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Unenhanced Breast MRI With Diffusion-Weighted Imaging for Breast Cancer Detection: Effects of Training on Performance and Agreement of Subspecialty Radiologists

  • Yeon Soo Kim;Su Hyun Lee;Soo-Yeon Kim;Eun Sil Kim;Ah Reum Park;Jung Min Chang;Vivian Youngjean Park;Jung Hyun Yoon;Bong Joo Kang;Bo La Yun;Tae Hee Kim;Eun Sook Ko;A Jung Chu;Jin You Kim;Inyoung Youn;Eun Young Chae;Woo Jung Choi;Hee Jeong Kim;Soo Hee Kang;Su Min Ha;Woo Kyung Moon
    • Korean Journal of Radiology
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    • v.25 no.1
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    • pp.11-23
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    • 2024
  • Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). Conclusion: Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Prevalence of Incidentally Detected Spondylolysis in Children (소아 환자에서 우연히 발견되는 척추분리증의 유병률)

  • Boram Song;Sun Kyoung You;Jeong Eun Lee;So Mi Lee;Hyun-Hae Cho
    • Journal of the Korean Society of Radiology
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    • v.83 no.1
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    • pp.127-137
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    • 2022
  • Purpose To assess the prevalence of incidentally detected lumbar spondylolysis in children. Materials and Methods We retrospectively reviewed the data of 809 patients under the age of 11 years (mean age, 7.0 ± 2.7 years; boys:girls = 479:330) who underwent abdominal and pelvic CT between March 2014 and December 2018. We recorded the presence, level, and laterality (unilateral or bilateral) of spondylolysis. Patients were divided into two groups based on the presence of spondylolysis: the spondylolysis (SP) and non-SP groups. Results In total, 21 cases of spondylolysis were detected in 20 patients (20/809, 2.5%). The mean age of the SP group was higher than that of the non-SP group (7.8 ± 1.8 vs. 6.9 ± 2.7 years, p > 0.05). The prevalence of spondylolysis in boys was higher than that in girls (15/479 [3.1%] vs. 5/330 [1.5%], p > 0.05). The prevalence of spondylolysis in school-age children (6-10 year olds) was higher than that in preschool-age children (0-5 year olds) (17/538 [3.2%] vs. 3/271 [1.1%], p > 0.05). L5 was the most common level of spondylolysis (76.2%); one 8-year-old boy had two-level spondylolysis. One case of isthmic spondylolisthesis was detected in a 10-year-old boy (1/809, 0.1%). There were 11 unilateral spondylolysis cases (11/21, 52.4%). Conclusion In our study, the prevalence of spondylolysis in children under the age of 11 was 2.5%. The prevalence was higher in boys than in girls and in school-age than in preschool-age children, despite the lack of any statistically significant differences.

Accuracy of bite registration according to the buccal bite scan range of intra-oral scanner (구강 스캐너의 협측 교합 스캔 부위에 따른 교합 인기의 정확도)

