• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.504-512
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• 1994

Background: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant cuases of cirrhosis. It is uncertain that the same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia, Method: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. Results: The hypoxemia of $PaO_2$ less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). But there was no patient with significant hypoxemia of $PaO_2$ less than 60 mmHg. $PaO_2$ was significantly decreased in the patients with spider angioma than the pathients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of $11.4{\pm}4.1%$ than normoxemic group of $4.1{\pm}2.0%$ (p<0.05). Conclusions: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to p1ay a major ro1e in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.

• Progress in Medical Physics
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• v.26 no.4
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• pp.258-266
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• 2015

The modern radiotherapy technique which delivers a large amount of dose to patients asks to confirm the positions of patients or tumors more accurately by using X-ray projection images of high-definition. However, a rapid increase in patient's exposure and image information for CT image acquisition may be additional burden on the patient. In this study, by introducing structural similarity (SSIM) index that can effectively extract the structural information of the image, we analyze the differences between daily acquired x-ray images of a patient to verify the accuracy of patient positioning. First, for simulating a moving target, the spherical computational phantoms changing the sizes and positions were created to acquire projected images. Differences between the images were automatically detected and analyzed by extracting their SSIM values. In addition, as a clinical test, differences between daily acquired x-ray images of a patient for 12 days were detected in the same way. As a result, we confirmed that the SSIM index was changed in the range of 0.85~1 (0.006~1 when a region of interest (ROI) was applied) as the sizes or positions of the phantom changed. The SSIM was more sensitive to the change of the phantom when the ROI was limited to the phantom itself. In the clinical test, the daily change of patient positions was 0.799~0.853 in SSIM values, those well described differences among images. Therefore, we expect that SSIM index can provide an objective and quantitative technique to verify the patient position using simple x-ray images, instead of time and cost intensive three-dimensional x-ray images.

• Journal of Nutrition and Health
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• v.49 no.3
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• pp.179-188
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• 2016

Purpose: This cross-sectional study aimed to document the dietary behaviors, dietary changes, and health status of female marriage immigrants residing in Gwangju, Korea. Methods: The survey included 92 female immigrants attending Korean language class at a multi-cultural family support center. General characteristics, health status, anthropometric data, dietary behaviors, and dietary changes were collected. Results: Mean age of subjects was 31.3 years, and home countries of subjects were Vietnam (50.0%), China (26.0%), Philippines (12.0%), and others (12.0%). Frequently reported chronic diseases were digestive diseases (13.2%), anemia (12.1%), and neuropsychiatry disorder (8.9%). Seventeen percent of the subjects was obese ($BMI{\geq}25kg/m^2$). Dietary score by Mini Dietary Assessment was 3.45 out of 5 points. Dietary scores for dairy foods, meat/fish/egg/bean intake, meal regularity, and food variety were low, and those for fried foods and high fat meat intake were also low. Thirty-three percent of subjects answered that they have changed their diet and increased their consumption of fruits and vegetables after immigration. Length of residence in Korea was positively associated with BMI and waist circumference. Length of residence tends to be positively associated with dietary changes and obesity as well as inversely associated with disease prevalence. Conclusion: The study shows that length of residence is inversely related to disease prevalence. However, this association is thought to be due to the relatively short period of residence in Korea and thus the transitional phase to adapting to dietary practices. As the length of residence increases, disease patterns related to obesity are subject to change. Healthy dietary behaviors and adaptation to dietary practices in Korea in female marriage immigrants will not only benefit individuals but also their families and social structure. Therefore, varied, long-term, and target-specific studies on female marriage immigrants are highly needed.

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.390-394
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• 1993

Background: Bronchiectasis is characterized by chronic sputum production and complications such as hemoptysis and repeated infections. Even though some patients are cured by surgical resection of bronchiectatic lesions, most bronchiectasis patients can not be treated surgically because of multiple site involvement, and they are treated by medical measures such as postura1 drainage and antibiotics when indicated. Recently there have been some reports that low-dose longterm erythromycin treatment is effective on bronchiectsis, and it is well known that low-dose longterm erythromycin treatment is the treatment of choice in diffuse panbronchiolitis which is characterized by chronic sputum production and dyspnea. To evaluate the efficacy of erythromycin, we tried erythromycin on twenty five stable bronchiectasis patients for more than six months. Methods: We tried erythromycin 250 mg b.i.d. for more than 6 months. We checked respiratory symptoms, chest PA, spirometry, and side effects before treatment and after 3 and 6 months of treatment. Results: 1) 32% of the patients showed marked improvement of symptoms and PFT. 32% showed slight improvement of symptoms with little change of PFT, and 36% showed no change of symptoms and signs. 2) Analysis of the patients showing marked improvement revealed that most of them had diffuse bronchiectasis and paranasal sinus involvement. Conclusion: These results suggest that low-dose longterm erythromycin treatment can be tried on diffuse bronchiectasis patients with sinus involvement. And further studies will be followed on the mechanism of erythromycin in bronchiectasis.

