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Two-Day Fraction Gamma Knife Radiosurgery for Large Brain Metastasis

  • Joo-Hwan Lee;In-Young Kim;Shin Jung;Tae-Young Jung;Kyung-Sub Moon;Yeong-Jin Kim;Sue-Jee Park;Sa-Hoe Lim
    • Journal of Korean Neurosurgical Society
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    • v.67 no.5
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    • pp.560-567
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    • 2024
  • Objective : We investigated how treating large brain metastasis (LBM) using 2-day fraction Gamma Knife radiosurgery (GKRS) affects tumor control and patient survival. A prescription dose of 10.3 Gy was applied for 2 consecutive days, with a biologically effective dose equivalent to a tumor single-fraction dose of 16.05 Gy and a brain single-fraction dose of 15.12 Gy. Methods : Between November 2017 and December 2021, 42 patients (mean age, 68.3 years; range, 50-84 years; male, 29 [69.1%]; female, 13 [30.9%]) with 44 tumors underwent 2-day fraction GKRS to treat large volume brain metastasis. The main cancer types were non-small cell lung cancer (n=16), small cell lung cancer (n=7), colorectal cancer (n=7), breast cancer (n=3), gastric cancer (n=2), and other cancers (n=7). Twenty-one patients (50.0%) had a single LBM, 19 (46.3%) had a single LBM and other metastases, and two had two (4.7%) large brain metastases. At the time of the 2-day fraction GKRS, the tumors had a mean volume of 23.1 mL (range, 12.5-67.4). On each day, radiation was administered at a dose of 10.3 Gy, mainly using a 50% isodose-line. Results : We obtained clinical and magnetic resonance imaging follow-up data for 34 patients (81%) with 35 tumors, who had undergone 2-day fraction GKRS. These patients did not experience acute or late radiation-induced complications during follow-up. The median and mean progression-free survival (PFS) periods were 188 and 194 days, respectively. The local control rates at 6, 9, and 12 months were 77%, 40%, and 34%, respectively. The prognostic factors related to PFS were prior radiotherapy (p=0.019) and lung cancer origin (p=0.041). Other factors such as tumor volumes, each isodose volumes, and peri-GKRS systemic treatment were not significantly related to PFS. The overall survival period of the 44 patients following repeat stereotactic radiosurgery (SRS) ranged from 15-878 days (median, 263±38 days; mean, 174±43 days) after the 2-day fraction GKRS. Eight patients (18.2%) were still alive. Conclusion : Considering the unsatisfactory tumor control, a higher prescription dose should be needed in this procedure as a salvage management. Moreover, in the treatment for LBM with fractionated SRS, using different isodoses and prescription doses at the treatment planning for LBMs should be important. However, this report might be a basic reference with the same fraction number and prescription dose in the treatment for LBMs with frame-based SRS.

Genetic Studies on the Sea Urchin Embryogenesis and Skeletogenesis (성게의 발생과 뼈대형성의 유전학적 연구)

  • Lee, Youn-Ho
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.6 no.4
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    • pp.265-273
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    • 2001
  • The sea urchin has been used as sea food in many countries. This species has also been an important organism of embryological studies for more than a century. In recent years, sea urchin embryos are being used as testing materials for toxicity of pollutants and toxins. Usefulness of sea urchin embryos as experimental models comes from the easiness in obtaining sea urchin samples and a lot of gametes, in rearing embryos in the laboratory, in observing the cellular movement and organ formation during the embryogenesis and in manipulating blastomeres and genetic maferials. The sea urchin in itself is a key organism for the understanding of deuterostome evolution from the protostomes and of indirect development of marine invertebrates which undergo the planktotrophic larval stage. A fertilized sea urchin egg goes through rapid cleavage and becomes a 60 cell embryo 7hr after fertilization. It then develops into a morula, a blastula, a gastrula and finally a pluteus larva approximately 70 hr after fertilization. At the 60 cell stage, the embryo comprises of five territories that express territory-speciflc genes and later form different organs. Micromeres at the vegetal pole ingress into the blastoceol and become the primary mesenchyme cells(PMCs). PMCs express genes involved in skeletogenesis such as SM30, SM37, SM50, PM27, msp130. Among the genes, SM37 and SM50 are considered to be members of a gene family which is characterized by early blastula expression, Glycine-Proline-Glutamine rich repeat structures and spicule matrix forming basic proteins. Genetic studies on the sea urchin embryos help understand the molecular basis of indirect development of marine invertebrates and also of the biomineralization common to the animal kingdom.