  • Tae-sung Kwon;Dae-hyun Kim;Min-su Kim;Dong-jun Song;Joo-Hun Song
    • Journal of Dental Rehabilitation and Applied Science
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    • v.40 no.3
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    • pp.125-134
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    • 2024
  • Purpose: The aim of this study was to determine which scan range would provide the most accurate bite registration when performing a bite scan after scanning an upper and lower arch using an intraoral scanner. Materials and Methods: The occlusal contact points were recorded using articulating paper for 30 adults, and the results of various ranges of buccal bite scan were compared based on this. Buccal bite scan of 5 ranges (1st premolar to 2nd premolar, 1st premolar to 1st molar, 1st premolar to 2nd molar, 2nd premolar to 1st molar, and canines to another side canine of the maxillary teeth) was performed, and then the buccal bite scan file was used in a CAD program to confirm the occlusal area in the scan file through data editing and alignment, leaving the buccal area of the teeth. Afterwards, the degree of agreement between the occlusal contact points obtained from the articulating paper and the occlusal area obtained from the scan file was compared, and statistical analysis was performed using the homoscedastic T-test (α = 0.05). Results: The alignment success and alignment failure rates among each group were 77.23% and 40.85% in canine to another side canine, 68.23% and 28.89% in bilateral first premolar to second premolar, 63.76% and 29.97% in bilateral first premolar to first molar, 61.31% and 32.04% in bilateral first premolar to second molar, 67.55% and 27.46% in second premolar to first molar. The results of the anterior scan of both canines showed higher alignment success and failure rates compared to the scan results of all maxillary posterior teeth. In the alignment success rate, statistical significance was not found depending on the scan range of the posterior teeth, but in comparing the results of the posterior teeth and both canines, statistical significance was observed except for the scan results of the second premolar to the first molar. There was no statistical significance in the alignment failure rate depending on the scan range of the posterior teeth, and statistical significance was observed in the results of the posterior teeth and both canines. Conclusion: When taking a buccal bite scan, in the case of scanning the anterior teeth, more occlusal area appear than when scanning the posterior teeth, and in the case of scanning the posterior teeth, there is no significant difference in the bite registration depending on the scan range.

Application of Westgard Multi-Rules for Improving Nuclear Medicine Blood Test Quality Control (핵의학 검체검사 정도관리의 개선을 위한 Westgard Multi-Rules의 적용)

  • Jung, Heung-Soo;Bae, Jin-Soo;Shin, Yong-Hwan;Kim, Ji-Young;Seok, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.1
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    • pp.115-118
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    • 2012
  • Purpose: The Levey-Jennings chart controlled measurement values that deviated from the tolerance value (mean ${\pm}2SD$ or ${\pm}3SD$). On the other hand, the upgraded Westgard Multi-Rules are actively recommended as a more efficient, specialized form of hospital certification in relation to Internal Quality Control. To apply Westgard Multi-Rules in quality control, credible quality control substance and target value are required. However, as physical examinations commonly use quality control substances provided within the test kit, there are many difficulties presented in the calculation of target value in relation to frequent changes in concentration value and insufficient credibility of quality control substance. This study attempts to improve the professionalism and credibility of quality control by applying Westgard Multi-Rules and calculating credible target value by using a commercialized quality control substance. Materials and Methods : This study used Immunoassay Plus Control Level 1, 2, 3 of Company B as the quality control substance of Total T3, which is the thyroid test implemented at the relevant hospital. Target value was established as the mean value of 295 cases collected for 1 month, excluding values that deviated from ${\pm}2SD$. The hospital quality control calculation program was used to enter target value. 12s, 22s, 13s, 2 of 32s, R4s, 41s, $10\bar{x}$, 7T of Westgard Multi-Rules were applied in the Total T3 experiment, which was conducted 194 times for 20 days in August. Based on the applied rules, this study classified data into random error and systemic error for analysis. Results: Quality control substances 1, 2, and 3 were each established as 84.2 ng/$dl$, 156.7 ng/$dl$, 242.4 ng/$dl$ for target values of Total T3, with the standard deviation established as 11.22 ng/$dl$, 14.52 ng/$dl$, 14.52 ng/$dl$ respectively. According to error type analysis achieved after applying Westgard Multi-Rules based on established target values, the following results were obtained for Random error, 12s was analyzed 48 times, 13s was analyzed 13 times, R4s was analyzed 6 times, for Systemic error, 22s was analyzed 10 times, 41s was analyzed 11 times, 2 of 32s was analyzed 17 times, $10\bar{x}$ was analyzed 10 times, and 7T was not applied. For uncontrollable Random error types, the entire experimental process was rechecked and greater emphasis was placed on re-testing. For controllable Systemic error types, this study searched the cause of error, recorded the relevant cause in the action form and reported the information to the Internal Quality Control committee if necessary. Conclusions : This study applied Westgard Multi-Rules by using commercialized substance as quality control substance and establishing target values. In result, precise analysis of Random error and Systemic error was achieved through the analysis of 12s, 22s, 13s, 2 of 32s, R4s, 41s, $10\bar{x}$, 7T rules. Furthermore, ideal quality control was achieved through analysis conducted on all data presented within the range of ${\pm}3SD$. In this regard, it can be said that the quality control method formed based on the systematic application of Westgard Multi-Rules is more effective than the Levey-Jennings chart and can maximize error detection.

