• Journal of Genetic Medicine
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• 제18권1호
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• pp.8-15
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• 2021

Recent genetic advances allow for identification of the genetic etiologies of epilepsy within individual patients earlier and more frequently than ever. Specific targeted treatments have emerged from improvements in understanding of the underlying epileptogenic pathophysiology. These targeted treatment strategies include modifications of ion channels or other cellular receptors and their function, mechanistic target of rapamycin signaling pathways, and substitutive therapies in hereditary metabolic epilepsies. In this review, we explore targeted treatments based on underlying pathophysiologic mechanisms in specific genetic epilepsies.

• 대한치과교정학회지
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• 제52권5호
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• pp.372-382
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• 2022

Anterior open bite and transverse discrepancy are often accompanied by hyperdivergent skeletal patterns. In addition, degenerative joint disorders and vertical maxillary excess contribute to an unfavorable convex facial profile with a retruded chin. Correction of this complex three-dimensional problem with orthodontic treatment alone is considered challenging owing to anatomical limitations. Moreover, a history of orthodontic treatment with premolar extraction makes retreatment difficult. This case report illustrates the application of a maxillary tissue bone-borne expander and biocreative reverse curve system in a 23-year-old female patient with a severe anterior open bite and transverse discrepancy who underwent orthodontic treatment with four premolar extractions. By setting the treatment target under precise diagnosis and using appropriate appliances, a satisfactory treatment result could be achieved without orthognathic surgery.

• 정신신체의학
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• 제31권1호
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• pp.19-24
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• 2023

Objectives : Biofeedback is a useful non-pharmacological treatment for panic disorder (PD), but no studies have identified physiological markers related to the treatment response. This study investigated predictors of the treatment response for biofeedback in patients with PD. Methods : A retrospective study based on the electronic medical records of 372 adult patients with PD was performed. Patients received biofeedback treatment at least once, and physiological markers including heart rate, heart rate variability, respiratory rate, skin conductance, skin temperature, and electromyography were collected before the treatment began. The patients were classified as responders or non-responders based on the change in Clinical Global Impression-Severity (CGI-S) score. Results : The response rate to biofeedback treatment was 30.4%. Multivariable logistic regression analysis revealed that a higher CGI-S score at baseline and fewer benzodiazepine prescriptions were associated with a better response to biofeedback treatment. According to subgroup analyses, the baseline CGI-S score, dose of benzodiazepines, and skin conductance are candidate predictors of the response to biofeedback treatment in men, while only baseline disease severity was associated with the treatment response in women. Conclusions : The present results suggest that skin conductance may be target marker and predictor for biofeedback in male patients with PD.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2243-2248
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• 2013

Background: To compare the dosimetric coverage of target volumes and organs at risk in the radical treatment of nasopharyngeal carcinoma (NPC) between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: Data from 10 consecutive patients treated with IMRT from June-October 2011 in Penang General Hospital were collected retrospectively for analysis. For each patient, dose volume histograms were generated for both the IMRT and 3DCRT plans using a total dose of 70Gy. Comparison of the plans was accomplished by comparing the target volume coverage (5 measures) and sparing of organs at risk (17 organs) for each patient using both IMRT and 3DCRT. The means of each comparison target volume coverage measures and organs at risk measures were obtained and tested for statistical significance using the paired Student t-test. Results: All 5 measures for target volume coverage showed marked dosimetric superiority of IMRT over 3DCRT. V70 and V66.5 for PTV70 showed an absolute improvement of 39.3% and 24.1% respectively. V59.4 and V56.4 for PTV59.4 showed advantages of 18.4% and 16.4%. Moreover, the mean PTV70 dose revealed a 5.1 Gy higher dose with IMRT. Only 4 out of 17 organs at risk showed statistically significant difference in their means which were clinically meaningful between the IMRT and 3DCRT techniques. IMRT was superior in sparing the spinal cord (less 5.8Gy), V30 of right parotid (less 14.3%) and V30 of the left parotid (less 13.1%). The V55 of the left cochlea was lower with 3DCRT (less 44.3%). Conclusions: IMRT is superior to 3DCRT due to its dosimetric advantage in target volume coverage while delivering acceptable doses to organs at risk. A total dose of 70Gy with IMRT should be considered as a standard of care for radical treatment of NPC.