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Analysis of Nursing Care Activities of Nursing Students in Clinical Experience (간호학생의 임상실습 간호활동시간 분석)

  • Lee Chung-Hee;Sung Young-Hee;Jung Yoen-Yi;Kim Jung-Suk
    • The Journal of Korean Academic Society of Nursing Education
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    • v.4 no.2
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    • pp.249-263
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    • 1998
  • The competence of newly graduated nurses is based on various clinical expriences gained when they were students. Therefore, instructors of nursing students, professors in nursing schools or directors in hospitals must play a critical role in assisting them to obtain various knowledge and experienced nursing skills. The purpose of this study was to investigate nursing care activities and nursing care hours practiced by nursing students in a general hospital. The subject students were total 214 nursing students, 2nd graders(sophomores) and 3rd graders(juniors) from 5 Junior Nursing Colleges in Seoul and they practiced at S general hospital to gain clinical experience. The data were collected for 4 days. The tools for this study were the direct nursing care activity list consisted of 15 nursing areas and the indirect nursing care activity list consisted of 9 nursing areas. The subject students were supposed to record their own score. The results of this study are ; 1. The nursing care hours per nursing student 1) The average total nursing care hours a day per each nursing student are 362.65 mins(6.04hr), the direct nursing care hours per each nursing stuent are 202.09 mins(direct nursing care rate 56.0%) and it is higher than the indirect nursing care hours, 159.75mins(indirect nursing care rate 44.0%). The direct nursing care rate of each student by a team approach in the evening shift(56.3%) is higher than that in the day shift(55.8%). 2) The hours of checking vital signs are the longest(47.35mins) among the direct nursing care activites and next is in order of counseling 8l emotional support, nurse rounds, and accompaning a patient during examination. The hours of reporting are the longest(32.39mins) among the indirect nursing care activites, and next is the activities related to education such as reviewing chart, looking up references, etc. 3) The freqency of checking vital signs practiced by nursing student is the highest(the average of 55.7 times) among the direct nursing care activities and next is in order of nurse rounds, assistance of feeding, and counseling & emotional support. The required time for nursing students to accompany their patient during examination is the longest(20.7mins) and next are in order of restriction on patient' activity, orientated by a head nurse, skin care, sitz bath, bathing & hair shampoo, and assisting with patients' exercise. 2. The nursing care hours per grader 1) The average hours of total nursing care per a nursing student are 369.2mins(6.2hrs) to 2nd graders, 355.9mins(5.9 hrs) to third graders. The direct nursing care rate per each nursing student to 3rd graders(59.3%) was higher than that to End graders(52.8%). 2) For 2nd graders, the highly marked nursing activities are teaching associated with direct nursing care activities such as drawing up papers, looking up references, reviewing charts, and being orientated by staff nurses. For 3rd graders, measurments, observations, and nurse rounds in indirect nursing care activities are taken highly 3) The most frequent practice of the nursing care activites is checking vital signs : 65 times to 3rd graders and 46.5 times to 2nd graders. Our suggestions based on the results of this study are : 1. It is recommanded to repeat the same designed study in a variety of clinical fields for further study. 2. It is recommanded to collect data not by self-record method but by observated method. 3. It is needed for nursing instructors in Nursing Schools and in hospitals to develop the guidelines and check-list of clinical practice courses.

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Exploring the Temporal Relationship Between Traffic Information Web/Mobile Application Access and Actual Traffic Volume on Expressways (웹/모바일-어플리케이션 접속 지표와 TCS 교통량의 상관관계 연구)