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A Study on Maternity Aids Utilization in the Maternal and Child Health and Family Planning (농촌(農村)에 있어서 분만개조요원(分娩介助要員)의 봉사(奉仕)에 의(依)한 모자보건(母子保健)rhk 가족계획(家族計劃)에 관(關) 연구(硏究))

  • Yeh, Min-Hae;Lee, Sung Kwan
    • Journal of Preventive Medicine and Public Health
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    • v.5 no.1
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    • pp.57-95
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    • 1972
  • This study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean-while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent' such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area. But, I expect that more maternity sids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if suck facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and post-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a 'notification' system instead of formal registration ststem, it would be improved significantly compared to present system. B. Effect of the project Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't want to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.

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If This Brand Were a Person, or Anthropomorphism of Brands Through Packaging Stories (가설품패시인(假设品牌是人), 혹통과고사포장장품패의인화(或通过故事包装将品牌拟人化))

  • Kniazeva, Maria;Belk, Russell W.
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.3
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    • pp.231-238
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    • 2010
  • The anthropomorphism of brands, defined as seeing human beings in brands (Puzakova, Kwak, and Rosereto, 2008) is the focus of this study. Specifically, the research objective is to understand the ways in which brands are rendered humanlike. By analyzing consumer readings of stories found on food product packages we intend to show how marketers and consumers humanize a spectrum of brands and create meanings. Our research question considers the possibility that a single brand may host multiple or single meanings, associations, and personalities for different consumers. We start by highlighting the theoretical and practical significance of our research, explain why we turn our attention to packages as vehicles of brand meaning transfer, then describe our qualitative methodology, discuss findings, and conclude with a discussion of managerial implications and directions for future studies. The study was designed to directly expose consumers to potential vehicles of brand meaning transfer and then engage these consumers in free verbal reflections on their perceived meanings. Specifically, we asked participants to read non-nutritional stories on selected branded food packages, in order to elicit data about received meanings. Packaging has yet to receive due attention in consumer research (Hine, 1995). Until now, attention has focused solely on its utilitarian function and has generated a body of research that has explored the impact of nutritional information and claims on consumer perceptions of products (e.g., Loureiro, McCluskey and Mittelhammer, 2002; Mazis and Raymond, 1997; Nayga, Lipinski and Savur, 1998; Wansik, 2003). An exception is a recent study that turns its attention to non-nutritional packaging narratives and treats them as cultural productions and vehicles for mythologizing the brand (Kniazeva and Belk, 2007). The next step in this stream of research is to explore how such mythologizing activity affects brand personality perception and how these perceptions relate to consumers. These are the questions that our study aimed to address. We used in-depth interviews to help overcome the limitations of quantitative