• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.135-142
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• 2020

Purpose: This paper presents the long term follow-up results of arthroscopic partial repair for massive irreparable rotator cuff tears using a biceps long head auto graft. Materials and Methods: Forty-one patients with massive irreparable rotator cuff tear, who underwent arthroscopic repair, were reviewed retrospectively. Patients who underwent arthroscopic partial repair using a biceps long head auto graft were assigned to group 1, and patients in group 2 underwent arthroscopic partial repair alone. Patients with a less than 50% partial tear of the long head biceps tendon were included in this study. The clinical scores were measured using a visual analogue pain scale (VAS) for pain, range of motion (ROM), The University of California, Los Angeles shoulder score (UCLA), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Korean Shoulder Scoring System (KSS) scores preoperatively and at the final follow-up. The acromiohumeral interval (AHI) was measured using plain radiographs taken preoperatively and at the final follow-up, and re-tear was evaluated using postoperative ultrasound or magnetic resonance imaging at the last follow-up. Results: The mean age of the patients was 62.1±12.7 years, and the mean follow-up period was 90.3±16.8 months. No significant differences in the VAS and ROM (forward flexion, external rotation, internal rotation) were found between the two groups (p=0.179, p=0.129, p=0.098, p=0.155, respectively). The UCLA (p=0.041), ASES (p=0.023), and KSS (p=0.019) scores showed functional improvements in group 1 compared to group 2. At the last follow-up, the measured AHI values were 9.46±0.41 mm and 6.86±0.64 mm in group 1 and 2, respectively (p=0.032). Re-tear was observed in six out of 21 cases (28.6%) in group 1 and nine out of 20 cases (45.0%) in group 2; the retear rate was significantly lower in group 1 than in group 2 (p=0.011). Conclusion: Arthroscopic partial repair for a massive irreparable rotator cuff tear using a biceps long head auto graft has significant clinical usefulness in functional recovery and decreases the re-tear rates after surgery than arthroscopic partial repair alone, showing favorable results after a long-term follow-up.

• Journal of Korea Water Resources Association
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• v.56 no.4
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• pp.235-243
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• 2023

Due to the revision of the River Act and the enactment of the Act on the Investigation, Planning, and Management of Water Resources, a regular bed change survey has become mandatory and a system is being prepared such that local governments can manage water resources in a planned manner. Since the topography of a bed cannot be measured directly, it is indirectly measured via contact-type depth measurements such as level survey or using an echo sounder, which features a low spatial resolution and does not allow continuous surveying owing to constraints in data acquisition. Therefore, a depth measurement method using remote sensing-LiDAR or hyperspectral imaging-has recently been developed, which allows a wider area survey than the contact-type method as it acquires hyperspectral images from a lightweight hyperspectral sensor mounted on a frequently operating drone and by applying the optimal bandwidth ratio search algorithm to estimate the depth. In the existing hyperspectral remote sensing technique, specific physical quantities are analyzed after matching the hyperspectral image acquired by the drone's path to the image of a surface unit. Previous studies focus primarily on the application of this technology to measure the bathymetry of sandy rivers, whereas bed materials are rarely evaluated. In this study, the existing hyperspectral image-based water depth estimation technique is applied to rivers with vegetation, whereas spatio-temporal hyperspectral imaging and cross-sectional hyperspectral imaging are performed for two cases in the same area before and after vegetation is removed. The result shows that the water depth estimation in the absence of vegetation is more accurate, and in the presence of vegetation, the water depth is estimated by recognizing the height of vegetation as the bottom. In addition, highly accurate water depth estimation is achieved not only in conventional cross-sectional hyperspectral imaging, but also in spatio-temporal hyperspectral imaging. As such, the possibility of monitoring bed fluctuations (water depth fluctuation) using spatio-temporal hyperspectral imaging is confirmed.

• Tuberculosis and Respiratory Diseases
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• v.55 no.1
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• pp.69-87
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• 2003

