• Sleep Medicine and Psychophysiology
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• v.25 no.2
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• pp.74-81
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• 2018

Objectives: Insomnia is one of the major concerns in the elderly population. Cognitive behavioral treatment for insomnia is the first line treatment option, but there are some limitations including time and cost burdens and the requirement for sufficient cognitive resources to obtain a proper treatment effect. The Brief intervention for insomnia (BII) is a treatment that focuses on behavioral aspects of insomnia in primary care practices. The purpose of this study was to evaluate the effects of BII in community-dwelling older adults. Methods: A total of 47 older adults with insomnia were enrolled from community centers between May 2016 and January 2018. They participated in the BII program for three weeks. We gathered sleep-related participant information with using the Pittsburgh sleep quality index (PSQI), the Sleep hygiene index, and a sleep diary. Clinical efficacy was evaluated by comparing total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) before and after the treatment. Results: There was significant improvement in sleep-related features after BII. Global score and sleep quality from the PSQI, freshness, and WASO from the sleep diary showed statistically significant improvement. Conclusion: We found BII showed positive clinical efficacy in community dwelling older adults, especially from the perspective of subjective sleep quality and WASO. This finding implies that BII can be effectively applied for the managment of elderly insomnia patients in a community setting.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.17-24
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• 2019

Purpose: The present study aims to assess the level of coherency and the accuracy of Point dose of the Isocenter of VERO, a linear accelerator developed for the purpose of the Stereotactic Body Radiation Therapy(SBRT). Materials and Method: The study was conducted randomly with 10 treatment plans among SBRT patients in Kyungpook National University Chilgok Hospital, using VERO, a linear accelerator between June and December, 2018. In order to assess the equipment's power stability level, we measured the output constancy by using PTW-LinaCheck, an output detector. We also attempted to measure the level of accuracy of the equipment's Laser, kV(Kilo Voltage) imaging System, and MV(Mega Voltage) Beam by using Tofu Phantom(BrainLab, Germany) to assess the accuracy level of geometrical Isocenter. We conducted a comparative analysis to assess the accuracy level of the dose by using an acrylic Phantom($30{\times}30{\times}20cm$), a calibrated ion chamber CC-01(IBA Dosimetry), and an Electrometer(IBA, Dosimetry). Results: The output uniformity of VERO was calculated to be 0.66 %. As for geometrical Isocenter accuracy, we analyzed the error values of ball Isocenter of inner Phantom, and the results showed a maximum of 0.4 mm, a minimum of 0.0 mm, and an average of 0.28 mm on X-axis, and a maximum of -0.4 mm, a minimum of 0.0 mm, and an average of -0.24 mm on Y-axis. A comparison and evaluation of the treatment plan dose with the actual measured dose resulted in a maximum of 0.97 % and a minimum of 0.08 %. Conclusion: The equipment's average output dose was calculated to be 0.66 %, meeting the ${\pm}3%$ tolerance, which was considered as a much uniform fashion. As for the accuracy assessment of the geometric Isocenter, the results met the recommended criteria of ${\pm}1mm$ tolerance, affirming a high level of reproducibility of the patient's posture. The difference between the treatment plan dose and the actual measurement dose was calculated to be 0.52 % on average, significantly less than the 3 % tolerance, confirming that it obtained predicted does. The current study suggested that VERO equipment is suitable for SBRT, and would result in notable therapeutic effect.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.31-42
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• 2022