studies. Our convenience sample was formed with the objective of providing demographic and psychographic diversity in order to elicit variations in consumer reflections to food packaging stories. Our informants represent middle-class residents of the US and do not exhibit extreme alternative lifestyles described by Thompson as "cultural creatives" (2004). Nine people were individually interviewed on their food consumption preferences and behavior. Participants were asked to have a look at the twelve displayed food product packages and read all the textual information on the package, after which we continued with questions that focused on the consumer interpretations of the reading material (Scott and Batra, 2003). On average, each participant reflected on 4-5 packages. Our in-depth interviews lasted one to one and a half hours each. The interviews were tape recorded and transcribed, providing 140 pages of text. The products came from local grocery stores on the West Coast of the US and represented a basic range of food product categories, including snacks, canned foods, cereals, baby foods, and tea. The data were analyzed using procedures for developing grounded theory delineated by Strauss and Corbin (1998). As a result, our study does not support the notion of one brand/one personality as assumed by prior work. Thus, we reveal multiple brand personalities peacefully cohabiting in the same brand as seen by different consumers, despite marketer attempts to create more singular brand personalities. We extend Fournier's (1998) proposition, that one's life projects shape the intensity and nature of brand relationships. We find that these life projects also affect perceived brand personifications and meanings. While Fournier provides a conceptual framework that links together consumers’ life themes (Mick and Buhl, 1992) and relational roles assigned to anthropomorphized brands, we find that consumer life projects mold both the ways in which brands are rendered humanlike and the ways in which brands connect to consumers' existential concerns. We find two modes through which brands are anthropomorphized by our participants. First, brand personalities are created by seeing them through perceived demographic, psychographic, and social characteristics that are to some degree shared by consumers. Second, brands in our study further relate to consumers' existential concerns by either being blended with consumer personalities in order to connect to them (the brand as a friend, a family member, a next door neighbor) or by distancing themselves from the brand personalities and estranging them (the brand as a used car salesman, a "bunch of executives.") By focusing on food product packages, we illuminate a very specific, widely-used, but little-researched vehicle of marketing communication: brand storytelling. Recent work that has approached packages as mythmakers, finds it increasingly challenging for marketers to produce textual stories that link the personalities of products to the personalities of those consuming them, and suggests that "a multiplicity of building material for creating desired consumer myths is what a postmodern consumer arguably needs" (Kniazeva and Belk, 2007). Used as vehicles for storytelling, food packages can exploit both rational and emotional approaches, offering consumers either a "lecture" or "drama" (Randazzo, 2006), myths (Kniazeva and Belk, 2007; Holt, 2004; Thompson, 2004), or meanings (McCracken, 2005) as necessary building blocks for anthropomorphizing their brands. The craft of giving birth to brand personalities is in the hands of writers/marketers and in the minds of readers/consumers who individually and sometimes idiosyncratically put a meaningful human face on a brand.