  • RYU, Ingon;LEE, Jaeyoung;CHOI, Keechoo;KIM, Junghwa;AHN, Soonwook
    • Journal of Korean Society of Transportation
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    • v.34 no.1
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    • pp.1-14
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    • 2016
  • In the recent years, the internet has become accessible without limitation of time and location to anyone with smartphones. It resulted in more convenient travel information access both on the pre-trip and en-route phase. The main objective of this study is to conduct a stationary test for traffic information web/mobile application access indexes from TCS (Toll Collection System); and analyzing the relationship between the web/mobile application access indexes and actual traffic volume on expressways, in order to analyze searching behavior of expressway related travel information. The key findings of this study are as follows: first, the results of ADF-test and PP-test confirm that the web/mobile application access indexes by time periods satisfy stationary conditions even without log or differential transformation. Second, the Pearson correlation test showed that there is a strong and positive correlation between the web/mobile application access indexes and expressway entry and exit traffic volume. In contrast, truck entry traffic volume from TCS has no significant correlation with the web/mobile application access indexes. Third, the time gap relationship between time-series variables (i.e., concurrent, leading and lagging) was analyzed by cross-correlation tests. The results indicated that the mobile application access leads web access, and the number of mobile application execution is concurrent with all web access indexes. Lastly, there was no web/mobile application access indexes leading expressway entry traffic volumes on expressways, and the highest correlation was observed between webpage view/visitor/new visitor/repeat visitor/application execution counts and expressway entry volume with a lag of one hour. It is expected that specific individual travel behavior can be predicted such as route conversion time and ratio if the data are subdivided by time periods and areas and utilizing traffic information users' location.

The Risk Factors Influencing the Postoperative Mortality of the Patients with an Abdominal Aortic Aneurysm (복부대동맥류 환자에서의 수술 후 사망의 위험인자 분석)

  • Lee, Seong-Kwang;Jun, Hee-Jae;Park, Kyung-Taek;Yoon, Young-Chul;Han, IL-Yong;Lee, Yang-Haeng;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.655-662
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    • 2010
  • Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

The Study of Land Surface Change Detection Using Long-Term SPOT/VEGETATION (장기간 SPOT/VEGETATION 정규화 식생지수를 이용한 지면 변화 탐지 개선에 관한 연구)

  • Yeom, Jong-Min;Han, Kyung-Soo;Kim, In-Hwan
    • Journal of the Korean Association of Geographic Information Studies
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    • v.13 no.4
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    • pp.111-124
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    • 2010
  • To monitor the environment of land surface change is considered as an important research field since those parameters are related with land use, climate change, meteorological study, agriculture modulation, surface energy balance, and surface environment system. For the change detection, many different methods have been presented for distributing more detailed information with various tools from ground based measurement to satellite multi-spectral sensor. Recently, using high resolution satellite data is considered the most efficient way to monitor extensive land environmental system especially for higher spatial and temporal resolution. In this study, we use two different spatial resolution satellites; the one is SPOT/VEGETATION with 1 km spatial resolution to detect coarse resolution of the area change and determine objective threshold. The other is Landsat satellite having high resolution to figure out detailed land environmental change. According to their spatial resolution, they show different observation characteristics such as repeat cycle, and the global coverage. By correlating two kinds of satellites, we can detect land surface change from mid resolution to high resolution. The K-mean clustering algorithm is applied to detect changed area with two different temporal images. When using solar spectral band, there are complicate surface reflectance scattering characteristics which make surface change detection difficult. That effect would be leading serious problems when interpreting surface characteristics. For example, in spite of constant their own surface reflectance value, it could be changed according to solar, and sensor relative observation location. To reduce those affects, in this study, long-term Normalized Difference Vegetation Index (NDVI) with solar spectral channels performed for atmospheric and bi-directional correction from SPOT/VEGETATION data are utilized to offer objective threshold value for detecting land surface change, since that NDVI has less sensitivity for solar geometry than solar channel. The surface change detection based on long-term NDVI shows improved results than when only using Landsat.

Renal Sympathetic Denervation Induces Acute Myocardial Inflammation through Activation of Caspase-1 and Interleukin-1β (교감신경절제술(RDN) 후 caspase-1과 interleukin-1β 활성화로 인해 유발된 염증성 급성심근손상)