Purpose: This study measures and compares the surface dose values in the virtual target volume using Tomotherapy, Halcyon, and TrueBeam equipment using 6MV-Flattening Filter-Free(FFF) energy. Materials and Methods: CT scan was performed under three conditions of without bolus, 0.5 cm bolus, and 1 cm bolus using an IMRT phantom (IBA, Germany). The Planning Target Volume (PTV) was set at the virtual target depth, and the treatment plan was established at 200 cGy at a time. For surface dosimetry, the Gafchromic EBT3 film was placed in the same section as the treatment planning system and repeated measurements were performed 10 times and then analyzed. Result: As a result of measuring the surface dose for each equipment, without, 0.5 cm, 1 cm bolus is in this order, and the result of Tomotherapy is 115.2±2.0 cGy, 194.4±3.3 cGy, 200.7±2.9 cGy, The result in Halcyon was 104.7±3.0 cGy, 180.1±10.8 cGy, 187.0±10.1 cGy, and the result in TrueBeam was 92.4±3.2 cGy, 148.6±5.7 cGy, 155.8±6.1 cGy, In all three conditions, the same as the treatment planning system, Tomotherapy, Halcyon, TreuBeam was measured highly in that order. Conclusion: Higher surface doses were measured in Tomotherapy and Halcyon compared to TrueBeam equipment. If the characteristics of each equipment are considered according to the treatment site and treatment purpose, it is expected that the treatment efficiency of the patient will increase as well as the treatment satisfaction of the patient.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.7-13
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• 2023

Purpose: In this study, we evaluated the effect of using a customized bolus on dose delivery in the treatment plan when cervical cancer protruded out of the body along with the uterus and evaluated reproducibility in patient set-up. Materials & Methods: The treatment plan used the Eclipse Treatment Planning System (Version 15.5.0, Varian, USA) and the treatment machine was VitalBeam (Varian Medical Systems, USA). The radiotherapy technique used 6 MV energy in the AP/PA direction with 3D-CRT. The prescribed dose is 1.8 Gy/fx and the total dose is 50.4 Gy/28 fx. Semiflex TM31010 (PTW, Germany) was used as the ion chamber, and the dose distribution was analyzed and evaluated by comparing the planned and measured dose according to each position movement and the tumor center dose. The first measurement was performed at the center by applying a customized bolus to the phantom, and the measurement was performed while moving in the range of -2 cm to +2 cm in the X, Y, and Z directions from the center assuming a positional error. It was measured at intervals of 0.5 cm, the Y-axis direction was measured up to ±3 cm, and the situation in which Bolus was set-up incorrectly was also measured. The measured doses were compared based on doses corrected to CT Hounsfield Unit (HU) 240 of silicon instead of the phantom's air cavity. Result: The treatment dose distribution was uniform when the customized bolus was used, and there was no significant difference between the prescribed dose and the actual measured value even when positional errors occurred. It was confirmed that the existing sheet-type bolus is difficult to compensate for irregularly shaped tumors protruding outside the body, but customized Bolus is found to be useful in delivering treatment doses uniformly.

• Journal of Intelligence and Information Systems
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• v.21 no.4
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• pp.17-35
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• 2015

