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Neutron dosimetry depending on the number of portals for prostate cancer IMRT(Intensity-Modulated Radiation Therapy) (전립선암의 세기조절 방사선치료 시 조사문수별 중성자선량 평가)

  • Lee, Joo-Ah;Son, Soon-Yong;Min, Jung-Whan;Choi, Kwan-Woo;Na, Sa-Ra;Jeong, Hoi-Woun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.15 no.6
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    • pp.3734-3740
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    • 2014
  • The aim of this study was provide basic information and establish the criteria in radiation therapy planning by measuring the absorbed neutron dose of normal tissues and lesions according to the number of portals. From September 2013 to January 2014, 20 patients who were diagnosed with prostate cancer and were previously treated with radiation therapy were replanned retrospectively to measure the absorbed neutron dose distribution according to the number of portals. The absorbed neutron dose was measured in each of the 5, 7 and 9 portals using a 15 MV energy, which meant a therapeutic dose of 220 cGy. The optical stimulation luminescence dosimeter was separated by 20cm and 60cm away from the center of the field of view. As a result, the average radiation dose in the abdomen appeared to have a positive relationship with the number of portals, which was statistically significant (p<.05). The average radiation dose was $4.34{\pm}1.08$. The average radiation dose in the thyroid was $2.71{\pm}.37$. Although it showed a positive relationship with the number of portals, it did not have statistical significance. The number of portals and the neutron dose depending on the position showed a significant positive relationship, particularly in the abdomen. As a result of linear regression analysis, as the number of the portal increased in steps, the average volume of the neutrons increased significantly (0.416 times). In conclusion, efficient selection of the number of portals is needed considering the difference in the absorbed neutron dose in the normal tissues depending on the number of the portals.

Grotesque Aesthetics with a Focus on Animations of Lee, ae-rim Director (카니발 그로테스크 미학과 이애림 감독의 애니메이션)

  • Oh, Jin-hee
    • Cartoon and Animation Studies
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    • s.47
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    • pp.81-101
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    • 2017
  • The present study argues that film director Lee Ae-rim animation works depict the world of the grotesque and not only are important sociocultural phenomena but also hold the significance of humor and subversion. The grotesque exhibits the intriguing characteristics of expressing a perspective critical of the existing society through the sensibilities of minorities and is used broadly as a term not only in the aesthetic sense but also designating sociocultural phenomena. Although discussed separately in terms of Mikhail Bakhtin's carnival grotesque and Mary Russo's uncanny grotesque, the grotesque fundamentally rejects existing order and conventions and is externalized through unique expressions, thus opening up a rich possibility for rejection, humor, satire, transformation, and deconstruction of and regarding the authority of the mainstream. Although they constitute a fictional medium, animation films are social products as well so that they are affected by society, culture, and history and stand as important texts that must be interpreted in terms of the relationships between humans' instinctive desires and society and between the overall culture and artistic media. However, the rarity of grotesque portrayals in South Korean animation films also proves that it is a society where even problems that are in themselves sensitive must be manifested ingeniously on a conventional level. South Korean society has a unique history of colonialism and national division and is simultaneously in the unique situation of a society that has undergone growth at a nearly unprecedented rate. Consequently, the society exhibits closed yet dynamic particularity where everyday tension and rigidity, wariness of others and extreme competition are intertwined in a complex manner. Intensively analyzed in the present discussions, director Lee's animation films and are characterized mainly by grotesque images, nonlinear narratives, and vivid depictions. In such a context, these works not only are artistic products of South Korean society but also rejections of a rigid society and share the significance of the aesthetics of the carnival grotesque, which consists of subversive expressions directed at a new world.

