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A Multicenter Study to Identify the Respiratory Pathogens Associated with Exacerbation of Chronic Obstructive Pulmonary Disease in Korea

  • Lee, Hyun Woo;Sim, Yun Su;Jung, Ji Ye;Seo, Hyewon;Park, Jeong-Woong;Min, Kyung Hoon;Lee, Jae Ha;Kim, Byung-Keun;Lee, Myung Goo;Oh, Yeon-Mok;Ra, Seung Won;Kim, Tae-Hyung;Hwang, Yong Il;Rhee, Chin Kook;Joo, Hyonsoo;Lee, Eung Gu;Lee, Jin Hwa;Park, Hye Yun;Kim, Woo Jin;Um, Soo-Jung;Choi, Joon Young;Lee, Chang-Hoon;An, Tai Joon;Park, Yeonhee;Yoon, Young-Soon;Park, Joo Hun;Yoo, Kwang Ha;Kim, Deog Kyeom
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.37-46
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    • 2022
  • Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma-COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

Developing a Diagnostic Bundle for Bronchiectasis in South Korea: A Modified Delphi Consensus Study

  • Choi, Hayoung;Lee, Hyun;Ra, Seung Won;Jang, Jong Geol;Lee, Ji-Ho;Jhun, Byung Woo;Park, Hye Yun;Jung, Ji Ye;Lee, Seung Jun;Jo, Kyung-Wook;Rhee, Chin Kook;Kim, Changwhan;Lee, Sei Won;Min, Kyung Hoon;Kwon, Yong-Soo;Kim, Deog Kyeom;Lee, Jin Hwa;Park, Yong Bum;Chung, Eun Hee;Kim, Yae-Jean;Yoo, Kwang Ha;Oh, Yeon-Mok
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.56-66
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    • 2022
  • Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion: Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

A Study on the Introduction of Performance Certification System of Inspection and Diagnostic Equipment for Infrastructure (시설물 진단장비의 성능인증제 도입에 관한 연구)

  • Hong, Sung-Ho;Kim, Jung-Gon;Cho, Jae-Young;Kim, Do-Hyoung;Kim, Jung-Yeol;Kim, Young-Min
    • Journal of the Society of Disaster Information
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    • v.18 no.1
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    • pp.104-115
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    • 2022
  • Purpose: Infrastructure inspection and its diagnostics technique have been rapidly developing recently. Therefore, it is important to secure the reliability of diagnostic equipment, and this paper deals with inspection of diagnostic equipment, introduction to a certification system and development plans for infrastructure. Method: Several certification systems are established and introduction plans are reviewed through experts by synthesizing the contents of certification research for existing infrastructure diagnosis equipment. In addition, the revision of the law for introduction of the system is reviewed, detailed operation regulations are prepared and phased development plans are reviewed, which are based on the operation scenario. Result: Inspection and certification plans were constructed through four routes in order to consider infrastructure inspection and diagnostic equipment in use, and new diagnostic equipment using state-of-the-art technology. Furthermore, market confusion depending on the introduction of a new certification system is minimized and reliability is secured by transforming a simple inspection system in the short term into a formal certification system in the long term. The law amendments according to the introduction of the system were reviewed and detailed operation regulations were developed. Also, phased development plans, which are based on the long-term development scenario including manpower, infrastructure and specifications, were presented. Conclusion: It is important to secure reliability through the distribution and certification of diagnostic equipment using 4th industrial technology to strengthen the safety management of infrastructure at the national level since the infrastructure is various in type and increasingly large in size. It is also essential to train human resources who can use new technology with inspection and diagnosis system in order to enhance the safety management of all infrastructures. Moreover, it is necessary to introduce a regular inspection system for infrastructure that combines loT technology in the long-term point of view and to promote the introduction by giving active incentives to institutions that actively accept it.

Evaluation of the Accuracy and usability of Trigger mode in Respiratory Gated Radiation Therapy (호흡동조방사선치료를 위한 Trigger mode 투시영상 획득 시 호흡 속도에 따른 정확성 평가 - Phantom Study)