Demand forecasting is the activity of estimating the quantity of a product or service that consumers will purchase for a certain period of time. Developing precise forecasting models are considered important since corporates can make strategic decisions on new markets based on future demand estimated by the models. Many studies have developed market growth curve models, such as Bass, Logistic, Gompertz models, which estimate future demand when a market is in its early stage. Among the models, Bass model, which explains the demand from two types of adopters, innovators and imitators, has been widely used in forecasting. Such models require sufficient demand observations to ensure qualified results. In the beginning of a new market, however, observations are not sufficient for the models to precisely estimate the market's future demand. For this reason, as an alternative, demands guessed from those of most adjacent markets are often used as references in such cases. Reference markets can be those whose products are developed with the same categorical technologies. A market's demand may be expected to have the similar pattern with that of a reference market in case the adoption pattern of a product in the market is determined mainly by the technology related to the product. However, such processes may not always ensure pleasing results because the similarity between markets depends on intuition and/or experience. There are two major drawbacks that human experts cannot effectively handle in this approach. One is the abundance of candidate reference markets to consider, and the other is the difficulty in calculating the similarity between markets. First, there can be too many markets to consider in selecting reference markets. Mostly, markets in the same category in an industrial hierarchy can be reference markets because they are usually based on the similar technologies. However, markets can be classified into different categories even if they are based on the same generic technologies. Therefore, markets in other categories also need to be considered as potential candidates. Next, even domain experts cannot consistently calculate the similarity between markets with their own qualitative standards. The inconsistency implies missing adjacent reference markets, which may lead to the imprecise estimation of future demand. Even though there are no missing reference markets, the new market's parameters can be hardly estimated from the reference markets without quantitative standards. For this reason, this study proposes a case-based expert system that helps experts overcome the drawbacks in discovering referential markets. First, this study proposes the use of Euclidean distance measure to calculate the similarity between markets. Based on their similarities, markets are grouped into clusters. Then, missing markets with the characteristics of the cluster are searched for. Potential candidate reference markets are extracted and recommended to users. After the iteration of these steps, definite reference markets are determined according to the user's selection among those candidates. Then, finally, the new market's parameters are estimated from the reference markets. For this procedure, two techniques are used in the model. One is clustering data mining technique, and the other content-based filtering of recommender systems. The proposed system implemented with those techniques can determine the most adjacent markets based on whether a user accepts candidate markets. Experiments were conducted to validate the usefulness of the system with five ICT experts involved. In the experiments, the experts were given the list of 16 ICT markets whose parameters to be estimated. For each of the markets, the experts estimated its parameters of growth curve models with intuition at first, and then with the system. The comparison of the experiments results show that the estimated parameters are closer when they use the system in comparison with the results when they guessed them without the system.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1058-1066
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• 1998

Background: Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiologic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. Diagnosis of choice was not definded yet and role of bronchoscopy on diagnosis was not described yet. Methods: From 1989 to 1998, we experienced 17 cases of thoracic actinomycosis. We have reviewed the case notes of 17 patients with thoracic actinomycosis. The mean age at presentation was $53{\pm}13$ years, 11 were male. Results: Cough, hemoptysis, sputum production, chest pain and weight loss were the commonest symptoms. The mean delay between presentation and diagnosis was $6.6{\pm}7.8$ months. There were six patients who presented with a clinical picture of a suppurative lesion and eleven patients were suspected of having primary lung tumor initially. In no cases was made an accurate diagnosis at the time of hospital admission. Associated diseases were emphysema (1 case), bronchiectasis (2 cases) and tuberculosis (2 cases). Bronchoscopic findings were mucosal swelling and stenosis(n=4), mucosal swelling, stenosis and necrotic covering (n=2), mass (n=3), mass and necrotic covering (n=1) and normal(n=6). Radiologic findings were mass lesion(n=8), pneumonitis(n=3), atelectasis(n=3), pleural effusion(n=2), and normal(n=3). Final diagnosis was based on percutaneous needle aspiration and biopsy (n=3), bronchoscopic biopsy specimens (n=9), mediastinoscopic biopsy (n=1) and histologic examination of resected tissue in the remaining patients(n=4) who received surgical excision. Among 17 patients, 13 were treated medically and the other 4 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation. However. both medically and surgically treated patients achieved good clinical results. Conclusion: Thoracic actinomycosis is rare. but should still be considered in the differential diagnosis of a chrinic, localized pulmonary lesion. Thoracic actinomycosis may co-exist with pulmonary tuberculosis or lung cancer. If the lesion is located in the central of the lung. the bronchoscopy is recommanded for the diagnosis.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.83-95
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• 2018