Outcome of the Modified Norwood Procedure: 7 Years of Experience from a Single Institution (변형된 노우드(Norwood) 수술의 결과: 단일병원의 지난 7년간의 경험)

  • Kim, Hyung-Tae;Sung, Si-Chan;Kim, Si-Ho;Bae, Mi-Ju;Lee, Hyoung-Doo;Park, Ji-Ae;Chang, Yun-Hee
    • Journal of Chest Surgery
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    • v.43 no.4
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    • pp.364-374
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    • 2010
  • Background: We assessed the early and mid-term results of the modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome (HLHS) and its variants to identify the risk factors for hospital mortality. Material and Method: Between March, 2003, and December, 2009, 23 patients (18 males and 5 females) with HLHS or variants underwent the modified Norwood procedure. The age at operation ranged from 3 to 60 days (mean, $11.7{\pm}13.2days$) and weight at operation ranged from 2.2 to 4.8 kg (mean, $3.17{\pm}0.52kg$). We used a modified technique that spared the anterior wall of the main pulmonary artery in 20 patients. The sources of pulmonary blood flow were RV-PA conduit in 15 patients (group I) and RMBTS in 8 (group II). Follow-up was completed in 19 patients (19/20, 95%) in our hospital (mean $26.0{\pm}22.8months$). Result: Early death occurred in 3 patients (3/23, 13%), of whom 2 had TAPVC. Fourteen patients underwent subsequent bidirectional cavopulmonary connection (BCPC, stage 2) and seven underwent the Fontan operation (stage 3). Three patients died between stages, 2 before stage 2 and one before stage 3. The estimated 1-year and 5-year survival rates were 78% and 69%, respectively. On multivariate regression analysis, aberrant right subclavian artery (RSCA) and associated total anomalous pulmonary venous connection (TAPVC) were risk factors for hospital mortality after stage 1 Norwood procedure. Conclusion: HLHS and its variants can be palliated by the modified Norwood procedure with low operative mortality. Total anomalous pulmonary venous connection adversely affects the survival after a stage 1 Norwood procedure, and interstage mortality rates need to be improved.

Active Prosthetic Valve Endocarditis: The Clinical Profile, Laboratory Findings and Mid-term Surgical Results (활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적)

  • Kim, Hwan-Wook;Joo, Seok;Kim, Hee-Jung;Choo, Suk-Jung;Song, Hyun;Lee, Jae-Won;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.447-455
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    • 2009
  • Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Effect of Microwave Hyperthermia on Radiotherapy of Human Malignant Tumors -An Analysis of Clinical Response of 42 Patients- (극초단파를 이용한 국소온열 치료 효과 -표재성 종양 42예의 분석-)

  • Yoon Sei Chul;Oho Yoon Kyung;Gil Hak Jun;Chung Su Mi;Shinn Kyung Sub;Bahk Yong Whee
    • Radiation Oncology Journal
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    • v.5 no.1
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    • pp.31-36
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    • 1987
  • Radiobiological and clinical evidences indicate that hyperthermia combined with ionizing radiation produces a significant improvement in therapeutic effect of cancer. In general, malignant cells are more sensitive to heat than normal cells in the heat range of $41\~45^{\circ}C$. We report the experiences obtained from 42 patients with advanced malignant neoplasms managed with 2,450MHz microwave-induced local hyperthermia and ionizing radiation at the Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. A clinical analysis of 42 thermoirradiated patients showed result of 11(26\%),\;15(36\%),\;11(26\%)\;and\;5(12\%)$ patients with complete response (CR), partial response (PR), minor response (MR) and no response (NR), respectively. Histologically there were $17(40.2\%)$ squamous cell carcinomas, $12(28.6\%)$ adenocarcinomas and $6(14.3\%)$ miscellaneous cancers. Eleven patients with CR consisted of five squamous cell carcinomas, five adenocarcinomas, and one chloroma. Among 15 patients with PR were five squamous cell carcinomas, five adenocarcinomas, three unknown primary tumors, and one poorly differentiated, and miscellaneous tumor each.