Halitosis and Related Factors among Rural Residents (농촌지역 주민들의 구취실태와 유발요인)

  • Lee, Young-Ok;Hong, Jung-Pyo;Lee, Tae-Yong
    • Journal of Oral Medicine and Pain
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    • v.32 no.2
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    • pp.157-175
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    • 2007
  • This study was conducted through an interview process in which questionnaires were administered to 293 people. The questionnaires related to the behaviors of oral hygiene care, and disease history related to halitosis, and status of halitosis, halitosis measurement, oral examination, and caries activity tests such as the snyder test, Salivary flow rate test, and Salivary buffering capacity test. Our sample was taken from 293 rural residents within the period from 4th to 21st of January 2006. This was done in order to provide basic data to prepare both policies of halitosis prevention and a device to efficiently measure halitosis status and investigate the factors related therein. The major findings of this study results are as follows: 1. As for frequency of tooth brushing, twice a day occupied the greatest portion at 46.1 % Women exceeded men in frequency of tooth brushing. Tongue brushing everyday produced a 25.6 % result among subjects and The use of auxiliary oral hygiene devices occupied 9.2 %. 2. As for degree of usual self-awareness of halitosis: 62.5 %. This result also demonstrate that the severest time of self-awareness in regards to halitosis is wake up time in the morning. The time period produced the highest portion of 72.7 % in times of self-awareness. In terms of the area in which halitosis was observed, gum resulted in 23.0 %. As for types of halitosis, fetid smell was the most frequent at 37.2 %. 3. As for the result of halitosis measurement, values of OG less than 50 ppm occupied 54.3 % and $50{\sim}100ppm$ occupied 41.6 %. As for $NH_3$ values, $20{\sim}60ppm$ showed the highest value range of 52.6 %. 4. As for OG per disease history related to halitosis, values of OG were significantly high in the ranges of $50{\sim}100ppm$ within family history groups of food impaction by dental caries, diabetes mellitus and halitosis. As for values of $NH_3$, there showed a significant difference in respiratory system disease groups. 5 Value range of OG per ordinary halitosis self-awareness degree: values ranging less than 50 ppm were recorded at 55.9 % from the group realizing not aware of smell. 57.5 % from groups only realizing sometimes, while values range of $50{\sim}100ppm$ were recorded at 52.0 % from groups always aware of smell. 63.6 % from groups always strongly aware of smell. Meanwhile as for the values ranges of $NH_3$, $20{\sim}60ppm$. they occupied high portions for all groups of exams. 6. Values of OG per oral examination: the more pulp-exposed teeth and food impaction and the higher the tongue plaque index, values of OG increased within the range of $50{\sim}100ppm$. As for values of $NH_3$, the more prosthetic teeth and the higher the tongue plaque index, this value increased significantly, and the values increased up to no less than 60 ppm for groups of mandibular partial denture. 7. Within the realm of caries activity test: as for the Snyder test, high activity was highest by 43.0 % wherewith the higher the activity of acidogenic bacteria the higher the OG values. As for the salivary flow rate test, the number of cases below 8.0 ml showed the highest tendency by 62.5 %. The larger the salivary flow rate the more decreased OG values distribution. As for the salivary buffering capacity test, $6{\sim}10$ drops of 0.1N lactic acid showed the overwhelming trend by 58.7 % whereby the higher the salivary buffering capacity the greater distribution occupancy ratio of OG values below 50 ppm which is scentless to on ordinary person. 8. As for the correlation between oral environment and halitosis, OG showed the positive correlation with pulp exposed teeth, filled teeth, present teeth, tongue plaque index, and food impaction, while the negative correlation with salivary flow rate and prosthetic teeth. $NH_3$ showed a positive correlation with prosthetic teeth and frequency of tooth brushing, while decayed teeth was negative correlation. 9. As for the multiple regression analysis result, there have been selected female, pulp exposed teeth, prosthetic teeth, food impaction, salivary flow rate, tongue plaque index and severe activities in the Snyder test as factors affecting OG wherein explanatory power on it was 45.1 %. There have been selected females, pulp exposed teeth, tongue plaque index, and prosthetic teeth as factors affecting on $NH_3$ wherein explanatory power on it was 6.6 %. With the aforementioned results in mind, the status of halitosis among rural residents is considered to bare a close relation with oral environments and other factors related to halitosis such as the Snyder test from caries activity test, and salivary flow rate test. For the prevention of halitosis of residents in rural areas, we have to focus on correct tooth brushing methods and tongue brushing, with using auxiliary oral hygiene devices to remove fur of tongue plaque and food impaction. Also, when the cause and ingredients of halitosis are diverse and complex, in order to analyze exactly the factors of individual halitosis development, we need continuous and systematic study in order to provide rural residents with programs of oral hygiene education and encourage the use of dental hygienists in public health centers.

Studies on the Functional Interrelation between the Vestibular Canals and the Extraocular Muscles (미로반규관(迷路半規管)과 외안근(外眼筋)의 기능적(機能的) 관계(關係)에 관(關)한 연구(硏究))

