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A Study of Influence of Filgrastim on PET/CT In Diffuse Large B cell Lymphoma (미만성 거대 B 세포 림프종 환자에서 Filgrastim 사용이 PET/CT 영상에 미치는 영향에 대한 고찰)

  • NamKoong, Hyuk;Park, Hoon-Hee;Ban, Yung-Gak;Kang, Sin-Chang;Kim, Sang-Kyoo;Lim, Han-Sang;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.13 no.3
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    • pp.17-23
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    • 2009
  • Purpose: It has been known that PET/CT is very valuable in follow-up study of diffuse large B cell lymphoma (DLBCL). Generally, in DLBCL, radiotherapy and chemotherapy has been progressed, because the lesion hasn‘t been limited to one site. And, it has lead to the decrease of leukocyte like neutropenia, due to myelosuppression of chemotherapy. So, in that case, administration of Filgrastim (Granulocyte colony-stimulating factor; G-CSF) is universal. However, in short time after administration, PET/CT has limitation to offer accurate images, through the uptake of $^{18}F$-FDG is increased in the region that is activated bone marrow by hematopoietic growth. Therefore, the aim of this study is that PET/CT in a certain period of time after administration of Filgrastim is able to show normal degree of $^{18}F$-FDG uptake. Materials and Methods: 10 patients under follow-up study of diffuse large B cell lymphoma were examined in this study from January, 2007 to January, 2009 (Male: 4 persons; Female: 6 persons; The mean age: 53.8 years old; The mean weight: 57.3 Kg). Using PET/CT (Discovery STe; GE Healthcare, Milwaukee, WI, USA), whole body images were acquired in 1 hour after $^{18}F$-FDG injection. For image analysis, each ROI ($120\;mm^2$) was drawn on $C^6$ (the sixth C-spine), $L_4$ (the forth L-spine), liver, spleen, and lung, then SUV (Standard Uptake Value)s were measured. We compared with each uptake between in 1-day and 5~7 days after administration of Filgrastim at same patient, so confirmed significance about these by SPSS version 12. Results: In case of $C_6$, $L_4$, spleen, every SUV of 1 day later was remarkably higher than that of 5~7 days later, but liver and lung were similar. Also, the images acquired after 5~7 days distinct remarkably and show normal degree of $^{18}F$-FDG uptake, because uptake of bone was almost disappeared. Conclusions: In this study, each SUV was prominent difference as a period of time after Filgrastim’s administration. And Filgrastim makes concentrate uptake of $^{18}F$-FDG in bone, but, after 5~7 days, bone‘s uptake was greatly decreased. Therefore, we are able to infer a certain period of time that shows normal degree of uptake, by numerical value proven. Also, we consider that this study contribute to advanced study about the other agent like Pegfilgrastim, Lenograstim besides Filgrastim, afterwards.

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Results of Hyperfractionated Radiation Therapy in Bulky Stage Ib, IIa, and IIb Uterine Cervical Cancer (종괴가 큰 병기 Ib, IIa, IIb 자궁경부암에서 다분할 방사선치료의 결과)

  • Kim, Jin-Hee;Kim, Ok-Bae
    • Radiation Oncology Journal
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    • v.15 no.4
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    • pp.349-356
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    • 1997
  • Purpose : To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb Materials and Materials : Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University. School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO s1aging system, therewere stage Ib (3 patients) IIa (6 patients) with exophytic ($\geq$5cm in dinmeter) and huge endophytic mass. and IIb (32 patients) with median age of 55 yeavs old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield $(4\times10cm)$, and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively . Results : Five year local control rate was $78\%$ and the actuarial overall five year survival rate was $66.1\%$ for all patients, $44.4\%$ for stage Ib, IIa and $71.4\%$ for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five rear survival rate was $88.9\%,\;73\%$ respectively Pelvic lymph node status (negative : $74\%,\;positive:25\%$, p=0.0015) was significant Prognostic factor affecting to five rear survival rate. There was marginally significant survival difference by total dose to A point ($>84Gy\;:\;70\%,\;>84Gy\;:\;42.8\%$, p=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy. IIb 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb The overall recurrence rate was $39\%$ (16/41). The rates of local failure alone. distant failure alone. and combined local and distant failure were $9.7\%,\;19.5\%,\;and\;9.7\%$, respectively. Two Patients developed leukopenia ($\geq$ grade 3) and Three patients develoued grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. Conclusion : We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophvtic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.