  • Lee, Dong Won;Kim, Il Young;Kwak, Ihm Soo
    • Journal of Life Science
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    • v.28 no.2
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    • pp.240-246
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    • 2018
  • Efferent and afferent sympathetic nerves are closely related to the development of hypertension and heart failure. Catheter-based renal sympathetic denervation (RDN) is implemented as a strategy to treat resistant hypertension. We investigated whether RDN procedure causes inflammatory damage on myocardium in the early phase of sympathetic denervation. Twenty-five female swine were divided into 3 groups: normal control (Normal, n=5), sham-operated control (Sham, n=5), and RDN groups (RDN, n=15). The RDN group was further subdivided into 3 subgroups according to the time of sacrifice: immediately (RDN-0, n=5), 1 week (RDN-1, n=5), and 2 weeks (RDN-2, n=5) after RDN. There were no significant changes in the clinical parameters between the normal control and sham-operated group using contrast-media. In the myocardium, inflammatory cytokines, $IL-1{\beta}$ and $TNF-{\alpha}$ increased at the first week, and then decreased at the second week after RDN. Anti-inflammatory cytokine, IL-10 increased immediately, and then decreased at the second week after RDN. Caspase-1 activity and apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) expression increased immediately after RDN until the second week. However, nucleotide-binding oligomerization domain, leucine rich repeat and pyrin domain containing protein 3 (NLRP3) expression did not show any significant differences among the groups. The RDN can cause acute myocardial inflammation through activation of caspase-1 and $IL-1{\beta}$. We should pay attention to protecting against early inflammatory myocardial damage after RDN.

Study on the Chemical Management - 2. Comparison of Classification and Health Index of Chemicals Regulated by the Ministry of Environment and the Ministry of the Employment and Labor (화학물질 관리 연구-2. 환경부와 고용노동부의 관리 화학물질의 구분, 노출기준 및 독성 지표 등의 특성 비교)

  • Kim, Sunju;Yoon, Chungsik;Ham, Seunghon;Park, Jihoon;Kim, Songha;Kim, Yuna;Lee, Jieun;Lee, Sangah;Park, Donguk;Lee, Kwonseob;Ha, Kwonchul
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.25 no.1
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    • pp.58-71
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    • 2015
  • Objectives: The aims of this study were to investigate the classification system of chemical substances in the Occupational Safety and Health Act(OSHA) and Chemical Substances Control Act(CSCA) and to compare several health indices (i.e., Time Weighted Average (TWA), Lethal Dose ($LD_{50}$), and Lethal Concentration ($LC_{50}$) of chemical substances by categories in each law. Methods: The chemicals regulated by each law were classified by the specific categories provided in the respective law; seven categories for OSHA (chemicals with OELs, chemicals prohibited from manufacturing, etc., chemicals requiring approval, chemicals kept below permissible limits, chemicals requiring workplace monitoring, chemicals requiring special management, and chemicals requiring special heath diagnosis) and five categories from the CSCA(poisonous substances, permitted substances, restricted substances, prohibited substances, and substances requiring preparation for accidents). Information on physicochemical properties, health indices including CMR characteristics, $LD_{50}$ and $LD_{50}$ were searched from the homepages of the Korean Occupational and Safety Agency and the National Institute of Environmental Research, etc. Statistical analysis was conducted for comparison between TWA and health index for each category. Results: The number of chemicals based on CAS numbers was different from the numbers of series of chemicals listed in each law because of repeat listings due to different names (e.g., glycol monoethylether vs. 2-ethoxy ethanol) and grouping of different chemicals under the same serial number(i.e., five different benzidine-related chemicals were categorized under one serial number(06-4-13) as prohibited substances under the CSCA). A total of 722 chemicals and 995 chemicals were listed at the OSHA and its sub-regulations and CSCA and its sub-regulations, respectively. Among these, 36.8% based on OSHA chemicals and 26.7% based on CSCA chemicals were regulated simultaneously through both laws. The correlation coefficients between TWA and $LC_{50}$ and between TWA and $LD_{50}$, were 0.641 and 0.506, respectively. The geometric mean values of TWA calculated by each category in both laws have no tendency according to category. The patterns of cumulative graph for TWA, $LD_{50}$, $LC_{50}$ were similar to the chemicals regulated by OHSA and CCSA, but their median values were lower for CCSA regulated chemicals than OSHA regulated chemicals. The GM of carcinogenic chemicals under the OSHA was significantly lower than non-CMR chemicals($2.21mg/m^3$ vs $5.69mg/m^3$, p=0.006), while there was no significant difference in CSCA chemicals($0.85mg/m^3$ vs $1.04mg/m^3$, p=0.448). $LC_{50}$ showed no significant difference between carcinogens, mutagens, reproductive toxic chemicals and non-CMR chemicals in both laws' regulated chemicals, while there was a difference between carcinogens and non-CMR chemicals in $LD_{50}$ of the CSCA. Conclusions: This study found that there was no specific tendency or significant difference in health indicessuch TWA, $LD_{50}$ and $LC_{50}$ in subcategories of chemicals as classified by the Ministry of Labor and Employment and the Ministry of Environment. Considering the background and the purpose of each law, collaboration for harmonization in chemical categorizing and regulation is necessary.

