• Journal of Food Hygiene and Safety
• /
• v.39 no.2
• /
• pp.109-117
• /
• 2024

This study investigated the microbial contamination of agricultural, livestock, and marine ingredients in 55 meal kits distributed across Gyeonggi-do, South Korea. Of the 55 meal kits, 48 contained agricultural ingredients, 43 contained livestock ingredients, and 16 contained marine ingredients. The detection rate of the total aerobic bacteria in the agricultural, livestock, and marine products was 100%. The average numbers of the total aerobic bacteria were 6.57 log colony-forming units (CFU)/g in the agricultural products, 4.60 log CFU/g in the livestock products, and 5.47 log CFU/g in the marine products. The coliform detection rates in the agricultural, livestock, and marine products were 81.25%, 69.77%, and 43.75%, respectively. The average numbers of coliforms were 2.83 log CFU/g in the agricultural products, 1.34 log CFU/g in the livestock products, and 1.12 log CFU/g in the marine products. Escherichia coli was detected in 13 livestock products (30.23%), with levels ranging from 0.70 to 2.36 log CFU/g. Contrastingly, E. coli was detected in only one marine product (6.25%) and was not detected in any agricultural products. The detection rates of fungi in agricultural, livestock, and marine products were 97.92%, 93.02%, and 93.75%, respectively. The average numbers of fungi were 3.82 log CFU/g for the agricultural products, 2.92 log CFU/g for the livestock products, and 2.82 log CFU/g for the marine products. The isolation rates of foodborne pathogens from the agricultural, livestock, and marine products were 35.42%, 37.21%, and 31.25%, respectively. Forty-five foodborne pathogens of seven species, including Bacillus cereus and Salmonella spp., were isolated from the raw materials of the agricultural, livestock, and marine products in 55 meal kits. To prevent foodborne diseases caused by meal kits, it is necessary to focus on washing, heating, and preventing cross-contamination during cooking.

• Pediatric Infection and Vaccine
• /
• v.30 no.3
• /
• pp.121-128
• /
• 2023

Purpose: This study aimed to investigate the recent age distribution of Mycoplasma pneumoniae in patients with respiratory infections and the differences in diagnostic usefulness according to the methods used in these patients. Methods: We retrospectively reviewed the medical records of patients aged ≤18 years with respiratory infectious diseases who underwent polymerase chain reaction (PCR) or a specific immunoglobulin M (IgM) test between July 2016 and February 2019. The diagnosis of M. pneumoniae infection was confirmed by a positive result in the PCR or IgM test. Results: Of the 2,721 patients tested for M. pneumoniae, 2,197 underwent IgM, and 1,144 underwent PCR, with positivity rates of 17% and 20%, respectively. Among the 620 patients tested for both IgM and PCR tests simultaneously, 35% had M. pneumoniae infection, with 14% under 1 year old and 13% under 1-2 years old. The positive rate increased with age in both tests. Higher positive rates were observed in the IgM test before 3 years of age and in the PCR test after 3 years of age. The agreement rate between the two tests was 77.9% (Cohen's kappa 0.402). Conclusions: As age increased, the rates of M. pneumoniae infection also increased. In patients under 2 years of age, 4¬-14% of infections were confirmed depending on the method used. The moderate agreement between the PCR and IgM tests suggests that the simultaneous use of PCR and the IgM test for the early diagnosis should be approached with caution.

• Pediatric Infection and Vaccine
• /
• v.30 no.3
• /
• pp.129-138
• /
• 2023

Purpose: Cancer incidence is known to be higher in patients with inborn errors of immunity (IEI) compared to the general population in addition to traditionally well-known infection susceptibility. We aimed to investigate cancer occurrence in patients with IEI in a single center. Methods: Medical records of IEI patients treated at Samsung Medical Center, Seoul, Korea were retrospectively reviewed from November 1994 to September 2023. Patients with IEI and cancer were identified. Results: Among 194 patients with IEI, seven patients (3.6%) were diagnosed with cancer. Five cases were lymphomas, 4 of which were Epstein-Barr virus (EBV)-associated lymphomas. The remaining cases included gastric cancer and multiple myeloma. The median age at cancer diagnosis was 18 years (range, 1-75 years). Among patients with cancer, underlying IEIs included X-linked lymphoproliferative disease-1 (XLP-1, n=3), activated phosphoinositide 3-kinase delta syndrome (APDS, n=2), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) haploinsufficiency (n=2). Seventy-five percent (3/4) of XLP-1 patients, 40.0% (2/5) of APDS patients, and 50.0% (2/4) of CTLA-4 haplo-insufficiency patients developed cancer. Patients with XLP-1 developed cancer at earlier age (median age 5 years) compared to those with APDS and CTLA-4 (P<0.001). One patient with APDS died during hematopoietic cell transplantation. Conclusions: Cancer occurred in 3.6% of IEI patients at a single center in Korea. In addition to infectious complications and inflammation, physicians caring for IEI patients should be aware of the potential risk of cancer, especially in association with EBV infection.