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A Study on the Women's Need during early Postpartum (산욕 초기 여성의 간호 요구에 관한 연구)

  • Yoo, Eun-Kwang;Lee, Mi-Young;Kim, Jin-Hee;Sin, Chu-Kyung;Yoo, Soon-Jae;Ji, Soo-Kyung
    • Women's Health Nursing
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    • v.6 no.3
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    • pp.439-452
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    • 2000
  • This study sought to figure out women's needs during early postpartum for developing adequate nursing intervention toward postpartal women's healthy adaptation. A convenience sample of 89 women who are in the early postpartal period and admitted in a university hospital located in Seoul, Korea was studied from July 1, 1999 to August 13. 1999. 1. The age group of 26-30 years was 52.8% and the level of education above high school 91%. 67.6% of women had no job, 62.9% had experienced one time of delivery, and 52.8% had no experience of abortion. 2. 31.5% of women received prenatal education, 44.9% only postpartal education. 77.5% of women planned breast-feeding, and 53.9% of women had an experience of breast-feeding during hospital stay. For the feeling of confidence related to the self-care, 27% only expressed 'yes. I have' and 59.5% 'just a little bit'. For the feeling of confidence related to the baby rearing, 29.2% only expressed 'yes. I have' and 60.7% 'just a little bit'. 3. The rate of postpartal women's mother as a preferred non-professional care giver was the highest, 75.3%. The rate of the style of Sanhujori highly preferred and planned at this time was at postpartal women's maiden home or her home with mother, 58.4%, 47.7% respectively. It shows that women still wish to have traditional Sanhuiori at home. 4. The mean of nursing need of postpartal women was 4.25% and it means that universally the degree of nursing need during postpartum is still high. General nursing need (4.29) was higher than that of traditional Sanhujori (4.09), however, the need of Sanhujori is still high. 5. Specifically, the degree of nursing need according to the category of needs was 'educational need for baby rearing,' 4.43; 'emotional-psychological care', 4.41; 'environmental care,' 4.31; 'self-care,' 4.14; and 'physical care,' 3.85 in rank. The educational need core of the specific method about Sanhuiori (4.35) was second to the highest among 15 items of self-care. 6. The related factors to the degree of nursing need were age to physical care; educational level, plan of breast feeding and experience of breast feeding during hospital stay to emotional-psychological care; and the feeling of confidence in baby rearing to environmental care. 7. There was highly positive correlation between the degree of traditional Sanhujori need and general care need(r=.77). This result strongly reflects that there is a necessity of professional care givers' capability to consider the integrative care reflecting the socio-cultural need for women's healthy adaptation during postpartum. It provides a challenge to the professional care givers to research further on the effects of Sanhuiori on the health status, health recovery after abortion or delivery from the various aspects through the cross-sectional and longitudinal research for the refinement of the reality of Sanhuiori not only as cultural phenomenon but as an inseparable factor influencing on women's postpartal healthy adaptation and for the appropriateness of intervention and quality of care for desirable health outcome.

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Sleep Patterns and Academic Performance in Medical Students (의과대학생의 수면 양상과 성적의 관련성)

