• The Korean Journal of Pain
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• v.33 no.4
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4733-4738
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• 2014

Purpose: We developed and evaluated a regimen including fotemustine, teniposide and dexamethasone (FTD) for treating patients with central nervous system (CNS) lymphoma based on pharmacokinetic properties of individual agents and in combination. Patients and Methods: In a comparison study, 8 patients with primary CNS lymphoma (PCNSL) and 8 with secondary CNS lymphoma (SCNSL) were treated with FTD (comprising fotemustine 100 mg/m2, 1h infusion, day 1; teniposide 60 mg/m2, >0.5 h infusion, on day 2, 3, 4; dexamethasone 40 mg, 1h infusion, on day 1, 2, 3, 4 and 5; and methotrexate 12 mg, cytosine arabinoside 50 mg plus dexamethasone 5 mg intrathecally, on day 2 and 7). Cycles were repeated every 3 weeks. After response assessment, patients received whole brain radiotherapy. Results: Of the 8 PCNSL patients, 4 (50%) achieved CR and 3 (38%) PR, an overall response rate of 88%. Four patients (50%) were in continuing remission at the end of this study after a median follow-up of 30 months (range 10 to 56 months). Of the 8 SCNSL patients the overall response rate was 63% (CR+PR: 38%+25%). All responses were achievable with predictable toxicity mainly reflecting reversible myelosuppression. Conclusion: This study suggests that FTD could be an effective treatment for CNS lymphoma, and is worthy of further evaluation.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.284-293
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• 2015

Purpose: To determine failure patterns and survival outcomes of T4N0-1 non-small cell lung cancer (NSCLC) treated with definitive radiotherapy. Materials and Methods: Ninety-five patients with T4N0-1 NSCLC who received definitive radiotherapy with or without chemotherapy from May 2003 to October 2014 were retrospectively reviewed. The standard radiotherapy scheme was 66 Gy in 30 fractions. The main concurrent chemotherapy regimen was $50mg/m^2$ weekly paclitaxel combined with $20mg/m^2$ cisplatin or AUC 2 carboplatin. The primary outcome was overall survival (OS). Secondary outcomes were failure patterns and toxicities. Results: The median age was 64 years (range, 34 to 90 years). Eighty-eight percent of patients (n = 84) had an Eastern Cooperative Oncology Group performance status of 0-1, and 42% (n = 40) experienced pretreatment weight loss. Sixty percent of patients (n = 57) had no metastatic regional lymph nodes. The median radiation dose was EQD2 67.1 Gy (range, 56.9 to 83.3 Gy). Seventy-one patients (75%) were treated with concurrent chemotherapy; of these, 13 were also administered neoadjuvant chemotherapy. At a median follow-up of 21 months (range, 1 to 102 months), 3-year OS was 44%. The 3-year cumulative incidences of local recurrence and distant recurrence were 48.8% and 36.3%, respectively. Pretreatment weight loss and combined chemotherapy were significant factors for OS. Acute esophagitis over grade 3 occurred in three patients and grade 3 chronic esophagitis occurred in one patient. There was no grade 3-4 radiation pneumonitis. Conclusion: Definitive radiotherapy for T4N0-1 NSCLC results in favorable survival with acceptable toxicity rates. Local recurrence is the major recurrence pattern. Intensity modulated radiotherapy and radio-sensitizing agents would be needed to improve local tumor control.

• The Journal of the Korean life insurance medical association
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• v.25
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• pp.9-24
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• 2006

