• Title/Summary/Keyword: 암관리법

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Comparative Evaluation of 25-OH-VitD and 25-OH-VitD3 by Radioimmunoassay (방사면역 측정법에 의한 25-OH-VitD와 25-OH-VitD3의 비교 평가)

  • Lee, Young-ji;Park, Ji-hye;Lim, Soo-yeon;Cheon, Jun-hong;Lee, Sun-ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.24 no.1
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    • pp.33-38
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    • 2020
  • Purpose Vitamin D is essential for maintaining bone health, controling cell proliferation or differentiation, strengthening immune function by controlling calcium metabolism in the body. Vitamin D deficiency can lead to increase the risk of rickets, osteoporosis, cardiovascular disease, diabetes and cancer. Especially, South Korea is one of the highest population proportion of vitamin D deficiency. Accurate determination of levels of 25-OH-VitD or 25-OH-VitD3 in blood serum is required for the diagnosis and treatment of vitamin D deficiency. In this study, radioimmunoassay of 25-OH-VitD and 25-OH-VitD3 was performed and compared to evaluate the effectiveness of Vitamin D radioimmunoassay. Materials and Methods Serum 25-OH-VitD and 25-OH-VitD3 levels were measured using radioimmunoassay. The interrelationship, reproducibility and population distribution rate were evaluated. In addition, the internal quality control was performed at Asan Medical Center from April 2017 to June 2019 and the result of external quality control (Interagency proficiency evaluation) of first and second half of 2018 hosted by the Korean Society of Nuclear Medicine Technology (KSNMT). Both tests were measured by same manufacturer's reagent. Results 25-OH-VitD showed a strong positive correlation on 97 samples, as 25-OH-VitD3 x 0.9 + 0.3 (R>0.9). In repeated measurement, the average Diff(%) value of the reproducibility evaluation of 25-OH-VitD and 25-OH-VitD3 were 7.7% and 7.4%, respectively. Population distribution results showed no statistically significant differences(p>0.05). The resultant value of internal quality control, which measured from April, 2017 to June 2019 in Blood test room of Nuclear Medicine at Asan Medical Center, showed average (CV%) 6.2% and 6.8%, respectively. As a result of the external quality control (interagency proficiency evaluation) Z value obtained under 2.0, as shown below; Conclusion The interrelationship, reproducibility, population distribution rate, internal quality control and external quality control between 25-OH-VitD and 25-OH-VitD3 radioimmunoassay shows superior outcome. Radioimmunoassay, which can be alone measured in the blood as 25-OH-VitD or 25-OH-VitD3, is considered suitable screening tests for the diagnosis of vitamin D deficiency.

Material Characteristics, Deterioration Evaluation and Crack Depth Estimation for Mulgyeseowon Stele in Changnyeong, Korea (창녕 물계서원 원정비의 재질특성 및 손상도 평가와 균열심도 측정)

  • Yoo, Ji Hyun;Lee, Chan Hee;Chun, Yu Gun
    • Journal of Conservation Science
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    • v.30 no.4
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    • pp.427-438
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    • 2014
  • To measure the depth and extension on the surface cracks of the stone monument, ultrasonic pulse velocity targeted at the Mulgyeseowon Stele in Changnyeong was used in this research. Additionally, to establish a long-term countermeasure of management and conservation for this stele, we have investigated the material properties and damage on it and have conducted a precise diagnosis by a variety of non-destructive techniques. Our research has revealed that stones of the stele are composed mainly of three rock types according to the parts of it, alkali-feldspar granite, gabbro and diorite. The result of the deterioration evaluation has occurred that cracks, which are observed from every direction in the body of the stele, are the significant factors to reduce structural stability. The ultrasonic velocity for an evaluation on the properties of the stele has revealed that the speed was high in the order of body, pedestal and crown. Furthermore, to understand the present condition and occurrences of the cracks which have measured in many different forms on the stele quantitatively, we have estimated from 0.6 to 24.1cm deep of the cracks by To-Tc method using ultrasonic velocity.