  • Kim, Jeh-Hyub
    • The Korean Journal of Physiology
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    • v.8 no.2
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    • pp.1-17
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    • 1974
  • This experiment was designed to explore the specific functional interrelations between the vestibular semicircular canals and the extraocular muscles which may disclose the neural organization, connecting the vestibular canals and each ocular motor nuclei in the brain system, for vestibuloocular reflex mechanism. In urethane anesthetized rabbits, a fine wire insulated except the cut cross section of its tip was inserted into the canals closely to the ampullary receptor organs through the minute holes provided on the osseous canal wall for monopolar stimulation of each canal nerve. All extraocular muscles of both eyes were ligated and cut at their insertio, and the isometric tension and EMG responses of the extraocular muscles to the vestibular canal nerve stimulation were recorded by means of a physiographic recorder. Upon stimulation of the semicircular canal nerve, direction if the eye movement was also observed. The experimental results were as follows. 1) Single canal nerve stimulation with high frequency square waves (240 cps, 0. 1 msec) caused excitation of three extraocular muscles and inhibition of remaining three muscles in the bilateral eyes; stimulation of any canal nerve of a unilateral labyrinth caused excitation (contraction) of the superior rectus, superior oblique and medial rectus muscles and inhibition (relaxation) of the inferior rectus, inferior oblique and lateral rectos muscles in the ipsilateral eye, and it caused the opposite events in the contralateral eye. 2) By the overlapped stimulation of triple canal nerves of a unilateral labyrinth, unidirectional (excitatory or inhibitory) summation of the individual canal effects on a given extraocular muscles was demonstrated, and this indicates that three different canals of a unilateral vestibular system exert similar effect on a given extraocular muscles. 3) Based on the above experimental evidences, a simple rule by which one can define the vestibular excitatory and inhibitory input sources to all the extraocular muscles is proposed; the superior rectus, superior oblique and medial rectus muscles receive excitatory impulses from the ipsilateral vestibular canals, and the inferior rectus, inferior oblique and lateral rectus muscles from the contralateral canals; the opposite relationship applies for vestibular inhibitory impulses to the extraocular muscles. 4) According to the specific direction of the eye movements induced by the individual canal nerve stimulation, an extraocutar muscle exerting major role (a muscle of primary contraction) and two muscles of synergistic contraction could be differentiated in both eyes. 5) When these experimental results were compared to the well known observations of Cohen et al. (1964) made in the cats, extraocular muscles of primary contraction were the same but those of synergistic contraction were partially different. Moreover, the oblique muscle responses to each canal nerve excitation appeared to be all identical. However, the responnes of horizontal (medial and lateral) and vertical (superior and inferior) rectus muscles showed considerable differences. By critical analysis of these data, the author was able to locate theoretical contradictions in the observations of Cohen et al. but not in the author's results. 6) An attempt was also made to compare the functional observation of this experiment to the morphological findings of Carpenter and his associates obtained by degeneration experiments in the monkeys, and it was able to find some significant coincidence between there two works of different approach. In summary, the author has demonstrated that the well known observations of Cohen et al. on the vestibulo-ocular interrelation contain important experimental errors which can he proved by theoretical evaluation and substantiated by a series of experiments. Based on such experimental evidences, a new rule is proposed to define the interrelation between the vestibular canals and the extraocular muscles.

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A Prospective Randomized Comparative Clinical Trial Comparing the Efficacy between Ondansetron and Metoclopramide for Prevention of Nausea and Vomiting in Patients Undergoing Fractionated Radiotherapy to the Abdominal Region (복부 방사선치료를 받는 환자에서 발생하는 오심 및 구토에 대한 온단세트론과 메토클로프라미드의 효과 : 제 3상 전향적 무작위 비교임상시험)

  • Park Hee Chul;Suh Chang Ok;Seong Jinsil;Cho Jae Ho;Lim John Jihoon;Park Won;Song Jae Seok;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.19 no.2
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    • pp.127-135
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    • 2001
  • Purpose : This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy of ondansetron $(Zofran^{\circledR})$ 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg lid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Materials and Methods : Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tablets including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Results : Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was $52.9{\pm}11.2$ in group M, $46.5{\pm}9.5$ in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly score for all three symptoms. Ondansetron $(Zofran^{\circledR})$ 8 mg bid dose and metoclopramide 5 mg lid dose were well tolerated without significant side effects. There were no clinically important changes In vital signs or clinical laboratory parameters with either drug. Conclusion : Concerning the fact that patients with younger age have higher emetogenic potential, there are possibilities that age difference between two treatment groups lowered the statistical power of analysis. There were significant difference favoring ondansetron group with respect to the severity of nausea, vomiting and loss of appetite. We concluded that ondansetron is more effective anti-emetic agents in the control of radiotherapy-induced nausea, vomiting, loss of appetite without significant toxicity, compared with commonly used drug, i.e., metoclopramide. However, there were patients suffering emesis despite the administration of ondansetron. The possible strategies to improve the prevention and the treatment of radiotherapy-induced emesis must be further studied.

