• Radiation Oncology Journal
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• v.20 no.4
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• pp.343-352
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• 2002

Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.393-402
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• 1997

Purpose : When an x-ray beam of small field size is irradiated to target area containing an air cavity, such as larynx, the underdosing effect is observed in the region near the interfaces of air and soft tissue. With a larynx model, air cavity embedded in tissue-equivalent material, this study is intonded for examining Parameters, such as beam quality, field size, and cavity size, to affect the dose distribution near the air cavity. Materials and Methods : Three x-rar beams, 4-, 6- and 10-MV, were employed to Perform a measurement using a 2cm $(width){\times}L$ (length in cm, one side of x-ray field used 2cm (height) air cavity in the simulated larynx. A thin window parallel-plate chamber connected to an electrometer was used for a dosimetry system. A ratio of the dose at various distances from the cavity-tissue interface to the dose at the same points in a homogeneous Phantom (ebservedlexpected ratio, O/E) normalized buildup curves, and ratio of distal surface dose to dose at the maximum buildup depth were examined for various field sizes. Measurement for cavity size effect was performed by varying the height (Z) of the air cavity with the width kept constant for several field sizes. Results : No underdosing effect for 4-MV beam for fields larger than $5cm\times5cm$ was found For both 6- and 10-MV beams, the underdosing portion of the larynx at the distal surface was seen to occur for small fields, $4cm\times4cm\;and\;5cm\times5cm$. The underdosed tissue was increased in its volume with beam energy even for similar surface doses. The relative distal surface dose to maximum dose was changed to 0.99 from 0.95, 0.92, and 0.91 for 4-, 6-, and 10-MV, respectively, with increasing field size, $4cm\times4cm\;to\;8cm\times8cm$, For 6- and 10-MV beams, the dose at the surface of the cavity is measured less than the predicted by about two and three percent. respectively. but decrease was found for 4-MV beam for $5cm\times5cm$ field. For the $4cm\timesL\timesZ$ (height in cm). varying depth from 0.0 to 4.8cm, cavity, O/E> 1.0 was observed regardless of the cavity size for any field larger than about $8cm\times8cm$. Conclusion : The magnitude of underdosing depends on beam energy, field size. and cavity size for the larynx model. Based on the result of the study. caution must be used when a small field of a high quality x-ray beam is irradiated to regions including air cavities. and especially the region where the tumor extends to the surface. Low quality beam. such as. 4-MV x-ray, and larger fields can be used preferably to reduce the risk of underdosing, local failure. In the case of high quality beams such as 6- and 10-MV x-rays, however. an additional boost field is recommended to add for the compensation of the underdosing region when a typically used treatment field. $8cm\times8cm$, is employed.

• 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.

• Radiation Oncology Journal
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• v.22 no.3
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• pp.200-207
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• 2004

Purpose: An analysis was to compare the results of radiation alone with those of radiation with dally low dose cisplatin as a radiation sensitizer in locally advanced cervical cancer. Materials and Methods: A retrospective analysis of 59 patients diagnosed with locally advanced uterine cervix cancer between December 1996 and March 2001 was peformed. Thirty one patients received radiation alone and 28 patients received dally low dose cisplatin, as a radiation sensitizer, and radiation therapy. The median follow-up period was 34 months, ranging from 2.5 to 73 months. The radiation therapy consisted of 4500 cGy external beam irradiation to the whole pelvis (midline block after 3060 cGy), a 900$\~$l,000 cGy boost to the involved parametrium and high dose-rate intracavitary brachytherapy (a total dose of 3,000$\~$3,500 cGy/500 cGy per fraction to point A, twice per week). In the chemoradiation group, 10 mg of daily intravenous cisplatin was given daily from the 1st day of radiation therapy to the 20th day of radiation therapy. According to the FIGO classification, the patients were subdivided into 51 (86.4$\%$) and 8 (13.6$\%$) stages IIB and stage IIIB, respectively. Results: The overall 5 year survival rate was 65.65$\%$ and according to treatment modality were 56.75$\%$ and 73.42$\%$ in the radiation alone and chemoradiation groups, respectively (p=0.180). The 5 year disease-free survival rates were 49.39$\%$ and 63.34$\%$ in the radiation alone and chemoradiatoin groups, respectively (p=0.053), The 5 year locoregional control rates were 52.34$\%$ and 73.58$\%$ in the radiation alone and chemoradiation groups, respectively (p=0.013). The 5 year distant disease-free survival rates were 59.29$\%$ and 81.46$\%$ in the radiation alone and chemoradiation groups, respectively (p=0.477), Treatment related hematologic toxicity were prominent in the chemoradiation group. Leukopenia $\geq$grade) occurred in 3.2$\%$and 28.5$\%$ of the radiation alone and chemoradiation groups, respectively (p=0.02). There were no statistical differences in the incidences of vesical, rectal and small bowel complications between two groups. Conclusion: Radiation therapy with low dose cisplatin did not improve the rates of survival and response rates, but did improve the rate of disease free survival and locoregional control rates In locally advanced cervical cancer. The incidence of bone marrow suppression was higher in the chemoradiation group.