  • Shin, Seo-Yeon;Lee, Jin-Seong;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.15 no.2
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    • pp.87-93
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    • 2008
  • Introduction: Although it is well known that medical students are not getting an adequate amount of sleep, there have been only few studies on the sleep patterns of medical students in Korea. Therefore, the present study aimed to investigate the life style and sleep patterns of Korean medical students and the impact they have on the students' academic performance. Methods: A questionnaire package was administered to the $3^{rd}$ year medical students at the Seoul National University to examine their sleep patterns on weekdays and weekends. It consisted of questions asking about their lifestyles as well as Pittsburgh sleep quality index (PSQI) and GPA (Grade Point Average) that are considered relevant to their sleep patterns. A total of 110 students (85 males and 25 females, mean age $24.4{\pm}20.6$) responded to the survey and the result was analyzed using the independent t-test, the chi-square test, the paired t-test, Pearson's rank correlation and ANOVA. P-values of less than 0.05 were considered statistically significant in all analyses. Results: The weekend bedtime was significantly delayed (01:24 on weekday;03:12 on weekend; t=-5.23, p<0.01), the weekend rise time was delayed (07:36 on weekday;10:30 on weekend ; t=-24.48, p<0.01) and the total sleep time was increased on weekends (5:57 on weekday;8:17 on weekend ; t=15.94, p<0.01). They wished to sleep for 7 hours 6 minutes which was different from their actual weekday total sleep time (t=-11.41, p<0.01). The poor sleeper group had lower GPAs than the good sleeper group (t=2.05, p<0.05). The GPA of medical students were negatively correlated with age (r=-0.23, p<0.05), daily amount of smoking (r=-0.78, p<0.01), total amount of smoking (r=-0.75, p<0.01), weekday sleep latency (r=-0.23, p<0.05), weekend sleep latency (r=-0.23, p<0.05) and PSQI score (r=-0.30, p<0.01). Conclusion: Medical students were experiencing a lack of sleep during weekdays as they have a later bedtime and earlier rise time, and consequently had more hours of sleep on weekends. Overall, the responded students were experiencing poor sleep quality, and the GPAs of the poor sleeper group were lower than those of the good sleeper group.

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A Study on the Health Problem of the Industrial Workers (산업장 근로자 건강문제의 산업위생학적 연구)

  • Park Moon Hee;Suh In Sun;Ahn Ok Hee
    • Journal of Korean Public Health Nursing
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    • v.4 no.2
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    • pp.59-77
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    • 1990
  • The purpose of this study was to provide the basic data for the effective health management of the industrial workers, by classifying factors influencing their perceived symptoms to examine their health status and identifying the inter' relationship of their perceived symptom with their working department. the environment of working area and their general characteristics. The study was undertaken from October 1 to November 30. 1989. The subjects were 999 workers who had worked in Industrial Corps located in Chungbuk Province. The results of this study were as follows: I . Worker's perceived symptoms were classified according to the following eight factors; 1) musculo - skeletal symptoms of shoulder, neck, back and arm 2) optical symptoms 3) symptoms in head(such as headache and dull) 4) musculo - skeletal symptoms of leg and lower back 5) gastro - intestinal symptoms 6) mental symptoms. 7) neural symptoms 8) lung and heart symptoms II . The degrees of workers' perception of perceived symptoms; Mean score of perceived symptoms:7.0 The rank of degrees of perceived symptoms: The highest:musculo - skeletal symptoms of shoulder, neck, back, and arm The second:optical symptoms The third:musculo - skeletal symptoms of leg and lower back The fourth:mental symptoms the fifth:gastro-intestinal symptoms m . Analysis of the inter-relationship of perceived symptoms with working department, environment of working area and general characteristics; 1) sexuality The difference of degrees of perceived symptoms was significant;femanle was higher than male(P<0.000). 2) level of education The difference of degrees of perceived symptoms according to the level of education was significant; The higher the level of education, the higher the degree. 3) working department The working department played a significant part in the degrees of perceived symptoms of workers; Workers of assembling department:musculo-skeletal symptoms both of shoulder. neck, back and arm and of leg and lower back(P<0.000). Workers of inspection department:optical symptoms(P<0.05). Office workers:mental symptoms(P<0.05). 4) kinds of job The difference of the degrees of perceived symptoms according to kinds of job was significant; Workers dealing with chemical materials and workers dealing with job with high tension:gastro-intestinal symptoms and symptoms in head. Workers dealing with weighty things or working a long time with the same posture:musculo-skeletal symptoms both of shoulder, neck, back and arm and of lower back(P<0.000). 5) working posture The difference of the degrees of perceived symptoms related with working posture was significant; Sitting:optical symptoms(P<0.0000) and symptoms in head(P<0.005) Standing:musculo-skeletal symptoms of leg and lower back(P<0.0000). 6) satisfaction with their own duty The more dissatisfien they were. the higher became the degrees of their perceived symptoms(P<0.0001). 7) satisfaction with their working condition The more dissatisfied with their working condition they were, the higher became the degrees of their perceived symptoms(P<0.001). 8) environment of working area The environment of working area played a significant part in the degrees of perceived symptoms of workers; Workers exposed to most of the factors of the environment of working area were higher than those not exposed in the degrees of musculoskeletal symptoms. Workers in the noisy environment:optican symptoms(P<0.000), symptoms in head(P<0.005). Workers in the damp environment:optical symptoms(P<0.005) and lung and heart symptoms(P <0.01). Workers with illumination problem:optical symptoms(P<0.000), mental symptoms(P<0.005) and neural symptoms(P<0.01). Workers with ventilation problem:optical symptoms and lung and heart symptoms(P<0.001)

