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Gamma Knife Radiosurgery for Metastatic Brain Tumors with Exophytic Hemorrhage

  • Park, Eun Suk;Lee, Eun Jung;Yun, Jung-Ho;Cho, Young Hyun;Kim, Jeong Hoon;Kwon, Do Hoon
    • Journal of Korean Neurosurgical Society
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    • v.61 no.5
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    • pp.592-599
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    • 2018
  • Objective : Metastatic brain tumors (MBTs) often present with intracerebral hemorrhage. Although Gamma Knife surgery (GKS) is a valid treatment option for hemorrhagic MBTs, its efficacy is unclear. To achieve oncologic control and reduce radiation toxicity, we used a radiosurgical targeting technique that confines the tumor core within the hematoma when performing GKS in patients with such tumors. We reviewed our experience in this endeavor, focusing on local tumor control and treatment-associated morbidities. Methods : From 2007 to 2014, 13 patients with hemorrhagic MBTs were treated via GKS using our targeting technique. The median marginal dose prescribed was 23 Gy (range, 20-25). GKS was performed approximately 2 weeks after tumor bleeding to allow the patient's condition to stabilize. Results : The primary sites of the MBTs included the liver (n=7), lung (n=2), kidney (n=1), and stomach (n=1); in two cases, the primary tumor was a melanoma. The mean tumor volume was $4.00cm^3$ (range, 0.74-11.0). The mean overall survival duration after GKS was 12.5 months (range, 3-29), and three patients are still alive at the time of the review. The local tumor control rate was 92% (tumor disappearance 23%, tumor regression 46%, and stable disease 23%). There was one (8%) instance of local recurrence, which occurred 11 months after GKS in the solid portion of the tumor. No GKS-related complications were observed. Conclusion : Our experience shows that GKS performed in conjunction with our targeting technique safely and effectively treats hemorrhagic MBTs. The success of this technique may reflect the presence of scattered metastatic tumor cells in the hematoma that do not proliferate owing to the inadequate microenvironment of the hematoma. We suggest that GKS can be a useful treatment option for patients with hemorrhagic MBTs that are not amenable to surgery.

Effects of Institution of Bankruptcy Proceedings on an Arbitration Agreement and Arbitral Proceedings (파산절차에 있어서의 중재합의의 효력과 중재절차)

  • Oh Chang-Seog
    • Journal of Arbitration Studies
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    • v.15 no.1
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    • pp.113-146
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    • 2005
  • Bankruptcy proceedings serve the purpose of the collective satisfaction of the debtor's creditors through the realisation of the debtor's assets and the distribution of the proceeds therefrom. Upon the adjudication bankruptcy, the debtor's right to administer and dispose of the property belonging to the bankruptcy estate shall be vested in the administrator. If a mutual contract was not or not completely fulfilled by the debtor and the other party at the time of the adjudication of bankruptcy, the administrator has right to choose wether to fulfil or terminate the contractual relation. Legal acts that have been conducted prior to the adjudication of bankruptcy and that are detrimental to the debtor's creditors may be contested by the administrator. However, these effects of bankruptcy will have not great influence on the arbitration agreement between the debtor and another party. An arbitration agreement that has been conducted prior to the adjudication of bankruptcy is binding the administrator as an universal legal successor of debtor. Only the arbitration agreement directly disadvantageous to the debtor's creditors may be contested by the administrator. Furthermore, it is not at the discretion of administrator whether or not to submit the dispute to arbitration because an arbitration agreement does not belong under the category of Art. 50 Korean bankruptcy Act which demands a mutual contract. Arbitral proceeding upon the property of the bankruptcy estate and pending for the debtor as plaintiff or against the debtor as defendant at the date of the adjudication of bankruptcy may be taken up at the given status by the administrator. This leads to a change of the party. If a duly summoned party fails to appear in arbitration court, the arbitrator, if satisfied there is no valid excuse, may continue the proceedings and make the award as if all the parties were present. This may be disadvantagious to the debtor's creditors because the arbitral award have the same effects on the participants as the final and conclusive judgement of the court. Even if there is a change of party on side of debtor to the administrator in bankruptcy, the arbitral proceedings will not be automatically postponed or suspended. The matter of how to proceed is at discretion of administrator, when the parties haven't agree on the arbitral proceedings. He can continue the arbitral proceedings without to grant an adjournment of hearing. However, an arbitration award may be challenged by a party dissatisfied and set aside by the court based upon the misconduct that violates the basic rights of the parties to a fair hearing. The arbitrator must treat the parties equally in the arbitral proceedings and give each party a full opportunity to present his case. The arbitrator, therefore, will carefully exercise his discretion in determining whether to continue the arbitral proceedings or to grant a postponing. In the practice, the arbitral proceedings may be usually postponed to grant due process.