• The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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• v.4 no.1
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• pp.63-70
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• 1999

The optimum sampling area which can be applied to the benthic community study is estimated from large survey data in the Songdo tidal flat and subtidal zone of Youngil Bay, Korea. A total of 250 samples by 0.02 $m^2$ box corer for the benthic fauna in Songdo tidal flat and 50 samples by 0.1 $m^2$ van Veen grab in Youngil Bay were taken from the total sampling area of 5 $m^2$. It was assumed that the sampling area could contain sufficient information on sediment fauna, if cumulative number of species, ecological indices, and similarity index by cluster analysis reflect the similarity level of 75% to those found at total sampling area (5 $m^2$). A total of 56 and 60 species occurred from Songdo tidal flat and Youngil Bay, respectively. The cumulative curve of the species number ($N_{sp}$) as a function of the sampling area (A in $m^2$ ) was fitted as $N_{sp}=37.379A^{0.257}$ ($r^2=0.99$) for intertidal fauna and $N_{sp}=40.895A^{0.257}$ ($r^2=0.98$) for subtidal fauna. Based on these curves and 75% of similarity to the total sampling area (5 $m^2$), the optimum sampling area was proposed as 1.6 $m^2$ for the intertidal and 1.5 $m^2$ for the subtidal fauna. Ecological indices (species diversity, richness, evenness and dominance indices) were again calculated on the basis of species composition in differently simulated sample sizes. Changes in ecological indices with these sample sizes indicated that samplings could be done by collecting fauna from < 0.5 $m^2$-1.5 $m^2$ on the Songdo tidal flat and from < 0.5 $m^2$-1.2 $m^2$ in Youngil Bay. Changes in similarity level of all units of each simulated sample size showed that sampling area of 0.3 $m^2$ (Songdo tidal flat) and 0.6 $m^2$ (Youngil Bay) should be taken to obtain a similarity level of 75%. In conclusion, sampling area which was determined by cumulative number of species, ecological indices and similarity index by cluster analysis could be determined as 1.5 $m^2$ (0.02 $m^2$ box corer, n=75) for Songdo tidal flat and 1.2 $m^2$ (0.1 $m^2$ van Veen grab, n=12) for Youngil Bay. If these sampling areas could be covered in the field survey, population densities of seven dominant species comprising 68% of the total faunal abundance occurring on Songdo tidal flat and six species comprising 90% in Youngil Bay can be estimated at the precision level of P=0.2.

• Journal of Nutrition and Health
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• v.41 no.8
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• pp.870-886
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• 2008

The purposes of this study were to (a) analyze school foodservice employees' knowledge and performance degree of HACCP system and (b) provide the basic data for planning the strategies which can be performed for systematic HACCP system in school foodservice. For these purposes, the subjects included 91 dieticians (a response rate 98.9%) and 270 foodservice employees (a response rate 98.2%) at school in Jeju city and they were surveyed from October 21 to November 4, 2006. The data were analyzed by descriptive analysis, reliability analysis, t-test, ANOVA (Duncan multiple range test) and Pearson's correlation coefficients using the SPSS Win Program (version 12.0). In terms of the number of training practice, the result of sanitary training indicated that the dieticians who trained the employees more than once per a week (48.6%) or everyday (36.3%) were 84.7%. And the dieticians who were higher age, full-time job, and working at middle school implemented significantly more training the employees. In the training methods, 40.7% of dieticians used the oral presentation and 37.4 % utilized the printed matters. Also, most of employees (98.1%) have experienced for the training, 39.6% of them did not have regular training experience and 40.7% of them responded that they were understanding the HACCP system well. The result of employees' knowledge level of HACCP system reported that the items of the personal hygiene scored the highest (92.3 points) whereas the items of CCP3 scored the lowest (58.3 points) as the average being 84.2 points (out of 100 scale). In terms of the performance degree of HACCP system, the average was 4.40 (out of 5 scale), the items of the personal hygiene scored the highest as 4.51 whereas the items of CCP2 scored the lowest as 4.31 points. The dieticians' perception degree of employees' performance degree in HACCP system showed that the average was 4.13 (out of 5 scale), so it was significantly lower than actual performance degree as average 4.40 (out of 5 scale). Additionally the employees' knowledge level was positively correlated to performance degree and employees' knowledge level of CCP3, CCP4, and the personal hygiene significantly influenced to the HACCP performance degree. Finally, the dieticians have to recognize correctly the employees' performance degree and on the basis of it must plan the sanitary training which has a proper contents and methods to enhance the employees' knowledge level and achieve more systematic HACCP system in school foodservice.