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A Study on the DWI and Pathologic Findings of Cancer Cells (암 세포주의 확산강조영상과 병리학적 관계에 관한 연구)

  • Seong, Jae-Gu;Lim, Cheong-Hwan
    • Journal of radiological science and technology
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    • v.34 no.3
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    • pp.239-244
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    • 2011
  • In this study, we evaluated diffusion weighted imaging (DWI) to investigate whether the DWI parameters can predict characteristic parameters on pathologic specimens of tumor or not. CFPAC-1 was injected subcutaneously on the back flank of athymic nude mice (n=13) then two tumors were initiated on each mouse (2${\times}$13=26 tumors). The mice were sacrificed to make specimen immediately after initial MR imaging then were compared with the MR image. A dedicated high-field (7T) small-animal MR scanner was used for image acquisitions. A T1 and T2 weighted axial image using RARE technique was acquired to measure the T2 values and tumor size. DWI MR was performed for calculating ADC values. To evaluate tumor cellularity and determine the levels of MVD, tumor cells were excised and processed for H-E staining and immunostaining using CD31. T2 values and ADC values were computed and analyzed for each half of the tumors and compared to the correlated specimens slide. Median ADC within each half of mass was compared to the cellularity and MVD in the correlated area of pathologic slide. The mean of ADC value is $0.7327{\times}10^{-3}$ $mm^2/s$ and standard deviation is $0.1075{\times}10^{-3}$ $mm^2/s$. There is a linear relationship between ADC value and tumor necrosis (R2=0.697, p< 0.001). DW image parameters including the ADC values can be utilized as surrogate markers to assess intratumoral neoangiogenesis and change of the internal structure of tumor cells.

A Preliminary Study on the Development of Korean Medication Algorithm for Attention-Deficit Hyperactivity Disorder (한국형 주의력결핍 과잉행동장애 약물치료 알고리듬 개발을 위한 예비연구)

  • Park, Jae-Hong;Kim, Bung-Nyun;Kim, Jae-Won;Kim, Ji-Hoon;Son, Jung-Woo;Shin, Dong-Won;Shin, Yun-Mi;Yang, Su-Jin;Yoo, Hanik-K.;Yoo, Hee-Jeong;Lee, Soyoung Irene;Cheon, Keun-Ah;Hong, Hyun-Ju;Hwang, Jun-Won
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.22 no.1
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    • pp.25-37
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    • 2011
  • Objectives:This study was conducted to develop a Korean algorithm of pharmacological and non-pharmacological treatment strategies in attention-deficit hyperactivity disorder (ADHD) and its specific comorbid disorders (e.g. tic disorder, depressive disorder, anxiety disorder, bipolar disorder, and oppositional defiant disorder/conduct disorder). Methods:Based on a literature review and expert consensus, both paper- and web-based survey tools were developed with respect to a comprehensive range of questions. Most options were scored using a 9-point scale for rating the appropriateness of medical decisions. For the other options, the surveyed experts were asked to provide answers (e.g., duration of treatment, aver-age dosage) or check boxes to indicate their preferred answers. The survey was performed on-line in a self-administered manner. Ultimately, 49 Korean child & adolescent psychiatrists, who had been considered experts in the treatment of ADHD, vol untarily completed the questionnaire. In analyzing the responses to items rated using the 9-point scale, consensus on each option was defined as a non-random distribution of scores as determined by a chi-square test. We assigned a categorical rank (first line/preferred choice, second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating score. Results:Specific medication strategies for key clinical situations in ADHD and its comorbid disorders were indicated and described. We organized the suggested algorithms of ADHD treatment mainly on the basis of the opinions of the Korean experts. The suggested algorithm was constructed according to the templates of the Texas Child & Adolescent medication algorithm Project (CMAP). Conclusion:We have proposed a Korean treatment algorithm for ADHD, both with and without comorbid disorders through expert consensus and a broad literature review. As the tools available for ADHD treatment evolve, this algorithm could be reorganized and modified as required to suit updated scientific and clinical research findings.