Purpose : After planning the Respiratory Gated Radiotherapy for Lung cancer, the movement and volume change of sparing normal structures nearby target are not often considered during dose evaluation. This study carried out 4-D dose evaluation which reflects the movement of normal structures at certain phase of Respiratory Gated Radiotherapy, by using Deformable Image Registration that is well used for Adaptive Radiotherapy. Moreover, the study discussed the need of analysis and established some recommendations, regarding the normal structures's movement and volume change due to Patient's breathing pattern during evaluation of treatment plans. Materials and methods : The subjects were taken from 10 lung cancer patients who received Respiratory Gated Radiotherapy. Using Eclipse(Ver 13.6 Varian, USA), the structures seen in the top phase of CT image was equally set via Propagation or Segmentation Wizard menu, and the structure's movement and volume were analyzed by Center-to Center method. Also, image from each phase and the dose distribution were deformed into top phase CT image, for 4-dimensional dose evaluation, via VELOCITY Program. Also, Using $QUASAR^{TM}$ Phantom(Modus Medical Devices) and $GAFCHROMIC^{TM}$ EBT3 Film(Ashland, USA), verification carried out 4-D dose distribution for 4-D gamma pass rate. Result : The movement of the Inspiration and expiration phase was the most significant in axial direction of right lung, as $0.989{\pm}0.34cm$, and was the least significant in lateral direction of spinal cord, as -0.001 cm. The volume of right lung showed the greatest rate of change as 33.5 %. The maximal and minimal difference in PTV Conformity Index and Homogeneity Index between 3-dimensional dose evaluation and 4-dimensional dose evaluation, was 0.076, 0.021 and 0.011, 0.0 respectfully. The difference of 0.0045~2.76 % was determined in normal structures, using 4-D dose evaluation. 4-D gamma pass rate of every patients passed reference of 95 % gamma pass rate. Conclusion : PTV Conformity Index was more significant in all patients using 4-D dose evaluation, but no significant difference was observed between two dose evaluations for Homogeneity Index. 4-D dose distribution was shown more homogeneous dose compared to 3D dose distribution, by considering the movement from breathing which helps to fill out the PTV margin area. There was difference of 0.004~2.76 % in 4D evaluation of normal structure, and there was significant difference between two evaluation methods in all normal structures, except spinal cord. This study shows that normal structures could be underestimated by 3-D dose evaluation. Therefore, 4-D dose evaluation with Deformable Image Registration will be considered when the dose change is expected in normal structures due to patient's breathing pattern. 4-D dose evaluation with Deformable Image Registration is considered to be a more realistic dose evaluation method by reflecting the movement of normal structures from patient's breathing pattern.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.162-174
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• 1997

Background : Metabolic cooperation via gap junctional intercellular communication (GJIC) is an important mechanism of the bystander effect in gene therapy using the Herpes Simplex Virus thymidine kinase/ganciclovir (HSVtk) "prodrug" system. Since retinoids have been reported to increase GJIC by induction of connexin 43 expression, we hyporthesized that treatment of tumor cells with retinoic acid could augment the bystander effect of the HSVtk/GCV system and result in improved tumor cell killing by enhancing GJIC. Methods : We transferred HSVtk gene to SKHep-J cell line that does not express connexin43, and also transferred the gene to human and murine mesothelioma cell lines that express connexin43. We verified that retinoic acid enhanced GJIC utilizing a functional double-dye transfer study and evaluated the effects of retinoic acid on the growth rate of tumor cells. We then tested the effects of retinoic acid on bystander-mediated cell killing. Results : Addition of all-trans retinoic acid (RA) increased GJIC in cell lines expressing connexin 43 and was asspciated with more efficient in vitro bystander killing in cells transduced with HSVtk via adenoviral and retroviral vectors. In contrast, there was no increase in the efficiency of the bystander effect after exposure to RA in a cell line which had no delectable connexin 43. Conclusion : These results provide evidence that retinoids can augment the efficiency of cell killing with the HSVtk/GCV system by enhancing bystander effect and may thus be a promising new approach to improve responses in gene therapy utilizing the HSVtk system to treat tumors.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.36-45
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• 2002