지속적으로 증가 하고 있는 악성 종양 발병률의 증가, 생존률의 향상, 조기발견의 증가 등이 암 기왕자의 보험 수요 상승을 가져오고 있으며, 보험시장에서 더 이상 암 기왕자를 도외시하기 어렵게 만들고 있다. 그러나, 현재 국내에서는 암 기왕자를 인수할 수 있는 상품과 언더라이팅 인수 기법이 부족한 실정이다. 본 논문은 이러한 상황 하에서 기존에 거절체로 인식되었던 암 기왕자의 적극적인 인수를 위해 악성종양에 대한 보험 의학적인 고찰과 사망률, 위험도에 대해 분석하고, 국내에서 암 기왕자의 보험 인수 시 문제점과 그 해결방안을 모색해 보았다. 종양은 종양세포의 성장과 확산의 정도를 나타내는 병기와 조직학적 등급에 의해 그 예후와 경과가 예측 가능하며, 이 병기를 표준화하려는 국제적 시도로 1977년 American Joint Committee on Cancer(AJCC)는 TNM system 을 제시하였다. 병기를 기초로 치료의 결정도 함께 이루어지는데, 주요 치료법을 수술, 방사선치료, 항암치료, 면역요법이 있다. 이러한 치료법들은 후기 부작용을 일으키거나 이차성 암(Secondary malignant neoplasm)의 원인이 되기도 한다. 병기에 따른 암환자의 사망률을 살펴 보면, 암은 일정시기 동안 사망률이 급격히 증가하다가 이후에 점차 사망률이 감소하고, 그 이후에는 사망률에 영향을 미치지 않는다. 이러한 사망률 변화의 특성은 암 기왕자에게 평준식 정액 할증법(Per mille flat extra)의 적용이 적절함을 보여준다. 그러나, 현재 국내에서는 악성 종양 기왕자를 위한 상품이 전무한 상태이며, 암의 병리적 병기와 치료에 관련된 정보를 얻을 수 있는 도구도 부족하고, 명확한 인수 기법이 없다. 또한, 자체의 경험통계의 부족으로 위험에 대한 부담감이 큰 것이 현실이다. 하지만, 병기에 따른 사망률의 변화에서도 알 수 있듯이 평준식 정액 할증법의 도입이나, 악성종양의 병기(Stage)별 정액 할증률을 삭감법으로 전환하는 기준을 개발한다면, 종신보험은 충분히 인수가 가능하다. 또한, CI 보험도 암에 대한 부담보를 하는 선진사의 인수 기법을 도입하거나, 암 기왕자만을 위한 CI 상품을 개발하는 등 새로운 인수 기법을 모색한다면, 암기왕자 인수의 폭은 넓어질 것이다. 이와 같은 노력과 함께, 언더라이팅의 정보 획득을 위한 암 기왕자만의 고지서를 개발하고, 전문 언더라이터의 양성을 위한 노력을 게을리 하지 않는다면, 암기왕자를 적극적으로 인수할 수 있을 것이다. 앞으로 국내 보험사가 위와 같은 노력을 지속적으로 해 나가고, 비교적 예후와 경과가 양호한 0기와 1기 암 기왕자부터 단계적으로 종신보험의 인수를 시도한다면, 비교적 안전하게 경험치를 축적할 수 있을 것이다. 뿐만 아니라 국내 보험업계는 새로운 시장의 확보와 보험에 대한 대외 이미지 개선이라는 효과도 함께 얻게 될 것이다.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.631-638
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• 2016

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.

• The Journal of the Korea Contents Association
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• v.15 no.3
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• pp.184-191
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• 2015

Prostate ultrasound is used to diagnose prostate cancer, BPH, prostatitis and biopsy of prostate cancer to determine the size of prostate. BPH is one of the common disease in elderly men. Prostate is divided into 4 blocks, peripheral zone, central zone, transition zone, anterior fibromuscular stroma. BPH is histologically transition zone urethra accompanying excessive nodular hyperplasia causes a lower urinary tract symptoms(LUTS) caused by urethral closure as causing the hyperplastic nodule characterized finding progressive ambient. Therefore, in this study normal transition zone image for hyperplasia prostate and normal transition zone image is analyzed quantitatively using a computer algorithm. We applied texture features of GLCM to set normal tissue 60 cases and BPH tissue 60cases setting analysis area $50{\times}50pixels$ which was analyzed by comparing the six parameters for each partial image. Consequently, Disease recognition detection efficiency of Autocorrelation, Cluster prominence, entropy, Sum average, parameter were high as 92~98%.This could be confirmed by quantitative image analysis to nodular hyperplasia change transition zone of the prostate. This is expected secondary means to diagnose BPH and the data base will be considered in various prostate examination.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.10
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• pp.4359-4366
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• 2014

Intention to smoke is a valid and reliable factor for predicting future smoking habits among adolescents. This factor, however, has received inadequate attention in Malaysia. The present paper elaborates the prevalence and factors associated with intent to initiate or to cease smoking, among adolescent nonsmokers and smokers in Kota Tinggi, Johor, Malaysia. A total of 2,300 secondary school students aged 13-16 years were selected through a two-stage stratified sampling method. A set of standardized questionnaires was used to assess the smoking behavior among adolescents and the inter-personal and intra-personal factors associated with smoking intention (intention to initiate smoking or to cease smoking). Multivariable logistic regression was used to identify factors related to smoking intention. The prevalence of intention to smoke in the future or to cease smoking among non-smoking adolescents and current smokers were 10.7% and 61.7% respectively. Having friends who smoke, social influence, and poor knowledge about the ill effects on health due to smoking showed significant relationships with intention to smoke in the future among non-smokers. Conversely, perceived lower prevalence of smoking among peers, weak contributory social influence, and greater awareness of the ill effects of smoking are factors associated with the intention to cease smoking sometime in the future. The study found that prevalence of intention to initiate smoking is low among non-smokers while the majority of current smokers intended to cease smoking in the future. Existing anti-smoking programmes that integrate the factors that have been identified in the current study should be put in motion to reduce the prevalence of intention to initiate smoking and increase the intention to cease smoking among adolescents.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.3
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• pp.1747-1753
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• 2013

