• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.37-52
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• 2022

Purpose : The purpose of this meta-analysis was to evaluate the effects of electrical stimulation on patients with non-specific low back pain. Methods : Domestic databases were gathered from studies that conducted clinical trials associated with electrical stimulation and its impact on pain of non-specific low back patients. A total of 681 studies were identified, with 12 studies satisfying the inclusion data. The studies consisted of patient, intervention, comparison, outcome, and study design (PICO-SD). The search outcomes were items associated with low back pain. Cochrane risk of bias 2 (RoB 2) was used to evaluate the quality of 12 randomized controlled trials. Effect sizes (Hedges's g) in this study were computed as the corrected standard mean difference (SMD). A random-effect model was used to analyze the effect size because of the high heterogeneity among the studies. Egger's regression and 'trim-and-fill' tests were carried out to analyze the publication bias. Cumulative meta-analysis and sensitivity analysis were conducted to analyze the effect according to the sample size and the consistency of the effect size. Results : The following factors had a large overall effect size (Hedges's g=1.28, 95 % CI=.20~2.36) involving electrical stimulation on non-specific low back pain. The subgroup analysis all showed a statistical difference in the types of study design, electrical stimulation, and assessment tool. No statistically significant difference was found in the meta-regression analysis. Publican bias was found in the data. Conclusion : The findings in this study indicate that electrical stimulation interventions have a positive effect on patients with non-specific low back pain. However, due to the low quality of studies and publication bias, the results of our study should be interpreted cautiously.

• Journal of Korean Neurosurgical Society
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• v.66 no.5
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• pp.562-572
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• 2023

Objective : Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. Methods : Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. Results : Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. Conclusion : The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.

• Korean journal of aerospace and environmental medicine
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• v.29 no.3
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• pp.96-100
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• 2019

The present study analyzed all of exotic malaria (EM) cases reported in the Republic of Korea (Korea) and Japan from 2015 to 2017 to assess the trends of incidence overtime to review the risk factors for travelers visiting malaria-endemic countries. We investigated 162 cases of EM in Korea with a cumulative incidence rate (CIR) of 0.105 per 100,000 populations nationwide and the CIR of the oversea travelers was 0.238 per 100,000 travelers, respectively. During the same period in Japan, 152 cases of EM in nationwide with a CIR of 0.041 and in the oversea travelers with a CIR of 0.297 were observed. When compared, the CIR of EM in nationwide was much higher than that in Japan (P<0.01), but a CIR of imported by travelers in Korea was lower than that in Japan (P<0.01).

• KSCE Journal of Civil and Environmental Engineering Research
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• v.29 no.2B
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• pp.155-162
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• 2009

Univariate frequency analyses are widely used in practical hydrologic design. However, a storm event is usually characterized by amount, intensity, and duration of the storm. To fully understand these characteristics and to use them appropriately in hydrologic design, a multivariate statistical approach is necessary. This study applied a Gumbel mixed model to a bivariate storm frequency analysis using hourly rainfall data collected for 46 years at the Seoul rainfall gauge station in Korea. This study estimated bivariate return periods of a storm such as joint return periods and conditional return periods based on the estimation of joint cumulative distribution functions of storm characteristics. These information on statistical behaviors of a storm can be of great usefulness in the analysis and assessment of the risk associated with hydrologic design problems.

• Proceedings of the Korea Water Resources Association Conference
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• 2022.05a
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• pp.516-516
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• 2022