• Fisheries and Aquatic Sciences
• /
• v.26 no.12
• /
• pp.738-751
• /
• 2023

The Sembilan Archipelago is famous for its great biodiversity, in which the humphead wrasse (Cheilinus undulatus) (locally named Napoleon fish) is the primary commodity (economically important), and currently, the environmental degradation occurs due to anthropogenic activities. This study aimed to examine the eco-environmental parameters and assess their influence on the abundance of humphead wrasse and other coral reef fish compositions in the Sembilan Archipelago. Direct field monitoring was performed using a visual census throughout an approximately one km transect. Coral cover data collection and assessment were also carried out. A coastal water quality index (CWQI) was used to assess the water quality status. Furthermore, statistical-based analyses [hierarchical clustering, Pearson's correlation, principal component analysis (PCA), and canonical correspondence analysis (CCA)] were performed to examine the correlation between eco-environmental parameters. The Napoleon fish was only found at stations 1 and 2, with a density of about 3.8 Ind/ha, aligning with the dominant composition of the family Serranidae (covering more than 15% of the total community) and coinciding with the higher coral mortality and lower reef fish abundance. The coral reef conditions were generally ideal for supporting marine life, with a living coral percentage of about > 50% in all stations. Based on CWQI, the study area is categorized as good and excellent water quality. Of the 60 parameter values examined, the phytoplankton abundance, Napoleon fish, and temperature are highly correlated, with a correlation coefficient value greater than 0.7, and statistically significant (F < 0.05). Although the adaptation of reef fish to water quality parameters varies greatly, the most influential parameters in shaping their composition in the study area are living corals, nitrites, ammonia, larval abundance, and temperature.

• KOREAN JOURNAL OF CROP SCIENCE
• /
• v.68 no.4
• /
• pp.431-437
• /
• 2023

This study evaluated the ecological characteristics related to spike heading time of three Korean foxtail millet cultivars, i.e., one early and two late maturities, and a finger millet cultivar in the north-central region of the Korean Peninsula, Kangwon Province. The changes in heading time occurred due to the changes in planting time from mid-May to late June. The heading time of the early-maturity cultivars was early August, with 80 days required for heading (DH) for the mid-May planting; late August, with 65 DHs for the late June planting; and mid-late August, with 100 DHs and mid-October, with 65 DHs, respectively, for the late-maturity cultivars. The accumulated temperature at heading time ranged from 1,700℃ of mid-May planting to 1,500℃ of late June planting in the early-maturity cultivars. In contrast, it ranged from 2,100℃ to 1,900℃ in the late-maturity cultivars. The photoperiod at heading time ranged from 14.0 h to 13.2 h in the early-maturity cultivars, whereas it was from 13.2 h to 12.5 h in the late-maturity cultivars. Considering that the limiting heading time of Korean foxtail millet and finger millet in the northern region of Kangwon Povince is late August, the limiting accumulated temperature at the heading time was evaluated to be approximately 1,500℃ and 2,000℃ for early and late-maturity cultivars, respectively. The mean daily temperature from planting to heading time showed a negative correlation with the DH, which was shortened with the increase in mean daily temperature. This suggests that delaying the planting time from May to June in the north-central region of the Korean Peninsula increases the mean daily temperature during vegetative growth periods, resulting in the decrease of the DH and the accumulated temperature.