Effect of Heat Insulation on Decomposition of Ricestraw Pile in the P.E.Film House during Winter Season (겨울철 비닐하우스내의 볏짚퇴비더미의 온도변화와 부숙효과)

  • Lee, Yun Hwan;Kim, Yong Yeon
    • Korean Journal of Soil Science and Fertilizer
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    • v.18 no.1
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    • pp.27-31
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    • 1985
  • To get well matured farm yard manure from ricestraw as quickly as possible during winter season, straw piles wrapped with polyethylene film and/or straw thatch were stored in the vinyl house or open air. Their maturities and changes of temperature in heap were investigated from the beginning of December 1983 to March of next year. Heat increment in vinyl house was high $2-5^{\circ}C$ than at open air at the lowest temperature but it didn't rise over the freezing point. However, the highest temperature was arisen over than $20^{\circ}C$ averagely at the vinylhouse compared to those of open air during three months. Temperature in piles of straw manure was reached to about $70^{\circ}C$ in maximum and rose again very rapidly after repiling in the vinyl house, whereas increment of temperature after repiling was delayed and took long times to reach the maximum temperature at open air. Wrapping with P.E. film also affected the insulation of decomposing heat of straw pile and promoted the repeat of piling even at open air. By these results, ricestraw would be decomposed rapidly by insulation with P.E. film in the vinyl house and could be reached to matured compost for application to field on next spring season. P.E. film covered for vinyl house was endured until May of next year without tear by weathering.

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A study on the perception of landscape through the selection process of Bandopalgyong - eight beautiful scenary in Korea - within Japanese colonial period (일제강점기 반도팔경 선정과정을 통해 본 경관인식)

  • Kim, Hai-Gyeong;An, Kyung-Jin
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.33 no.2
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    • pp.78-88
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    • 2015
  • In the 1920s, the period of cultural governance ruled by Japan, the diverse media were founded and various events were conducted to boost circulation. Under the Japanese colonial period in 1920s, a number of media - newspapers and magazines - were published and often they carried out entertaining events in order to obtain more subscribers. A hobby magazine, Samchunri, for instace, set up a media event to selecting Korea's eight beautiful scenary (Bandopalgyong) for the first edition in 1929. The paper aims to analyse and understand the perception of landscape in 1929 through the media event carried out by Samchunri. In particular, the selection was made by well-known writers within Japanese colonial period 1910 - 1945). The selection process and views from the writers on landscape were analysed; firstly, the selection of Bandopalgyong was carried out by questionnaires to writers in 1929 where Korea is under Japanese colonial rules. The conditions of the selection were unknown; however, the purpose was enlightening the people specially the youngs and introduction of beautiful places in Korea. As a result, views and opinions on Bandopalgyong by the writers were progressed. Secondly, within the Bandopalgyong, the natural landscape areas include Gumgansan(金剛山), Daedonggang(大洞江), Buyeo(扶餘), Gyongju(慶州), Myongsasipri (明沙十里), Haundae(海雲臺), Baekdusan(白頭山), and Choksukru(矗石樓). Those chosen places were not cohesive nor did not have any consistant reasons to be chosen in terms of size and location; however, some writers claimed that there were other places to match the chosen ones and therefore, the selection process was highly dependent on access (i.e. transport). Thirdly, the travelogue on Baekdusan and Nackwhaam(洛花岩) illustrated interesting views on landscape in particular. Baekdusan landscape were described in overlaping with long history and national soul. In the Nackwhaam travelogue, it described 'Buyeo (夫餘) was an ancient capital of Backjae Dynasty and empty place' as well as denying Chosun Dynasty. It was assumed that the two places weren't visited but rewritten with existing literatures. Fourthly, edited by Kim Dong Whan, a travelogue style book, 'Bandosanha' was published in 1941. It did repeat the selection of Bandopalgyong, but this time, it was classified the eight beautiful landscape into two categories; historic/cultural places and natural landscape. This paper was able to analyse and understand the perception of landscape in 1929 through the travelogue of Samchunri. It is an empirical study on the process and perception on Korea landscape under Japanese colonical period by views of the selected writers.