  • Park, je wan;Kim, min su;Um, ki cheon;Choi, seong hoon;Song, heung kwon;Yoon, in ha
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.25-33
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    • 2021
  • Purpose : The purpose of this study is to evaluate the accuracy and usefulness of the Trigger mode for the Respiratory Gated Radiation Therapy (RGRT) Materials and methods : A QUASAR respiratory phantom that inserted a 3 mm fiducial marker (a gold marker) was used to estimate the accuracy of the Trigger mode. And the 20 bpm was used as reference respiration rate in this study. The marker that placed at the center of the phantom was contoured, and the lower threshold of a gating window was fixed at 2.0 mm using an OBI with Truebeam STxTM. The upper threshold was measured every 0.5 mm from 1.0 mm to 3.0 mm. The respiration rates were changed every 10 bpm from 10 bpm to 60 bpm. We repeatedly measured five times to check the error rate of the trigger mode in the same condition. Result : The differences of a distance from a peak phase to upper threshold, 1.0 to 3.0 mm at a 20 bpm as a reference for 3 days in a row were 0.68±0.05 mm, 0.91±0.03 mm, 1.23±0.03 mm, 1.42±0.04 mm, and 1.66±0.06 mm, respectively. Measurement result of changes in respiratory rate compared to baseline respiratory rate in maximum absolute difference. The coefficient of determination (R2) to estimate the correlation between the respiration velocity and variation of absolute difference was on average 0.838, 0.887, 0.770, 0.850, and 0.906. The p-values of all the variables were below 0.05. Conclusion : Using Trigger mode during respiratory gated radiation therapy (RGRT), accuracy and usefulness of trigger mode at reference breathing rate were confirmed. However, inaccuracies depending on the rate of breathing it could be uncertain in case of respiration rate is faster than 20 bpm as a standard respiration rate compared to slower than 20 bpm. Consequently, when conducting a RGRT using the trigger mode, real time monitoring is required with well educated respiration.

Examination of Dose Change at the Junction at the Time of Treatment Using Multi-Isocenter Volumetric Modulated Arc Therapy (용적조절호형방사선치료(VMAT)의 다중치료중심(Multi- Isocenter)을 이용한 치료 시, 접합부(Junction)의 선량 변화에 대한 고찰)

  • Jung, Dong Min;Park, Kwang Soon;Ahn, Hyuk Jin;Choi, Yoon Won;Park, Byul Nim;Kwon, Yong Jae;Moon, Sung Gong;Lee, Jong Oon;Jeong, Tae Sik;Park, Ryeong Hwang;Kim, Se young;Kim, Mi Jung;Baek, Jong Geol;Cho, Jeong Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.9-14
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    • 2021
  • This study examined dose change depending on the reposition error of the junction at the time of treatment with multi-isocenter volumetric modulated arc therapy. This study selected a random treatment region in the Arccheck Phantom and established the treatment plan for multi-isocenter volumetric modulated arc therapy. Then, after setting the error of the junction at 0 ~ 4 mm in the X (left), Y (upper), and Z (inner and outer) directions, the area was irradiated using a linear accelerator; the point doses and gamma indexes obtained through the Phantom were subsequently analyzed. It was found that when errors of 2 and 4 mm took place in the X and Y directions, the gamma pass rates (point doses) were 99.3% (2.085) and 98% (2.079 Gy) in the former direction and 98.5% (2.088) and 95.5% (2.093 Gy) in the latter direction, respectively. In addition, when errors of 1, 2, and 4 mm occurred in the inner and outer parts of the Z direction, the gamma pass rates (point doses) were found to be 94.8% (2.131), 82.6% (2.164), and 72.8% (2.22 Gy) in the former part and 93.4% (2.069), 90.6% (2.047), and 79.7% (1.962 Gy) in the latter part, respectively. In the X and Y directions, errors up to 4 mm were tolerable; however, in the Z direction, error values exceeding 1 mm were beyond the tolerance level. This suggests that for high and low dose areas, errors in the direction same as the progress direction in the treatment region have a more sensitive dose distribution. If the guidelines for set-up errors are established at the institutional level through continuous research in the future, it will be possible to provide good quality treatment using junctions.

Agronomic and End-use Quality Analysis of 'AromaT', a Black Rice (Oryza Sativa L.) Variety with Floury Endosperm (분질배유를 지니는 흑미, '아로마티'의 주요 농업형질 및 가공적성 평가)