• Pediatric Infection and Vaccine
• /
• v.31 no.1
• /
• pp.75-82
• /
• 2024

Purpose: As the coronavirus disease 2019 (COVID-19) pandemic ended, the number of patients with respiratory syncytial virus (RSV) pneumonia increased during the spring/summer of 2022. This study aimed to analyze the clinical features and antibiotic usage of children hospitalized for RSV pneumonia in a recently established general hospital in Sejong city. Methods: In this retrospective review, we included inpatients of the Pediatric Department of Chungnam National University Sejong Hospital diagnosed with RSV pneumonia between March 2022 and April 2023. Patients were divided into 2 groups: with and without antibiotic treatment. Demographic data, initial presentations, and clinical courses were reviewed. Results: A total of 116 patients with RSV pneumonia were hospitalized during this period, of which 102 were analyzed, excluding 14 with underlying diseases or who did not fall within the definition of pneumonia. The median age was 17 months. Diagnoses of bacterial infections (acute otitis media and sinusitis) were documented in 9.8% of cases. Intravenous (IV) antibiotics were administered in 46% of cases. The group receiving IV antibiotics showed higher inflammatory levels (C-reactive protein; CRP), more infiltration on initial chest X-rays, and longer fever duration. There was no difference in the length of hospitalization between the groups with and without IV antibiotics. Conclusions: This study showed a tendency for the attending physician to prescribe IV antibiotics to patients with longer fever duration, pulmonary infiltrations on the initial chest X-ray, and higher CRP levels. However, given the high rate of IV antibiotic usage compared to previous studies, care should be taken in antibiotic use.

• Food Science and Preservation
• /
• v.31 no.3
• /
• pp.452-461
• /
• 2024

This study evaluated the in vitro antioxidant activities of ethanolic Polygonum multiflorum (P. multiflorum) extracts and their cytoprotective effects on H₂O₂-induced HT22 and SK-N-MC cells. Among ethanolic extracts of P. multiflorum, the 40% ethanolic extract of P. multiflorum exhibited high total phenolics and flavonoid contents, with 105.68 mg of GAE/g and 28.92 mg of RE/g, respectively. The 40% ethanolic extract of P. multiflorum showed a high 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) radical scavenging activity and malondialdehyde (MDA) inhibitory effect. The 40% ethanolic extract of P. multiflorum also showed efficient inhibitory activity against α-glucosidase and acetylcholinesterase. Moreover, the 40% ethanolic extract of P. multiflorum reduced oxidative stress and increased cell viability in H₂O₂-induced HT22 and SK-N-MC cells as determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetra-zoliumbromide (MTT) and 2',7'-dichlorodihydrofluorescein diacetate (DCF-DA) assay. High-performance liquid chromatography (HPLC) identified 2,3,5,4'-tetrahydroxystilbene-2-O-beta-D-glucoside (TSG) as the bioactive compound in the 40% ethanolic extract of P. multiflorum.

• Journal of Korean Academy of Nursing
• /
• v.11 no.2
• /
• pp.83-104
• /
• 1981