The Clinical Trial of Terminal Cancer Patients and The Nature of Self-Determination of The Subject (말기 암 환자에 대한 임상시험과 피험자의 자기결정권의 본질)

  • Song, Young-Min
    • The Korean Society of Law and Medicine
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    • v.15 no.1
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    • pp.211-237
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    • 2014
  • Because of unpredictability and high possibility of abnormal results by clinical trials compared to general medical behaviors, a procedure for ensuring with sufficient explanations by investigators must be secured. Therefore, in a sequence of clinical trials, what kinds of scope, stage, and method of explanations provided by investigators, including doctors or researchers, to trial subjects are closely related to the compensation for damages by violation of liability for explanation. In case of application of clinical trials to patients who have critical illness such as cancer, issues of "Quality of Life" regarding trial subjects, cancer patients, should be discussed. Especially, in case of clinical trials for terminal cancer patients, the right of subjects' self-determination, which is a fundamental principle in medical behaviors, should be discussed. The right of self-determination includes participation in clinical trials for the possibility of life-sustaining even a little bit, or no participation in clinical trials in order to have a time for completing the rest of his life. Like this, if the extent and scope of explanations related to the issues of "Quality of Life" are raised as main issues, the evaluation of "Quality of Life", should be a prerequisite. In many occasions, realistically, despite bad results such as deaths or serious adverse drug reactions after clinical trials, it may not be easy for compensating to trial subjects or their survivors, who requested civil compensation for damage. Futhermore, in abnormal results after concealment of clinical trials or performance of clinical trials without permission, and in the case of trial subjects' failures of proving proximate cause between the clinical trials and abnormal results, problematic results such as no protection to the trial subjects could be occurred. In performing clinical trials, investigators should provide sufficient explanations for trial subjects and secure voluntary informed consents from the trial subjects. Therefore, clinical trials without trial subjects' permissions and the informed consent process violate trial subjects' rights of self-determination, and the investigators shall be liable for compensation for damages. Then, issues might be addressed are what are essential contents of patients' "rights of self-determination" infringed by clinical trials without subjects' permissions. Two perspectives about patients' rights of self-determination might be considered. One perspective regards physical distress of patients (subjects) from therapies without sufficient explanations as the crux of the matter. The other perspective regards infringement of human dignity caused by being subjects without permission as the crux of the matter irrespective of risks' big and small influences. This research follows perspective of the latter. Forming constant fiduciary relation between investigators (doctors) and subjects (patients) pursuant medical contracts, and in accordance with this fiduciary relation, subjects, who are patients, have expectations of explanations and treatments by the best ways. If doctors and patients set this forth as a premise, doctors should assume civil liability when doctors infringe patients' expectations.

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Nutritional Assessment and Dietary Management during Anti-Cancer Chemotherapy in Pediatric Oncology Patients (항암 화학요법 중인 소아암 환자의 영양 평가 및 식이 관리)

  • Jang, Se-Ri;Kim, Hee-Sun;Lee, Young-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.2 no.2
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    • pp.204-210
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    • 1999
  • Purpose: We assessed the nutritional status and the alterations of oral diets during anti-cancer chemotherapy in pediatric oncology patients. Methods: Twenty children with malignancy were evaluated from day 0 until day 21 of post-chemotherapy. Nutritional status was assessed by body weight and biochemical parameters. The amount and calories of oral diets were assessed and food preference before and during chemotherapy were analysed by questionnelle. Results: 1) The underlying diseases of 20 patients were 11 acute lymphoblastic lekemia, 2 non-Hodgkin's lymphoma, 2 Langerhans cell histiocytosis, 2 Wilm's tumor, 2 brain tumor, 1 rhabdomyosarcoma. 2) There were weight loss during chemotherapy in 8 patients (40.0%), weigt gain in 5 patients (25.0%), and no significant changes in 7 patients (35.0%). 3) Biochemical parameters showed no significant interval changes during chemotherapy except elevation of serum ALT level. 4) The daily caloric intakes of oral diets during chemotherapy were 310~600 Kcal which was much lower than average of daily recommended calory for Korean children. 5) The most favorate food was altered by chemotherapy, from meats to carbonated beverages and unfavorate food was not altered as vegetables. Conclusion: The periodic assessment of nutritional status and dietary supplements according to preferred foods of patients will be required for the optimal nutrition care in cancer patients.

