• 대한두경부종양학회지
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• 제19권1호
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• 한국산학기술학회논문지
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• 제20권7호
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• pp.380-386
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• 2019

어깨관절 통증은 성인의 약 20% 정도가 일생에 한 번 이상 경험하는 매우 흔한 근골격계 질환이다. 이에 본 연구에서는 작은가슴근 신장운동에 의해 어깨뼈봉우리 밑 공간이 증가하여 충돌증후군 및 어깨통증에 긍정적인 효과가 있다는 객관적 평가를 실시하고, 작은가슴근 자가 신장운동이 도수 신장운동과 비교하여 작은가슴근의 길이와 봉우리 위팔 거리에 미치는 영향을 알아보고자 실시하였다. 경상북도 소재의 대학교에서 성인 남녀 30명을 대상으로 하여 대상자가 스스로 작은가슴근 자가 신장운동을 실시하는 실험군 15명과 치료사에 의해 수행되는 작은가슴근 도수 신장운동을 적용한 대조군 15명으로 두 그룹을 무작위 배치하여 치료의 즉각적인 효과를 비교하였다. 어깨뼈봉우리 위팔 거리를 측정하기 위해 초음파 장비를 사용하였고, 작은가슴근 길이를 측정하기 위해 4번째 늑골과 복장뼈가 만나는 부위 그리고 오훼돌기 아래측면 사이의 거리를 재었다. 연구결과 실험군과 대조군 모두 그룹 내에서 작은가슴근의 길이와 봉우리 위팔 거리 모두 유의하게 증가되었고(p<.05), 그룹 간 비교에서는 통계학적으로 유의한 차이가 나타나지 않았다(p>.05). 이러한 결과는 작은가슴근의 자가 신장운동이 충돌증후군 및 어깨질환의 예방 및 치료에 효율적인 운동방법으로 제시될 수 있다고 사료된다.

• Journal of Rheumatic Diseases
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• 제24권4호
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• pp.227-235
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• 2017

Objective. Failure of first-line anti-tumor necrosis factor (TNF) agents in in rheumatoid arthritis patients leads to decisions among second-line biologic agents. To better inform these decisions, the therapeutic effectiveness of rituximab is compared with other second-line biologic agents in this observational study. Methods. Between November 2011 and December 2014, study subjects were observed for 12 month periods. Patients with an inadequate response to initial anti-TNF agent received either rituximab or alternative anti-TNF agents (adalimumab/etanercept/infliximab) based on the preference of patients and physicians. The efficacy end point of this study was the change in 28-joint count Disease Activity Score (DAS28) at six and 12 months from baseline. Safety data were also collected. Results. Ninety patients were enrolled in the study. DAS28 at six months did not change significantly whether the patients were treated with rituximab or alternative anti-TNF agents in intention-to-treat analysis (n=34, $-1.63{\pm}0.30$ vs. n=31, $-2.05{\pm}0.34$) and standard population set analysis (n=31, $-1.51{\pm}0.29$ vs. n=24, $-2.21{\pm}0.34$). Similarly, the change in DAS28 at 12 months did not reach statistical significance ($-1.82{\pm}0.35$ in the rituximab vs. $-2.34{\pm}0.44$ in the alternative anti-TNF agents, p=0.2390). Furthermore, the incidences of adverse events were similar between two groups (23.5% for rituximab group vs. 25.8% for alternative anti-TNF agents group, p=0.7851). Conclusion. Despite the limitations of our study, switching to rituximab or alternative anti-TNF agents after failure of the initial TNF antagonist showed no significant therapeutic difference in DAS28 reduction.

• 한국방사선학회논문지
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• 제14권7호
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• pp.975-980
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• 2020

경추 신경공 협착은 모든 연령대의 비교적 많은 수의 사람들에게 침범하는 매우 흔한 척추 질환이다. 그러나 신경공 협착을 정량적으로 제공하는 영상검사법이 부족하므로, 본 연구는 3차원 전산화단층촬영상을 재구성하여 정량적인 측정방법을 제시하고자 한다. 3차원 영상처리 프로그램을 이용하여 경추의 후극돌기와 측돌기, 층뼈를 포함하여 신경공이 잘 관찰되도록 주변 뼈를 제거하였다. Image J를 이용하여 3차원 영상의 신경공 면적을 포함하는 관심영역을 설정하고, 신경공 면적의 화소수를 측정하였다. 측정 화소수에 화소크기를 곱하여 신경공 면적을 산출하였다. 가장 넓은 신경공 면적을 측정하기 위하여 측정 반대쪽 방향으로 40~50도 사이와, 머리쪽으로 15~20도 사이에서 측정하였다. 측정한 경추 신경공의 면적은 일관된 측정값을 보였다. 가장 크게 측정한 우측 신경공 C5-6 면적은 12.21 ㎟에서, 2년 후에 9.95 ㎟으로 18% 협착이 진행된 것을 알 수 있었다. 기존에 CT 검사 영상을 이용하여 3차원 재구성하므로 추가적인 방사선 피폭을 받지 않으며 신경공 협착 면적을 객관적으로 제시할 수 있다. 또한 3차원 영상을 보면서 신경공 협착 환자에게 설명하기 좋으며, 협착의 진행정도와 수술 후 평가에서도 사용하기 좋은 방법이라 사료된다.