• Journal of the East Asian Society of Dietary Life
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• v.19 no.5
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• pp.703-712
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• 2009

The principal objective of this study was to supply basic material determine basic information regarding effective health promotion regimens for elderly women via a comparative survey of health status by aging age between elderly women (=70 y) and college women. The subject groups of elderly women (=70 y) and college women were selected and surveyed from March to October, 2008, in the Seoul area. The average age of the elderly women assessed in this study was $78.64{\pm}7.30$, the average height was $147.07{\pm}5.72$ cm, and the average weight was $50.47{\pm}7.44$ kg. As compared with college women, a higher percentage of elderly women ate breakfast regularly, but the elderly women also experienced difficulties in chewing due to dentures, and therefore ate their meals with large quantities of liquids, and usually ate their meals within 10 minutes. The majority of elderly women suffered from at least one disease, and the most common symptom reported was hypertension (25%). 52.2% of elderly women and 47.8% of college women reported that they exercised 1~2 times per week. They reported that their favorite exercise was light exercise, such as jogging and athletics (73.1%). As compared with college women, the smoking rate was lower among elderly women, but some of the elderly women were long-time smokers or alcoholics. The differences in red blood cells counts, Hb, hematocrit, and MCV of the between elderly women and college women were significant. In addition, but the MCH and MCHC were higher in elderly women compared with college women and the total cholesterol of elderly woman ($175.62{\pm}38.89$ mg/dL) was significantly lower compared with college woman ($186.13{\pm}28.19$ mg/dL). TG ($127.89{\pm}51.25$ mg/dL) and LDL-cholesterol ($120.51{\pm}32.88$ mg/dL) of elderly woman were significantly higher than TG ($79.71{\pm}40.9$ 6mg/dL) and LDL-cholesterol($103.78{\pm}22.94$ mg/dL) of college woman (p<0.05). The levels of HDL-cholesterol ($58.78{\pm}12.90$ mg/dL) in the college women was significantly higher than the HDLcholesterol levels ($48.17{\pm}13.79$ mg/dL) of the elderly women (p<0.05). Serum vitamin C levels in elderly women were significantly higher than those of college women (p<0.05), whereas no significant difference was detected between the two groups. Consequently, it can be concluded that the appropriate education programs for dietary habits and health promotion are necessary for a healthier life. Additionally, it is necessary for individuals to precisely determine precisely their own health status, and develop appropriate dietary programs for themselves.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.631-637
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• 1993

Background: In normal adults, ventilation is uneven and greater in the base than the apex of the lung in tidal volume breathing. However infants have fragile chest wall and reduced elastic recoil, resulting in easy closure of peripheral airways especially in the dependent portion of the lung. So ventilation in infants is greater in the apex than the base of the lung. We assumed that in adults whose closing volume is increased, dependent portion could be easily collapsed during tidal breathing and ventilation could be greater in the uppear than than the lower portion of the lung. Methods: We measured spirometry and closing volume(CV) in normal controls and in patients with chronic lung disease. Also we measured fractional distribution of ventilation at supine, left lateral and right lateral decubitus with $^{133}Xe$ ventilation scan in normal controls, patients with normal closing volume and patients with increased closing volume. Results: The subjects consisted of 7 normal controls(mean $age{\pm}SD$, $62.9{\pm}6.1$ years). 6 patients with normal CV($62.8{\pm}8.2$ years) and 7 patients with increased CV($63.0{\pm}15.3$ years). 1) Normal controls have mean(${\pm}SD$) FVC $104{\pm}11%$ of predicted value, $FEV_1\;120{\pm}16%,\;FEV_1/FVC\;112{\pm}5%$ and CV $86.9{\pm}12.5%$. Patients with normal CV have FVC $62{\pm}11%,\;FEV_1\;54{\pm}17%,\;FEV_1/FVC\;84{\pm}23%$ and CV $92.6{\pm}15.5%$. Patients with increased CV, have FVC $53{\pm}9%,\;FEV_1\;38{\pm}13,\;FEV_1/FVC\;69{\pm}16%$ and CV $176.1{\pm}36.6%$, CV was significantly different between two patient groups(p<0.02) 2). In normal controls mean fractional ventilation to left lung was $48.1{\pm}5.3%$ at supine, $54.1{\pm}9.8%$ at dependent and $40.9{\pm}6.5%$ at left uppermost position. In patients with normal CV mean fractional ventilation to left lung was $44.6{\pm}2.1%$ at supine, $59.7{\pm}5.6%$ at left dependent and $31.7{\pm}8.3%$ at left uppermost position. In patients with increased CV mean fractional ventilation to left lung was $48.7{\pm}4.5%$ at supine, $41.7{\pm}6.6%$ at left dependent and $60.9{\pm}15.7%$ at left uppermost position. In normal controls and patients with normal CV, ventilation to left lung at left dependent position tends to be higher than that at supine position but without statisitical significance and it was significantly lower at left uppermost than at left lung dependent position. In patients with increased CV, ventilation to left at left dependent position tends to be higher than that at supine position but without significance and it was significantly higher at left uppermost than that at left dependent position. Conclusion: These data suggest that in patients with increased CV ventilation to one side of lung could be higher at uppermost than at dependent position on lateral decubitus during tidal breathing and this fact should be taken into account in positioning of patients with unilateral lung disease.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.109-121
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• 2016