Background : LB20304(gemifloxacin) is a new fluoroquinolone antibacterial agent with excellent activity against both Gram-negative and Gram-positive organisms. In vitro studies using clinical isolates have shown gemifloxacin to be highly active against penicillin-resistant strains of S. pneumoniae and in contrast to other reference quinolones, gemifloxacin retained good activity against clinical isolates of S. pneumoniae that were resistant to other members of the quinolone class. Therefore, gemifloxacin is thought to be effective in treating acute bacterial exacerbation of chronic bronchitis(AECB). The objective of this study was to evaluate the efficacy and safety of oral gemifloxacin at doses of 160mg or 320mg once daily for 7 days for the treatment of AECB in Korean adult population. Methods : This was a randomized, multicenter, double-blind, parallel group Phase II study to assess the clinical and antibacterial efficacy and safety of oral gemifloxacin for the treatment of AECB. Treatment Group A (67 patients) took oral gemifloxacin 160mg once daily for seven days and treatment Group B (70 patients) took oral gemifloxacin 320mg once daily for seven days. Results : The demographic profiles of the two treatment groups were similar. The clinical response at follow-up was 84.2% in the gemifloxacin 160-mg group, and 88.7% in the gemifloxacin-320 mg group, showing no statistically significant difference between two treatment groups(p=0.49). The clinical response at the end of therapy was 96.5% in the 160-mg group, and 96.4% in the 320-mg group. The bacteriological response at the end of therapy and follow-up were 81.8% and 78.9%, respectively, in the 160-mg group, and 86.4% and 84.2%, respectively, in the 320-mg group, showing no statistically significant difference between two treatment groups(p=0.68 and 0.68, respectively). S. pneumoniae(12 isolates) and H. influenzae(10 isolates) were the most prevalent pathogens. The MICs were lower for gemifloxacin than other quinolones against these key pathogens, and for S. pneumoniae, the MICs for gemifloxacin were considerably lower(${\leq}0.03$ ug/mL) than those for other quinolones, beta-lactams and macrolides. In the period on-therapy plus 30 days post-therapy, a total of 18 patients(26.9%) in the gemifloxacin 160mg group and 22 patients(31.4%) in the 320mg group reported at least one adverse event(AE). The most frequently reported AE was abdominal pain(3/67 patients, 4.5%) in the gemifloxacin 160mg group and increased level of hepatic enzyme(5/70 patients, 7.1%) in the 320mg group. The overall AE profiles for the two treatment groups were similar. Two out of 67 patients(3.0%) in the gemifloxacin 160mg group and 1/70 patients(1.4%) in the 320mg group reported at least one serious AE, however, none of which was considered by the investigator to be of suspected or probable relationship to study medication. Conclusion : The results of this study showed that gemifloxacin at doses of 160mg or 320mg once daily for 7 days in the treatment of acute exacerbations of chronic bronchitis(AECB) in adult Koreans was a very effective and safe treatment both clinically and bacteriologically.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.35 no.3
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• pp.41-66
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• 2017

The purpose of this research is to empirically trace the junctures of Yigye-gugok managed by Gwan-am Hong Gyeong-mo, a grandson of Yigye Hong Yang-ho who originally designed Yigye-gugok, while reviewing the features of the forms and patterns of gugok. The results of the research are as follows. 1. Ui-dong was part of the domain of the capital during the Chosun dynasty, which also is located in the city of Seoul as a matter of administrative zone. Likewisely, Yigye-gugok is taken as a special meaning for it was one and only gugok. Starting with Mangyeong Waterfall as the $1^{st}$ gok, Yigye follows through the $2^{nd}$ gok of Jeokchwibyeong Rock, the $3^{rd}$ gok of Chanunbong Peak, the $4^{th}$ gok of Jinuigang Rock, the $5^{th}$ gok of Okkyeongdae Rock, the $6^{th}$ gok of Wolyeongdam Pond, the $7^{th}$ gok of Tagyeongam Rock, the $8^{th}$ gok of Myeongoktan Stream, and the $9^{th}$ gok of Jaeganjeong Pavilion. Of these, Mangyeong Waterfall, Chanunbong Peak, and Okkyeongdae Rock are distinct for their locations in as much as their features, while estimated locations for Jinuigang Rock, Wolyeongdam Pond, Myeongoktan Stream, and Jaeganjeong Pavilion were discovered. However, Jeokchwibyeong Rock and Tagyeongam Rock demonstrated multiple locations in close resemblance to documentary literatures within secretive proximity, whereas geography, scenery, and sighted objects were considered to evaluate the 1st estimated location. Through these endeavored, it was possible to identify the shipping routes and structures for the total distance of 2.1km running from the $1^{st}$ gok to the $9^{th}$ gok, which nears Gwanam's description of 5ri(里), or approximately 1.96km for gugok. 2. Set towards the end of the $18^{th}$ century, Yigye-gugok originated from a series of work shaping the space of Hong Yang-ho's tomb into a space for the family. Comparing Yigye-gugok to other gugoks, numerous differences are apparent from beyond the rather more general format such as adjoining the $8^{th}$ gok while paving through the lower directions from the upper directions of the water. This gives rises to the interpretation such that Yigye-gugok was positioned to separate the doman of the family from those of the other families in power, thereby taking over Ui-dong. Yet, the aspect of the possession of the space lends itself to the determination that the location positioned at the $8^{th}$ gok above Mangyeongpok Waterfall representing Wooyi-dong was a consequence of the centrifugal space creation efforts. 3. While writings and poetic works were manufactured in such large quantities in Yigye-gugok whose products of setters and managers seemed intended towards gugok-do and letters carved on the rocks among others, there is yet a tremendous lack of visual media in the same respect. 'Yigye-gugok Daejacheop' Specimens of Handwriting offers the traces of Gwanam's attempts to engrave gakja at the food of Yigye-gugok. This research was able to ascertain that 'Yigye-gugok Daejacheop' Specimens of Handwriting was a product of Hong Yang-ho's collections maintained under the auspices of the National Central Museum, which are renowned for Song Shi-yeol's penmanship.

