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Randomized Trial of Early Versus Late Alternating Radiotherapy/ Chemotherapy in Limited-Disease Patients with Small Cell Lung Cancer (국한성병기 소세포폐암 환자에서 조기 혹은 지연 교대 방사선-항암제치료의 전향적 비교연구)

  • Lee Chang Geol;Kim Joo Hang;Kim Sung Kyu;Kim Sei Kyu;Kim Gwi Eon;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.116-122
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    • 2002
  • Purpose : A randomized prospective study was conducted to compare the efficacy of early or late alternating schedules of radiotherapy, and carboplatin and ifosfamide chemotherapy in patients with limited-disease small cell lung cancer. Materials and Methods: From August 1993 to August 1996, a total of 44 patients with newly diagnosed, limited-disease small cell lung cancer, PS $H0\~2$, wt $loss<10\%$ were enrolled in a randomized trial which compared early alternating radiotherapy (RT)/chemotherapy (CT) and late alternating RT/CT. The CT regimen included ifosfamide $1.5\;g/m^2$ IV, d1-5 and carboplatin AUC 5/d IV, d2 peformed at 4 week intervals for a total of 6 cycles. RT (54 Gy/30 fr) was started after the first cycle of CT (early arm, N=22) or after the third cycle of CT (late arm, N=22) with a split course of treatment. Results : The pretreatment characteristics between the two arms were well balanced. The response rates in the early $(86\%)$ and late $(85\%)$ arm were similar. The median survival durations and 2-year survival rates were 15 months and $22.7\%$ in the early arm, and 17 months and $14.9\%$ in the late arm (p=0.47 by the log-rank test). The two-year progression free survival rates were $19.1\%$ in the early arm and $19.6\%$ in the late arm (p=0.52 by the log-rank test). Acute grade 3 or 4 hematologic and nonhematologic toxicities were similar between the two arms. Eighteen patients $(82\%)$ completed 6 cycles of CT in the early arm and 17 $(77\%)$ in the late arm. Four patients received less than 45 Gy of RT in the early arm and two in the late arm. There was no significant difference in the failure patterns. The local failure rate was $43\%$ in the early arm and $45\%$ in the late arm. The first site of failure was the brain in $24\%$ of the early arm patients compared to $35\%$ in the late arm (p=0.51). Conclusion : There were no statistical differences in the overall survival rate and the pattern of failure between the early and late alternating RT/CT in patients with limited-disease small cell lung cancer.

Status of Tuberculosis Control in Rural Area (일부 농촌지역 결핵환자들의 관리 양상)

  • Park, Chan-Byoung;Chun, Byung-Yeol;Yeh, Min-Hae
    • Journal of agricultural medicine and community health
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    • v.18 no.2
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    • pp.141-151
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    • 1993
  • This study was done about 371 tuberculosis(TB) patients composed 195 newly registered at Kyungju Gun Health Center from May 1989 to April 1990 (Group A) and 176 being treated at hospitals or private clinics from January 1988 to November 1989(Group B). When Group A patients visited and newly registered at Health Center, data was obtained by interviewing with a prepared questionnaire paper. And well trained inquirer visited Group B patients and obtained data by the same method from February 1990 to April 1990. The results are as follows ; Group A was generally lower than Group B in socioeconomic status and in family history of TB, the rate of Group A was 24.1% and higher than 11.9% in Group B(p<0.05). Knowledge about TB was improved more than past, but those who answered that TB is 'a communicable disease' were 59.5% in Group A and 51.7% in Group B(p<0.05). Those answered that TB is 'a inherited disease' were 9.2% and 11.4% each. And 1.7% of Group B answered that TB is 'a incurable disease'. Knowledge about TB treatment also was improved more than past, but in the rate of those who answered that TB is a curable disease provided by well treatment Group B(77.8%) was worse than Group A(91.3%). The rate of those who answered that TB were been able to cure by regularly anti-TB medication were 98.0% in Group A and 89.8% in Group B. Its difference was statistically significant. The rate that patients took the first diagnosis and wanted to receive treatments at the same organ were 34.9% of Group A at Health Center and 72.2% of Group B at hospitals or private clinics. And its difference was statistically significant. In the reasons that Group B knew Health Center treated pulmonary TB but they was treated at hospitals or private clinics, unreliability to Health Center was 48.1%. The reasons that Group A was treated at Health Center were 'because of trust' 63.1%, 'because of low cost' 50.3%, 'because of low cost except trust' 9.3%, 'no specific reasons' 27.7%. In the courses of knowing that TB was controlled at Health Center, 'by neighborhood, health worker and doctors' were 84.9% in Group A and 69.0% in Group B. But 'by TV or radio' were 8.2% in Group A and 14.7% in Group B, 'by school education' 2.5% in Group A and 6.2% in Group B. Conclusively, Group A patients were lower than Group B in socioeconomic status, but better than in knowledge about TB. Its reasons was suggested that Health Center had controlled TB patients better than hospitals and private clinics. But considering, that difference in the rate of the same organ for the first diagnosis and treatment, that the only 63.0% of Group A have treated due to 'reliability to Health Center', and that 48.1% of Group B knew that Health Center treated pulmonary TB but didn't visit it due to 'unreliability to Health Center', that public relations(PR) about use Health Center for pulmonary TB and health education for TB was thought to have to strengthened.