Agricultural reservoirs are critical water resources structures to ensure continuous water supplies for rice cultivation in Korea. Climate change has increased the risk of reservoir failure by exacerbating discrepancies in upstream runoff generation, downstream irrigation water demands, and evaporation losses. In this study, the variations in water balance components of 400 major reservoirs during 1973-2017 were examined to identify the reservoirs with reliable storage capacities and resilience. A conceptual lumped hydrological model was used to transform the incident rainfall into the inflows entering the reservoirs and the paddy water balance model was used to estimate the irrigation water demand. Historical climate data analysis showed a sharp warming gradient during the last 45 years that was particularly evident in the central and southern regions of the country, which were also the main agricultural areas with high reservoir density. We noted a country-wide progressive increase in average annual cumulative rainfall, but the forcing mechanism of the rainfall increment and its spatial-temporal trends were not fully understood. Climate warming resulted in a significant increase in irrigation water demand, while heavy rains increased runoff generation in the reservoir watersheds. Most reservoirs had reliable storage capacities to meet the demands of a 10-year return frequency drought but the resilience of reservoirs gradually declined over time. This suggests that the recovery time of reservoirs from the failure state had increased which also signifies that the duration of the dry season has been prolonged while the wet season has become shorter and/or more intense. The watershed-irrigated area ratio (W-I_ratio) was critical and the results showed that a slight disruption in reservoir water balance under the influence of future climate change would seriously compromise the performance of reservoirs with W-I_ratio< 5.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.458-466
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• 2024

Objective : Several clinical studies have explored the feasibility and efficacy of radiosurgical treatment for mesial temporal lobe epilepsy, but the long-term safety of this treatment has not been fully characterized. This study aims to report and describe radiation-induced cavernous malformation as a delayed complication of radiosurgery in epilepsy patients. Methods : The series includes 20 patients with mesial temporal lobe epilepsy who underwent Gamma Knife radiosurgery (GKRS). The majority received a prescribed isodose of 24 Gy as an adjuvant treatment after anterior temporal lobectomy. Results : In this series, we identified radiation-induced cavernous malformation in three patients, resulting in a cumulative incidence of 18.4% (95% confidence interval, 6.3% to 47.0%) at an 8-year follow-up. These late sequelae of vascular malformation occurred between 6.9 and 7.6 years after GKRS, manifesting later than other delayed radiation-induced changes, such as radiation necrosis. Neurological symptoms attributed to intracranial hypertension were present in those three cases involving cavernous malformation. Of these, two cases, which initially exhibited an insufficient response to radiosurgery, ultimately demonstrated seizure remission following the successful microsurgical resection of the cavernous malformation. Conclusion : All things considered, the development of radiation-induced cavernous malformation is not uncommon in this population and should be acknowledged as a potential long-term complication. Microsurgical resection of cavernous malformation can be preferentially considered in cases where the initial seizure outcome after GKRS is unsatisfactory.

• Korean Journal of Radiology
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• v.20 no.5
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• pp.844-853
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• 2019

Objective: To evaluate the learning curve for C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous transthoracic needle biopsy (PTNB) and to determine the amount of experience needed to develop appropriate skills for this procedure using cumulative summation (CUSUM). Materials and Methods: We retrospectively reviewed 2042 CBCT virtual navigation-guided PTNBs performed by 7 novice operators between March 2011 and December 2014. Learning curves for CBCT virtual navigation-guided PTNB with respect to its diagnostic performance and the occurrence of biopsy-related pneumothorax were analyzed using standard and risk-adjusted CUSUM (RA-CUSUM). Acceptable failure rates were determined as 0.06 for diagnostic failure and 0.25 for PTNB-related pneumothorax. Results: Standard CUSUM indicated that 6 of the 7 operators achieved an acceptable diagnostic failure rate after a median of 105 PTNB procedures (95% confidence interval [CI], 14-240), and 6 of the operators achieved acceptable pneumothorax occurrence rate after a median of 79 PTNB procedures (95% CI, 27-155). RA-CUSUM showed that 93 (95% CI, 39-142) and 80 (95% CI, 38-127) PTNB procedures were required to achieve acceptable diagnostic performance and pneumothorax occurrence, respectively. Conclusion: The novice operators' skills in performing CBCT virtual navigation-guided PTNBs improved with increasing experience over a wide range of learning periods.

