• 대한방사선치료학회지
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• 제13권1호
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• pp.14-22
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• 2001

Purpose: The aim of this study is to investigate geometrical and volumetrical changes of liver due to breathing and its impact to NTCP. In order to attain better treatment results it should be considered deliberately during planning session. Mehtods and Materials : Seven patients were examined in this study who have done TACE for accurate tumor margin drawing. After contrast media injection, C-T scan data were obtained in supine position during breathing free, inhalation and exhalation, respectively. For all patients C-T scan were done with same scanning parameters- 5 mm index, 5 mm thickness and pitch 1. Based on C-T data we have measured differences of each variables between breathing status such as changes of total and remained liver volumes, GTV, beam path length and superior to inferior shift. NTCP were calculated using Lyman's effective volume DVH reduction scheme and for this NTCP calculation, the V50 was computed from DVH and each m, n value were referred from Burmans data. Results : The measured total tilter volume and the remained liver volume changed between inspiration and expiration about $1.2-7.7\%(mean+2.7\%)$ and $2.5-13.23\%(mean=5.8\%)$ respectively, and these results were statistically significant(p>0.1). The GTV difference in each patient varied widely from $1.17\%\;to\;30.69\%$, but this result was not statistically significant. Depending on the breathing status, the beam path length was changed from 0.5 cm to 1.1 cm with the average of 0.7 cm, and it was statistically significant(p=0.006). The measured superior to inferior shifts were ranged from 0.5 cm to 3.74 cm. The NTCPs were changed relatively small in each patient, but the variation was large between the patients. The mean NTCP difference was $10.5\%$, with the variation ranged from $7\%\;to\;23.5\%$. Conclusion : Variations of liver volume and of beam path length were changed significantly depending on the breathing statues and the range of variation itself was very different between the patients. Since this variance could seriously affect the clinical outcomes of radiation treatments, the breathing of patients need to be accounted when a final treatment planning is derided.

• 대한방사선치료학회지
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• 제24권2호
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• pp.123-135
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• 2012

목 적: 비소세포성 폐암 환자의 호흡 조절 방사선 치료 시 호흡에 의한 종양의 움직임을 최소화하는 것이 필수적이다. 이에 본 연구에서는 자유호흡 주기와 제한호흡 주기를 각각 적용한 치료 계획을 비교, 분석하여 제한 호흡 주기의 유용성을 평가하고자 한다. 대상 및 방법: 2011년 4월부터 12월까지 비소세포성 폐암 환자 9명(tumor n=10)을 대상으로 환자에게 평소의 호흡주기를 바탕으로 측정한 '자유호흡 주기'와 의도적으로 줄인 '제한호흡 주기'를 '신호모니터-호흡(guided-breathing)'법을 사용하여 각각 훈련을 실시한 후 RPM과 4차원 전산화 단층촬영 모의치료기를 이용해 치료계획용 4D CT를 실시하여 총 10개의 호흡 위상(respiration phase)별 CT 영상을 획득하였다. 각 호흡 주기의 CT 영상에 관측자 두 명이 각각 설정한 육안적 종양체적(Gross Tumor Volume, GTV)과 내부표적체적(Internal Target Volume, ITV)부피를 측정, 비교하였고 들숨(end-inspiration, EI)인 0%와 날숨(end-exhalation, EE)인 50% 위상에서의 center of mass (COM)를 측정하여 종양 움직임의 진폭을 측정했다. 또한 관측자 두명이 각각 두 호흡 주기를 적용한 치료계획을 수립하였고 정상 폐 평균선량(mean dose to normal lung, MDTNL)과 정상 폐 용적의 정상조직합병증확률(normal tissue complication probability, NTCP)을 비교, 분석하였으며 측정된 자료의 정량적 평가를 위해 통계 분석을 실시했다. 결 과: 관측자 두 명의 '제한호흡 주기'를 적용한 치료 계획을 분석한 결과 '자유호흡 주기'에 비해 종양의 3D 방향 움직임이 관측자 1의 경우 38.75%, 관측자 2의 경우 41.10%의 감소율을 보였고 GTV와 ITV의 부피를 측정, 비교한 결과 GTV의 부피는 관측자 1의 경우 $14.96{\pm}9.44%$, 관측자 2의 경우 $19.86{\pm}10.62%$, ITV의 부피는 관측자 1의 경우 $8.91{\pm}5.91%$, 관측자 2의 경우 $15.52{\pm}9.01%$의 감소율을 보였으며 MDTNL과 NTCP를 분석, 비교한 결과 MDTNL은 관측자 1의 경우 $3.98{\pm}5.62%$, 관측자 2의 경우 $7.62{\pm}10.29%$의 감소율을, NTCP의 경우 관측자 1의 결과 $21.70{\pm}28.27%$, 관측자 2의 결과 $37.83{\pm}49.93%$의 감소율을 나타냈다. 또한 두 관측자의 결과 값의 상관관계를 분석한 결과 '자유호흡 주기'에서는 관측자간의 유의한 차이를 보이는 데 비해 '제한호흡 주기'에서는 관측자간의 차이가 없는 감소율을 보였다. 결 론: '자유호흡 주기'에 비해 '제한호흡 주기'를 적용한 치료 계획에서 평가인자들의 상대적인 감소를 나타내어 비소세포성 폐암 환자의 호흡 조절 방사선 치료 시 '제한호흡 주기'의 유용성 및 타당성을 확인할 수 있었다.

