• Radiation Oncology Journal
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• v.37 no.3
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• pp.166-175
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• 2019

Purpose: This study aimed to investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors in patients with locally advanced non-small cell lung cancer (NSCLC) who received concurrent chemoradiotherapy (CCRT). Materials and Methods: We retrospectively analyzed 66 patients with locally advanced NSCLC treated with definitive CCRT. Among these patients, 95% received paclitaxel/carboplatin or docetaxel/cisplatin. The median radiation dose was 66 Gy in 33 fractions. The NLR and PLR before/after CCRT were evaluated. The maximally selected log-rank test was used to obtain the cutoff values related to the overall survival (OS). Results: Patients with high post-CCRT NLR (>3.12) showed worse OS, locoregional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS) than those with low NLR (2-year OS: 25.8% vs. 68.2%, p < 0.001; 2-year LRPFS: 12.9% vs. 33.8%, p = 0.010; 2-year DMFS: 22.6% vs. 38.2%, p = 0.030). Patients with high post-CCRT PLR (>141) showed worse OS and LRPFS than those with low PLR (2-year OS: 37.5% vs. 71.1%, p = 0.004; 2-year LRPFS: 16.5% vs. 40.3%, p = 0.040). Patients with high NLR change (>1.61) showed worse OS and LRPFS than those with low NLR change (2-year OS: 26.0% vs. 59.0%, p < 0.001; 2-year LRPFS: 6.8% vs. 31.8%, p = 0.004). The planning target volume (hazard ration [HR] = 2.05, p = 0.028) and NLR change (HR = 3.17, p = 0.025) were the significant factors for OS in the multivariate analysis. Conclusion: NLR change after CCRT was associated with poor prognosis of survival in patients with locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased treatment failure risk.

• Radiation Oncology Journal
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• v.37 no.3
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• pp.224-231
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• 2019

Purpose: To investigate the patterns of recurrence in patients with neuroblastoma treated with radiation therapy to the primary tumor site. Materials and Methods: We retrospectively analyzed patients with high-risk neuroblastoma managed with definitive treatment with radiation therapy to the primary tumor site between January 2003 and June 2017. These patients underwent three-dimensional conformal radiation therapy or intensity-modulated radiation therapy. A total of 14-36 Gy was delivered to the planning target volume, which included the primary tumor bed and the selected metastatic site. The disease stage was determined according to the International Neuroblastoma Staging System (INSS). We evaluated the recurrence pattern (i.e., local or systemic), progression-free survival, and overall survival. Results: A total of 40 patients with high-risk neuroblastoma were included in this study. The median patient age was 4 years (range, 1 to 11 years). Thirty patients (75%) had INSS stage 4 neuroblastoma. At the median follow-up of 58 months, there were 6 cases of local recurrence and 10 cases of systemic recurrence. Among the 6 local failure cases, 4 relapsed adjacent to the radiation field. The other 2 relapsed in the radiation field (i.e., para-aortic and retroperitoneal areas). The main sites of distant metastasis were the bone, lymph nodes, and bone marrow. The 5-year progression-free survival was 70.9% and the 5-year overall survival was 74.3%. Conclusion: Radiation therapy directed at the primary tumor site provides good local control. It seems to be adequate for disease control in patients with high-risk neuroblastoma after chemotherapy and surgical resection.

• Radiation Oncology Journal
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• v.37 no.3
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• pp.176-184
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• 2019

Purpose: It is unclear whether adding concurrent chemotherapy (CT) to definitive radiotherapy (RT) following induction CT is a tolerable and cost effective treatment for non-small-cell lung cancer (NSCLC) patients aged 70 years or older with comorbidities. This study evaluated the actual clinical outcomes between concurrent chemoradiotherapy (CCRT) and RT alone following induction CT or not in patients (≥70 years) in a single institution's clinical practice. Materials and Methods: A total of 82 patients with unresectable stage III NSCLC between 2004 and 2016 were retrospectively analyzed. Their treatment tolerance and clinical outcomes such as overall survival (OS), locoregional recurrence (LRR), treatment toxicities and distant metastasis (DM) were evaluated. Early mortality rates were also evaluated as 4-month mortality after RT. Results: Fifty-four patients received CCRT and 28 patients received RT alone. Induction CT before RT was performed for 68.5% and 50.0% in CCRT and RT alone groups. Treatment tolerance was significantly worse in CCRT (p = 0.046). The median survival was 21.1 and 18.1 months for CCRT and RT alone, which was not statistically significant. LRR and DM were also not different. Most early deaths after CCRT were attributed to non-cancer-related mortality. Acute esophagitis of grade ≥2 occurred more following CCRT (p = 0.017). In multivariate analysis, a Charlson Comorbidity Index (CCI) of ≥5 and a weight loss of ≥5% after RT were associated with poor OS. The factors adversely affecting 4-month survival were a CCI of ≥5 and CCRT. Conclusion: There were no significant differences in OS, LRR, and DM between CCRT and RT alone treatment in elderly patients. However, there was a poorer tolerance and higher incidence of acute esophagitis in the CCRT group. Specifically, when the patients had a CCI of ≥5, RT alone seems to be reasonable with a low probability of early death.