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Brand Equity and Purchase Intention in Fashion Products: A Cross-Cultural Study in Asia and Europe (상표자산과 구매의도와의 관계에 관한 국제비교연구 - 아시아와 유럽의 의류시장을 중심으로 -)

  • Kim, Kyung-Hoon;Ko, Eun-Ju;Graham, Hooley;Lee, Nick;Lee, Dong-Hae;Jung, Hong-Seob;Jeon, Byung-Joo;Moon, Hak-Il
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.245-276
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    • 2008
  • Brand equity is one of the most important concepts in business practice as well as in academic research. Successful brands can allow marketers to gain competitive advantage (Lassar et al.,1995), including the opportunity for successful extensions, resilience against competitors' promotional pressures, and the ability to create barriers to competitive entry (Farquhar, 1989). Branding plays a special role in service firms because strong brands increase trust in intangible products (Berry, 2000), enabling customers to better visualize and understand them. They reduce customers' perceived monetary, social, and safety risks in buying services, which are obstacles to evaluating a service correctly before purchase. Also, a high level of brand equity increases consumer satisfaction, repurchasing intent, and degree of loyalty. Brand equity can be considered as a mixture that includes both financial assets and relationships. Actually, brand equity can be viewed as the value added to the product (Keller, 1993), or the perceived value of the product in consumers' minds. Mahajan et al. (1990) claim that customer-based brand equity can be measured by the level of consumers' perceptions. Several researchers discuss brand equity based on two dimensions: consumer perception and consumer behavior. Aaker (1991) suggests measuring brand equity through price premium, loyalty, perceived quality, and brand associations. Viewing brand equity as the consumer's behavior toward a brand, Keller (1993) proposes similar dimensions: brand awareness and brand knowledge. Thus, past studies tend to identify brand equity as a multidimensional construct consisted of brand loyalty, brand awareness, brand knowledge, customer satisfaction, perceived equity, brand associations, and other proprietary assets (Aaker, 1991, 1996; Blackston, 1995; Cobb-Walgren et al., 1995; Na, 1995). Other studies tend to regard brand equity and other brand assets, such as brand knowledge, brand awareness, brand image, brand loyalty, perceived quality, and so on, as independent but related constructs (Keller, 1993; Kirmani and Zeithaml, 1993). Walters(1978) defined information search as, "A psychological or physical action a consumer takes in order to acquire information about a product or store." But, each consumer has different methods for informationsearch. There are two methods of information search, internal and external search. Internal search is, "Search of information already saved in the memory of the individual consumer"(Engel, Blackwell, 1982) which is, "memory of a previous purchase experience or information from a previous search."(Beales, Mazis, Salop, and Staelin, 1981). External search is "A completely voluntary decision made in order to obtain new information"(Engel & Blackwell, 1982) which is, "Actions of a consumer to acquire necessary information by such methods as intentionally exposing oneself to advertisements, taking to friends or family or visiting a store."(Beales, Mazis, Salop, and Staelin, 1981). There are many sources for consumers' information search including advertisement sources such as the internet, radio, television, newspapers and magazines, information supplied by businesses such as sales people, packaging and in-store information, consumer sources such as family, friends and colleagues, and mass media sources such as consumer protection agencies, government agencies and mass media sources. Understanding consumers' purchasing behavior is a key factor of a firm to attract and retain customers and improving the firm's prospects for survival and growth, and enhancing shareholder's value. Therefore, marketers should understand consumer as individual and market segment. One theory of consumer behavior supports the belief that individuals are rational. Individuals think and move through stages when making a purchase decision. This means that rational thinkers have led to the identification of a consumer buying decision process. This decision process with its different levels of involvement and influencing factors has been widely accepted and is fundamental to the understanding purchase intention represent to what consumers think they will buy. Brand equity is not only companies but also very important asset more than product itself. This paper studies brand equity model and influencing factors including information process such as information searching and information resources in the fashion market in Asia and Europe. Information searching and information resources are influencing brand knowledge that influences consumers purchase decision. Nine research hypotheses are drawn to test the relationships among antecedents of brand equity and purchase intention and relationships among brand knowledge, brand value, brand attitude, and brand loyalty. H1. Information searching influences brand knowledge positively. H2. Information sources influence brand knowledge positively. H3. Brand knowledge influences brand attitude. H4. Brand knowledge influences brand value. H5. Brand attitude influences brand loyalty. H6. Brand attitude influences brand value. H7. Brand loyalty influences purchase intention. H8. Brand value influence purchase intention. H9. There will be the same research model in Asia and Europe. We performed structural equation model analysis in order to test hypotheses suggested in this study. The model fitting index of the research model in Asia was $X^2$=195.19(p=0.0), NFI=0.90, NNFI=0.87, CFI=0.90, GFI=0.90, RMR=0.083, AGFI=0.85, which means the model fitting of the model is good enough. In Europe, it was $X^2$=133.25(p=0.0), NFI=0.81, NNFI=0.85, CFI=0.89, GFI=0.90, RMR=0.073, AGFI=0.85, which means the model fitting of the model is good enough. From the test results, hypotheses were accepted. All of these hypotheses except one are supported. In Europe, information search is not an antecedent of brand knowledge. This means that sales of global fashion brands like jeans in Europe are not expanding as rapidly as in Asian markets such as China, Japan, and South Korea. Young consumers in European countries are not more brand and fashion conscious than their counter partners in Asia. The results have theoretical, practical meaning and contributions. In the fashion jeans industry, relatively few studies examining the viability of cross-national brand equity has been studied. This study provides insight on building global brand equity and suggests information process elements like information search and information resources are working differently in Asia and Europe for fashion jean market.