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Evaluation of Uncertainty of IMRT QA Using 2Dimensional Array Detector for Head & Neck Patients (두경부암에서 2차원 배열 검출기를 이용한 IMRT QA의 불확실성에 대한 연구)

  • Ban, Tae-Joon;Lee, Woo-Suk;Kim, Dae-Sup;Baek, Geum-Mun;Kwak, Jung-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.23 no.2
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    • pp.97-102
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    • 2011
  • Purpose: IMRT QA using 2Dimensional array detector is carried out with condition for discrete dose distribution clinically. And it can affect uncertainty of evaluation using gamma method. We analyze gamma index variation according to grid size and suggest validate range of grid size for IMRT QA in Hospital. Materials and Methods: We performed QA using OniPro I'mRT system software version 1.7b on 10 patients (head and neck) for IMRT. The reference dose plane (grid size, 0.1 cm; location, [0, 0, 0]) from RTP was compared with the dose plane that has different grid size (0.1 cm, 0.5 cm, 1.0 cm, 2.0 cm, 4.0 cm) and different location (along Y-axis 0 cm, 0.2 cm, 0.5 cm, 1.0 cm). The gamma index variation was evaluated by observing the level of changes in Gamma pass rate, Average signal, Standard deviation for each case. Results: The average signal for each grid size showed difference levels of 0%, -0.19%, -0.04%, -0.46%, -8.32% and the standard deviation for each grid size showed difference levels of 0%, -0.30%, 1.24%, -0.70%, -7.99%. The gamma pass rate for each grid size showed difference levels of 0%, 0.27%, -1.43%, 5.32%, 5.60%. The gamma evaluation results according to distance in grid size range of 0.1 cm to 1.0 cm showed good agreement with reference condition (grid size 0.1 cm) within 1.5% and over 5% in case of the grid size was greater than 2.0 cm. Conclusion: We recognize that the grid size of gamma evaluation can make errors of IMRT QA. So we have to consider uncertainty of gamma evaluation according to the grid size and apply smaller than 2 cm grid size to reduce error and increase accuracy clinically.

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Conceptual Cost Estimation Model Using by a Parametric Method for High-speed Railroad (매개변수기법을 이용한 고속철도 노반공사의 개략공사비 예측모델)

  • Lee, Young Joo;Jang, Seong Yong
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.31 no.4D
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    • pp.595-601
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    • 2011
  • There is currently applied to the unit cost per a distance (KRW/km) for estimating the conceptual cost of civil work on basic planning stage of high speed railroad. This unit cost is an arithmetic average value based on historical data, which could be in big error. It also is difficult to explain the deficiency comparing the estimated cost derived from next basic design stage. This study provides the conceptual estimation model using by the parametric method and regression analysis. Independent variables are the distance and the geological materials (earth, weathered rock, soft-rock, hard-rock), extracting from the actual data to 36 contracts. The deviation between the unit costs estimated using the developed model and the actual cost data is presented in the range from -0.4% to +31%. This range is acceptable compared the typical range "-30% to + 50%". This model will improve the accuracy of existing method and be expected to contribute to effective total cost management and the economic aspects, reduce the financial expenditure.

Eine vergleichende Betrachtung der Haftungszurechnung im Arztrecht (의료판례에서의 인과성과 책임귀속의 판단 - 독일법원 판결례와의 비교 고찰 -)

  • Ahn, Bup-Young
    • The Korean Society of Law and Medicine
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    • v.14 no.1
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    • pp.147-208
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    • 2013
  • In der vorliegenden Arbeit geht es um die vergleichende Betrachtung von deutschen Urteilen OLG Munchen, Urt. v. 21. 4. 2011 - Az. 1 U 2363/10; BGH, Urt. v. 22. 5. 2012 - VI ZR 157/11) und einer Reihe von koreanischen Urteilen im Bereich des Arzthaftungsrechts. Sie behandelt die Kausalitat von Tatbestand und Rechtswidrigkeitszusammenhang in der normativen Haftungszurechung. In Korea gilt die sog. Adaquanztheorie noch entscheidend als bewertendes Zurechnungskriterium - sogar manchmal als umgangssprachliches Homonym im Sinne der Verh$\ddot{a}$ltnism$\ddot{a}{\ss}$igkeit angewendet -, die dogmengeschichtlich von Deutschland $\ddot{o}$bernommen wurde. Doch wie aus den deutschen Urteilen ersichtlich, ist sie dort schon $\ddot{u}$berwunden. Die Ergebnisse der betrffenden koreanischen Urteile sind zwar nicht unbillig, deren Urteilsbegrundungen aber theoretisch bzw. praktisch nicht $\ddot{u}$berzeugend. Nach allgemeiner Ansicht kommt es vielmehr auf den Schutzzweck an, der auch bei der Anwendung des ${\S}$ 393 KBGB gelten kann. Schlie${\ss}$lich wurde die $\ddot{U}$bertragung des praxisgerechten L$\ddot{o}$sungsansatzes in deutschen Urteilen auf rechtsvergleichende Weise dazu beitragen, die Zivilrechtspraxis in der koreanischen Justiz nachvollziehbarer machen.