To verify the accuracy of the image guided radiotherapy using ExacTrac 6D couch, the error values in six directions are randomly assigned and corrected and then the corrected values were compared with CBCT image to check the accurateness of ExacTrac. The therapy coordination values in the Rando head Phantom were moved in the directions of X, Y and Z as the translation group and they were moved in the directions of pitch, roll and yaw as the rotation group. The corrected values were moved in 6 directions with the combined and mutual reactions. The Z corrected value ranges from 1mm to 23mm. In the analysis of errors between CBCT image of the phantom which is corrected with therapy coordinate and 3D/3D matching error value, the rotation group showed higher error value than the translation group. In the distribution of dose for the error value of the therapy coordinate corrected with CBCT, the restricted value of dosage for the normal organs in two groups meet the prescription dose. In terms of PHI and PCI values which are the dose homogeneity of the cancerous tissue, the rotation group showed a little higher in the low dose distribution range. This study is designed to verify the accuracy of ExacTrac 6D couch using CBCT. It showed that in terms of the error value in the simple movement, it showed the comparatively accurate correction capability but in the movement when the angle is put in the couch, it showed the inaccurate correction values. So, if the body of the patient is likely to have a lot of changes in the direction of rotation or there is a lot of errors in the pitch, roll and yaw in ExacTrac correction, it is better to conduct the CBCT guided image to correct the therapy coordinate in order to minimize any side effects.

• Radiation Oncology Journal
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• v.14 no.2
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• pp.149-158
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• 1996

Purpose : To get an accute steepness of dose gradients at outside the target volume in intracranial lesion and a less limitation of beam selection avoiding the high dose at normal brain tissue, this Photon Knife Radiosurgery System was developed in order to provide the three-dimensional dose distribution through the reconstruction of CT scan and the combined stereotactic trans-multiarc beam mode based on linear accelerator photon beam. Materials and methods : This stereotactic radiosurgery, Photon Knife based on linear accelerator photon beam was provided the non-coplanar multiarc and trans-multiarc irradiations. The stereotactic trans-multiarc beam mode can be obtained from the patient position in decubitus. This study has provided the 3-dimensional isodose curve and anatomical structures with the surface rendering technique. The dose distribution from the combined two trans-multiarcs (2M 2TM) was compared to that of four non-coplanar multiarcs (4M) with same collimator size of 25 mm in a diameter and total gantry movements. Results : In this study, it shows that the dose distributions of stereotactic beam mode are significantly depended on the selected couch and gantry angle in same collimator size. Practical dose distribution of combined stereotactic trans-multiarc beam has shown a more small rim thickness than that of the non-coplanar multiarc beam mode in axial, sagittal and coronal plane in our study. 3-Dimensional dose line displayed with surface rendering of irregular target shape is helpful to determine the target dose and to predict the prognosis in follow-up radiosurgery. Conclusions : 3-Dimensional dose line displayed with surface rendering of irregular target shape is essential in stereotactic radiosurgery. This combined stereotactic trans-multiarc beam has shown a less limitation of the selection couch and gantry beam angles for the target surrounding critical organs. It has shown that the dose distribution of combined trans-multiarc beam greatly depended on the couch and gantry angles. In our experiments, the absorbed dose has been decreased to $27%$ / mm in maximum at the interval of $50\%$ to $80\%$ of isodose line.