Background : In mammals, the activity of antioxidant enzymes is increased in adult lung to adapt to hyperoxia. The increase of these activities is augmented in neonates and is known as an important mechanism of tolerance to high oxygen levels. Peroxiredoxin(Prx) is an abundant and ubiquitous intracellular antioxidant enzyme. Prx I and II are major cytosolic subtypes. The aim of this study was to examine th Prx I and II mRNA and protein expression levels in adult rat lungs and to compare then with those of neonatal rat lungs exposed to hyperoxia. Materials and Methods : Adult Sprague-Dawley rats and neonates that were delivered from timed pregnant Sprague-Dawley rat were randomly exposed to normoxia or hyperoxia. After exposure to high oxygen level for a set time, the bronchoalveolar lavage fluid and lung tissue were obtained. The Prx I and II protein expression levels were measured by western blot analysis using polyclonal rabbit anti-Prx I or anti-Prx II antibodies and the relative expression of the Prx I and Prx II per Actin protein were obtained as an internal standard. The Prx I and II mRNA expression levels were measured by northernblot analysis using Prx I and Prx II-specific cDNA prepared from pCRPrx I and pCRPrx II, and the relative Prx I and Prx II expression levels per Actin mRNA were obtained as an internal standard. Results : Hyperoxia induced some peak increase in the Prx I mRNA levels after 24 hour in adult rats. Interestingly, hyperoxia induced a marked increase of Prx I mRNA 24 hour in neonatal rats. However, hyperoxia did not induce an alteration in the expression of Prx II mRNA in both the adult and neonatal rat lungs. Hyperoxia did not induce an alteration in the expression of the Prx I and Prx II protein in both the adult and neonatal rat lungs. Hyperoxia did not induce an alteration in the amount of Prx I and Prx II protein all the times in the bronchoalveolar fluid of adult rats. Conclusion : Prx I and II is differently regulated by hyperoxia in adult and neonatal rat lung at the transcriptional level. The prominent upregulation of Prx I mRNA in neonates compared to those in adults by hyperoxia may be another mechanism of resistance to high oxygen levels in neonate.

• Childhood Kidney Diseases
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• v.6 no.1
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• pp.68-74
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• 2002

Purpose: Suprapubic bladder aspiration(SBA) of urine is the most reliable method to obtain urine avoiding contamination in non-toilet trained infants. Ultrasonography is a useful tool for guiding the anatomic location as well as for direct visualization during procedure. We evaluated the success rate and complication of ultrasound(US) assisted SBA Methods. Sixty infants who visited Ewha Womans University Mokdong Hospital, with suspected urinary tract infection were randomly divided into the US assisted (n=32) and blind SBA(control, n=28) group. In US assisted SBA group, the anteroposterior(AP), transverse, and sagittal diameters and the volume of the bladder were measured. In the blind SBA group, urine was blindly aspirated when the urinary bladder was palpated at the suprapubic area. The rate of successful urine aspiration, the number of attempts until successful aspiration, aspirated urine volume were compared between the two groups. Results: The success rate was $100\%$(32/32) in the US assisted group, which was significantly higher than $85.7\%$(24/28) of the control group (P<0.05). The aspirated urine volume in the US assisted group was $7.4{\pm}3.7\;mL$, which was significantly higher than $4.5{\pm}3.4\;mL$ of the control group (P<0.05), The diameters and volume of bladder in successful aspiration were $2.1{\pm}0.7\;cm$ in AP diameter, $3.1{\pm}0.6\;cm$ in transverse diameter, $4.2{\pm}1.0\;cm$ in sagittal diameter and $15.2{\pm}10.4\;mL$ in volume, which were significantly higher than those ($1.7{\pm}0.3\;cm,\;1.7{\pm}0.3\;cm,\;1.8{\pm}0.7\;cm,\;2.4{\pm]0.6\;cm,\;3.9{\pm}2.5$) of the control group (P<0.05) The correlations between the AP(r=0.78), transverse (r=0.72), sagittal(r=0.91) diameter and bladder volume were significant (P<0.05). SBA was $100\%$ successful in the AP diameter >3 cm, transverse diameter >4 cm, depth >4 cm and bladder volume >5 mL. Conclusion: US assistance can significantly improve the success rate of SBA in infant with suspected urinary tract infection. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 68-74)