• 대한방사선치료학회지
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• 제11권1호
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• pp.43-48
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• 1999

Purpose : For practical application of the MR image for stereotactic radiosurgery, the target point achieved by acquisition of MR image in a relatively homogeneous phantom has to agree with the actual isocenter of irradiation in real radiosurgery and the amount of distortion of the MR image should be known. Materials and Methods : A dosimetric film with a random target point was inserted into a radish vertically and horizontally on axis Z and they were fixed with a headring. After image acquisition by stereotactic radiosurgery planning system, we achieved stereotactic coordinate of the target point and examined irradiation using the coordinate acquired as isocenter. After the irradiation, the film in the radish was developed and processed and the degree of coincidence between the target point marked on the film and the center of the radiation distribution. In order to measure the degree of distortion of the MR image in a different way, an acryl phantom was made and punctures were made at intervals of 1 cm and a drop of oil was dropped into it. Then, it was inserted into the radish vertically and horizontally on axis Z to acquire the MR image. Each coordinate was achieved and the estimation of distortion of MR image was made both in vertical and horizontal directions Results : The film from the radio was developed and for the one inserted vertically on axis Z, there was a good coincidence in the discrepancy between the target point marked on the film and the center of the radiation distribution. For the one inserted horizontally, the discrepancy between them was under 0.5 mm. As a result of estimating distortion of MR image using acryl, the discrepancy was under 0.45 mm in the case of the phantom inserted vertically on axis Z, and that of the one inserted horizontally was 1.4 mm. Conclusion : We were able to confirm good coincidence in homogeneous phantom in actual treatment position of radiosurgery using the MR image and the discrepancy measured in the analysis of distortion of the MR image did not exceed the permissible level. Therefore, it was evident the system of the hospital is suitable for radiosurgery using MR image.

• 대한방사선치료학회지
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• 제17권2호
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• pp.95-103
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• 2005

목 적 : 정위적 방사선수술 시 환자의 set up을 정확히 하며 정확한 종양의 위치를 찾아내어 확인하고 평가하는 것은 치료성적을 좌우하는데 매우 중요한 일이다. 특히 체부에 종양이 있는 환자의 경우 호흡 등에 의한 종양의 움직임으로 인하여 정확한 종양위치에 치료를 시행하는데는 많은 어려움이 따르는데 이러한 문제점들을 보완하기 위하여 본원에서 자체 제작한 고정용구를 이용하여 환자의 움직임을 최소화시키고 또한 환자의 호흡에 따른 CT 영상을 획득하였으며 이를 통하여 Image Guided Radiosurgery를 시행함으로써 방사선수술의 정확성을 높이고자 한다. 대상 및 방법 : 본원에서 자체 개발한 Body SRS용 Vacuum cushion (BSRS Vacuum cushion)을 이용하여 환자의 호흡에 따른 CT영상을 세 번에 걸쳐 획득한 후 (shallow, inhalation, exhalation) RTP computer상에서 이들을 fusion하며 Global GTV (PTVsim target)를 찾아내어 가장 적합한 수술계획을 수립한다. 수술 전 위와 같은 방법으로 Global GTV (PTVtx target)를 찾아내어 Posterior Pb ball을 기준으로 처음 수립된 수술계획의 PTVsim target에 PTVtx target을 조합시켜 비교함으로써 환자의 New PTVcenter를 찾아내고 수술을 시행한 후 EPID 영상을 획득하며 환자의 움직임 여부와 정확한 방사선수술이 시행되었는지 확인한다. 결 과 : 환자의 호흡에 따른 target volume의 위치는 Inhalation에서 cranio-caudal 방향으로 최대 10 mm까지 변화되었으며 체적은 Shallow respiration 일 때 $0.93cm^3$로 가장 크게 변화되는 것을 확인할 수 있었다. 수술 전후의 CT 영상을 통하여 New PTVcenter target volume의 위치에 따른 치료 정확성을 DVH로 분석한 결과 100% 전후의 치료 선량이 조사되는 것을 확인할 수 있었다. 결 론 : 체부의 SRS는 환자의 호흡에 따른 종양의 움직임 때문에 환자의 적용에는 회의적인 입장이었으나 고정기구 개발과 IGRT를 접목함으로써 보다 정확한 방사선수술을 시행할 수 있었고 이를 통하여 많은 BSRS에 적용할 수 있을 것으로 사료된다.