• 대한방사선기술학회지:방사선기술과학
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• 제44권6호
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• pp.623-627
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• 2021

Cervical foraminal stenosis is a disease in which the nerves that pass from the spinal canal to the limbs are narrowed and the nerves are compressed or damaged. Due to the lack of an imaging method that provides quantitatively stenosis, this study attempted to evaluate the area of the cervical vertebrae by reconstructing a three-dimensional computed tomography image, and to determine the area of the neural foramen in normal adults to calculate the stenosis rate. Using a three-dimensional image processing program, the surrounding bones including the posterior spinous process, lateral process, and lamellar bones of the cervical vertebra were removed so that the neural foramen could be observed well. A region of interest including the neural foraminal area of the three-dimensional image was set using ImageJ, and the number of pixels in the neural foraminal area was measured. The neural foraminal area was calculated by multiplying the number of measured pixels by the pixel size. To measure the largest neural foraminal area, it was measured between 40~50 degrees in the opposite direction and 15~20 degrees toward the head. The average area of the right C2-3 foramen was 44.32 mm², C3-4 area was 34.69 mm², C4-5 area was 36.41 mm², C5-6 area was 35.22 mm², C6-7 area was 36.03 mm². The average area of the left C2-3 foramen was 42.71 mm², C3-4 area was 32.23 mm², C5-6 area was 34.56 mm², and C6-7 area was 31.89 mm². By creating a reference table based on the neural foramen area of normal adults, the stenosis rate of patients with neural foraminal stenosis could be quantitatively calculated. It is expected that this method can be used as basic data for the diagnosis of cervical vertebral foraminal stenosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.6.1-6.6
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• 2020

Background: Various types of miniplates have been developed and used for the reduction of facial bone fractures. We introduced Yang's Keyhole (YK) plate, and reported on its short-term stability. The purpose of this study was to evaluate the long-term stability of the YK plate, as a follow-up study, by examining the patients who had used the YK plate among the patients with the reduction of mandible fractures and who visited for plate removal. Methods: We reviewed the medical records of 16 patients who underwent mandibular fracture fixation using a YK plate (group I) and 17 patients who underwent mandibular fracture fixation using a conventional plate (group II). Assessment was then made on malunion, occlusal stability, discomfort during the application, and clinical symptoms. Results: From January 2015 to December 2017, a total of 36 patients underwent mandibular fracture surgery using a YK plate. A total of 16 patients received plate removal. Among them, 15 were male and 1 female. The average age was 26 years. The applied surgical sites were the 12 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of YK plate was an average of 335 days. During the same period, 45 people underwent surgery on the conventional plate. A total of 17 patients received plate removal. Among them, 15 were male and 2 females. The average age was 36 years. The applied surgical sites were the 8 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of the conventional plate was an average of 349 days. No malocclusion occurred at the time of removal, and occlusion was stable. No patient complained of joint disease or discomfort. Conclusion: The YK plate system, in which the screw was first inserted and the plate was applied, for clinical convenience did not cause any particular problem and no significant difference from the conventional plate.

• Clinical and Experimental Reproductive Medicine
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• 제49권1호
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• pp.2-8
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• 2022

Humanity is in the midst of the coronavirus disease 2019 (COVID-19) pandemic, and vaccines-including mRNA vaccines-have been developed at an unprecedented speed. It is necessary to develop guidelines for vaccination for people undergoing treatment with assisted reproductive technology (ART) and for pregnancy-related situations based on the extant laboratory and clinical data. COVID-19 vaccines do not appear to adversely affect gametes, embryos, or implantation; therefore, active vaccination is recommended for women or men who are preparing for ART. The use of intravenous immunoglobulin G (IVIG) for the treatment of immune-related infertility is unlikely to impact the effectiveness of the vaccines, so COVID-19 vaccines can be administered around ART cycles in which IVIG is scheduled. Pregnant women have been proven to be at risk of severe maternal and neonatal complications from COVID-19. It does not appear that COVID-19 vaccines harm pregnant women or fetuses; instead, they have been observed to deliver antibodies against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) to the fetus. Accordingly, it is recommended that pregnant women receive COVID-19 vaccination. There is no rationale for adverse effects, or clinical cases of adverse reactions, in mothers or neonates after COVID-19 vaccination in lactating women. Instead, antibodies to SARS-CoV-2 can be delivered through breast milk. Therefore, breastfeeding mothers should consider vaccination. In summary, active administration of COVID-19 vaccines will help ensure the safe implementation of ART, pregnancy, and breastfeeding.