  • Ha, Su Kyung;Mo, Young-Jun;Jeong, Jong-Min;Lee, Hyun-Sook;Kim, Jinhee;Seo, Woo-Duck;Jeong, Ji-Ung
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.67 no.1
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    • pp.9-16
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    • 2022
  • Rice is one of the most important staple foods in Wnju, Jeonbuk, South Korea. However, rice consumption has dramatically decreased as eating habits have diversified owing to rapid economic growth. Recently, floury endosperm rice varieties have been developed to invigorate the rice processing industry, because dry-milled rice flour is economically and environmentally suitable for massive rice flour distribution. The National Institute of Crop Science has developed 'AromaT', an early-maturing black rice with floury-endosperm, suitable for tea and dry milling. 'AromaT' was derived from a cross between 'Suweon542' as the floury endosperm source and 'Heugjinju' as the black and aromatic source. In this study, 'AromaT' and its parents, 'Suweon542' and 'Heugjinju', were analyzed for agronomic traits, anthocyanin content, and their major physicochemical properties by different planting date. The field experiment was conducted in Wanju, Jeollabuk-do Province, South Korea, in 2019. The transplanting dates were May 30 (ordinary season), June 25 (double-cropping season), and July 10 (late season). The yield performance of brown rice 'AromaT' was 330 kg/10 a in the double-cropping cultivation method and was the highest among the transplanting dates. The floury endosperm of 'AromaT' was derived from 'Suweon542' containing 'flo7', located on chromosome 5 and known to control floury endosperm. With the late planting date, the anthocyanin content of 'AromaT' was 570.5 mg/100 g, much higher than that of 'Heugjinju' (376.3 mg/100 mg). The brown rice of 'AromaT' also exhibited the pop-corn-flavoring 2-acetyl-1-pyrroline, exclusively detected in aroma rice varieties. The average particle sizes of 'AromaT' and 'Suweon542' were 67.12 ㎛ and 70.9 ㎛, respectively, lower than that of 'Heugjinju' (95.5 ㎛) with a black transparent endosperm. The average damaged starch content of 'AromaT' was 8.1%, lower than that of 'Heugjinju' (10.05%) and Suweon542 (9.5%). As a result, 'AromaT' with high anthocyanin content, fine particle size, and low damaged starch content is expected to provide a new rice material in various processing fields.

Evaluation of usefulness for Stereotactic Partial Breast Irradiation(S-PBI) by using Surface Fiducial Marker (표면위치표지자를 적용한 정위적 부분유방방사선치료의 유용성 평가)

  • Kim, JongYeol;Jung, DongMin;Kim, SeYoung;Yoo, HyunJong;Choi, JungHoan;Park, HyoKuk;Baek, JongGeol;Lee, SangKyu;Cho, JeongHee
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.99-108
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    • 2021
  • Purpose: The goal of this study is to evaluate usefulness of noninvasive method instead of previous inserting Fiducial Marker Method when performing Stereotactic Partial Breast Irradiation in CyberKnife. Material and methods: For consistency of Imaging Center, we evaluated both oblique images at angle 45 and 315 acquired from 2D Simulator and CyberKnife quantitatively through dice similarity coefficient. Also, location reproducibility of Surface Fiducial Marker was analyzed from 2D Simulator, treatment plans and CyberKinfe images by using 8 Fiducial Markers made of gold attached to ATOM Phantom based on our institution's protocols. Results: The results of the estimated consistency were 0.87 and 0.9 at the oblique angle 45 and 315, respectively. For location consistency of Surface Fiducial Markers, values of horizontal vertical direction of left breast were Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, and the values of rotational direction were Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 °. The values of horizontal vertical direction of right breast were Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm, and the values of rotational direction were Roll 0.2°, Pitch 0.1°, Yaw 0.1°. Conclusions: We expect that the protocols used by Surface Fiducial Markers when performing Stereotactic Partial Breast Irradiation in CyberKnife will provide protection from pain and cut expenses for treatment and reduce treatment errors and make treatment more accurate by suggesting treatment protocols based on high consistency of Imaging Center and reproducibility of Fiducial Markers.

A study on the manufacturing method and usefulness of Bolus-helmet used for malignant scalp tumor patients (악성두피종양환자에게 사용되는 보루스헬멧(Bolus-helmet)의 제작방법 및 유용성에 관한 연구)

  • Lee, joung jin;Moon, jae hee;Kim, hee sung;Kim, koon joo;Seo, jung min;Choi, jae hoon;Kim, sung gi;Jang, in gi
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.15-24
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    • 2021
  • This study is about the introduction and usefulness evaluation of the manufacturing method of the bolus-helmet. Helmet-production for the treatment of scalp tumor patients has been tried and will continue in many creative and various ways. However, Most of the research data did not significantly reduce the psychological burden and physical and physical discomfort that the patient had to bear due to the time and economic cost required for the production of the helmet, the convenience of production, and the complexity of the process. In addition, recently, studies using more advanced technologies and equipment such as 3D-printer technology, which are being studied as a way to increase the treatment effect, are being introduced, but the time, economic cost, and psychological and physical burden are still the sole responsibility of the patient. Isn't it getting worse? The reality is that the thoughts of concern cannot be erased. Therefore, by maintaining the physical properties of the bolus and manufacturing a helmet without incurring additional costs, the physical and physical discomfort aggravated to the patient was reduced and the procedure and time for helmet manufacturing were minimized. In this way, it was possible to reduce the time, economic cost, and physical discomfort required for the production of the helmet, and it was also possible to minimize the psychological burden of the patient, although it is invisible. Additionally, in evaluating the usefulness of helmets, we are able to continuously seek and develop ways to reduce the air-gap interval, and as a result, we will be able to introduce a method to keep it within 2.0mm along with the manufacturing method through this study. I feel very welcome. Finally, I hope that anyone working in the Department of Radiation Oncology will be able to easily manufacture the helmet required for radiation therapy using a bolus through the guide-line on helmet manufacturing provided by this institute. I hope and hope that if you have any questions or inquiries that arise during the production process, please feel free to contact us through the researcher's e-mail or mobile phone at any time.