Hemodialysis is essential treatment for the chronic renal failure patient's long-term cure and for the patient management before and after kidney transplantation. It sustains the endstage renal failure patient's life which didn't get well despite strict regimen and furthermore it becomes an essential treatment to maintain civil life. Bursing implementation in hemodialysis may affect the significant effect on patient's life. The purpose of this study was to obtain the basic data to solve the hypotension problem encountable to patient and the blood loss problem affecting hemodialysis patient'a anemic states by incomplete rinsing of blood in coil through all process of hemodialysis. The subjects for this study were 44 patients treated hemodialysis 691 times in the hemodialysis unit, The .data was collected at Gang Nam 51. Mary's Hospital from January 1, 1981 to April 30, 1981 by using the direct observation method and the clinical laboratory test for laboratory data and body weight and was analysed by the use of analysis of Chi-square, t-test and anlysis of varience. The results obtained an follows; A. On clinical laboratory data and other data by dialysis Procedure. The average initial body weight was 2.37 ± 0.97kg, and average body weight after every dialysis was 2.33 ± 0.9kg. The subject's average hemoglobin was 7.05±1.93gm/dl and average hematocrit was 20.84± 3.82%. Average initial blood pressure was 174.03±23,75mmHg and after dialysis was 158.45±25.08mmHg. The subject's average blood ion due to blood sample for laboratory data was 32.78±13.49cc/ month. The subject's average blood replacement for blood complementation was 1.31 ±0.88 pint/ month for every patient. B. On the hypotensive state and the coping approaches occurrence rate of hypotension was 28.08%. It was 194 cases among 691 times. 1. In degrees of initial blood pressure, the most 36.6% was in the group of 150-179mmHg, and in degrees of hypotension during dialysis, the most 28.9% in the group of 40-50mmHg, especially if the initial blood pressure was under 180mmHg, 59.8% clinical symptoms appeared in the group of“above 20mmHg of hypotension”. If initial blood pressure was above 180mmHg, 34.2% of clinical symptoms were appeared in the group of“above 40mmHg of hypotension”. These tendencies showed the higher initial blood pressure and the stronger degree of hypotension, these results showed statistically singificant differences. (P=0.0000) 2. Of the occuring times of hypotension,“after 3 hrs”were 29.4%, the longer the dialyzing procedure, the stronger degree of hypotension ann these showed statistically significant differences. (P=0.0142). 3. Of the dispersion of symptoms observed, sweat and flush were 43.3%, and Yawning, and dizziness 37.6%. These were the important symptoms implying hypotension during hemodialysis accordingly. Strages of procedures in coping with hypotension were as follows ; 45.9% were recovered by reducing the blood flow rate from 200cc/min to 1 00cc/min, and by reducing venous pressure to 0-30mmHg. 33.51% were recovered by controling (adjusting) blood flow rate and by infusion of 300cc of 0,9% Normal saline. 4.1% were recovered by infusion of over 300cc of 0.9% normal saline. 3.6% by substituting Nor-epinephiine, 5.7% by substituting blood transfusion, and 7,2% by substituting Albumin were recovered. And the stronger the degree of symptoms observed in hypotention, the more the treatments required for recovery and these showed statistically significant differences (P=0.0000). C. On the effects of the changes of blood pressure and osmolality by albumin and hemofiltration. 1. Changes of blood pressure in the group which didn't required treatment in hypotension and the group required treatment, were averaged 21.5mmHg and 44.82mmHg. So the difference in the latter was bigger than the former and these showed statistically significant difference (P=0.002). On the changes of osmolality, average mean were 12.65mOsm, and 17.57mOsm. So the difference was bigger in the latter than in the former but these not showed statistically significance (P=0.323). 2. Changes of blood pressure in the group infused albumin and in the group didn't required treatment in hypotension, were averaged 30mmHg and 21.5mmHg. So there was no significant differences and it showed no statistical significance (P=0.503). Changes of osmolality were averaged 5.63mOsm and 12.65mOsm. So the difference was smaller in the former but these was no stitistical significance (P=0.287). Changes of blood pressure in the group infused Albumin and in the group required treatment in hypotension were averaged 30mmHg and 44.82mmHg. So the difference was smaller in the former but there is no significant difference (P=0.061). Changes of osmolality were averaged 8.63mOsm, and 17.59mOsm. So the difference were smaller in the former but these not showed statistically significance (P=0.093). 3. Changes of blood pressure in the group iutplemented hemofiltration and in the Uoup didn't required treatment in hypotension were averaged 22mmHg and 21.5mmHg. So there was no significant differences and also these showed no statistical significance (P=0.320). Changes of osmolality were averaged 0.4mOsm and 12.65mOsm. So the difference was smaller in the former but these not showed statistical significance（P=0.199). Changes of blood pressure in the group implemented hemofiltration and in the group required treatment in hypotension were averaged 22mmHg and 44.82mmHg. So the difference was smatter in the former and these showed statistically significant differences (P=0.035). Changes of osmolality were averaged 0.4mOsm and 17.59mOsm. So the difference was smaller in the former but these not showed statistical significance (P=0.086). D. On the changes of body weight, and blood pressure, between the group of hemofiltration and hemodialysis. 1, Changes of body weight in the group implemented hemofiltration and hemodialysis were averaged 3.340 and 3.320. So there was no significant differences and these showed no statistically significant difference, (P=0.185) but standard deviation of body weight averaged in comparison with standard difference of body weight was statistically significant difference (P=0.0000). Change of blood Pressure in the group implemented hemofiltration and hemodialysis were averaged 17.81mmHg and 19.47mmHg. So there was no significant differences and these showed no statistically significant difference (P=0.119), But in comparison with standard deviation about difference of blood pressure was statistically significant difference. (P=0.0000). E. On the blood infusion method in coil after hemodialysis and residual blood losing method in coil. 1, On comparing and analysing Hct of residual blood in coil by factors influencing blood infusion method. Infusion method of saline 200cc reduced residual blood in coil after the quantitative comparison of Saline Occ, 50cc, 100cc, 200cc and the differences showed statistical significance (p < 0.001). Shaking Coil method reduced residual blood in Coil in comparison of Shaking Coil method and Non-Shaking Coil method this showed statistically significant difference (P < 0.05). Adjusting pressure in Coil at OmmHg method reduced residual blood in Coil in comparison of adjusting pressure in Coil at OmmHg and 200mmHg, and this showed statistically significant difference (P < 0.001). 2. Comparing blood infusion method divided into 10 methods in Coil with every factor respectively, there was seldom difference in group of choosing Saline 100cc infusion between Coil at OmmHg. The measured quantity of blood loss was averaged 13.49cc. Shaking Coil method in case of choosing saline 50cc infusion while adjusting pressure in coil at OmmHg was the most effective to reduce residual blood. The measured quantity of blood loss was averaged 15.18cc.