• Journal of Veterinary Clinics
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• v.22 no.1
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• pp.56-59
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• 2005

An about 5-month-old, female rabbit was presented with pruritus, alopecia and mucopurulent ocular discharge. On physical examination mild to moderate scales on whole body were observed. Dermatological lesions such as alopecia, erythema, papules, pustules and crusts were observed in the eyelids, nose, inner pinna, medial sites of four feet, metacarpal and metatarsal areas, and cranial site of left stifle joint. Also, mild conjunctivitis, blepharitis and keratitis were found. For extensive dermatologic diagnostic evaluation skin scraping, tape stripping, impression smear, combing, wood' light, bacterial culture and fungal culture were performed. Finally, Cheyletiella spp. was found by combing. Many heterophils and eosinophills were appeared in impression smear. The result of fungal culture was negative. Pasteurella spp was cultured. Definitive diagnosis of Cheyletiellosis and secondary Pasteurella spp infection were established. The rabbit was treated with 6 mg/kg of selamectin topically every two weeks and restricted in cage for one month. During one month of initial treatment, clinical signs such as pruritus, alopecia, scales, papules, pustules and crusts were remarkably improved. However, in spite of good therapeutic response of selamectin the rabbit was dead suddenly at 22 days after second administration of selamectin. This case showed that selamectin was possibly effective for cheyletiellosis in rabbit; safety of selamectin for rabbit was not identified.

• Journal of Veterinary Clinics
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• v.30 no.4
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• pp.320-323
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• 2013

Spinal cord infarction is becoming recognized as an important cause of acute myelopathy in cats. Although the definitive diagnosis is confirmed through postmortem histopathologic examination, MR imaging features provide valuable informations for the diagnosis of spinal cord infarction. The aim of this report is to describe MR findings of acute spinal cord infarction in two cats and to evaluate usefulness of low field MRI (0.3Tesla) as a potential diagnostic tool of acute spinal cord infarction. A cat (unknown age, neutered male mixed breed cat) was referred one day after the acute onset of non-ambulatory spastic tetraparesis and the other cat (a 9-year-old, neutered female domestic short hair cat) was presented due to the acute onset of non-ambulatory paraparesis and one day later paraplegia. The lesions of the MR images were shown on the spinal cord parenchyma over C2 to C6 in case 1 and L2 to L5 in case 2. The MR images in these two cases were characterized by focal intramedullary lesions, mainly involving grey matter which were hyperintense T2 weighted and FLAIR images and hyperintense on DWI and hypointense on ADC map. The MR findings in both cases were highly suggestive of acute spinal cord infarctions, based upon previous reported small animal cases and human cases. In conclusion, based on MR features, together with the history and clinical examination findings, MRI modality can be used as an antemortem tool for the diagnosis of acute spinal cord infarction in cats.

• Parasites, Hosts and Diseases
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• v.26 no.3
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• pp.179-188
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• 1988

The life cycle of Fibricola seoulensis was studied in the laboratory and in the field, with special interests in the larval developments within the eggs and in the intermediate hosts. The first emergence of miracidia after incubation of eggs in 26C water began on the ninth day. The miracidia, elongate and cylindrical shape, had epidermal plates in the formula of 6, 9, 4 and 3, with two pairs of flame cells and lateral processes. A kind of fresh water snail, Hippeutis (H.) cantori, was found to shed furcocercous cercariae from the 13th day after experimental challenge with miracidia while Physa acute failed to shed. The same kind of snail collected from the field also shed the same cercariae. The cercariae were equipped with 2 pairs of penetration glands and 5 pairs of fame cells. The tadpoles of Rana nigromaculata were found susceptible to experimental infection with the cercariae. The same kind of tadpoles collected from various areas were also found naturally infected. The metacercariae in the tadpoles which were infected experimentally became infective to the definitive host in 21 days. The metacercariae were located free in the body cavity of tadpoles, and attained sexual maturity in rats in 7 days. The present study successfully followed the complete life cycle of F. seoulensis and found that it is possible to maintain the life cycle in the laboratory.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.63-67
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• 2010

