• 대한방사선치료학회지
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• 제24권2호
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• pp.137-147
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• 2012

목 적: 알고리즘에 따른 치료계획의 영향을 분석하고 실제 치료계획을 수립할 때 고려사항을 적용하고, 나아가 최선의 치료계획을 수립하는 프로토콜을 제시하고자 한다. 대상 및 방법: 치료계획 시스템은 이클립스 10.0 (Eclipse 10.0, Varian, USA)이다. 선량계산의 알고리즘은 PBC (Pencil Beam Convolution)와 AAA (Anisotropic Analytical Algorithm)을 각각 적용하였고, 세기 조절 방사선 치료(IMRT)를 위한 최적화(Optimization) 알고리즘은 DVO (Dose Volume Optimizer 10.0.28), VMAT을 위한 최적화 알고리즘은 PRO II (Progressive Resolution Optimizer V 8.9.17)와 PRO III (Progressive Resolution Optimizer V 10.0.28)을 사용하였다. 실험을 위한 팬텀은 치료계획시스템에서 가상으로 만들었으며, $30{\times}30{\times}30$ cm의 규격에 밀도가 균일한 것(HU: 0)과 중간에 공기(HU: -1,000)로 가정되는 물질이 삽입한 된 비균질 팬텀으로 설정하였다. 실험은 먼저 팬텀(Phantom) 계획을 실시하여 일반적인 치료계획의 특징을 분석하고 그 내용을 토대로 실제 임상적용 할 치료계획을 수립하였다. 결 과: 균일한 밀도 팬텀에서 6 MV, 10 cm PDD (Percentage Depth Dose)는 PBC와 AAA는 모두 65.2%로 유사한 값을 나타냈지만, 비균질 팬텀에서 PDD는 저밀도 물질을 만나기 전까진 유사한 PDD 값을 보이다가 공기 영역에서 다른 선량곡선을 보여주고, 투과한 후에는 PDD 10 cm은 각각 75%, 73%이었다. 동일한 MU의 3차원 치료계획에서 보면, AAA 치료계획이 폐가 포함된 영역에서 저 선량으로 나타났다. 기관지와 폐의 영역이 포함된 경추 치료 환자의 2차원 대향 2문조사 치료계획을 15 MV을 이용하여 설계하였을 때, Conformity Index (ICRU 62)는 PBC 계산에서 0.95, AAA에서 0.93이었다. IMRT 치료계획은 DVO에서 보여지는 DVH가 선량계산 DVH와 동일하게 나타났다. 하지만 AAA으로 선량계산을 하였을 때는 DVO에서 조건을 만족하는 결과가 선량계산에서는 선량부족으로 나타났다. PRO II을 이용한 VMAT 치료계획은 최적화 할 때는 만족스런 결과를 얻었지만, 선량계산을 실시하였을 때는 저밀도 영역이 선량 부족으로 나타났다. 하지만 PRO III에서 같은 조건을 1회 더 최적화함으로써 최적화 결과와 선량계산 결과가 유사하였다. 결 론: 본 연구에서는 선량계산 알고리즘의 옳고 그름을 판단하지 않는다. 알고리즘이 나타내는 선량 분포의 특성을 분석하고, 특히 최적화가 필요한 IMRT나 VMAT 치료계획에서 최적화 알고리즘의 요인도 치료계획을 수립할 때 고려함으로써 최적의 치료계획을 위한 방법을 제시하고자 한다.