• Journal of Nutrition and Health
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• v.47 no.4
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• pp.277-286
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• 2014

Purpose: The aim of this study was to examine the characteristics of nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients and how nutrition education affects these nutritional behaviors. Methods: Subjects included 37 adult male alcoholic patients who were hospitalized. The nutrition education program consisted of five lessons over a five-week period. An each 80-minute nutrition education program per week was implemented for the alcoholic patients over a five-week period. Both before and after the implementation of nutrition education, their nutrition-related knowledge and dietary habits were assessed and nutrient intakes were investigated. Results: The subjects showed drinking habits of considerably high frequency, a large quantity of alcohol consumption, and preference for soju (a liquor) over beer. They had proper weight, height, and BMI, and came from relatively poor socioeconomic backgrounds with a low-level of self-rated health status and a comparatively high rate of suffering from disease. Mean score of their nutrition-related knowledge and dietary habits was quite low. They consumed less energy, dietary fiber, vitamin C, thiamin, riboflavin, folic acid, Ca, and K, but more Na compared to each Dietary Reference Intake (DRI). After implementing the nutrition education, mean score of nutrition-related knowledge and dietary habits showed significant improvement. In addition, the meeting rate of each DRI of several nutrients was increased significantly, including energy, carbohydrate, dietary fiber, vitamins A, C, and $B_6$, thiamin, riboflavin, niacin, pyridoxine, folic acid, Ca, P, K, Fe, and Zn, while that of Na decreased. Conclusion: The findings of this study indicate that alcoholic patients had various nutritional problems, such as lack of nutrition-related knowledge, bad dietary habits, and insufficient nutrient intakes, however, these problems can be positively modified by implementation of a relatively short-term nutrition education program.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.379-388
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• 1994

Background : In sleep apnea syndrome, arterial oxygen saturation($SaO_2$) decreases at a variable rate and to a variable degree for a given apneic period from patient to patient, and various kinds of cardiac arrythmia are known to occur. Factors supposed to affect arterial oxygen desaturation during apnea are duration of apnea, lung voulume at which apnea occurs, and oxygen consumption rate of the subject. The lung serves as preferential oxygen source during apnea, and there have been many reports related with the influence of lung volume on $SaO_2$ during apnea, but there are few, if any, studies about the influence of oxygen consumption rate of an individual on $SaO_2$ during breath holding or about the profile of arterial oxygen resaturation after breathing resumed. Methods : To investigate the changes of $SaO_2$ and heart rate(HR) during breath holding(BH) and rebreathing(RB) and to evaluate the physiologic factors responsible for the changes, lung volume measurements, and arterial blood gas analyses were performed in 17 healthy subjects. Nasal airflow by thermistor, $SaO_2$ by pulse oxymeter and ECG tracing were recorded on Polygraph(TA 4000, Gould, U.S.A.) during voluntary BH & RB at total lung capacity(TLC), at functional residual capacity(FRC) and at residual volume(RV), respectively, for the study subjects. Each subject's basal metabolic rate(BMR) was assumed on Harris-Benedict equation. Results: The time needed for $SaO_2$ to drop 2% from the basal level during breath holding(T2%) were $70.1{\pm}14.2$ sec(mean${\pm}$standard deviation) at TLC, $44.0{\pm}11.6$ sec at FRC, and $33.2{\pm}11.1$ sec at RV(TLC vs. FRC, p<0.05; FRC vs. RV, p<0.05). On rebreathing after $SaO_2$ decreased 2%, further decrement in $SaO_2$ was observed and it was significantly greater at RV($4.3{\pm}2.1%$) than at TLC($1.4{\pm}1.0%$)(p<0.05) or at FRC($1.9{\pm}1.4%$)(p<0.05). The time required for $SaO_2$ to return to the basal level after RB(Tr) at TLC was not significantly different from those at FRC or at RV. T2% had no significant correlation either with lung volumes or with BMR respectively. On the other hand, T2% had significant correlation with TLC/BMR(r=0.693, p<0.01) and FRC/BMR (r=0.615, p<0.025) but not with RV/BMR(r=0.227, p>0.05). The differences between maximal and minimal HR(${\Delta}HR$) during the BH-RB manuever were $27.5{\pm}9.2/min$ at TLC, $26.4{\pm}14.0/min$ at RV, and $19.1{\pm}6.0/min$ at FRC which was significantly smaller than those at TLC(p<0.05) or at RV(p<0.05). The mean difference of 5 p-p intervals before and after RB were $0.8{\pm}0.10$ sec and $0.72{\pm}0.09$ sec at TLC(p<0.001), $0.82{\pm}0.11$ sec and $0.73{\pm}0.09$ sec at FRC(p<0.025), and $0.77{\pm}0.09$ sec and $0.72{\pm}0.09$ sec at RV(p<0.05). Conclusion Healthy subjects showed arterial desaturation of various rates and extent during breath holding at different lung volumes. When breath held at lung volume greater than FRC, the rate of arterial desaturation significantly correlated with lung volume/basal metabolic rate, but when breath held at RV, the rate of arterial desaturation did not correlate linearly with RV/BMR. Sinus arrythmias occurred during breath holding and rebreathing manuever irrespective of the size of the lung volume at which breath holding started, and the amount of change was smallest when breath held at FRC and the change in vagal tone induced by alteration in respiratory movement might be the major responsible factor for the sinus arrythmia.