Identification of soil Remedial Goal due to Arsenic in Soil near Abandoned Mine- Approach to Regarding Future Land Use - (폐광산 지역의 비소오염에 대한 복원목표 설정 - 미래 토지용도를 고려한 접근방법 -)

  • 이효민;윤은경;최시내;박송자;황경엽;조성용;김선태
    • Journal of Korea Soil Environment Society
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    • v.3 no.2
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    • pp.13-29
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    • 1998
  • Recently, It is increasing popularity to research on the soil remediation in aspect of management by reason of the hazardous impact on the contaminated soil in Korea. It was investigated high levels of arsenic salts in soil near abandoned five mines(Darak, Daduk, Jingok, Dalsung, Ilkwang) located in Youngnam area. Arsenic, classified as group A(Human Carcinogens) from IRIS, have shown statistically significant increment in skin cancer with oral exposure. This paper was conducted to predict excess cancer risk value (to the skin cancer) based on multiple pathway such as soil ingestion, dermal uptake and food(plant) ingestion contaminated by arsenic, and also, to identify the remedial goal regarded in future land use. The mine having the highest arsenic level was Daduk(mean : 1950mg/kg) and the next rank was Jingok(1690mg/kg), Ilkwang(352.37mg/kg), Dalsung(86.08mg/kg), Darak(0.83mg/kg). The chronic daily intake to the multiple exposure were calculated using Monte-Carlo simulation regarded in future land use and used q: value was $1.5(mg/kg/day)^{-1}$ to the oral proposed by IRIS(1997). The computated excess cancer risk 95th value to all the mine regarding future land use as residential and rural area were more than $10^{-4}$. If the level of acceptable risk is aimed for 1$\times$$10^{-6}$, it could be used Darak as commercial and industrial area without soil remediation due to the lowest risk value(6$\times$$10^{-8}$ and 3$\times$$10^{-8}$). Computated remedial goal based on 1$\times$$10^{-6}$ of acceptable risk to the future land use as the residential, rural, commercial and industrial area were 0.02mg/kg, 0.003mg/kg, 97.31mg/kg and 194.62mg/kg, respectively.

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Semantic Process Retrieval with Similarity Algorithms (유사도 알고리즘을 활용한 시맨틱 프로세스 검색방안)