• Journal of the Korean Society of Food Culture
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• v.15 no.5
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• pp.435-442
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• 2000

This study was carried out to investigate misconception for physique and desire for physique of college women in Taegu(412 subjects) and Fukuoka(423 subjects). The data was collected by questionnaire interview and anthropometric measurement. The results were as follows : The mean age, height, weight, and BMI of Taegu subjects were $19.9{\pm}1.2$ years old, $159.6{\pm}4.9cm,\;51.2{\pm}6.0kg\;and\;20.1{\pm}2.2$, respectively. The mean age, height , weight, and BMI of Fukuoka subjects were $18.3{\pm}0.6$ year old, $157.5{\pm}5.0cm,\;53.3{\pm}6.9kg\;and\;21.5{\pm}2.5$, respectively. The average ideal height desired by subjects in Taegu was higher than their real mean height by 5.1cm ; while the average ideal weight desired by subjects was lower than real mean weight by 2.6kg. The average ideal height desired by subjects in Fukuoka was higher than their real mean height by 3.2cm ; while the average ideal weight desired by subjects was lower than real mean weight by 5.4kg. The percentage of Taegu subjects who desired to be slender, be fatty and maintain weight were 70.1%, 7.3%, and 22.6% respectively. The percentage of Fukuoka subjects who desired to be slender, be fatty and maintain weight were 85.3%,2.6% and 12.1% respectively. The rate of misconception for the actual physique was 56.5% in Taegu subjects, and 57.2% In fukuoka subjects. The over estimation rate was higher in subjects desired for slenderness than in others. The adolescent females having a fatty body image in self-consciousness indicated that they felt high social physique anxiousness. Finally, the rate of misconception and the degree of social physique anxiousness were higher in those who had a desire for slenderness.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.33 no.5
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• pp.455-462
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• 2000

The objective of this study was to examine the physicochemical characteristics of coagulation reaction between loess and red tide organisms (RTO) and its feasibility, in developing a technology for the removal of RTO bloom in coastal sea. The physicochemical characteristics of loess were examined for a particle size distribution, surface characteristics by scanning electron microscope, zeta potential, and alkalinity and pH variations in sea water. Two kinds of RTO that were used in this study, Cylindrothen closterium and Skeietonema costatum, were sampled in Masan bay and were cultured in laboratory. Coagulation experiments were conducted using various concentrations of loess, RTO, and a jar tester. The supernatant and RTO culture solution were analyzed for pH, alkalinity, RTO cell number. A negative zeta potential of loess increased with increasing pH at $10^(-3)M$ NaCl solution and had -71.3 mV at pH 9.36. Loess had a positive zeta potential of +1,8 mV at pH 1.98, which resulted in a characteristic of material having an amphoteric surface charge. In NaCl and $CaCl_2$, solutions, loess had a decreasing negative zeta potential with increasing $Na^+\;and\;Ca^(+2)$ ion concentration and then didn't result in a charge reversal due to not occurring specific adsorption for $Na^+$ ion while resulted in a charge reversal due to occurring specific adsorption for $Ca^(+2)$ ion. In sea water, loess and RTO showed the similar zeta potential values of -112,1 and -9.2 mV, respectively and sea sand powder showed the highest zeta potential value of -25.7 mV in the clays. EDLs (electrical double-layers) of loess and RTO were extremely compressed due to high concentration of salts included in sea water, As a result, there didn't almost exist EDL repulsive force between loess and RTO approaching each other and then LVDW (London-yan der Waals) attractive force was always larger than EDL repulsive force to easily form a floe. Removal rates of RTO exponentially increased with increasing a loess concentration. The removal rates steeply increased until $800 mg/l$ of loess, and reached $100{\%}$ at 6,400 mg/l of loess. Removal rates of RTO exponentially increased with increasing a G-value. This indicated that mixing (i.e., collision among particles) was very important for a coagulation reaction. Loess showed the highest RTO removal rates in the clays.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.311-323
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• 1998