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Study on 『BianZhengGiMun)』's medical characteristics - In view of ShangHan - (『변증기문(辨證奇聞)』의 의학적(醫學的) 특징(特徵)에 관(關)한 고찰(考察) -상한문(傷寒門)을 중심(中心)으로-)

  • Lee, Won-Suk;Park, Sun-Dong;Park, Won-Hwan;Kim, Jun-Ki;Kim, Jong-Dae
    • The Journal of Dong Guk Oriental Medicine
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    • v.6 no.2
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    • pp.33-85
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    • 1998
  • In order to find the characteristic medical methods of "BianZhengGiMun" by the author ChenShihTo, we have translated and analyzed the mentioned book. Upon analyses, the following facts were noted : 1) "BianZhengGiMun" is written and composed of case studies. Prescriptive methods described here differ rather from previously known methods, where as our nation's Oriental medicine practitioners refer and consider these methods as miraculous modern methodologies. 2) Book's content has much similarities to "ShangHanLun"'s original text. Moreover, the content is adjusted towards presenting methodologies not coverd in "ShangHanLun"'s text, together with adding more information to conserve "ShangHanLun"'s methods as well as to critique them. 3) Diagnostic methods mainly follow the ZangFuBianZheng(臟腑辨證)'s pattern, where it's recorded information and theories are valid. 4) "BianZhengGiMun"'s proscriptive methods usually follow BuYinShengJin(補陰生津)'s form, where they were appropriate for that period and circumstances. 5) In consideration of all of the above factors, ChenShihTo grasped ShangHan and WenBing(acute febrile disease due to exogenous factor) as WaiGanReBing(外感熱病)'s double sided characteristics, where this corresponds with the current belief. It is believed that this in turn would provide much practical value to the present time.

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An Investigation on the Eating Status and Expenditures of the Traditional Fermented foods for the Housewives in Jeonbuk Province (전북지역 주부들의 전통발효식품 섭취실태 및 소비현황 조사)

  • Choi, Na-Mi;Cha, Jin-A
    • Journal of the Korean Home Economics Association
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    • v.46 no.4
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    • pp.71-81
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    • 2008
  • The purposes of this study were to investigate the eating status and to analyze expenditures of the traditional fermented foods. A structured questionnaire survey was conducted from 370 housewives in Jeonbuk province and there were 300 usable samples(81.1%) valid for analysis. For the statistical analysis, the data was analyzed by $x^2$-test using SPSSIPC 12.0 for windows. The results of this study were as follows : 1. In the investigation on the eating status of the traditional fermented foods, Kimchi showed highest intake frequency(over once a day) and next Doenjang, Gochujang, Ganjang were consumed $2\;{\sim}\;3$ times per week. Jeotgal and Jangajji consumption showed the significant difference frequencies between the age groups(p < 0.001). The frequencies of using the home-made fermented foods were either similar or decreased, while the manufactured products were either similar or increased. The reasons behind the decreasing consumption were 'because of appetite change(47.0%)', 'the effect of western food(25.2%)' and 'dislike of salty food(17.4%)'. 90.7%(Kimchi), 54.9%(Doenjang), 54.8%(Gochujang), 53.2%(Cheongkukjang) of respondents knew the methods of preparation, while 62.5%(Ganjang), 41.1%(Jeotgal,) 31.2%(Jangajji) of respondents didn't know the methods of preparation. 2. In the analysis of the expenditure for the purchasing of the traditional fermented foods, most of the respondents procured Kimchi, Doenjang, Gochujang from their families or relatives, but they bought Ganjang, Jeotgal, Jangajji in the markets. And most of the respondents bought the fermented foods in the general merchandise stores or the department store except Kimchi. The places of buying Kimchi were specialty stores(34.6%), general merchandise stores or department stores(25.0%). Overall scores of satisfaction for the quality of manufactured fermented foods showed 3.29 of 5 - point scales. The average cost per month of Kimchi was 19,550won and Gochujang 7,878won, Doenjang 5,764won, Jeotgal 5,439won, Jangajji 5,412won, Ganjang(for soup) 4,714won, Cheongkukjang 4,677won, Ganjang(for seasoning) 4,464won, and total cost was 20,920won. The reasons behind purchasing the traditional fermented foods were 'because of convenience(58.4%)', 'no time to make by oneself(23.0%)' and 'for not knowing the making methods(12.8%)'. The problems of the manufactured traditional fermented foods were 'worry about safety of the raw materials or additives(71.2%)', 'lack of sanitation(12.0%)'. The most important thing considered in purchasing was 'materials and origins(86.6%)' and next 'quality(64.1%)' was another important thing.

