tunnel is also formulated, where the tunnel depth, soil type, geometry of the tunnel and reinforcing spites, together with soil arching effects, are considered. To examine the suitability of the proposed method of threedimensional stability analysis in practice, overall stability of the spill-reinforced shallow tunnel at facing is evaluated, and the predicted safety factors are compared with results from twotimensional analyses. Using the proposed method of threetimensional limit equilibrium stability analysis of the smile-reinforced shallow tunnel in soft ground, a parametric study is also made to investigate the effects of various design parameters such as tunnel depth, smile length and wadial spill spacing. With slight modifications the analytical method of threeiimensional stability analysis proposed may also be extended for the analysis and design of steel pipe reinforced multi -step grouting technique frequently used as a supplementary reinforcing method in soft ground tunnel construction.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.12-20
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• 2008

Purpose: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. Methods: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a $^{99m}Tc$-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. Results: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). Conclusion: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.

• Childhood Kidney Diseases
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• v.9 no.2
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• pp.213-221
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• 2005

Purpose : Urachal anomalies are rare but are known to develop several complications, especially infection. Moreover, uniform guidelines for management have not been presented because of the variable clinical characteristics of these anomalies. The purpose of this report is to review our experience with urachal anomalies and attempt to determine the optimal management. Methods : We retrospectively reviewed the records of fourteen children with a variety of urachal anomalies who had been treated from January 1996 to June 2005 at Dong Kang General Hospital. Results : The age distribution of the patients(mean age; 3.8 years) was six neonates, one infant, five preschool-age and two school-age children. The male to female ratio was 1:1. Six cases of urachal cyst, four cases of patent urachus, two cases of urachal sinus and two cases of urachal diverticulum were found. Three patients with patent urachus and one with urachal cyst had hydronephrosis. Other associated anomalies included an inguinal hernia in one patient with urachal sinus and a vesicoureteral reflux in one patient with urachal diver ticulum. As a first-line diagnostic tool, high-resolution ultrasound examination was performed in thirteen cases and computed tomography in one case. Surgical excision was performed in nine patients with urachal anomaly. Five cases out of six neonatal cases experienced spontaneous improvement during a three-month follow up period. Due to frequent infection of the umbilicus, surgical excision was performed on one neonate with urachal sinus. Conclusion : All patients with urachal anomalies should undergo investigation for associated anomalies. The neonate with urachal anomalies, especially patent urachus, do not require surgical excision unless the patient has multiple episodes of recurrent infection. (J Korean Soc Pediatr Nephrol 2005;9:213-221)