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Advances in Hospice and Palliative Care in Japan: A Review Paper

  • Mori, Masanori;Morita, Tatsuya
    • Journal of Hospice and Palliative Care
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    • v.19 no.4
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    • pp.283-291
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    • 2016
  • Over the past decade, hospice and palliative care in Japan have progressed rapidly under the national policies supported by the Cancer Control Act. The numbers of palliative care units/inpatient hospices, hospital palliative care teams, and clinics with a home hospice function have been steadily increasing. The increasing numbers of physicians, nurses, and pharmacists have been certified as specialists in palliative care by national associations. Collaborative efforts have been made to standardize and disseminate educational programs and training opportunities in undergraduate, postgraduate, and continuing medical education. Research activities in Japan have markedly contributed to the growing body of evidence, especially in the fields of terminal delirium, terminal dehydration, palliative sedation, care for dying patients, prognostication, communication, psycho-oncology, and regional palliative care programs. This review focuses on major palliative care settings, specialty, national associations, education, and research in palliative care in Japan.

Cancer Pain Management by Continuous Epidural Morphine Infusion via Subcutaneous Tunneling (경막외 카테터 피하매몰법을 이용한 지속적 모르핀 투여에 의한 말기암 환자의 통증관리)

  • Ryu, Sie Jeong;Choi, Hyung Kyu;Kim, Jun Young;Kim, Doo Sik;Jang, Tae Ho;Kim, Se Hwan;Kim, Kyung Han
    • The Korean Journal of Pain
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    • v.18 no.1
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    • pp.19-22
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    • 2005
  • Background: Most terminal cancer patients suffered from intractable pain. For the treatment of these patients, opioids, via various routes, are usually administered. Continuous epidural opioid, especially morphine, administration is a good method for the management of intractable cancer pain. Methods: We retrospectively analyzed 347 terminal cancer patients, who had been treated with continuous epidural morphine infusion, between 1999 and 2004. For the epidural infusion, an epidural catheter was inserted, tunneled subcutaneously and exited from the anterior chest or abdomen. Multiday $Infursor^{(R)}$ (Baxter, 0.5 ml/h) was used for the continuous infusion. Results: Of the 347 patients studied, there were 211 males and 136 females. The mean treatment time was 54.7 days, ranging from 5 to 481 days. The mean starting and termination doses of morphine were 32.4 (for 5 days) and 100.0 mg, respectively. The doubling time of the morphine dose was 26.3 days, corresponded to a 3.8 percent increase per day. Incidental catheter removal was the most common side effect, which occurred 130 times in 61 cases. Conclusions: The procedure of epidural catheterization, with subcutaneous tunneling, was simple and inexpensive. Despite the disadvantages, such as incidental catheter removal, it is a useful method for the control of terminal cancer pain.

The Evaluation and Fabrication of Photoconductor Sensor for Quality Assurance of Radiation Therapy Devices (방사선치료기기 정도관리를 위한 광도전체 센서 제작 및 평가)

  • Kang, Sang Sik;Noh, Sung Jin;Jung, Bong Jae;Noh, Ci Chul;Park, Ji Koon
    • Journal of the Korean Society of Radiology
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    • v.10 no.8
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    • pp.565-569
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    • 2016
  • Recently, a use of linear accelerator with a multi-leaf collimator(MLC) for radiation therapy is increasing. The importance of quality assurance (QA) for the linear accelerator is emphasized as the side effects of the inaccurate delivery of the radiation beam has been increased according to the high dose irradiation technique. In this study, The $HgI_2$ and $PbI_2$ photoconductor layer samples of $400{\mu}m$ thickness were fabricated using sedimentation method among particle-in-binder technology. From the fabricated samples, the electrical properties(dark current, output current, response properties and linearity) were investigated. From the experimental results, $HgI_2$ has good charge signal generation and linearity. Finally, from the signal response results about various thickness of $HgI_2$ sensor, the signal creation efficiency of $400{\mu}m$ thickness of $HgI_2$ sensor has the highest value and the excellent reproducibility below ${\pm}2.5%$.