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International Success the Second Time Around: A Case Study (제이륜국제성공(第二轮国际成功): 일개안례연구(一个案例研究))

  • Colley, Mary Catherine;Gatlin, Brandie
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.2
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    • pp.173-178
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    • 2010
  • A privately held, third generation family owned company, Boom Technologies, Inc. (BTI), a provider of products and services to the electric utility, telecommunications and contractor markets, continues to make progress in exporting. Although export sales only equaled 5% of total revenue in 2008, BTI has an entire export division. Their export division's Managing Director reveals the trial and errors of a privately held company and their quest for success overseas. From its inception, BTI has always believed its greatest asset is its employees. When export sales struggled due to lack of strategy and direction, BTI hired a Managing Director for its export division. With leadership and guidance from BTI's president and from the Managing Director, they utilized the department's skills and knowledge. Structural changes were made to expand their market presence abroad and increase export sales. As a result, export sales increased four-fold, area managers in new countries were added and distribution networks were successfully cultivated. At times, revenue generation was difficult to determine due to the structure of the company. Therefore, in 1996, the export division was restructured as a limited liability company. This allowed the company to improve the tracking of revenue and expenses. Originally, 80% of BTI's export sales came from two countries; therefore, the initial approach to selling overseas was not reaching their anticipated goals of expanding their foreign market presence. However, changes were made and now the company manages the details of selling to over 80 countries. There were three major export expansion challenges noted by the Managing Director: 1. Product and Shipping - The major obstacle for BTI was product assembly. Originally, the majority of the product was assembled in the United States, which increased shipping and packaging costs. With so many parts specified in the order, many times the order would arrive with parts missing. The missing parts could equate to tens of thousands of dollars. Shipping these missing parts separately in another shipment also cost tens of thousands of dollar, plus a delivery delay time of six to eight weeks; all of which came out of the BTI's pockets. 2. Product Adaptation - Safety and product standards varied widely for each of the 80 countries to which BTI exported. Weights, special licenses, product specification requirements, measurement systems, and truck stability can all differ from country to country and can serve as a type of barrier to entry, making it difficult to adapt products accordingly. Technical and safety standards are barriers that serve as a type of protection for the local industry and can stand in the way of successfully pursuing foreign markets. 3. Marketing Challenges - The importance of distribution creates many challenges for BTI as they attempt to determine how each country prefers to operate with regard to their distribution systems. Some countries have competition from a small competitor that only produces one competing product; whereas BTI manufactures over 100 products. Marketing material is another concern for BTI as they attempt to push marketing costs to the distributors. Adapting the marketing material can be costly in terms of translation and cultural differences. In addition, the size of paper in the United States differs from those in some countries, causing many problems when attempting to copy the same layout and With distribution being one of several challenges for BTI, the company claims their distribution network is one of their competitive advantages, as the location and names of their distributors are not revealed. In addition, BTI rotates two offerings yearly: training to their distributors one year and then the next is a distributor's meeting. With a focus on product and shipping, product adaptation, and marketing challenges, the intricacies of selling overseas takes time and patience. Another competitive advantage noted is BTI's cradle to grave strategy, where they follow the product from sale to its final resting place, whether the truck is leased or purchased new or used. They also offer service and maintenance plans with a detailed cost analysis provided to the company prior to purchasing or leasing the product. Expanding abroad will always create challenges for a company. As the Managing Director stated, "If you don't have patience (in the export business), you better do something else." Knowing how to adapt quickly provides BTI with the skills necessary to adjust to the changing needs of each country and its own unique challenges, allowing them to remain competitive.

Improvement of the Dose Calculation Accuracy Using MVCBCT Image Processing (Megavoltage Cone-Beam CT 영상의 변환을 이용한 선량 계산의 정확성 향상)