Background: It is projected that low and middle-income countries will bear a major burden of tobacco related morbidity and mortality, yet, only limited information is available on the determinants of smoking initiation among youth in Africa. This study aimed to assess the determinants of smoking initiation and susceptibility to future smoking among a population of high school school students in Lagos, Nigeria. Materials and Methods: Baseline data from an intervention study designed to assess the effect of an anti-smoking awareness program on the knowledge, attitudes and practices of adolescents was analyzed. The survey was carried out in six randomly selected public and private secondary schools in local government areas in Lagos state, Nigeria. A total of 973 students completed self-administered questionnaires on smoking initiation, health related knowledge and attitudes towards smoking, susceptibility to future smoking and other factors associated with smoking. Results: Of the respondents, 9.7% had initiated smoking tobacco products with the predominant form being cigarettes (7.3%). Males (OR: 2.77, 95%CI: 1.65-4.66) and those with more pro-smoking attitudes (OR: 1.44, 95%CI: 1.34-1.54) were more likely to have initiated smoking. Those with parents and friends who are smokers were 3.47 (95%CI: 1.50-8.05) and 2.26 (95%CI: 1.27-4.01) times more likely to have initiated smoking. Non-smoking students, in privately owned schools (OR: 5.08), with friends who smoke (5.09), with lower knowledge (OR: 0.87) and more pro-smoking attitudes (OR 1.13) were more susceptible to future smoking. In addition, respondents who had been sent to purchase cigarettes by an older adult (OR: 3.68) were also more susceptible to future smoking. Conclusions: Being male and having parents who smoke are predictors of smoking initiation among these students. Consistent with findings in other countries, peers not only influence smoking initiation but also influence smoking susceptibility among youth in this African setting. Prevention programs designed to reduce tobacco use among in-school youth should take these factors into consideration. In line with the recommendations of article 16 of the WHO FCTC, efforts to enforce the ban on the sales of cigarettes to minors should be also emphasised.

• Journal of Environmental Health Sciences
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• v.39 no.4
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• pp.312-321
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• 2013

Objective: In May 2011, an interview with three United States Forces Korea veterans revealed that chemicals believed to be 'Agent Orange' were buried at Camp Carroll (situated in Waegwan, Chilgok-gun, Gyeongsangbuk-do, Korea) in 1978. Many hazardous chemicals, such as perchloroethylene (PCE), trichloroethylene (TCE), and organochlorines were subsequently found in a joint US-ROK environmental investigation, although dioxins or burial evidence related to 'Agent Orange' have been not uncovered. This study was carried out to investigate the relevance of hazardous chemical exposure and health effects of the residents around Camp Carroll. Methods: The authors conducted a health questionnaire survey among residents around Camp Carroll regarding Waegwan groundwater ingestion, length of residence in Waegwan, and physician-diagnosed disease history (such as cancer, hypertension, diabetes and etc.). Logistic regression was performed to identify the associations between hazardous chemical exposure and physician-diagnosed diseases. Results: Among the 5,320 residents, excluding those living outside the Waegwan area, 3,430 subjects age 30 and over were analyzed. Among females, upon correction of age, smoking history and Camp Carroll working history, a higher distribution in the Waegwan groundwater ingestion group was demonstrated for patients with physician-diagnosed cancer and hypertension. The odds ratios have a tendency to increase with increased length of Waegwan groundwater ingestion. Conclusions: This study may be limited by not adopting a cohort study for the evaluation of factors that may confound environmental exposure. Yet it is meaningful that the correlation between Waegwan groundwater ingestion and chronic diseases were found through regression analysis in female; and further, this outcome may be used as a sampling basis for a secondary epidemiologic study.

• Tuberculosis and Respiratory Diseases
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• v.73 no.6
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• pp.303-311
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• 2012

Background: This study was designed to analyze the efficacy of gefitinib as a second-line therapy, according to the clinical characteristics in Korean patients with non-small-cell lung cancer (NSCLC). Methods: In this Phase IV observational study, we recruited patients, previously failed first-line chemotherapy, who had locally advanced or metastatic NSCLC, and who were found to be either epidermal growth factor receptor (EGFR) mutation-positive or satisfied 2 or more of the 3 characteristics: adenocarcinoma, female, and non-smoker. These patients were administered with gefitinib 250 mg/day, orally. The primary endpoints were to evaluate the objective response rate (ORR) and to determine the relationship of ORRs, depending on each patient's characteristics of modified intent-to-treat population. Results: A total of 138 patients participated in this study. One subject achieved complete response, and 42 subjects achieved partial response (ORR, 31.2%). The subgroup analysis demonstrated that the ORR was significantly higher in patients with EGFR mutation-positive, compared to that of EGFR mutation-negative (45.8% vs. 14.0%, p=0.0004). In a secondary efficacy variable, the median progression-free survival (PFS) was 5.7 months (95% confidence interval, 3.9~8.4 months) and the 6-month PFS and overall survival were 49.6% and 87.9%, respectively. The most common reported adverse events were rash (34.4%), diarrhea (26.6%), pruritus (17.5%), and cough (15.6%). Conclusion: Gefitinib was observed in anti-tumor activity with favorable tolerability profile as a second-line therapy in these selected patients. When looking at EGFR mutation status, EGFR mutation-positive showed strong association with gefitinib by greater response and prolonged PFS, compared with that of EGFR mutation-negative.