• 한국의학물리학회지:의학물리
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• 제9권2호
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• pp.89-94
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• 1998

자기공명영상을 정위적 방사선 수술에 이용하기 위한 우선 과제로 비교적 균일한 phantom에서 자기공명영상으로 구한 정위적 표적점이 실제 방사선수술시의 방사선 빔의 isocenter와 일치하는지 확인하고자 하였다. 무 속에 임의의 표적점이 표시된 선량측정용 필름을 끼우고 head ring 을 고정시킨 다음 자기공명영상올 얻어 방사선 수술용 planning computer 로 표적점의 정위적 좌표를 구한 다음 실제 치료와 같이 무 phantom 을 테이블에 고정한 후 구해진 표적점의 좌표를 isocenter로 하여 방사선을 조사하고 필름을 현상하여 필름에 표시한 표적점과 실제 방사선이 조사된 부위의 선량분포의 중심을 비교하였는데 오차가 0.5 mm 이내였다. 따라서 무와 같은 비교적 균일한 phantom 에서는 표적점과 실제 방사선이 조사된 부위의 선량분포의 중심이 잘 일치함을 알 수 있었다. 또 다른 방법으로 자기공명영상의 왜곡의 정도를 직접 확인하기 위해서 아크릴에 1 cm 간격으로 구멍을 뚫고 오일방울을 넣어준 후 아크릴 phantom을 무 속에 수평과 수직방향으로 삽입한 뒤 자기공명영상을 얻은 후 각각의 좌표를 구하여 자기공명영상의 수평과 수직방향에서 왜곡의 정도를 측정하였다. 결과는 균일한 물질 내에서는 7 cm 거리에서 0.4 mm 이내의 오차를 보여서 비교적 잘 일치하였다. 그런데 이 측정과정에서 device 자체와 digitizing 과정의 오차가 있는 것으로 판단되므로 더 정교한 device 의 제작이 필요한 것으로 생각된다.

• 대한방사선치료학회지
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• 제26권2호
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• pp.177-182
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• 2014

목 적 : 토모테라피(Tomotherapy)의 두 가지 빔 모드(fixed jaw, dynamic jaw)에 따른 선량 분포 특성과 치료 시간의 차이를 분석하여 dynamic jaw(DJ)를 이용한 Tomo_edge 모드의 임상적 유용성을 고찰하고자 하였다. 대상 및 방법 : 토모테라피를 이용하여 치료받은 환자 7명을 대상으로 임상에서 보편적으로 사용되는 fixed jaw(FJ)를 이용하여 치료 계획을 수립하였다. 각각의 환자에서 모두 동일한 선량계획조건을 부여하였고, 토모테라피의 치료계획 인자인 Modulation Factor(MF), Pitch를 동일하게 유지한 상태에서 1) 동일한 조사면을 적용하고 FJ 와 DJ를 적용한 치료 계획을 비교하였다. 2) FJ를 적용한 치료 계획과 한 단계 큰 조사면과 DJ를 적용한 치료 계획을 비교하였다. 각 실험의 결과는 선량분포의 특성을 확인하기 위하여 종양체적 내 최소값(Dmin)과 선량 조형지수(CI=$V_{95%}$/TV)를 비교하고 표적을 포함한 조사영역 내 체적의 누적선량을 분석하였다. 또한, 임상적 유용성을 확인하기 위하여 빔 조사시간과 MU의 증감을 비교 분석하였다. 결 과 : 동일한 조사면을 적용하고 FJ와 DJ를 적용한 경우, $V_{75%}$은 1.04%, $V_{50%}$은 4.75% 감소하였고, $V_{25%}$은 7.6%, $V_{10%}$은 11.91% 감소하였다. FJ를 적용한 치료계획보다 한 단계 큰 조사면과 DJ를 적용한 경우에 Dmin은 0.72%, CI는 1.25% 줄어들었고, 동일 조사면을 적용한 경우와 마찬가지로 $V_{x%}$는 저선량 영역으로 갈수록 크게 감소하여 $V_{10%}$이 6.13%의 감소 값을 나타냈다. 빔 조사시간과 누적 MU는 동일 조사면 적용 시 각각 3.66%와 3.77%의 값으로 증가하였으나, 한 단계 큰 조사면을 적용한 경우, 빔 조사시간이 31.55%로 누적 MU는 32.28%으로 크게 감소하였음을 보여준다. 결 론 : 동일한 조사면을 사용하면서 DJ를 사용하는 경우, 표적의 선량분포를 거의 변화시키지 않으면서 환자의 용적선량을 효과적으로 감소시킬 수 있었다. 보다 큰 조사면을 사용하는 것과 동시에 DJ를 사용하는 경우는 일부 선량조형성의 저하를 나타내었으나 환자의 용적선량이 감소하고 치료 시간을 감소시킴으로써 Tomo-edge 모드는 임상적으로 유용한 것으로 사료된다.