• Journal of the Korean Wood Science and Technology
• /
• v.6 no.2
• /
• pp.3-19
• /
• 1978

Five species, Abies koreana Wilson (A. koreana), Castanopsis cuspidata var. Sieboldii Nakai (C. Cuspidata). Machilus thunbergii Sieb. et Zucc. (M. thunbergii), Styrax japonica (S. japonica), and Quercus acuta Thunberg(Q. acuta) growing in the southern part of Korea were selected for the investigation of wood properties. In order to evaluate the wood properties of these five species, anatomical, physical, mechanical, chemical and pulping characteristics were investigated. And this study also covered wood technological problems related to the drying, gluing, debarking, flooring, and wood workability so that these species might serve to the best advantage. The results obtained were summarized as follows: 1. The trunk of A. koreana with many knots was straight. However, the trunks of S. japonica and C. cuspidata were crooked. 2. A. koreana showed the longest and the widest ill the fiber morphology; 2.97mm in length, 39.3${\mu}$ in width. In general, fiber width of all the species investigated were greater than those of other Korean hardwoods. 3. The specific gravity of Q. acuta was 0.74${\pm}$0.03, and that of A.koreana was 0.34${\pm}$0.02. The range of specific gravity of the other species was 0.47-0.52. 4. The adsorption of water was propotioned inversely with the specific gravity, but the adsorption of humidity was proportioned with the specific gravity. In spite of their medium density, S. japonica showed the greatest adsorption, and M. thunbergii the least. The water adsorption of cross section was twice greater than that of lateral direction, and there was a slight difference in between the radial and the tangential direction. 5. Shrinkage for tested five species was ranged from 5.36 to 10.24% in tangential direction, and 2.83~6.13% in radial direction. Q. acuta recorded the greatest shrinkage rate, and A. koreana the least. The greater was the specific gravity, the larger was the shrinkage rate. 6. The mechanical properties of Q. acuta were similar to those of Quercus mongolica which grow in Kangwon-Do. Strength properties of C. cuspidata, M. thunbergii, A. koreana were equivalent to those of other Korean commercial woods with similar specific gravity, except S. japonica which showed slightly higher strength than that of other species with similar density. 7. Higher glue joint strength for urea and phenol adhesieves was recorded in the species of M. thunbergii and C. cuspidata, however, high-density species(Q. acuta) and even low-density species(A. koreana) did not show good joint strength. 8. The attractive figure of M. thunbergii in texture seemed to he appreciated for decoration. And the grain and texture of other species were proper for furniture and building materials. 9. All of the species except Q. acuta were considered good for wood workability. 10. The denser the specific gravity was, the longer the drying time took. However, severe drying defects were formed in M. thunbergii whose density was medium. 11. All the species were considered suitable for the flooring wood expect A. koreana whose density was light. 12. Pentosan component in all the species was great, and the amount of extractives in Q. acuta was worth noticing. 13. Yield in kraft pulp was above the level of economic pulp yield, i.e. 45% in all species. 14. Debarking was easy in the species of A. koreana and M. thunbergii, and debarking after being boiled in water was the most efficient in all species.

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