Study on dose comparison using X-Jaw split in VMAT treatment planning for left breast cancer including supraclavicular lymph nodes. (쇄골 상부 림프절을 포함하는 왼쪽 유방암의 VMAT 치료계획시 X-Jaw split을 이용한 선량비교에 관한 연구)

  • Kim, Hak Jun;Lee, Yang Hoon;Min, Jae Soon
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.137-144
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    • 2021
  • Purpose : The usability of X-Jaw split VMAT was evaluated by comparative analysis of the dose distribution between the treatment plan divided by X-Jaw and Full field VMAT treatment plan in left breast cancer treatment including supraclavicular lymph nodes. Materials and Methods : 10 patients with left breast cancer, including supraclavicular lymph nodes, were simulated using vacuum cushion, and 2 Full field Arc VMAT and 4 X-Jaw split Arc VMAT were planned The treatment plan was designed to include more than 95% of the Planning Target Volume (PTV) and to be minimally irradiated in the surrounding Organ at risk (OAR). Dose analysis of PTV and OAR was performed through dose volume histogram (DVH). Results : The Full field VMAT treatment plan and the X-Jaw split VMAT treatment plan of 10 patients were expressed as average values and compared. The difference between the two treatment plans was not large, with a Conformity index (CI) of 1.05±0.04, 1.04±0.03, and a Homogeneity index (HI) of 1.07±0.008, 1.07±0.009. For OAR, V5 in the left lung is 56.1±6.50%, 50.4±6.30%, and V20 is 20.0±4.15%, 13.52±3.61%. Compared to Full field VMAT, V5 decreased by 10.0% V20 by 32.6% in X-Jaw split VMAT. The V30 of the heart is 3.68±1.85%, 2.23±1.52%, and the Mean dose is 8.93±1.65 Gy, 7.67±1.52 Gy. In the X-Jaw split VMAT, V30 decreased by 39.3% and the Mean dose decreased by 14.1%. The left lung and heart, which are normal tissues, were found to have a statistical significance of that p-value is less than 0.05. Conclusion : In the case of left breast cancer treatment, which includes Supraclavicular lymph nodes with a large PTV volume and a length of X Jaw of 15 cm or more, the X-Jaw split VMAT shows improved dose distribution, which can reduce radiation dose of OAR such as lungs and heart, while maintaining similar PTV coverage with HI and CI equivalent to Full field VMAT. It is thought to be effective in reducing radiation complications.

Calculation of Dry Matter Yield Damage of Whole Crop Maize in Accordance with Abnormal Climate Using Machine Learning Model (기계학습 모델을 이용한 이상기상에 따른 사일리지용 옥수수 생산량 피해량)

  • Jo, Hyun Wook;Kim, Min Kyu;Kim, Ji Yung;Jo, Mu Hwan;Kim, Moonju;Lee, Su An;Kim, Kyeong Dae;Kim, Byong Wan;Sung, Kyung Il
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.41 no.4
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    • pp.287-294
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    • 2021
  • The objective of this study was conducted to calculate the damage of whole crop maize in accordance with abnormal climate using the forage yield prediction model through machine learning. The forage yield prediction model was developed through 8 machine learning by processing after collecting whole crop maize and climate data, and the experimental area was selected as Gyeonggi-do. The forage yield prediction model was developed using the DeepCrossing (R2=0.5442, RMSE=0.1769) technique of the highest accuracy among machine learning techniques. The damage was calculated as the difference between the predicted dry matter yield of normal and abnormal climate. In normal climate, the predicted dry matter yield varies depending on the region, it was found in the range of 15,003~17,517 kg/ha. In abnormal temperature, precipitation, and wind speed, the predicted dry matter yield differed according to region and abnormal climate level, and ranged from 14,947 to 17,571, 14,986 to 17,525, and 14,920 to 17,557 kg/ha, respectively. In abnormal temperature, precipitation, and wind speed, the damage was in the range of -68 to 89 kg/ha, -17 to 17 kg/ha, and -112 to 121 kg/ha, respectively, which could not be judged as damage. In order to accurately calculate the damage of whole crop maize need to increase the number of abnormal climate data used in the forage yield prediction model.