• Journal of the Korean Society of Radiology
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• v.14 no.2
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• pp.105-109
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• 2020

Intensity-modulated radiotherapy(IMRT) has disadvantages such as increasing the low doses of irradiation to normal tissues and accumulated dose for the whole volume by leakage and transmission of the Multi Leaf Collimator (MLC). The accumulated dose and low dose may increase the occurrence of secondary malignant neoplasms. For this reasons, the jaw tracking function of the TrueBeam (Varian Medical Systems, Palo Alto, CA) was developed to reduce the leakage and transmission dose of the MLC with existing linear accelerators. But quantitative analysis of the dose reduction has not been verified. Therefore, in the present study, we intended to verify the clinical possibility of utilizing the jaw tracking function in brain tumor with comparison of treatment plans. To accomplish this, 3 types of original treatment plans were made using Eclipse11 (Varian Medical Systems, Palo Alto, CA): 1) beyond 2 cm distance from the Organs At Risk (OARs); 2) within 2 cm distance from the OARs; and 3) intersecting with the OARs. Jaw tracking treatment plans were also made with copies of the original treatment planning using Smart LMC Version 11.0.31 (Varian Medical Systems, Palo Alto, CA). A comparison between the 2 types of treatment planning methods was performed using the difference of the mean dose and maximum dose to the OARs in cumulative Dose Volume Histogram (DVH). In the DVH comparison, the maximum difference of 0.5 % was observed between the planning methods in the case of over 2 cm distance, and the maximum of 0.6 % was obtained for within the 2 cm distance. For the case intersecting with the OAR, the maximum difference of 2 % was achieved. According to these results, it could be realized that the differences of mean dose and maximum dose to the OARs was larger when the OARs and PTV were closer. Therefore, treatment plans with the jaw tracking function consistently affected the dose reduction and the clinical possibility could be verified.

• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.15-21
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• 2003

Background : There are many risk factors for osteoporosis in patients with chronic obstructive pulmonary disease(COPD). These include smoking, a low body mass index, insufficient exercise, and the use of glucocortcoids. However, there is lack of data on the incidence of osteoporosis according to the different glucocorticoid administration methods in patients with COPD. This study compared the incidence of osteoporosis according to the different administration methods of glucocorticoid. Methods : A matched case-controlled study (gender, age, cumulative steroid dose and pack-years of smoking) was conducted. Forty-five patients with documented COPD for at least a 3 year duration and a cumulative glucocorticoid dose above 1,000 mg were enrolled in study. The patients were classified into the following three groups. First, fifteen patients received continuous inhaled glucocorticoid with intermittent oral steroids but had no admission history due to an acute exacerbation(Group I). Secondly, fifteen patients received a multiple course of oral steroids with additional inhaled glucocorticoid but had no admission history due to their acute exacerbation(Group II). Lastly, fifteen patients received intermittent oral or inhaled glucocorticoids and had an admission history due to the acute exacerbation with intravenous steroid treatment for at least 2 weeks per year(Group III). The enrolled patients had apulmonary function test and bone densitometry performed at the lumbar spine and femoral neck. Results : The patients from Group III had significantly high incidence of osteoporosis in the lumbar and femoral neck compared to Group I and Group II (p<0.01). Conclusion : The incidence of osteoporosis in patients with COPD appears to be strongly affected by the method of steroid administration. This result suggests that intravenous steroid administration is strongly associated with the risk of osteoporosis.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.1
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• pp.8-17
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• 2019

Purpose: The study analyzed the prevalence of peri-implantitis and factors which may have affected the disease. Materials and methods: This study based on medical records and radiographs of 422 patients (853 implant cases) who visited Ewha Womans University Mokdong Hospital Dental Center from January 1, 2012 to December 31, 2016. Generalized estimation equations (GEE) was utilized to determine the statistical relationship between peri-implantitis and each element, and the cumulative prevalence of peri-implantitis during the observation period was obtained by using the Kaplan Meier Method. Results: The prevalence rate of peri-implantitis at the patient level resulted in 7.3% (31 patients out of a total of 422 patients), and at the implant level 5.5% (47 implants out of a total of 853 implants). Sex, GBR, guided bone regeneration (GBR) and functional loading periods had statistical significance with the occurrence of peri-implantitis. Upon analysis of the cumulative prevalence of peri-implantitis in terms of implant follow-up period, the first case of peri-implantitis occurred at 9 months after the placement of an implant, and the prevalence of peri-implantitis showed a non-linear rise over time without a hint of a critical point. Conclusion: The prevalence of peri-implantitis at the patient level and the implant were 7.3% and 5.5%, respectively. Male, implant installed with GBR and longer Functional Loading Periods were related with the risk of peri-implantitis.