• Radiation Oncology Journal
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• 제38권1호
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• pp.68-76
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• 2020

Purpose: The present study was conducted to compare dosimetric parameters for the heart and left lung between free breathing (FB) and deep inspiration breath hold (DIBH) and determine the most important potential factors associated with increasing the lung dose for left-sided breast radiotherapy using image analysis with 3D Slicer software. Materials and Methods: Computed tomography-simulation scans in FB and DIBH were obtained from 17 patients with left-sided breast cancer. After contouring, three-dimensional conformal plans were generated for them. The prescribed dose was 50 Gy to the clinical target volume. In addition to the dosimetric parameters, the irradiated volumes and both displacement magnitudes and vectors for the heart and left lung were assessed using 3D Slicer software. Results: The average of the heart mean dose (D_mean) decreased from 5.97 to 3.83 Gy and V₂₅ from 7.60% to 3.29% using DIBH (p < 0.001). Furthermore, the average of D_mean for the left lung was changed from 8.67 to 8.95 Gy (p = 0.389) and V₂₀ from 14.84% to 15.44% (p = 0.387). Both of the absolute and relative irradiated heart volumes decreased from 42.12 to 15.82 mL and 8.16% to 3.17%, respectively (p < 0.001); however, these parameters for the left lung increased from 124.32 to 223.27 mL (p < 0.001) and 13.33% to 13.99% (p = 0.350). In addition, the average of heart and left lung displacement magnitudes were calculated at 7.32 and 20.91 mm, respectively. Conclusion: The DIBH is an effective technique in the reduction of the heart dose for tangentially treated left sided-breast cancer patients, without a detrimental effect on the left lung.

• Tuberculosis and Respiratory Diseases
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• 제72권1호
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• pp.8-14
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• 2012

Background: Although airway obstruction in chronic obstructive pulmonary disease (COPD) is due to pathologic processes in both the airways and the lung parenchyma, the contribution of these processes, as well as other factors, have not yet been evaluated quantitatively. We therefore quantitatively evaluated the factors contributing to airflow limitation in patients with COPD. Methods: The 213 COPD patients were aged >45 years, had smoked >10 pack-years of cigarettes, and had a post-bronchodilator forced expiratory volume in one second ($FEV_1$)/forced vital capacity (FVC) <0.7. All patients were evaluated by medical interviews, physical examination, spirometry, bronchodilator reversibility tests, lung volume, and 6-minute walk tests. In addition, volumetric computed tomography (CT) was performed to evaluate airway wall thickness, emphysema severity, and mean lung density ratio at full expiration and inspiration. Multiple linear regression analysis was performed to identify the variables independently associated with $FEV_1$ - the index of the severity of airflow limitation. Results: Multiple linear regression analysis showed that CT measurements of mean lung density ratio (standardized coefficient ${\beta}$=-0.46; p<0.001), emphysema severity (volume fraction of the lung less than -950 HU at full inspiration; ${\beta}$=-0.24; p<0.001), and airway wall thickness (mean wall area %; ${\beta}$=-0.19, p=0.001), as well as current smoking status (${\beta}$=-0.14; p=0.009) were independent contributors to $FEV_1$. Conclusion: Mean lung density ratio, emphysema severity, and airway wall thickness evaluated by volumetric CT and smoking status could independently contribute to the severity of airflow limitation in patients with COPD.