• 한국노년학
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• 제30권3호
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• pp.793-802
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• 2010

열 스트레스는 건강의 위험요인으로 장시간 노출시 열손상과 근기능 감소 등 신체 기능을 감소시키며 특히 생리적 기능이 감소되어 있는 노인에서 영향을 받기 쉽다. 본 연구는 여름철 폭염주의보 수준의 열 스트레스가 여성노인들의 근기능 및 근손상 지표에 미치는 영향을 살펴보고자 시도되었다. 65세 이상의 여성 자원자 총 8명을 대상으로 2주일 간격으로 상온(20℃) 그리고 폭염주의보 수준의 고온(33℃)에서 등속성 슬관절 근기능을 측정하였으며, 폭염주의보 수준의 열 스트레스가 근손상에 미치는 영향을 알아보기 위하여 근기능 측정 전과 후에 채혈을 실시하였다. 각속도 60°/sec 운동시, 고온(33℃) 환경에서 우측 굴곡근과 신전근에서 최대우력, 단위체중당 최대우력, 평균파워 그리고 단위체중당 평균파워에서 근기능이 감소하였다(p<0.05). 또한 각속도 180 °/sec 운동시, 고온(33℃) 환경에서 우측 슬관절 신전근 피로도가 증가하였으며(p<0.05), 굴곡근 총일량은 유의하게 증가하였다(p<0.05). 고온환경(33℃)에서 근손상 지표인 HSP70, CK 그리고 LDH는 상온(20℃)과 비교하여 유의하게 증가하였다(p<0.05). 결론적으로 열 스트레스가 여성노인들의 근기능을 감소시키고 근손상을 유발하는 것으로 나타났다. 따라서 여성노인들의 건강유지를 위하여 여름철 폭염환경에서 열 스트레스의 노출 및 신체활동을 최소화 시키는 방안이 효과적이라 사료된다.

• 대한족부족관절학회지
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• 제27권4호
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• pp.123-130
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• 2023

Purpose: "Hallux valgus" is a common disease encountered in clinical practice and is accompanied by foot deformities. Conservative treatment is commonly used in the early stages of hallux valgus. On the other hand, surgical treatment often becomes necessary as the deformity progresses. Surgical treatments involve various osteotomy methods or joint fusion procedures combined with soft tissue release, and outcomes from these surgical treatments are generally favorable. This study compared two soft tissue release techniques in the hallux region. Materials and Methods: This study conducted a retrospective cohort study on 48 participants who underwent surgical treatment for hallux valgus at a single institution from March 1, 2018, to March 31, 2023. A scarf osteotomy was performed in all cases, and the "Modified Mcbride procedure" or "Trans-articular approach" was done for soft tissue release. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and the degree of subluxation of the lateral sesamoid were measured through simple foot radiographs taken before surgery and one year after surgery. Results: In the Modified Mcbride procedure group, HVA, IMA, and the sesamoid position grade decreased from 34.94° to 9.98°, 15.64° to 5.44°, and 2.47 to 0.44, respectively. In the trans-articular approach group, HVA, IMA, and the sesamoid position grade decreased from 33.42° to 7.34°, 15.06° to 6.03°, and 2.17 to 0.58, respectively. There was no significant difference in these changes between the preoperative and one-year postoperative measurements for both techniques (p-value>0.05). Conclusion: A radiological assessment of soft tissue release through the Modified Mcbride procedure and trans-articular approach in hallux valgus did not show significant differences. Therefore, both surgical techniques can be considered in the distal soft tissue release for a hallux valgus correction.

• 대한치과보철학회지
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• 제62권2호
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• pp.113-122
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• 2024

연령 증가에 따른 치아의 점진적인 마모는 자연적인 현상이나 생리적인 정도를 넘어 과도하게 발생하게 되면 수직 고경 상실, 교합 부조화, 악관절 질환, 치수병변 등을 일으킬 수 있어 보철물 수복이 필요하며, 이 때 적절한 수직 고경 거상과 함께 중심위(Centric Relation, CR)에서의 안정적인 교합 설정이 중요하다. 본 증례는 이 악물기와 이갈이 습관이 있는 74세 남환이 과도한 치아 마모를 주소로 내원하였고 이에 악간 거리, 마모 정도, 발음, 안모 평가 등을 시행한 결과 4 mm 수직 고경 거상을 동반한 전악 고정성 보철 수복을 진행하기로 하였다. 또한 비기능 하악 운동으로 인해 반복 재현성이 크게 떨어진 최대교두간 접촉위(Maximum Intercuspal Position, MICP)를 중심위에서의 안정적인 교합과 전‧측방 유도 시 상호보호교합이 되도록 적절히 형성해 주었다. 4개월간 임시 수복물에 적응한 것을 확인한 후 최종 보철물을 제작하였고 이후 4개월간 관찰한 결과 기능 및 심미적으로 결과를 만족하였기에 이를 보고하고자 한다.