The Early Write Back Scheme For Write-Back Cache (라이트 백 캐쉬를 위한 빠른 라이트 백 기법)

  • Chung, Young-Jin;Lee, Kil-Whan;Lee, Yong-Surk
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.46 no.11
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    • pp.101-109
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    • 2009
  • Generally, depth cache and pixel cache of 3D graphics are designed by using write-back scheme for efficient use of memory bandwidth. Also, there are write after read operations of same address or only write operations are occurred frequently in 3D graphics cache. If a cache miss is detected, an access to the external memory for write back operation and another access to the memory for handling the cache miss are operated simultaneously. So on frequent cache miss situations, as the memory access bandwidth limited, the access time of the external memory will be increased due to memory bottleneck problem. As a result, the total performance of the processor or the IP will be decreased, also the problem will increase peak power consumption. So in this paper, we proposed a novel early write back cache architecture so as to solve the problems issued above. The proposed architecture controls the point when to access the external memory as to copy the valid data block. And this architecture can improve the cache performance with same hit ratio and same capacity cache. As a result, the proposed architecture can solve the memory bottleneck problem by preventing intensive memory accesses. We have evaluated the new proposed architecture on 3D graphics z cache and pixel cache on a SoC environment where ARM11, 3D graphic accelerator and various IPs are embedded. The simulation results indicated that there were maximum 75% of performance increase when using various simulation vectors.

Review of Allowable Condition of the Discretionary not Covered Service (임의비급여 허용요건에 관한 검토)

  • Park, Tae-Shin
    • The Korean Society of Law and Medicine
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    • v.13 no.2
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    • pp.11-38
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    • 2012
  • The Supreme Court stand in the position in specific lawsuit that it doesn't allow the discretionary not covered service, but recently in revocation suit of fine disposal that is imposed on medical fee of leukemia patient, it altered the existing adjudgement and admitted the discretionary not covered service exceptionally. It put forward the allowable condition roughly in that case. According as this alteration, it has become more important to embody the allowance conditions of exceptions. The Supreme Court presented three things, which are procedural condition, medical condition and subscriber's agreement. Concerning procedural condition, several present conciliation procedures are as follows: medical care benefit arret request, relative value conciliation etc, prior request on anti-cancer drug among chemicals which exceed acceptance criteria, request of non benefit object on common drugs. To be granted the existence of those system, there should be no obstacle to use that. Even if it were so, we should take circumstances into consideration; individual situation is unescapable concerning substance and urgency of the discretionary not covered service, process of the procedure, time required etc. Regarding medical condition, safety and effectiveness will be verified through evaluation procedures of new medical skill. About the necessity, the Supreme Court made clear through a sentence that it allow the discretionary not covered service, in case that needs to treat a patient out of the standard of medical benefit. Strict interpretation is right and it answer the purpose of the sentence that the supreme court permit the discretionary not covered service, exceptionally. We need to differentiate medical necessity and medical validity. Subscriber's agreement should holds true if it entails full explanation, and if it is preliminary, explicit and individual. On this account, it should be difficult to admit that someone agree effectively when he call for the affirmation that he is recipient of medical care. Reasonable expense needs to be a part of review whether the agreement is valid. Meanwhile If we adjust system of medical expense and eventually reorganize a fee for consultation payment system (Fee-for-service controlled by item to DRG (Diagnosis Related Groups)), controversial area of the discretionary not covered service will be decreased and that will guarantee the discretion of the doctor.

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A Case Study on the Validity of Dental Communication Curriculum of a Dental Hygiene Department (일개 대학 치위생학과의 치과의료커뮤니케이션 교육 과정 타당성에 관한 사례연구)

  • Choi, Yong-Keum;Bae, Soo-Myoung;Shin, Bo-Mi;Son, Jung-Hui;Park, Deok-Young;Choi, Jin-Sun
    • Journal of dental hygiene science
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    • v.17 no.4
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    • pp.306-314
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    • 2017
  • The purpose of this study was to examine the validity of the content of an educational curriculum by understanding the opinions of experts in the development of weekly educational content for dental communication or communication-related subjects. It was composed of educational content on how to communicate with patients by cultivating a professional attitude through basic contents and a self-understanding of communication. Three experts were asked to evaluate the feasibility of educational contents and their appropriateness in order to evaluate the criteria for certification as a dental hygienist. The validity of the weekly educational contents and the period of education were awarded 4 points out of a maximum of 5 points; overall, the curriculum was evaluated to be valid and to be acceptable for use as criteria for certification evaluation. On the other hand, it was confirmed that not only should the contents be made appropriate for the grade level, but it should be complemented so that theoretical and practical learning can be achieved in a gradual and interrelated manner rather than as a one-time curriculum. Therefore, the result of this study can be considered for use as background data for curriculum development, and for standardization of the communication course in the dental hygiene department.