• Tuberculosis and Respiratory Diseases
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• v.55 no.2
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• pp.140-153
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• 2003

Background : The cell-mediated immune reaction to tuberculosis infection involves a complex network of cytokines. The extent of inflammation, tissue damage and severity of the disease suggested to be determined by the balance between extent and duration of the proinflammatory cytokine response versus those of the suppressive cytokines. The systemic cytokine response in pathogenesis of tuberculosis can be assessed by measuring serum cytokine levels. Method : Serum interleukin-1 beta(IL-$1{\beta}$), IL-2, IL-4, IL-6, IL-10, IL-12(p40), tumor necrosis factor-alpha(TNF-${\alpha}$), interferon-gamma(IFN-${\gamma}$) and transforming growth factor-beta(TGF-${\beta}$) levels were measured in 83 patients with pulmonary tuberculosis, 10 patients with endobronchial tuberculosis before treatment and 20 healthy subjects by using a sandwich ELISA. In patients with pulmonary tuberculosis, they were divided into mild, moderate and far advanced group according to the severity by ATS guidelines. To compare with those of pretreatment levels, we measured serum IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-10, IL-12(p40), TNF-${\alpha}$, IFN-${\gamma}$ and TGF-${\beta}$ levels in 45 of 83 patients with pulmonary tuberculosis after 2 and 6 months of treatment. Results : 1) In sera of patients with active pulmonary tuberculosis(n=83), IL-$1{\beta}$, IL-6(p<0.05), TNF-${\alpha}$, and IFN-${\gamma}$ were elevated and TGF-${\beta}$ was decreased comparing to control. IL-2, Il-12(p40), IL-4 and IL-10 were similar between the patients with tuberculosis and control. 2) In endobronchial tuberculosis, IL-6 and TNF-${\alpha}$ were elevated and TGF-${\beta}$ was decreased comparing to control. IL-12(p40) seemed to be elevated comparing to pulmonary tuberculosis. 3) Far advanced tuberculosis showed markedly elevated IL-6 and IFN-${\gamma}$ level(p<0.05). 4) The significant correlations were noted between IL-1, IL-6 AND TNF-${\alpha}$ and between IL-12, Il-2 and IL-4(p<0.01). 5) After 2 and 6 months of standard treatment, the level of IL-6 and IFN-${\gamma}$ was significantly decreased(p<0.05). Conclusion : These results showed that an altered balance between cytokines is likely to be involved in the extent of inflammation, tissue damage and severity of the disease tuberculosis. But, it should be considered diversities of cytokine response according to type of tuberculosis and immunity in clinical application and interpreting future studies.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.428-437
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• 2000

Background : Five year survival rate of postoperative stage I non-small cell lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and the overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, the patterns and factors for postoperative recurrence in patients with staged I and II NSCLC were studied. Method : A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I and II NSCLC. All patients who were followed up for at least one year were included in this study. Results : 1) There were 177 men and 57 women The median age was 63. The median duration of the follow up period was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5%, and the recurrence occurred $358.8{\pm}239.8$ days after operation. 2) The ages of recurred NSCLC patients were higher ($63.2{\pm}8.8$ years) than those of non-recurred patients ($60.3{\pm}9.8$ years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%) NSCLC p<0.001. The size of primary lung mass was larger in recurred ($5.45{\pm}3.22\;cm$) than that of non-recurred NSCLC ($3.74{\pm}1.75\;cm$, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumor was less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was higher in females and in cases of adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than in those with squamous cell carcinoma (p=0.024). Conclusion: The tumor size and stage were two important factors for determining the possibility of a recurrence. Because distant brain metastasis was more frequent in patients with adenocarinoma, a prospective study should be conducted to evaluate the effectiveness of preoperative brain imaging.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.280-289
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• 1997

Background : Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings ; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment. BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. Methods : We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. Results : Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were $T_1N_0N_0$ in 8 patients and $T_2N_0M_0$ in 3 patients. Conclusion : Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.