• The Korean Journal of Pain
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• 제4권2호
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• pp.111-121
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• 1991

It has been well known that the splanchnic nerve block is effective for patients who suffer from intractable upper abdominal pain. However, it is unclear whether the effect of the splanchnic nerve block depends on varied alcoholic concentration. In this study, an attempt was made to use absolute ethanol on patients who recieved a splanchnic nerve block at Severance Hospital during the period from September l990 to April l991. The results are as follows; 1) Among the 33 patients, including 22 males and 1l females, the fifties and sixties were the major age groups. 2) Stomach cancer was the most common underlying disease(13 cases), with pancreatic can- cer next(9 cases). 3) The main locations of pain were the upper abdomen, epigastrium, and entire abdomen in decreasing order. 4) There were 17 cases who had had chemotherapy, and 1l cases of whom had had surgery before the splanchnic nerve block. 5) The volume of alcohol used was 12 ml bilaterally. 6) Among the 33 patients, 15.2% required a second block within two weeks of the first block. One case required a third block. 7) The most common complications of splanchnic nerve block were hypotension(33.3%), occasional transient sharp burning pain, flushing of face, pain on injection site, nausea, vomiting, dyspnea, chest discomfort and diarrhea. 8) The supplemental block most commonly used was a continuous epidural block. It was used both as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 9) The interval between the receiving the absolute ethanol block and discharge was within 2 weeks in l5 cases. But, in the patients with poor general health, the interval between the splanchnic nerve block and discharge prolonged. The above results suggest that bilateral splanchnic nerve block done with absolute ethanol after an effective test block with 1% lidocaine under C-arm fluroscopic control is satisfactory and reliable. Still, 26.6% of the patients received a repeat block within 2 weeks. Insufficient spread of ethanol due to its small volume seems to be a major factor in the repeat block. Minimizing the incidence of repeat block remains a problem to be solved.

• 대한미생물학회지
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• 제20권1호
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• pp.35-44
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• 1985

Isolation and identification of anaerobic bacteria from blood cultures are still technically demanding procedures. Recently, with the use of gas liquid chromatography, the accuracy of identification is much improved. However, there has never been a satisfactory data analysis on anaerobic bacteremia in Korea. The authors evaluated both the clinical and the bacteriological data of 129 anaerobic bacteremias found at the Yonsei Medical Center during the period of 1973 to 1984. The most frequently isolated anaerobic bacteria were Bacteroides (52.7%), among which the major species was B. fragilis (38.7%). Incidence of anaerobic bacteremia by sex was 57% in male and 43% in female. Mortality was higg in groups below 1-year old and above 50-year old. The cause of death seemed closely correlated with the patient's age, general condition and the severity of the underlying disease. Various neoplasms were the most common (20%) underlying diseases predisposing the anaerobic bacteremia. Biliary tract was considered the most frequent route of infection in anaerobic bacteremia. The frequent clinical signs in anaerobic bacteremia were fever (65%), followed by liver function abnormality (29%), jaundice (20%) and hypotention(18%). When analysis of positive rate of blood culture was made on the patients from whom 4 cultures were done within 24 hours, it was found that 33% of the samples were positive. Isolation rate of anaerobic bacteria in thioglycollate medium was 83.8%, while it was 44% in Tryptic soy broth. Among the anaerobic bacteremia, 25.4% were polymicrobial infections with aerobic bacteria (92.5%), such as E. coli(33.3%). From these studies, it is concluded that B. fragilis is the most important causative organism in anaerobic bacteremia, with high fatality, particularly in those who have underlying diseases. The ports of entry are mainly biliary, gastrointestinal and female genital tract. Fever is the most frequent clinical sign. Single blood culture is not sufficient to detect all anaerobic bacteremia, therefore more cultures with optimal time interval are needed. The incidence of polymicrobial infection in anaerobic bacteremia is higher than that in overall bacteremia.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.565-570
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• 2013