The implementation of Korean adult's optimal formant setting by Praat scripting (성인 포먼트 측정에서의 최적 세팅 구현: Praat software와 관련하여)

  • Park, Jiyeon;Seong, Cheoljae
    • Phonetics and Speech Sciences
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    • v.11 no.4
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    • pp.97-108
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    • 2019
  • An automated Praat script was implemented to measure optimal formant frequencies for adults. Optimal formant analysis could be interpreted to show that the deviation of formant frequency that resulted from the two variously combined setting parameters (maximum formant and number of formants) was minimal. To increase the reliability of formant analysis, LPC order should be set differently, based on the gender or vowel type. Praat recommends 5,000 Hz and 5,500 Hz as maximum formant settings and, at the same time, recommends 5 as the number of formants for males and females. However, verification is needed to determine whether these recommended settings are valid for Korean vowels. Statistical analysis showed that formant frequencies significantly varied across the adapted scripts, especially with respect to the data on females. Formant plots and statistical results showed that linear_script and qtone_script are much more reliable in formant measurements. Among four kinds of scripts, the linear and qtone_scripts proved to be more stable and reliable. While the linear_script was designed to have a linearly increased formant step in for-loop, the increment of formant step in the qtone_script was arranged by quarter tone scale (base frequency×common ratio ($\sqrt[24]{2}$)). When looking at the tendency of the formant setting drawn by the two referred algorithms in the context of front vowel [i, e], the maximum formant was set higher; and the number of formants set at a lower value than recommended by Praat. The back vowel [o, u], on the contrary, has a lower maximum formant and a higher number of formants than the standard setting.

Development of a Test of Science Inquiry Skills for Elementary School Fifth and Sixth Graders (초등학교 고학년 학생의 과학 탐구능력 측정을 위한 평가 도구 개발)

  • Song, Kyoung-Hye;Lee, Hang-Ro;Lim, Cheong-Hwan
    • Journal of The Korean Association For Science Education
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    • v.24 no.6
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    • pp.1245-1255
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    • 2004
  • The purpose of this study is to develop a valid and reliable evaluating instrument for elementary school fifth and sixth graders. The instrument is developed through R&D procedure, which includes two checks of science specialist and two field trials of the instrument. Evaluating items are content-free for each science inquiry skill. Each science inquiry element is based on SAPA and the 7th curriculum. This study has selected 10 science inquiry skills(observing, classifying, measuring, predicting, inferring, recognizing of a problem, controlling variables, interpreting data, drawing a conclusion, designing an experiment), formulated a clear definition of the elements of science inquiry skills, and established the objectives of evaluation. The content areas are divided into three categories, material and energy, life and environment, and the earth and circulation. Each category contains 10 items. So the instrument consists of 30 items. The content validity of items, objectivity of the scoring keys, and clarity of the items has been checked twice by specialists in science education. At the same time, two field trials were performed to produce the reliability of the instruments, discrimination index, and item difficulty index. The instrument has the content validity is 91.6%, reliability 0.79, objectivity 93.3%, discrimination index 0.30, and item difficulty index 66.1%.

Patent trend analysis for postharvest technology of fresh mushrooms (신선 버섯의 수확 후 관리 기술과 관련된 특허 동향 분석)

  • Choi, Ji Weon;Kim, Su Yeon;Choi, Mi Hee;Lim, Sooyeon;Yang, Haejo;Shin, Il Sheob;Hong, Yoon Pyo
    • Journal of Mushroom
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    • v.18 no.3
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    • pp.280-285
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    • 2020
  • The production and consumption of fresh mushrooms has been increasing worldwide because of the health benefits of the dietary fiber and antioxidant components. Using 142 valid patents from five countries, trends in postharvest technology patents were analyzed and categorized into packaging and storage. The patent portfolio index showed that the number of patents for postharvest storage technology is growing, with the number of both approved patents and applications increasing from the third to the fourth time period, albeit the overall growth pattern suggests that this is a recovery stage. Notably, Korea showed an increasing trend in the number of patent applications related to postharvest technologies, although the number of patent applications was smaller than that of China. Our study describes trends in technical patents that support the performance of new postharvest projects of fresh mushrooms.