• 복식
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• 제66권8호
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• pp.14-32
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• 2016

This study examines the morphological expression type and formative characteristics of women's shoes designs that integrate 3D printing technology. The results of the study are as follows. First, the morphological expression types of contemporary shoes that integrate 3D printing technology express a structural form created by repetition. Second, it expresses a dynamic form, which combines organic curves that create an external volume. Third, it expresses a surrealistic form centered on an object with the creation of a unique shape that utilizes objects easily experienced in local surroundings. Fourth, it expresses a hybrid form on a partial derivation. Each of the other system's components are fused to create another beauty that develops a new value in a colorful variation on the shape of 3D printing shoes. The first formative characteristic of women's shoes designs that integrate 3D printing technology is continuity. This creates an invisible form of a new space through repetitive unidirectional layers with a gradual expansion of a unitary seamless curves. Second, it is an exaggeration. This exaggeration elicits an enormous aesthetic quality by structuring the outward space in the difference of the volume formed based on the maximization of a specific part and the volume of a line's atypical movement. Third, it is a decoration. It displays the beauty of a decoration that evokes a unique artistic inspiration by partial unification or a practical representation of a specific form. This can also be seen as superimposing a 3D printing figure that has an outstanding shape onto part of the fashion shoes. Fourth, it concerns a geometrical characteristic that formulates a new structure with rationality in combining basic shapes such as circles, triangles and squares with lines, hexagons and interconnected geometrical forms to create a multi-dimensional space for shoes in a systematic and unidirectional pattern.

• 한국의류산업학회지
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• 제19권5호
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• pp.535-546
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• 2017

This study considers direction types and formative characteristics by analyzing natural objets in contemporary fashion window display. The research methods are both literature review and content analysis based on images of contemporary fashion window display. The conclusions of this study are as follows. First, the direction types of natural objets in contemporary fashion window display expand objective outlines by maximizing the morphological form of objects. Second, a rhythmic sense expressed through a gradual repetition of patterns or a sequential arrangement of natural objects. Third, it represents a reversal of image accomplished through a modification of material on the natural objects. Fourth, a new space is created by transforming two dimensional forms of natural objects. The first formative characteristic of natural objects in contemporary fashion window display is exaggeration. This is expressed through either the expansion of the external volume, the collapsed form of natural objects, or the distortion of external colors. Second, it is a dynamics. This makes it possible to recall the dynamic image of the integration of the observer with a priori thinking by systematically sequencing objects or inducing a specific motion. Third, it is an abstraction. This provides an opportunity for the observer to find in a natural beauty by exchanging physical form or reinterpreting characteristic points. Fourth, it concerns eclecticism characteristic that objects created through the mutual fusion of heterogeneous elements indicates an aesthetic inspiration in a limited space by diverting conventional thinking toward natural objects with expansion of consciousness on formative arts.

• Physical Therapy Rehabilitation Science
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• 제4권2호
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• pp.108-114
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• 2015

Objective: The purpose of this study was to examine the effect on vital capacity (VC) and inspiratory muscle activation according to the anterior and posterior pelvic tilt positions. Design: One group pretest-posttest design. Methods: Twenty-six healthy adult men and women, age 19 to 27 years, volunteered to participate in this study. Forced vital capacity (FVC), and forced expiratory volume in 1 second ($FEV_1$) were measured by desktop spirometer in the pelvic positions during respiration, and muscle activation was recorded from sternocleidomastoid, upper trapezius, external intercostal, rectus abdominis, and external oblique muscles by surface electromyography (EMG) at the same time. EMG values were normalized by maximum muscle contractions (% maximum voluntary isometric contraction). Subjects were to breathe in as much air as possible and then exhale as quickly as possible in both anterior and posterior pelvic tilt positions. To measure lung capacity, inspiration was measured for 5 seconds and expiration was measured for 7 seconds with data collection taken place during the middle three seconds. Lung capacities were measured in each position three times. Results: For the results of this study, there was a significant increase in both FVC and $FEV_1$ values during the anterior pelvic tilting compared to the posterior pelvic tilting posture (p<0.05). The sternocleidomastoid, upper trapezius muscle, rectus abdominus and external oblique muscle activation was significantly increased during anterior pelvic tilt compared to the posterior pelvic tilt position (p<0.05). Conclusions: These findings suggest that pelvic anterior tilt position could be more effective for vital capacity and respiratory muscles activation during respiration.