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The Results of Combined External Radiotherapy and Chemotherapy in the Management of Esophageal Cancer (식도암의 방사선-항암화학 병용치료결과)

  • Lee Hyun Joo;Suh Hyun Suk;Kim Jun Hee;Kim Chul Soo;Kim Sung Rok;Kim Re Hwe
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.17-23
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    • 1996
  • Purpose : To evaluate the role of combination therapy of external radio-therapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. Materials and Methods : A retrospective review of evaluable 55 esophageal cancer patients referred to the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul, 1983 and Dec. 1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group (ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fifty patients had squamous cell carcinomas. Radiation doses of 2520-6480c0y were delivered over a period of 4-7weeks, using 4MV LINAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1, 2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. Resuts : Median follow up Period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months (20 days-73 months) in B group. The 1, 2 YSRs were $26.7\%$, $8.9\%$ in A group, $12.7\%$, $4.3\%$ in B group (p>0.05), respectively. The 1, 2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose (5000cGymore or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000cGy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were $43.8\%$. $25.0\%$, respectively. Complete response rate of $25.0\%$ in A and $8.3\%$ in B were achieved. The local failure and distant metastsis were $52.4\%$. $23.8\%$ in A group, $64.3\%$, $14.3\%$ in 8 group, respectively. The combination therapy revealed more frequent leukopenia and nausea/vomiting than radiation alone group, but degree of side effects was only mild to moderate. Conclusion : The combined external radiotherapy and chemotherapy for advanced esophageal cancer appears to improve the response rate, local control rate and survival rate, but the improvement was not statistically significant. The side effects of combined modalities were mild to moderate without significant morbidity. Therefore it may be worthwhile to continue the present combined external radiotherapy and chemotherapy in the management of advanced esophageal cancer to confirm our result.

