• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.113-121
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• 2024

Purpose: In response to the surge in coronavirus disease 2019 (COVID-19) omicron variant cases, we have implemented preemptive testing for preschool and school. The purpose is to quickly detect COVID-19 cases using a rapid antigen test (RAT) kit so that normal school activities can continue. Methods: The results entered in The Healthcare Self-Test App were merged with the information on the status of confirmed cases in the COVID-19 Information Management System by Korea Disease Control and Prevention Agency (KDCA) for preschool and school of students and staffs March 2 to May 1, 2022 to analyze the RAT positive rate and positive predictive value of RAT. Results: In preschool and school 19,458,575 people were tested, weekly RAT positive rate ranged from 1.10% to 5.90%, positive predictive value of RAT ranged from 86.42% to 93.18%. By status, RAT positive rate ranged from 1.13% to 6.16% for students, 0.99% to 3.93% for staffs, positive predictive value of RAT ranged from 87.19% to 94.03% for students, 77.55% to 83.10% for staffs. RAT positive rate by symptoms ranged from 76.32% to 88.02% for those with symptoms and 0.34% to 1.11% for those without symptoms. As a result of preschool and school RAT, 943,342 confirmed cases were preemptively detected, before infection spread in preschool and school. Conclusions: RAT was well utilized to detect confirmed cases at an early stage, reducing the risk of transmission to minimize the educational gap in preschool and school. To compensate for the limitations of RAT, further research should continue to reevaluate the performance of RAT as new strains of viruses continue to emerge. We will have to come up with various ways to utilize it, such as performing periodic and repeated RAT and parallel polymerase chain reaction.

• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.247-256
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• 2008

Purpose: The purpose of this study is to evaluate anal sphincter preservation rates, survival rates, and prognostic factors in patients with rectal cancer treated with preoperative chemoradiotherapy. Materials and Methods: One hundred fifty patients with pathologic confirmed rectal cancer and treated by preoperative chemoradiotherapy between January 1999 and June 2007. Of the 150 patients, the 82 who completed the scheduled chemoradiotherapy, received definitive surgery at our hospital, and did not have distant metastasis upon initial diagnosis were enrolled in this study. The radiation dose delivered to the whole pelvis ranged from 41.4 to 46.0 Gy (median 44.0 Gy) using daily fractions of $1.8{\sim}2.0\;Gy$ at 5 days per week and a boost dose to the primary tumor and high risk area up to a total of $43.2{\sim}54\;Gy$ (median 50.4 Gy). Sixty patients (80.5%) received 5-fluorouracil, leucovorin, and cisplatin, while 16 patients (19.5%) were administered 5-fluorouracil and leucovorin every 4 weeks concurrently during radiotherapy. Surgery was performed for 3 to 45 weeks (median 7 weeks) after completion of chemoradiotherapy. Results: The sphincter preservation rates for all patients were 73.2% (60/82). Of the 48 patients whose tumor was located at less than 5 cm away from the anal verge, 31 (64.6%) underwent sphincter-saving surgery. Moreover, of the 34 patients whose tumor was located at greater than or equal to 5 cm away from the anal verge, 29 (85.3%) were able to preserve their anal sphincter. A pathologic complete response was achieved in 14.6% (12/82) of all patients. The downstaging rates were 42.7% (35/82) for the T stage, 75.5% (37/49) for the N stage, and 67.1% (55/82) for the overall stages. The median follow-up period was 38 months (range $11{\sim}107$ months). The overall 5-year survival, disease-free survival, and locoregional control rates were 67.4%, 58.9% and 84.4%, respectively. The 5-year overall survival rates based on the pathologic stage were 100% for stage 0 (n=12), 59.1% for stage I (n=16), 78.6% for stage II (n=30), 36.9% for stage III (n=23), and one patient with pathologic stage IV was alive for 43 months (p=0.02). The 5-year disease-free survival rates were 77.8% for stage 0, 63.6% for stage I, 58.9% for stage II, 51.1% for stage III, and 0% for stage IV (p<0.001). The 5-year locoregional control rates were 88.9% for stage 0, 93.8% for stage I, 91.1% for stage II, 68.2% for stage III, and one patient with pathologic stage IV was alive without local recurrence (p=0.01). The results of a multivariate analysis with age (${\leq}55$ vs. >55), clinical stage (I+II vs. III), radiotherapy to surgery interval (${\leq}6$ weeks vs. >6 weeks), operation type (sphincter preservation vs. no preservation), pathologic T stage, pathologic N stage, pathologic overall stage (0 vs. I+II vs. III+IV), and pathologic response (complete vs. non-CR), only age and pathologic N stage were significant predictors of overall survival, pathologic overall stage for disease-free survival, and pathologic N stage for locoregional control rates, respectively. Recurrence was observed in 25 patients (local recurrence in 10 patients, distant metastasis in 13 patients, and both in 2 patients). Acute hematologic toxicity ($\geq$grade 3) during chemoradiotherapy was observed in 2 patients, while skin toxicity was observed in 1 patient. Complications developing within 60 days after surgery and required admission or surgical intervention, were observed in 11 patients: anastomotic leakage in 5 patients, pelvic abscess in 2 patients, and others in 4 patients. Conclusion: Preoperative chemoradiotherapy was an effective modality to achieve downstaging and sphincter preservation in rectal cancer cases with a relatively low toxicity. Pathologic N stage was a statistically significant prognostic factor for survival and locoregional control and so, more intensified postoperative adjuvant chemotherapy should be considered in these patients.