• Radiation Oncology Journal
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• 제33권3호
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• pp.226-232
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• 2015

Purpose: Toxicity of mucosa is one of the major concerns of radiotherapy (RT), when a target tumor is located near a mucosal lined organ. Energy of photon RT is transferred primarily by secondary electrons. If these secondary electrons could be removed in an internal cavity of mucosal lined organ, the mucosa will be spared without compromising the target tumor dose. The purpose of this study was to present a RT dose reduction in near target inner-surface (NTIS) of internal cavity, using Lorentz force of magnetic field. Materials and Methods: Tissue equivalent phantoms, composed with a cylinder shaped internal cavity, and adjacent a target tumor part, were developed. The phantoms were irradiated using 6 MV photon beam, with or without 0.3 T of perpendicular magnetic field. Two experimental models were developed: single beam model (SBM) to analyze central axis dose distributions and multiple beam model (MBM) to simulate a clinical case of prostate cancer with rectum. RT dose of NTIS of internal cavity and target tumor area (TTA) were measured. Results: With magnetic field applied, bending effect of dose distribution was visualized. The depth dose distribution of SBM showed 28.1% dose reduction of NTIS and little difference in dose of TTA with magnetic field. In MBM, cross-sectional dose of NTIS was reduced by 33.1% with magnetic field, while TTA dose were the same, irrespective of magnetic field. Conclusion: RT dose of mucosal lined organ, located near treatment target, could be modulated by perpendicular magnetic field.

• 대한원격탐사학회지
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• 제26권3호
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• pp.297-304
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• 2010

Since the change in Doppler centroid according to moving targets brings alteration to the phase in azimuth differential signals of synthetic aperture radar (SAR) data, one can measure the velocity of the moving targets using this effect. In this study, we will investigate theoretically measuring the velocity of an object from azimuth differential signals by using range compressed data which is the interim outcome of treatment from the simulated SAR raw data of moving targets on the background of sea clutter. Also, it will provide evaluation for the elements that affect the estimation error of velocity from a single SAR sensor. By making RADARSAT-1 simulated image as a specific case, the research includes comparisons for the means of velocity measurement classified by the directions of movement in the four following cases. 1. A case of a single target without currents, 2. A case of a single target with tidal currents of 0.5 m/s, 1 m/s, and 3 m/s, 3. A case of two targets on a same azimuth line moving in a same direction and velocity, 4. A case of a single target contiguous to land where radar backscatter is strong. As a result, when two moving targets exist in SAR image outside the range of approximately 256 pixels, the velocity of the object can be measured with high accuracy. However, when other moving targets exist in the range of approximately 128 pixels or when the target was contiguous to the land of strong backscatter coefficient (NRCS: normalized radar cross section), the estimated velocity was in error by 10% at the maximum. This is because in the process of assuming the target's location, an error occurs due to the differential signals affected by other scatterers.