• 대한통합의학회지
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• 제4권1호
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• pp.41-47
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• 2016

Purpose : The purpose of this study was to examine the Compare the effects of inspiratory muscle strengthening training and expiratory muscle strengthening training of normal adult respiratory function. Method : In this study, we want to compare the effect of inspiratory muscle strengthening training(n=8) and expiratory muscle strengthening training(n=8) to target the normal adult 16 people. expiratory muscle strengthening training, was 25 minutes of training on the basis of the breathing image program that has been pre-recorded. inspiratory muscle strengthening training, use the power-breathe plus on the measured resistance value, was carried out for 25 minutes. Using the spirometer in order to examine the ability to breathe, FVC, FEV1, FEV1 / FVC, MVV was measured. Result : The results showd that in the breath muscle strengthening training FVC, FEV1, MVV increased statistically significantly. The inspiration muscle strength training FVC, FEV1, MVV was a statistically significant increase, FEV1/FVC decreased. There was no statistically significant difference between. Conclusion : In conclusion, both methods give the result of increasing the effective respiratory function. Inspiratory muscle strengthening training, the function of the lung is very limited to be used when and by us effectively and expiratory muscle strengthening training to increase the capacity of the lung is an effective way that will increase the volume.

• Physical Therapy Rehabilitation Science
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• 제7권4호
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• pp.147-153
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• 2018

Objective: This study investigated the effects of air stacking training (AST) on pulmonary function, respiratory strength, and peak cough flow (PCF) in persons with cervical spinal cord injury (CSCI). Design: Randomized controlled trial. Methods: A total of 24 persons with CSCI were randomly allocated to the AST group (n=12) or the incentive spirometry training (IST) group (n=12). Patients with CSCI received AST or IST for 15 minutes, with 3 sessions per week for 4 weeks, and all groups performed basic exercises for 15 minutes. In the AST group, after the subject inhaled the maximal amount of air as best as possible, the therapist insufflated additional air into the patient's lung using an oral nasal mask about 2-3 times. In the IST group, patients were allowed to hold for three seconds at the maximum inspiration and then to breathe. The pre and post-tests measured forced vital capacity (FVC), forced expiratory volume one at second (FEV1), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and PCF. Results: Both groups showed significant improvements in FVC, FEV1, MEP, MIP and PCF values after training (p<0.05). The FVC in the post-test and the mean change of FVC, FEV1, MIP were significantly higher in the AST group than the IST group (p<0.05). Conclusions: The findings of this study suggested that AST significantly improved pulmonary function, respiratory strength, and PCF in persons with CSCI. Therefore, AST should be included in respiratory rehabilitation programs to improve coughing ability, pulmonary function and respiratory muscle strength.

• Journal of Veterinary Science
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• 제23권6호
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• pp.68.1-68.8
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• 2022

Background: Studies on anesthetized dogs regarding pulse pressure variation (PPV) are increasing. The influence of respiratory rate (RR) on PPV, in mechanically ventilated dogs, has not been clearly identified. Objectives: This study evaluated the influence of RR on PPV in mechanically ventilated healthy dogs after hemorrhage. Methods: Five healthy adult Beagle dogs were premedicated with intravenous (IV) acepromazine (0.01 mg/kg). Anesthesia was induced with alfaxalone (3 mg/kg IV) and maintained with isoflurane in 100% oxygen. The right dorsal pedal artery was cannulated with a 22-gauge catheter for blood removal, and the left dorsal pedal artery was cannulated and connected to a transducer system for arterial blood pressure monitoring. The PPV was automatically calculated using a multi-parameter monitor and recorded. Hemorrhage was induced by withdrawing 30% of blood (24 mL/kg) over 30 min. Mechanical ventilation was provided with a tidal volume of 10 mL/kg and a 1:2 inspiration-to-expiration ratio at an initial RR of 15 breaths/min (baseline). Thereafter, RR was changed to 20, 30, and 40 breaths/min according to the casting lots, and the PPV was recorded at each RR. After data collection, the blood was transfused at a rate of 10 mL/kg/h, and the PPV was recorded at the baseline ventilator setting. Results: The data of PPV were analyzed using the Friedman test followed by the Wilcoxon signed-rank test (p < 0.05). Hemorrhage significantly increased PPV from 11% to 25% at 15 breaths/min. An increase in RR significantly decreased PPV from 25 (baseline) to 17%, 10%, and 10% at 20, 30, and 40 breaths/min, respectively (all p < 0.05). Conclusions: The PPV is a dynamic parameter that can predict a dog's hemorrhagic condition, but PPV can be decreased in dogs under high RR. Therefore, careful interpretation may be required when using the PPV parameter particularly in the dogs with hyperventilation.