• Journal of Intelligence and Information Systems
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• v.17 no.4
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• pp.143-155
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• 2011

Lately electronic tagging policy for the sexual offenders was introduced in order to reduce and prevent sexual offences. However, most sexual offences against children happening these days are committed by the tagged offenders whose identities have been released. So, for the crime prevention, we need measures with which we could minimize the suffers more promptly and actively. This paper suggests a new system to relieve the sexual abuse related anxiety of the children and solve the problems that electronic bracelet has. Existing bracelets are only worn by serious criminals, and it's only for risk management and positioning, there is no way to protect the children who are the potential victims of sexual abuse and there actually happened some cases. So we suggest also letting the students(children) wear the LBS(Location Based Service) and USN(Ubiquitous Sensor Network) technology based electronic bracelets to monitor and figure out dangerous situations intelligently, so that we could prevent sexual offences against children beforehand, and while a crime is happening, we could judge the situation of the crime intelligently and take swift action to minimize the suffer. And by checking students' attendance and position, guardians could know where their children are in real time and could protect the children from not only sexual offences but also violent crimes against children like kidnapping. The overall system is like follows : RFID Tag for children monitors the approach of offenders. While an offender's RFID tag is approaching, it will transmit the situation and position as the first warning message to the control center and the guardians. When the offender is going far away, it turns to monitoring mode, and if the tag of the child or the offender is taken off or the child and offender stay at one position for 3~5 minutes or longer, then it will consider this as a dangerous situation, then transmit the emergency situations and position as the second warning message to the control center and the guardians, and ask for the dispatch of police to prevent the crime at the initial stage. The RFID module of criminals' electronic bracelets is RFID TAG, and the RFID module for the children is RFID receiver(reader), so wherever the offenders are, if an offender is at a place within 20m from a child, RFID module for children will transmit the situation every certain periods to the control center by the automatic response of the receiver. As for the positioning module, outdoors GPS or mobile communications module(CELL module)is used and UWB, WI-FI based module is used indoors. The sensor is set under the purpose of making it possible to measure the position coordinates even indoors, so that one could send his real time situation and position to the server of central control center. By using the RFID electronic roll book system of educational institutions and safety system installed at home, children's position and situation can be checked. When the child leaves for school, attendance can be checked through the electronic roll book, and when school is over the information is sent to the guardians. And using RFID access control turnstiles installed at the apartment or entrance of the house, the arrival of the children could be checked and the information is transmitted to the guardians. If the student is absent or didn't arrive at home, the information of the child is sent to the central control center from the electronic roll book or access control turnstiles, and look for the position of the child's electronic bracelet using GPS or mobile communications module, then send the information to the guardians and teacher so that they could report to the police immediately if necessary. Central management and control system is built under the purpose of monitoring dangerous situations and guardians' checking. It saves the warning and pattern data to figure out the areas with dangerous situation, and could help introduce crime prevention systems like CCTV with the highest priority. And by DB establishment personal data could be saved, the frequency of first and second warnings made, the terminal ID of the specific child and offender, warning made position, situation (like approaching, taken off of the electronic bracelet, same position for a certain time) and so on could be recorded, and the data is going to be used for preventing crimes. Even though we've already introduced electronic tagging to prevent recurrence of child sexual offences, but the crimes continuously occur. So I suggest this system to prevent crimes beforehand concerning the children's safety. If we make electronic bracelets easy to use and carry, and set the price reasonably so that many children can use, then lots of criminals could be prevented and we can protect the children easily. By preventing criminals before happening, it is going to be a helpful system for our safe life.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.871-877
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• 1995

Background: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. Methods: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1(D1), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the D1 score, and also in respect to the changes of the updated D2 and D3 scores. Results: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older($62.7{\pm}12.6$ vs $51.1{\pm}18.1$ yrs), presented with lower mean arterial pressure($56.9{\pm}26.2$ vs $67.7{\pm}14.2\;mmHg$) and showed greater number of multisystem organ failure($1.2{\pm}0.8$ vs $0.2{\pm}0.4$) than the survivors(p<0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The D1 score was lower in the survivors (n=21) than in the nonsurvivors ($44.1{\pm}14.6$, $78.5{\pm}18.6$, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (D1 vs D2, $44.1{\pm}14.6$ : $37.9{\pm}15.0$, p=0.035; D2 vs D3, $37.9{\pm}15.0$ : $30.1{\pm}9.3$, p=0.0001) but showed a tendency to increase in the nonsurvivors (D1 vs D2 (n=21), $78.5{\pm}18.6$ : $81.3{\pm}23.0$, p=0.1337; D2 vs D3 (n=11), $68.2{\pm}19.3$ : $75.3{\pm}18.8$, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, $53.8{\pm}10.0$ in the survivors, $55.3{\pm}10.3$ in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(D1 vs D2, $53.3{\pm}10.0$ : $43.6{\pm}16.4$, p=0.0278; D2 vs D3, $43.6{\pm}16.4$ : $31.2{\pm}10.3$, p=0.0005), but showed a tendency to increase in the nonsurvivors(D1 vs D2 (n=6), $55.3{\pm}10.3:66.7{\pm}13.9$, p=0.1562; D2 vs D3 (n=4), $64.0{\pm}16.4:74.3{\pm}18.6$, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors ($5.5{\pm}2.9$ vs $1.9{\pm}3.7$, p=0.046) in this group. Conclusion: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.