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The Influence of Ventilation and Shade on the Mean Radiant Temperature of Summer Outdoor (통풍과 차양이 하절기 옥외공간의 평균복사온도에 미치는 영향)

  • Lee, Chun-Seok;Ryu, Nam-Hyung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.5
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    • pp.100-108
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    • 2012
  • The purpose of the study was to evaluate the influence of shading and ventilation on Mean Radiant Temperature(MRT) of the outdoor space at a summer outdoor. The Wind Speed(WS), Air Temperature(AT) and Globe Temperature(GT) were recorded every minute from $1^{st}$ of May to the $30^{th}$ of September 2011 at a height of 1.2m above in four experimental plots with different shading and ventilating conditions, with a measuring system consisting of a vane type anemometer(Barini Design's BDTH), Resistance Temperature Detector(RTD, Pt-100), standard black globe(${\O}$ 150mm) and data acquisition systems(National Instrument's Labview and Compfile Techs' Moacon). To implement four different ventilating and shading conditions, three hexahedral steel frames, and one natural plot were established in the open grass field. Two of the steel frames had a dimension of $3m(W){\times}3m(L){\times}1.5m(H)$ and every vertical side covered with transparent polyethylene film to prevent lateral ventilation(Ventilation Blocking Plot: VP), and an additional shading curtain was applied on the top side of a frame(Shading and Ventilation Blocking Plot: SVP). The third was $1.5m(W){\times}1.5m(L){\times}1.5m(H)$, only the top side of which was covered by the shading curtain without the lateral film(Shading Plot: SP). The last plot was natural condition without any kind of shading and wind blocking material(Natural Open Plot: NP). Based on the 13,262 records of 44 sunny days, the time serial difference of AT and GT for 24 hour were analyzed and compared, and statistical analysis was done based on the 7,172 records of daytime period from 7 A.M. to 8 P.M., while the relation between the MRT and solar radiation and wind speed was analyzed based on the records of the hottest period from 11 A.M. to 4 P.M.. The major findings were as follows: 1. The peak AT was $40.8^{\circ}C$ at VP and $35.6^{\circ}C$ at SP showing the difference about $5^{\circ}C$, but the difference of average AT was very small within${\pm}1^{\circ}C$. 2. The difference of the peak GT was $12^{\circ}C$ showing $52.5^{\circ}C$ at VP and $40.6^{\circ}C$ at SP, while the gap of average GT between the two plots was $6^{\circ}C$. Comparing all four plots including NP and SVP, it can be said that the shading decrease $6^{\circ}C$ GT while the wind blocking increase $3^{\circ}C$ GT. 3. According to the calculated MRT, the shading has a cooling effect in reducing a maximum of $13^{\circ}C$ and average $9^{\circ}C$ MRT, while the wind blocking has heating effect of increasing average $3^{\circ}C$ MRT. In other words, the MRT of the shaded area with natural ventilation could be cooler than the wind blocking the sunny site to about $16^{\circ}C$ MRT maximum. 4. The regression and correlation tests showed that the shading is more important than the ventilation in reducing the MRT, while both of them do an important role in improving the outdoor thermal comfort. In summary, the results of this study showed that the shade is the first and the ventilation is the second important factor in terms of improving outdoor thermal comfort in summer daylight hours. Therefore, it can be apparently said that the more shade by the forest, shading trees etc., the more effective in conditioning the microclimate of an outdoor space reducing the useless or even harmful heat energy for human activities. Furthermore, the delicately designed wind corridor or outdoor ventilation system can improve even the thermal environment of urban area.