  • Kim, Min-Joo;Cho, Woong;Kang, Young-Nam;Suh, Tae-Suk
    • Progress in Medical Physics
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    • v.23 no.1
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    • pp.62-69
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    • 2012
  • The dose re-calculation process using Megavoltage cone-beam CT images is inevitable process to perform the Adaptive Radiation Therapy (ART). The purpose of this study is to improve dose re-calculation accuracy using MVCBCT images by applying intensity calibration method and three dimensional rigid body transform and filtering process. The three dimensional rigid body transform and Gaussian smoothing filtering process to MVCBCT Rando phantom images was applied to reduce image orientation error and the noise of the MVCBCT images. Then, to obtain the predefined modification level for intensity calibration, the cheese phantom images from kilo-voltage CT (kV CT), MVCBCT was acquired. From these cheese phantom images, the calibration table for MVCBCT images was defined from the relationship between Hounsfield Units (HUs) of kV CT and MVCBCT images at the same electron density plugs. The intensity of MVCBCT images from Rando phantom was calibrated using the predefined modification level as discussed above to have the intensity of the kV CT images to make the two images have the same intensity range as if they were obtained from the same modality. Finally, the dose calculation using kV CT, MVCBCT with/without intensity calibration was applied using radiation treatment planning system. As a result, the percentage difference of dose distributions between dose calculation based on kVCT and MVCBCT with intensity calibration was reduced comparing to the percentage difference of dose distribution between dose calculation based on kVCT and MVCBCT without intensity calibration. For head and neck, lung images, the percentage difference between kV CT and non-calibrated MVCBCT images was 1.08%, 2.44%, respectively. In summary, our method has quantitatively improved the accuracy of dose calculation and could be a useful solution to enhance the dose calculation accuracy using MVCBCT images.

Determinants of Nicotine Dependence in Chronic Obstructive Pulmonary Disease

  • Sim, Yun Su;Lee, Jin Hwa;Kim, Ki Uk;Ra, Seung Won;Park, Hye Yun;Lee, Chang-Hoon;Kim, Deog Kyeom;Shin, Kyeong-Cheol;Lee, Sang Haak;Hwang, Hun Gyu;Ahn, Joong Hyun;Park, Yong Bum;Kim, Yu-Il;Yoo, Kwang Ha;Jeong, Ina;Oh, Yeon-Mok;Lee, Sang-Do;KOLD Investigators
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.3
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    • pp.277-283
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    • 2017
  • Background: Smoking cessation is the most powerful intervention to modify progress of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. We evaluated nicotine dependence status and investigated factors associated with moderate to high nicotine dependence in patients with COPD. Methods: We included 53 current smokers with COPD in the Korean Obstructive Lung Disease II cohort enrolled between January 2014 and March 2016. Nicotine dependence was measured by using Fagerstrom test for nicotine dependence (FTND). Cognitive function was assessed by Korean version of Montreal Cognitive Assessment. Results: The median FTND score was 3, and 32 patients (60%) had moderate to high nicotine dependence. The median smoking amount was 44 pack-years, which was not related to nicotine dependence. Multiple logistic regression analysis revealed that high education status (odds ratio, 1.286; 95% confidence interval, 1.036-1.596; p=0.023), age <70 (odds ratio, 6.407; 95% confidence interval, 1.376-29.830; p=0.018), and mild to moderate airflow obstruction (odds ratio, 6.969; 95% confidence interval, 1.388-34.998; p=0.018) were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

Concentration of E-cadherin Correlated with Pathologic Features in Gastric Cancer (위암에서 조직학적 특징에 따른 혈청 E-cadherin의 농도)