Objectives: To describe the development and validation of a cancer awareness questionnaire (CAQ) based on a literature review of previous studies, focusing on cancer awareness and prevention. Materials and Methods: A total of 388 Chinese undergraduate students in a private university in Kuala Lumpur, Malaysia, were recruited to evaluate the developed self-administered questionnaire. The CAQ consisted of four sections: awareness of cancer warning signs and screening tests; knowledge of cancer risk factors; barriers in seeking medical advice; and attitudes towards cancer and cancer prevention. The questionnaire was evaluated for construct validity using principal component analysis and internal consistency using Cronbach's alpha (${\alpha}$) coefficient. Test-retest reliability was assessed with a 10-14 days interval and measured using Pearson product-moment correlation. Results: The initial 77-item CAQ was reduced to 63 items, with satisfactory construct validity, and a high total internal consistency (Cronbach's ${\alpha}$=0.77). A total of 143 students completed the questionnaire for the test-retest reliability obtaining a correlation of 0.72 (p<0.001) overall. Conclusions: The CAQ could provide a reliable and valid measure that can be used to assess cancer awareness among local Chinese undergraduate students. However, further studies among students from different backgrounds (e.g. ethnicity) are required in order to facilitate the use of the cancer awareness questionnaire among all university students.

• 대한치과교정학회지
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• 제50권5호
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• pp.324-335
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• 2020

Objective: To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion. Methods: Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment: CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed. Results: The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables. Conclusions: Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.

• Archives of Plastic Surgery
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• 제47권6호
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• pp.551-558
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• 2020

Background Giant congenital melanocytic nevus (GCMN) is a rare disease, for which complete surgical resection is recommended. However, the size of the lesions presents problems for the management of the condition. The most popular approach is to use a tissue expander; however, single-stage expansion in reconstructive surgery for GCMN cannot always address the entire defect. Few reports have compared tissue expansion techniques. The present study compared single and serial expansion to analyze the risk factors for complications and the surgical outcomes of the two techniques. Methods We retrospectively reviewed the medical charts of patients who underwent tissue expander reconstruction between March 2011 and July 2019. Serial expansion was indicated in cases of anatomically obvious defects after the first expansion, limited skin expansion with two more expander insertions, or capsular contracture after removal of the first expander. Results Fifty-five patients (88 cases) were analyzed, of whom 31 underwent serial expansion. The number of expanders inserted was higher in the serial-expansion group (P<0.001). The back and lower extremities were the most common locations for single and serial expansion, respectively (P =0.043). Multivariate analysis showed that sex (odds ratio [OR], 0.257; P=0.015), expander size (OR, 1.016; P=0.015), and inflation volume (OR, 0.987; P=0.015) were risk factors for complications. Conclusions Serial expansion is a good option for GCMN management. We demonstrated that large-sized expanders and large inflation volumes can lead to complications, and therefore require risk-reducing strategies. Nonetheless, serial expansion with proper management is appropriate for certain patients and can provide aesthetically satisfactory outcomes.

• Plant Resources
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• 제4권3호
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• pp.161-170
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• 2001

A major portion of drugs used in Ayurvedic system of medicine which has been practiced since the early human civilization in Indian subcontinent were of plant origin. It should be noted that 70% of the population in this region depends on Ayurveda for their medical treatment and 60% of the drug resources are obtained from the Himalayan region. Therefore, Nepal becomes a potential source of plant drug resource since it occupies a major portion of the Himalaya. In the present paper, in general a current status of medicinal plant resources of Himalayan region especially Nepal will be discussed. In addition to this, a typical example of antidiabetic activity of Shilajit will be taken for the discussion. Shilajit is one of the crucial elements in several formulations including those of Rasayana, a therapy in Ayurveda, which has been practiced in the prevention of ageing and mental disorder. Although, Shilajit is widely used for the treatment of diabetes, no satisfactory scientific reports are available up to now. The crude Shilajit in the market is a dark brown or black rock-like substance collected from the Himalayan region with a strong smell of cow's stale urine. In our studies, Shilajit (collected in the central Himalayan region) prevented the diabetes in nonobese diabetic (NOD) mice model. Shilajit also prevented the diabetes in the rats against the action of multiple low-dose (10 mg/kg, i.v., 5 times) of streptozotocin. On the other hand, Shilajit did not show antioxidative activity. The preventive action of Shilajit on diabetes is mainly focused on the Thl and Th2 cell activities, since Th2 cells activity was found to be significantly upregulated. Shilajit, however, showed a mild action in controlling the blood sugar level in young, old, and mild diabetic rats, but not in the severe diabetic rats. It also stimulated the nitric oxide production in macrophages. Based on these evidences, the antidiabetic activities of Shilajit appear to be immunomodulative probably by protecting or strengthening insulin-producing b-cells in the pancreas. Further systematic research on constituents of Shilajit and its quality evaluation is necessary to enable the use of natural medicines in the treatment of diabetes.