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Results of Conventional Radiotherapy in Oropharyngeal Cancer (구인두암의 방사선 치료 성적)

  • Nam Taek Keun;Ahn Sung Ja;Chung Woong Ki;Nah Byung Sik
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.1-8
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    • 1996
  • Purpose: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in oropharyngeal cancer in terms of survival rates and to identify prognostic factors affecting survival by retrospective analysis. Materials and Methods: Forty seven patients of oropharyngeal cancer were treated by conventional radiotherapy in our hospital from Nov. 1985 to APr. 1993. Of these, twenty six patients were treated by conventional radio-therapy alone, and 21 patients with neoadjuvant chemotherapy of mostly two or more cycles of cisplatin and pepleomycin. The Patient characteristics of radiotherapy alone group and neoadjuvant chemotherapy group were not different generally. Radiotherapy was performed by 6MV-LINAC and the total radiation doses of Primary tumors were 54.0-79.2 Gy and cervical lymph nodes were 55.8-90.0 Gy with a fraction size of 1.8 or 2.0 Gy per day. The range of follow-up periods was 3-102 months and median was 20 months. The range of a9e was 33-79 years old and median was 58 years old. Results : Overall 3-year actuarial survival rate (3YSR) of all patients was $39\%$. The 3YSRS of stage I (n=5), II (n=11), III (n=12) and IV (n=19) were 60, 55, 33 and $32\%$, respectively The 3YSRS of Tl+2, T3+4 and No, N+ were 55, $18\%$ (p=0.005) and 43, $36\%$ (p>0.1), respectively. There was no difference in 3YSRS between radiotherapy alone group and neoadjuvant chemotherapy group (38 vs $43\%$, p>0.1). According to the original site of primary tumor, the 3YSRS of tonsil (n=32), base of tongue (n=8), soft palate or uvula (n=6) and pharyngeal wall (n=1) were 36 38, 67 and $0\%$, respectively The Patients of soft palate or uvular cancer had longer survival than other primaries but the difference was not significant statistically (p>0.1). Of 32 patients of tonsillar cancer, 22 Patients who had primary extension to adjacent tissue showed inferior survival rate to the ones who had not Primary extension, but the difference was marginally significant statistically (24 vs $60\%$, p=0.08). On Cox multivariate analysis in entire patients with variables of age, T stage, N stage, total duration of radiotherapy, the site of primary tumor and the use of neoadjuvant chemotherapy, only T stage was a significant Prognostic factor affecting 3YSR. Conclusion : The difference of 3YASRS of conventional radiotherapy alone group and neoadjuvant chemotherapy group was not significant statistically. These treatments could be effective in oropharyngeal cancer of early stage, especially such as soft palate, uvular or tonsillar cancer which did not extend to adjacent tissue. But in order to improve the survival of patients of most advanced oropharyngeal cancer, other altered fractionated radiotherapy such as hyperfractionation rather than conventional fractionation or multi-modal approach combining radiotherapy and accessible surgery or concurrent chemotherapy might be beneficial.

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Hyperfractionated Radiotherapy Following Induction Chemotherapy for Stage III Non-Small Cell Lung Cancer -Randomized for Adjuvant Chemotherapy vs. Observation- (절제 불가능한 제 3 기 비소세포 폐암의 MVP 복합 항암요법과 다분할 방사선 치료 -추가 항암요법에 대한 임의 선택 -)