  • Lee, Hong-Joo;Klein, Mark
    • Asia pacific journal of information systems
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    • v.18 no.1
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    • pp.79-96
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    • 2008
  • One of the roles of the Semantic Web services is to execute dynamic intra-organizational services including the integration and interoperation of business processes. Since different organizations design their processes differently, the retrieval of similar semantic business processes is necessary in order to support inter-organizational collaborations. Most approaches for finding services that have certain features and support certain business processes have relied on some type of logical reasoning and exact matching. This paper presents our approach of using imprecise matching for expanding results from an exact matching engine to query the OWL(Web Ontology Language) MIT Process Handbook. MIT Process Handbook is an electronic repository of best-practice business processes. The Handbook is intended to help people: (1) redesigning organizational processes, (2) inventing new processes, and (3) sharing ideas about organizational practices. In order to use the MIT Process Handbook for process retrieval experiments, we had to export it into an OWL-based format. We model the Process Handbook meta-model in OWL and export the processes in the Handbook as instances of the meta-model. Next, we need to find a sizable number of queries and their corresponding correct answers in the Process Handbook. Many previous studies devised artificial dataset composed of randomly generated numbers without real meaning and used subjective ratings for correct answers and similarity values between processes. To generate a semantic-preserving test data set, we create 20 variants for each target process that are syntactically different but semantically equivalent using mutation operators. These variants represent the correct answers of the target process. We devise diverse similarity algorithms based on values of process attributes and structures of business processes. We use simple similarity algorithms for text retrieval such as TF-IDF and Levenshtein edit distance to devise our approaches, and utilize tree edit distance measure because semantic processes are appeared to have a graph structure. Also, we design similarity algorithms considering similarity of process structure such as part process, goal, and exception. Since we can identify relationships between semantic process and its subcomponents, this information can be utilized for calculating similarities between processes. Dice's coefficient and Jaccard similarity measures are utilized to calculate portion of overlaps between processes in diverse ways. We perform retrieval experiments to compare the performance of the devised similarity algorithms. We measure the retrieval performance in terms of precision, recall and F measure? the harmonic mean of precision and recall. The tree edit distance shows the poorest performance in terms of all measures. TF-IDF and the method incorporating TF-IDF measure and Levenshtein edit distance show better performances than other devised methods. These two measures are focused on similarity between name and descriptions of process. In addition, we calculate rank correlation coefficient, Kendall's tau b, between the number of process mutations and ranking of similarity values among the mutation sets. In this experiment, similarity measures based on process structure, such as Dice's, Jaccard, and derivatives of these measures, show greater coefficient than measures based on values of process attributes. However, the Lev-TFIDF-JaccardAll measure considering process structure and attributes' values together shows reasonably better performances in these two experiments. For retrieving semantic process, we can think that it's better to consider diverse aspects of process similarity such as process structure and values of process attributes. We generate semantic process data and its dataset for retrieval experiment from MIT Process Handbook repository. We suggest imprecise query algorithms that expand retrieval results from exact matching engine such as SPARQL, and compare the retrieval performances of the similarity algorithms. For the limitations and future work, we need to perform experiments with other dataset from other domain. And, since there are many similarity values from diverse measures, we may find better ways to identify relevant processes by applying these values simultaneously.

To Assess Whether Lee's Grading System for Central Lumbar Spinal Stenosis Can Be Used as a Decision-Making Tool for Surgical Treatment (요추 중심 신경관 협착에 있어서 Lee's Grade를 통한 MRI 평가방법이 수술적 치료 결정에 유용한가에 대한 연구)

  • Do Yeon Ahn;Hee Jin Park;Jung Woo Yi;Ji Na Kim
    • Journal of the Korean Society of Radiology
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    • v.83 no.1
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    • pp.102-111
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    • 2022
  • Purpose To evaluate the correlation between Lee's grades and surgical intervention for central lumbar spinal stenosis (CLSS) and to assess whether this grading system can be used as a decision-making tool for the surgical treatment of this condition. Materials and Methods This retrospective study included 290 patients (M:F = 156:134; mean age, 46 ± 16 years). Radiologists assessed the presence and grade of CLSS at the stenosis point according to Lee's grading system, in which CLSS is classified into four grades according to the shape of the cauda equina. Correlation coefficients (rs) between Lee's grades and the operation were calculated with Spearman rank correlation. Results Among the operated patients, grade 2 was the most commonly assigned grade (50%-58%), grade 3 was less common (35%), and grade 0 was the least common (2%-3%). Among the non-operated patients, grade 1 was the most common (63%-65%), grade 0 was less common (15%-16%), and grade 3 was the least common (8%). The distribution of grades differed between the operated and non-operated groups (p < 0.001). Less than 25% of patients who underwent surgery were assigned grades 0 and 1, and more than 88% were assigned grades 2 and 3. A moderate correlation was found between the grade and surgical intervention (rs = 0.632 and rs = 0.583). Conclusion Lee's grade was moderately correlated with surgical intervention. Lee's grading system can be a decision-making tool for the surgical treatment of CLSS.