• Journal of Preventive Medicine and Public Health
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• 제36권2호
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• pp.163-170
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• 2003

Objectives : This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. Methods : To develop the valuation protocol, the Global Burden of Disease(GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. Results : The disability weights were valued in a two step panel sfudy. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. Conclusions : It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies, This would provide a rational basis for an international comparative study of disability weights.

• 한국의류학회지
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• 제34권2호
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• pp.345-356
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• 2010

This study investigates the present conditions of hospital clothes management. A survey was conducted with 72 respondents from 28 different hospitals in April and May 2009. Data were analyzed with descriptive statistics and correlations using PASW 17.0. The results were as follows: (1) Administrators, nurses, and outside specialists took part in the clothes management process. The administrators participated in the process of purchase determination. Nurses involved in the design, size selection, and outside specialists were responsible for routine management. (2) Most clothes were planned through the discussions between hospitals and manufacturers. Price was the most important element to determine the purchase of clothes. Size systems were various depending on the conditions of the hospital according to the number of beds. (3) Laundry duties were performed by the hospitals themselves or in specialized laundry plants. In addition, the hygienic condition of clothes management were satisfactory. (4) Patient gowns were evaluated positively, yet some complaints from patients were reported. (5) Various medical supplies were used and were uncomfortable related to textile and fitting problems. Future research themes are suggested based on these results.

• 한국자원식물학회:학술대회논문집
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• 한국자원식물학회 2001년도 The 8th International Symposium
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• pp.20-33
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• 2001

A major portion of drugs used in Ayurvedic system of medicine which has been practiced since the early human civilization in Indian subcontinent were of plant origin. It should be noted that 70% of the population in this region depends on Ayurveda for their medical treatment and 60% of the drug resources are obtained from the Himalayan region. Therefore, Nepal becomes a potential source of plant drug resource since it occupies a major portion of the Himalaya. In the present paper, in general a current status of medicinal plant resources of Himalayan region especially Nepal will be discussed. In addition to this, a typical example of antidiabetic activity of Shilajit will be taken for the discussion. Shilajit is one of the crucial elements in several formulations including those of Rasayana, a therapy in Ayurveda, which has been practiced in the prevention of ageing and mental disorder. Although, Shilaiit is widely used for the treatment of diabetes, no satisfactory scientific reports are available up to now. The crude Shilajit in the market is a dark brown or black rock-like substance collected from the Himalayan region with a strong smell of cow's stale urine. In our studies, Shilajit (collected in the central Himalayan region) prevented the diabetes in nonobese diabetic (NOD) mice model. Shilajit also prevented the diabetes in the rats against the action of multiple low-dose (10 ㎎/㎏, i.v., 5 times) of streptozotocin. On the other hand, Shilajit did not show antioxidative activity. The preventive action of Shilajit on diabetes is mainly focused on the Th1 and Th2 cell activities, since Th2 cells activity was found to be significantly upregulated. Shilajit, however, showed a mild action in controlling the blood sugar level in young, old, and mild diabetic rats, but not in the severe diabetic rats. It also stimulated the nitric oxide production in macrophages. Based on these evidences, the antidiabetic activities of Shilajit appear to be immunomodulative probably by protecting or strengthening insulin-producing b-cells In the pancreas. further systematic research on constituents of Shilajit and its quality evaluation is necessary to enable the use of natural medicines in the treatment of diabetes.