  • Choi, Eun-Kyung;Chang, Hye-Sook;Ahn, Seung-Do;Yang, Kwang-Mo;Suh, Cheol-Won;Lee, Kyoo-Hyung;Lee, Jung, Shin;Kim, Sang-Hee;Ko, Youn-Suk;Kim, Woo-Sung;Kim, Won-Dong;Song, Koun-Sik;Sohn, Kwang-Hyun
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.295-301
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    • 1993
  • Since Jan. 1991 a prospective randomized study for Stage III unresectable non small cell lung cancer (NSCLC) has been conducted to evaluate the response rate and tolerance of induction chemotherapy with MVP followed by hyperfractionated radiotherapy and evaluate the efficacy of maintenance chemotherapy in Asan Medical Center. All patients in this study were treated with hyperfractionated radiotherapy (120 cGy/fx BID, 6480 cGy/54 fx) following 3 cycles of induction chemotherapy, MVP (Mitomycin C 6 $mg/m^2,$ Vinblastin 6 $mg/m^2,$ Cisplatin 60 $mg/m^2$) and then the partial and complete responders from induction chemotherapy were randomized to 3 cycles of adjuvant MVP chemotherapy group and observation group. 48 patients were registered to this study until December 1992; among 48 patients 3 refused further treatment after induction chemotherapy and 6 received incomplete radiation therapy because of patient's refusal, 39 completed planned therapy. Twenty-three $(58\%)$ patients including 2 complete responders showed response from induction chemotherapy. Among the 21 patients who achieved a partial response after induction chemotherapy,1 patient rendered complete clearance of disease and 10 patients showed further regression of tumor following hyperfractionated radiotherapy. Remaining 10 patients showed stable disease or progression after radiotherapy. Of the sixteen patients judged to have stable disease or progression after induction chemotherapy, seven showed more than partial remission after radiotherapy but nine showed no response in spite of radiotherapy. Of the 39 patients who completed induction chemotherapy and radiotherapy, 25 patients $(64\%)$ including 3 complete responders showed more than partial remission. Nineteen patients were randomized after radio-therapy. Nine Patients were allocated to adjuvant chemotherapy group and 4/9 showed further regression of tumor after adjuvant chemotherapy. For the time being, there is no suggestion of a difference between the adjuvant chemotherapy group and observation group in distant metastasis rate and survival. Median survival time was 13 months. Actuarial survival rates at 6,12 and 18 months of 39 patients who completed this study were $84.6\%,\;53.7\%\;and\;40.3\%,$ respectively. The partial and complete responders from induction chemotherapy showed significantly better survival than non-responders (p=0.028). Incidence of radiation pneumonitis in this study group was less than that in historical control group inspite of induction chemotherapy. All patients tolerated hypertractionated radiotherapy without definite increase of acute complications compared with conventional radiotherapy group. The longer follow up is needed to evaluate the efficacies of induction and maintenance chemotherapy and survival advantage by hyperfractionated radiotherapy but authors are encouraged with an excellent tolerance, higher response rate and improvement of one year survival rate in patients of this study.

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A Study on the Differences of Information Diffusion Based on the Type of Media and Information (매체와 정보유형에 따른 정보확산 차이에 대한 연구)

  • Lee, Sang-Gun;Kim, Jin-Hwa;Baek, Heon;Lee, Eui-Bang
    • Journal of Intelligence and Information Systems
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    • v.19 no.4
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    • pp.133-146
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    • 2013
  • While the use of internet is routine nowadays, users receive and share information through a variety of media. Through the use of internet, information delivery media is diversifying from traditional media of one-way communication, such as newspaper, TV, and radio, into media of two-way communication. In contrast of traditional media, blogs enable individuals to directly upload and share news, which can be considered to have a differential speed of information diffusion than news media that convey information unilaterally. Therefore this Study focused on the difference between online news and social media blogs. Moreover, there are variations in the speed of information diffusion because that information closely related to one person boosts communications between individuals. We believe that users' standard of evaluation would change based on the types of information. As well, the speed of information diffusion would change based on the level of proximity. Therefore, the purpose of this study is to examine the differences in information diffusion based on the types of media. And then information is segmentalized and an examination is done to see how information diffusion differentiates based on the types of information. This study used the Bass diffusion model, which has been frequently used because this model has higher explanatory power than other models by explaining diffusion of market through innovation effect and imitation effect. Also this model has been applied a lot in other information diffusion related studies. The Bass diffusion model includes an innovation effect and an imitation effect. Innovation effect measures the early-stage impact, while the imitation effect measures the impact of word of mouth at the later stage. According to Mahajan et al. (2000), Innovation effect is emphasized by usefulness and ease-of-use, as well Imitation effect is emphasized by subjective norm and word-of-mouth. Also, according to Lee et al. (2011), Innovation effect is emphasized by mass communication. According to Moore and Benbasat (1996), Innovation effect is emphasized by relative advantage. Because Imitation effect is adopted by within-group influences and Innovation effects is adopted by product's or service's innovation. Therefore, ours study compared online news and social media blogs to examine the differences between media. We also choose different types of information including entertainment related information "Psy Gentelman", Current affair news "Earthquake in Sichuan, China", and product related information "Galaxy S4" in order to examine the variations on information diffusion. We considered that users' information proximity alters based on the types of information. Hence, we chose the three types of information mentioned above, which have different level of proximity from users' standpoint, in order to examine the flow of information diffusion. The first conclusion of this study is that different media has similar effect on information diffusion, even the types of media of information provider are different. Information diffusion has only been distinguished by a disparity between proximity of information. Second, information diffusions differ based on types of information. From the standpoint of users, product and entertainment related information has high imitation effect because of word of mouth. On the other hand, imitation effect dominates innovation effect on Current affair news. From the results of this study, the flow changes of information diffusion is examined and be applied to practical use. This study has some limitations, and those limitations would be able to provide opportunities and suggestions for future research. Presenting the difference of Information diffusion according to media and proximity has difficulties for generalization of theory due to small sample size. Therefore, if further studies adopt to a request for an increase of sample size and media diversity, difference of the information diffusion according to media type and information proximity could be understood more detailed.