Purpose: A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches. Methods: The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm. Results: The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60). Conclusion: The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.321-330
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• 1993

Purpose: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. Method and Materials: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinoma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years (range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range or 2 to 150 days (median in days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose (ED) model, $ED=D{\dot}N^{-0.377}{\dot}T^{-0.058}$ was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. Result: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic changes consistent with radiation pneumonitis were seen in $100\%$ of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced change between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy No correlation was seen between incidence of radiation pneumonitis and age or sex. Conclusions: The occurrence of radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.

• The Korean Society of Law and Medicine
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• v.20 no.2
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• pp.83-107
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• 2019

This article focuses on §10 of Criminal Act of the Republic of Korea to discuss how to determine criminal responsibility of a perpetrator suffering from mental disorders, while reviewing existing process and standards of mental examination at each stage of the criminal procedure as well as exploring suggestions regarding how they should be complied. The determination of the sanity or criminal responsibility of the mentally ill as defined in the §10 of Criminal Act, by its nature, cannot be approached with a traditional, clear-cut dichotomy of biology by medical practitioner and psychology·normative science by lawyer. Looking into the actual procedure of determining mental and physical disorder with special consideration of mental illness reveals the inevitability of collaboration between lawyers and psychiatrists. In the meantime, the process and standards of mental examination at each stage of the criminal procedure must be definitive and clear. First of all, during the investigation stage, examination prior to prosecution should be more actively encouraged, considering that judging sanity of the perpetrator at the time of committing a criminal act is important. During the trial stage, the mandatory examination must be conducted depending on the sensitivity and gravity of the case. Next, medical examination to determine criminal responsibility and the one to order treatment and custody must be separately conducted in order to properly execute medical treatment and custody. Obligatory mental examination could be considered both during the stage of request for and execution of the treatment and custody. Lastly, the procedure of examination and format of examination documents need to be standardized for better objectivity and reliability.

• Toxicological Research
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• v.6 no.2
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• pp.205-213
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• 1990

The regulation of neurotoxicants has usually been based upon setting reference doses by dividing a no observed adverse effect level (NOAEL) by uncertainty factors that theoretically account for interspecies and intraspecies extraploation of experimental results in animals to humans. Recently, we have proposed a four-step alternative procedure which provides quantitative estimates of risk as a function of dose. The first step is to establish a mathematical relationship between a biological effect or biomarker and the dose of chemical administered. The second step is to determine the distribution (variability) of individual measurements of biological effects or their biomarkers about the dose response curve. The third step is to define an adverse or abnormal level of a biological effect or biomarker in an untreated population. The fourth and final step is to combine the information from the first three steps to estimate the risk (proportion of individuals exceeding on adverse or abnormal level of a biological effect or biomarker) as a function of dose. The primary purpose of this report is to enhance the certainty of the first step of this procedure by improving our understanding of the relationship between a biomarker and dose of administered chemical. Several factors which need to be considered include: 1) the pharmacokinetics of the parent chemical, 2) the target tissue concentrations of the parent chemical or its bioactivated proximate toxicant, 3) the uptake kinetics of the parent chemical or metabolite into the target cell(s) and/or membrane interactions, and 4) the interaction of the chemical or metabolite with presumed receptor site(s). Because these theoretical factors each contain a saturable step due to definitive amounts of required enzyme, reuptake or receptor site(s), a nonlinear, saturable dose-response curve would be predicted. In order to exemplify this process, effects of the neurotoxicant, methlenedioxymethamphetamine (MDMA), were reviewed and analyzed. Our results and those of others indicate that: 1) peak concentrations of MDMA and metabolites are ochieved in rat brain by 30 min and are negligible by 24 hr, 2) a metabolite of MDMA is probably responsible for its neurotoxic effects, and 3) pretreatment with monoamine uptake blockers prevents MDMA neurotoxicity. When data generated from rats administerde MDMA were plotted as bilolgical effect (decreases in hippocampal serotonin concentrations) versus dose, a saturation curve best described the observed relationship. These results support the hypothesis that at least one saturable step is involved in MDMA neurotoxicity. We conclude that the mathematical relationship between biological effect and dose of MDMA, the first step of our quantitative neurotoxicity risk assessment procedure, should reflect this biological model information generated from the whole of the dose-response curve.