Purpose : Prospective, single arm, Phase I/II clinical trial was performed to assess the efficacy and toxicity of the concurrent chemotherapy and definitive radiotherapy (RT) in patients with previously untreated locally advanced carcinoma of the uterine cervix. Methods and Materials : From Mar 1992 to January 1997, a total of 73 patients with advanced cervical carcinoma were entered on the protocol but 5 patients were excluded in analysis because of patients' refusal of treatment. Their ages ranged from 31 to 77 years, median 58 years. The International Federation of Gynecology and Obstetrics (FIGO) stage distribution was as follows: IIB 46, IIIA 2, IIIB 15 and IVA 5. RT consisted of external beam irradiation to 4,140-5,040 cGy/23-28 fractions plus high dose rate intracavitary treatments to deliver a dose of 30-35 Gy to point A in 6-7 fractions. During the intracavitary treatments parametrial boost was delivered for point B dose of 60 Gy in stage IIB and 65 Gy in stage IIIB. Two cycles of concurrent 5-fluorouracil and cisplatin (FP) chemotherapy (5-fluorouracil 1,000 mg/$m^2$/day continuous infusion for 4 days, day 1-4, 29-32 and cisplatin 20 mg/$m^2$/day intravenous bolus for 3 days day 1-3, 29-31) administered starting on day 1 of RT. Results : The median follow-up was 24 months (range 4-68+). Sixty-four patients were evaluable for survival rate in this protocol: The 5-year actuarial and disease-free survival rate were 52$\%$ and 64$\%$, respectively. The 5-rear actuarial survival for stage IIB and III+IVA patients were 58$\%$ and 36$\%$, respectively The 5-year disease-free survival rate for stage IIB and III+IVA patients were 71$\%$ and 40$\%$, respectively. Of the 68 patients evaluated for patterns of failure, overall recurrence rate was 27.9$\%$ (19/68) : local failure in 5.9$\%$ (4/68), distant metastasis in 10.3$\%$ (7/68) and both in 11.8$\%$ (8/68). Of the 64 patients evaluated for response at one month after the completion of treatment the complete response rate was 78$\%$ (50/64). Concurrent chemoradiation appear to be a well-tolerated regimen but there were two treatment-related deaths. Conclusion : Concurrent chemotherapy of FP with high-dose definitive RT in locally advanced carcinoma of the uterine cervix is feasible and effective with acceptable toxicities. This chemoradiation regimen may offer a modest survival benefit for advanced stage. Further follow-up of these patients will evaluate the impact of this regimen on the long-term local control and their survival.

• Journal of the East Asian Society of Dietary Life
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• v.10 no.2
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• pp.116-128
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• 2000

The purpose of this study is to analyze the nutrient intakes and growth development of rural middle school students provided with and without the national school lunch program(NSLP). The subjects consisted of 340 rural middle school students provided with(n=177) and without(n=163) NSLP. Anthropometric measurements were taken for body weight, height, triceps skinfold thickness and percentage of body fat, and nutrient intakes were assessed by food record method. The results of this study were summarized as follows: There was no significant difference in the height, body weight girls provided with (155.8cm 47.2kg) and without (156.0cm, 49.7kg) NSLP. Total energy intakes of boys were 2123kca1 in with NSLP and 1857kca1 in without NSLP. Total energy intakes of girls were 1913kca1 in with NSLP and 1814kca1 in without NSLP. Total daily energy was provided in the ratio of 19.1%, 39.8%, 32.4% and 8.7% by breakfast, lunch, dinner and snacks in the with NSLP and 17.5%, 32.0%, 34.8% and 15.7% in without NSLP, respectively. Phosphorus, vitamin A, vitamin E, ascorbic acid, thiamin, riboflavin, niacin intakes were above the RDA in with NSLP. In without NSLP, phosphorus, vitamin E, thiamin intakes were above the RDA. however, calcium. iron, vitamin A, vitamin B$_{6}$ were less than the RDA. The study showed that total daily energy and nutrient intakes were significantly higher in students provided with than without school-lunch. Thus, the school-lunch program is recommended and necessary to improve the nutritional status of middle school students.