Comparison of CT based-CTV plan and CT based-ICRU38 plan in brachytherapy planning of uterine cervix cancer (자궁경부암 강내조사 시 CT를 이용한 CTV에 근거한 치료계획과 ICRU 38에 근거할 치료계획의 비교)

  • Shim JinSup;Jo JungKun;Si ChangKeun;Lee KiHo;Lee DuHyun;Choi KyeSuk
    • The Journal of Korean Society for Radiation Therapy
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    • v.16 no.2
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    • pp.9-17
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    • 2004
  • Purpose : Although Improve of CT, MRI Radio-diagnosis and Radiation Therapy Planing, but we still use ICRU38 Planning system(2D film-based) broadly. 3-Dimensional ICR plan(CT image based) is not only offer tumor and normal tissue dose but also support DVH information. On this study, we plan irradiation-goal dose on CTV(CTV plan) and irradiation-goal dose on ICRU 38 point(ICRU38 plan) by use CT image. And compare with tumor-dose, rectal-dose, bladder-dose on both planning, and analysis DVH Method and Material : Sample 11 patients who treated by Ir-192 HDR. After 40Gy external radiation therapy, ICR plan established. All the patients carry out CT-image scanned by CT-simulator. And we use PLATO(Nucletron) v.14.2 planing system. We draw CTV, rectum, bladder on the CT image. And establish plan irradiation-$100\%$ dose on CTV(CTV plan) and irradiation-$100\%$ dose on A-point(ICRU38 plan) Result : CTV volume($average{\pm}SD$) is $21.8{\pm}26.6cm^3$, rectum volume($average{\pm}SD$) is $60.9{\pm}25.0cm^3$, bladder volume($average{\pm}SD$) is $116.1{\pm}40.1cm^3$ sampled 11 patients. The volume including $100\%$ dose is $126.7{\pm}18.9cm^3$ on ICRU plan and $98.2{\pm}74.5cm^3$ on CTV plan. On ICRU planning, the other one's $22.0cm^3$ CTV volume who residual tumor size excess 4cm is not including $100\%$ isodose. 8 patient's $12.9{\pm}5.9cm^3$ tumor volume who residual tumor size belows 4cm irradiated $100\%$ dose. Bladder dose(recommended by ICRU 38) is $90.1{\pm}21.3\%$ on ICRU plan, $68.7{\pm}26.6\%$ on CTV plan, and rectal dose is $86.4{\pm}18.3\%,\;76.9{\pm}15.6\%$. Bladder and Rectum maximum dose is $137.2{\pm}50.1\%,\;101.1{\pm}41.8\%$ on ICRU plan, $107.6{\pm}47.9\%,\;86.9{\pm}30.8\%$ on CTV plan. Therefore CTV plan more less normal issue-irradiated dose than ICRU plan. But one patient case who residual tumor size excess 4cm, Normal tissue dose more higher than critical dose remarkably on CTV plan. $80\%$over-Irradiated rectal dose(V80rec) is $1.8{\pm}2.4cm^3$ on ICRU plan, $0.7{\pm}1.0cm^3$ on CTV plan. $80\%$over-Irradiated bladder dose(V80bla) is $12.2{\pm}8.9cm^3$ on ICRU plan, $3.5{\pm}4.1cm^3$ on CTV plan. Likewise, CTV plan more less irradiated normal tissue than ICRU38 plan. Conclusion : Although, prove effect and stability about previous ICRU plan, if we use CTV plan by CT image, we will reduce normal tissue dose and irradiated goal-dose at residual tumor on small residual tumor case. But bigger residual tumor case, we need more research about effective 3D-planning.