  • Hur, Hoon;Song-Gyo-Young;Kim, Jin-Jo;Chin-Hyung-Min;Kim, Wook;Park, Cho-Hyun;Park, Seung-Man;Lim-Keun-Woo;Park, Woo-Bae;Kim, Seung-Nam;Jeon, Hae-Myoung
    • Journal of Gastric Cancer
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    • v.4 no.3
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    • pp.156-163
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    • 2004
  • Purpose: While E-cadherin in normal cells induces calciumdependent cell-cell adhesion, in malignant cell, it plays a role in invasion and metastasis with a reduction of adhesion. Serum soluble E-cadherin is a result of the reduction of the cellular E-cadherin molecule and is found in the circulation of normal individuals, but it is particularly known to be increased in patients with malignancies. Accordingly, through checking the level of serum soluble E-cadherin in patients with gastric cancer and analyzing it in the view of clinicopathology, we investigated whether serum soluble E-cadherin could be translated into a clinicopathologic esult and used as a tumor marker. Materials and Methods: The investigation targeted 88 patients who had been diagnosed as having gastric cancer by the Department of Surgery, St. Mary's Hospital, from October 1, 2002, to July 30, 2003, and who had under gone performed surgery. We measured the level of preoperative serum E-cadherin in the 88 patients by unsing ELISA. Among them, we collected gastric cancer tissues from 54 patients and executed immunohistochemistry for E-cadherin. The samples were compared with normal tissues in terms of both serum E-cadherin level and immunohistochemistry level, as well as with other clinicopathologic factors. Result: The mean serum E-cadherin level of the 88 patients was 4368.7 ng/ml and was significantly higher than the level in 12 normal control patients, 3335.5 ng/ml (P=0.016). In terms of clinicopathology, the serum level of E-cadherin was significantly correlated with increasing age (P=0.0006) and was higher in positive venous invasion patients (P=0.0005). When the E-cadherin immunohistochemical stain was compared with the serum E-cadherin level in 54 patients, no significant statistically meaningful result was obtained (P=0.2881). However, 4 patients with serum E-cadherin levels about 6000 ng/ml were classified into the lower expression group ($<80\%$ of E-cadherin immunohistochemicals stain. In the analysis for 36 patients who were early gastric cancer patients, the serum E-cadherin level in lymph-node-metastatic patients was higher than it was in the other patients (P=0.0442). Conclusion: The serum E-cadherin level in gastric cancer patients was higher than the level in normal control patients. In advanced gastric cancer patients, that the difference was increased. Also, since the E-cadherin level correlated with the serum E-cadherin level with venous invasion, it can be used as an effective tumor marker for gastric cancer. Particularly, in that the serum E-cadherin level correlated with lymph node metastasis in early gastic cancer, it can be used when a therapeutic method for early gastric cancer is selected.

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Clinical Significance of VEGF-C and COX-2 Expression in Gastric Carcinoma with Submucosal Invasion (점막하 침윤 조기위암 환자에서 VEGF-C와 COX-2 발현의 임상적 의의)

  • Cho, Yun-Jung;Lee, Jung-Uee;Lee, Kwan-Ju;Park, Cho-Hyun;Park, Seung-Man;Jeon, Hae-Myung;Ahn, Chang-Joon;Kim, Jeong-Goo;Lee, Dong-Ho;Lee, Sang-Chul
    • Journal of Gastric Cancer
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    • v.9 no.3
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    • pp.96-103
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    • 2009
  • Purpose: Lymph node metastasis is an important factor in determining prognosis and therapeutic options for early gastric cancer (EGC) patients. Vascular endothelial growth factor (VEGF)-C and D are known as lymphangiogenic factors, and cyclooxygenase (COX)-2 is thought to play a role in lymph node metastasis in gastric carcinoma. This study was designed to determine whether the expression of VEGF-C, VEGF-D, and COX-2 is associated with clinicopathologic factors, especially lymph node metastasis in EGCs invading the submucosa. Materials and Methods: Tissue samples were obtained from 85 Patients undergoing standard gastrectomy with lymph node dissection between 1991 and 2007 in the Department of Surgery of Daejeon St. Mary's Hospital in Daejeon, Korea. All patients were diagnosed with gastric cancers and submucosal invasion. We examined the expression of VEGF-C, VEGF-D, and COX-2 using immunohistochemical methods. Results: Of the 85 patients, 16 (18.8%) had lymph node metastasis. VEGF-C, VEGF-D, and COX-2 were positively expressed in 34.1% (29/85), 22.3% (19/85), and 37.6% (32/85) of the patients. VEGF-C and COX-2 expression was significantly correlated with lymph node metastasis (P<0.05). A positive correlation existed between VEGF-C and COX-2 expression (P< 0.001). Conclusion: VEGF-C and COX-2 expression is associated with lymph node metastasis in gastric cancer with submucosal invasion. VEGF-C and COX-2 may thus be predictive markers for lymph node metastasis in EGC patients with submucosal invasion.

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