• Korean Journal of Environmental Agriculture
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• v.37 no.4
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• pp.291-301
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• 2018

BACKGROUND: Rice is one of the main sources for inorganic arsenic among the consumed crops in the world population's diet. Arsenic is classified into Group 1 as it is carcinogenic for humans, according to the IARC. This study was carried out to assess dietary exposure risk of inorganic arsenic in husked rice and polished rice to the Korean population health. METHODS AND RESULTS: Total arsenic was determined using microwave device and ICP-MS. Inorganic arsenic was determined by ICP-MS coupled with HPLC system. The HPLC-ICP-MS analysis was optimized based on the limit of detection, limit of quantitation, and recovery ratio to be $0.73-1.24{\mu}g/kg$, $2.41-4.09{\mu}g/kg$, and 96.5-98.9%, respectively. The inorganic arsenic concentrations of daily exposure (included in body weight) were $4.97{\times}10^{-3}$ (${\geq}20$ years old) $-1.36{\times}10^{-2}$ (${\leq}2$ years old) ${\mu}g/kg\;b.w./day$ (PTWI 0.23-0.63%) by the husked rice, and $1.39{\times}10^{-1}$ (${\geq}20$ years old) $-3.21{\times}10^{-1}$ (${\leq}2$ years old) ${\mu}g/kg\;b.w./day$ (PTWI 6.47-15.00%) by the polished rice. CONCLUSION: The levels of overall exposure to total and inorganic arsenic by the husked and polished rice were far lower than the recommended levels of The Joint FAO/WHO Expert Committee on Food Additives (JECFA), indicating of little possibility of risk.

• Korean Journal of Heritage: History & Science
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• v.45 no.4
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• pp.140-157
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• 2012

The result of a study on the useful trend of plants related to landscape and how to plant and cultivate through 'ImwonGyeongjaeji Manhakji'of Seoyugu is as follows: First, 'ImwonGyeongjaiji Manhakji', composed of total 5 volumes (General, Fruit trees, vegetables and creeper, plants, others) is a representative literature related to landscape which described the names of plants and varieties, soil condition, how to plant and cultivate, graft, how to prevent the insect attack etc systematically. Second, he recorded the tree planting as Jongjae(種栽) or Jaesik(栽植), and the period to plant the trees as Jaesusihoo(栽樹時候), transplanting as Yijae(移栽), making the fence as Jakwonri(作園籬), the names of varietieis as Myeongpoom(名品), the suitable soil as Toeui(土宜), planting and cultivation as Jongye(種藝), treatment as Euichi(醫治), protection and breeding as Hoyang(護養), garden as Jeongwon(庭園) or Wonpo(園圃), garden manager as Poja(圃者) or Wonjeong(園丁). Third, the appearance frequency of plants was analyzed in the order of flowers, fruits, trees, and creepers and it showed that the gravity of deciduous trees was 3.7 times higher than that of evergreen trees. The preference of flower and trees, fruit trees and deciduous trees and broad-leaved trees includes (1) application of the species of naturally growing trees which are harmonized with the natural environment (2) Aesthetic value which enables to enjoy the beauty of season, (3) the trend of public welfare to take the flowers and fruits, (4) the use of symbolic elements based on the value reference of Neo-Confucianism etc. Fourth, he suggested the optimal planting period as January(上時) and emphasized to transplant by adding lots of fertile soil and cover up the seeds with soil as high as they are buried in accordance with the growing direction and protect them with a support. That is, considering the fact that he described the optimal planting period as January by lunar calendar, this suggests the hints in judging the planting period today. For planting the seeds, he recommended the depth with 1 chi(寸 : approx. 3.3cm), and for planting a cutting, he recommended to plant the finger-thick branch with depth 5 chi(approx. 16.5cm) between January and February. In case of graft of fruit trees, he described that if used the branch stretched to the south, you would get a lot of fruit and if cut the branches in January, the fruits would be appetizing and bigger. Fifth, the hedge(fence tree) is made by seeding the Jujube tree(Zizyphus jujuba var. inermis) in autumn densely and transplanting the jujube tree with 1 ja(尺 : approx. 30cm) interval in a row in next autumn and then binding them with the height of 7 ja(approx. 210cm) in the spring of next year. If planted by mixing a Elm tree(Ulmus davidiana var. japonica) and a Willow(Salix koreensis), the hedge whose branch and leaves are unique and beautiful like a grating can be made. For the hedge(fence tree), he recommended Trifoliolate orange(Poncitus trifoliata), Rose of sharon(Hibiscus syriacus), Willow(Salix koreensis), Spindle tree(Euonymus japonica), Cherry tree(Prunus tomentosa), Acanthopanax tree(Acanthopanax sessiliflorus), Japanese apricot tree(Prunus mume), Chinese wolf berry(Lycium chinense), Cornelian tree(Cornus officinalis), Gardenia(Gardenia jasminoides for. Grandiflora), Mulberry(Morus alba), Wild rosebush(Rosa multiflora) etc.

• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.