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Treatment Results of Radical Radiotherapy in Uterine Cervix Cancer (자궁경부암 환자의 근치적 방사선치료성적)

  • Huh Seung Jae;Kim Bo Kyong;Lim Do Hoon;Shin Seong Soo;Lee Jeong Eun;Kang Min Kyu;Ahn Yong Chan
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.237-245
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    • 2002
  • Purpose : This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Materials and Methods : Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radio-therapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range $30.6\~50.4\;Gy$ to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of $24\~28\;Gy$ with $6\~7$ fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Results : Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was $82\%,\;and\;73\%$, and the disease free survival (DFS) rate was $72\%,\;and\;69\%$, at 3, and 5 years, respectively. The pelvic control rate (PCR) was $79\%$ at both 3 and 5 years. According to the FIGO stage,3 and 5 year OS were $100\%\;and\;50\%$ in CIS/IA, $100\%\;and\;100%$ in IB, $83\%\;and\;69\%$ in IIA, $87\%\;and\;80\%$ in IIB, and $62\%\;and\;62\%$ in III, respectively. The 3 year OS in 4 patients with stage IVA was $100\%$. Three-year DFS were $80\%$ in CIS/IA, $88\%$ in IB, $100\%$ in IIA, $64\%$ in IIB, $58\%$ in III, and $75\%$ in IVA. Three-year PCR were $100\%$ in CIS/IA, $94\%$ in IB, $100\%$ in IIA, $84\%$ in IIB, $69\%$ in III, and $50\%$ in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (0=0.0872). A total of 14 patients $(13\%)$ experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy. Conclusion : HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.

Analysis of the ESD and DAP According to the Change of the Cine Imaging Condition of Coronary Angiography and Usefulness of SNR and CNR of the Images: Focusing on the Change of Tube Current (관상동맥 조영술(Coronary Angiography)의 씨네(cine) 촬영조건 변화에 따른 입사표면선량(ESD)과 흡수선량(DAP) 및 영상의 SNR·CNR 유용성 분석: 관전류 변화를 중점으로)

  • Seo, Young Hyun;Song, Jong Nam
    • Journal of the Korean Society of Radiology
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    • v.13 no.3
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    • pp.371-379
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    • 2019
  • The purpose of this study was to investigate the effect of the change in the X-ray condition on the entrance surface dose (ESD) and dose area product (DAP) in the cine imaging of coronary angiography (CAG), and to analyze the usefulness of the condition change on the dose relation and image quality by measuring and analyzing the Signal to Noise Radio (SNR) and Contrast to Nois Ratio (CNR) of the angiographic images taken by the Image J program. Data were collected from 33 patients (24 males and 9 females) who underwent CAG at this hospital from November 2017 to March 2018. In terms of imaging condition and data acquisition, the ESD and DAP of group A with a high tube current of 397.2 mA and group B with a low tube current of 370.7 mA were retrospectively obtained for comparison and analysis. For the SNR and CNR measurement and analysis via Image J, the result values were derived by substituting the obtained data into the formula. The correlations among ESD and DAP according to the change in the imaging condition, SNR, and CNR were analyzed by using the SPSS statistical analysis software. The relationships of groups A and B, having a difference in the imaging condition, mA, with ESD ($A:483.5{\pm}60.1$; $B: 464.4{\pm}39.9$) and DAP ($A:84.3{\pm}10.7$; $B:81.5{\pm}7$) were not statistically significant (p>0.05). In the relationships with SNR and CNR based on Image J, the SNR ($5.451{\pm}0.529$) and CNR ($0.411{\pm}0.0432$) of the images obtained via the left coronary artery (LCA) imaging of group B showed differences of $0.475{\pm}0.096$ and $-0.048{\pm}0.0$, respectively, from the SNR ($4.976{\pm}0.433$) and CNR ($0.459{\pm}0.0431$) of the LCA of group A. However, the differences were not statistically significant (p<0.05). In the SNR and CNR obtained via the right coronary artery (RCA) imaging, the SNR ($4.731{\pm}0.773$) and CNR ($0.354{\pm}0.083$) of group A showed increased values of $1.491{\pm}0.405$ and $0.188{\pm}0.005$, respectively, from the SNR ($3.24{\pm}0.368$) and CNR ($0.166{\pm}0.033$) of group B. Among these, CNR was statistically significant (p<0.05). In the correlation analysis, statistically significant results were shown in SNR (LCA) and CNR (LCA); SNR (RCA) and CNR (RCA); ESD and DAP; ESD and sec; DAP and CNR (RCA); and DAP and sec (p<0.05). As a result of the analyses on the image quality evaluation and usefulness of the dose change, the SNR and CNR were increased in the RCA images of the CAG obtained by increasing the mA. Based on the result that CNR showed a statistically significant difference, it is believed that the contrast in the image quality can be further improved by increasing the mA in RCA imaging.