• Journal of Nutrition and Health
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• v.43 no.5
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• pp.533-542
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• 2010

The objective of this study is to provide basic information and policy implications needed to balance the supply and demand for dietitian by projecting supply and demand for dietitian. The data from the Ministry of Health Welfare and Family on the number of licensed nutritionist, resident registration data of the Ministry of Public Administration and Security, and health insurance qualification data of the National Health Insurance Corporation were used to examine the current status of supply. To project the supply of nutritionist workforce, the in-out moves method and demographic method were used. The ratios of nutritionist to population and GDP, and that of other countries were applied as the demand projection method. According to the study results, the projection on the imbalance of supply and demand for dietitian by year 2021 differs depending on the method used. First, according to the results based on age-adjusted population ratio, there is an oversupply of 1,643 dietitians in year 2010, and 2,076 dietitians in year 2020. Second, although the projection on the imbalance of the supply and demand for dietitian differs depending on whether the GDD is calculated in won(￦) or dollar($). it is expected that there will be an oversupply in general. Third, as to the scenario using the nutritionist ratio in foreign countries, the oversupply of dietitian is likely in Korea, under any scenario, when comparing the nutritionist supply projection with the demand projection based on the nutritionist ratio in the United States. However, the projection of the supply and demand varies in each scenario when the European nutritionist ratio is applied. Under European 'scenario 1', an oversupply is expected, whereas under 'scenario 2', a shortage of supply is expected. A careful approach is required in interpreting the supply and demand projection using criteria of other countries, because dietitian assumes different roles and functions in each country. Although a slight oversupply of nutritionist workforce is projected, it does not cause a major problem as the demand for diet therapy is expected to rise due to aging and the increase of chronic diseases, and as the demand for clinical dietitians in hospitals increases. Accordingly, the demand for dietitians will rise and, in this context, the oversupply of nutritionist will not incur much problem. However, the nutritionist qualification is much too open in Korea, and this has a negative effect on the quality of the nutritionist workforce. Therefore, it is important that the nutritionist qualifications and requirements are reinforced in the future, enhance the quality level of the nutritionist supply, and maintain the balance between the supply and demand.

• Journal of Preventive Medicine and Public Health
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• v.5 no.1
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• pp.57-95
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• 1972

This study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean-while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent' such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area. But, I expect that more maternity sids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if suck facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and post-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a 'notification' system instead of formal registration ststem, it would be improved significantly compared to present system. B. Effect of the project Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't want to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.

• Journal of Society of Preventive Korean Medicine
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• v.5 no.2
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• pp.40-68
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• 2001

In this study, grade of subjective symptom appealed by laborer of Jeollabuk-do was evaluated using questionary regarding factor made effect on musculoskeletal disease and in addition, studied relationship with health promotion life style of them. Based on the result, relationship of general characteristics of musculoskeletal subjective symptom and life-style of the subjects was concluded as below. 1. General characteristics of study subjects were as following. Ratio of male was higher as 57.7% of male and 42.2% female and age distribution was 5.1% of 20s, 34.99% of 30s, 36.3% of 40s and 23.7% of 50s and therefore, $30{\sim}40$ aged groups showed highest ratio. Most subjects (74.9%) was married status and in case of education level, high-school graduate and dropout (23.3%) and over-college graduate (46.8%) showed highest distribution. $1{\sim}2$ Mil. KRW (29.5%) and $2{\sim}2.99$ Mil. KRW (21.2%) is the main income distribution and however there was high ratio of non-reply (29.0%). In case of employment period, $10{\sim}14$ years (15.3%) and over 15 years (29.6%) showed highest ratio and there were many non-reply (39.4%) and in addition, 67.6% replied as own house and 14.3% as lease on deposit base in question of residence type. 2. Subjects showed high ratio of subjective symptom appeal of 62.79% and many cases (50.23%) appealed 1 or 2 symptoms. Symptom by body region was 29.8% (waist), 27% (shoulder), 21.2% (knee), 15.5% (neck), 9.5% (ankle), 8.1% (wrist) and 5.0% (elbow) in order. In case of relationship with general characteristics, female comparing with male, non-residence of own house, subjects with lower education level and employment period of $10{\sim}14$ years showed higher appeal rate and kind of symptoms than others. Therefore, it was concluded that rate of musculoskeletal symptom appeal have close relationship with gender, level of living, education level, age and employment period. 3. In case of severe pain of upper body except waist and ankle, it was appealed in both or right side and it means that upper body pain is originated from right side and right region pain is transited to both region pain. In addition, there was 39.41% of non-reply to existence of right-left region pain and therefore, it was evaluated that, in may cases, there was no awareness of their own symptom condition even on subjective symptom. 4. Degree of pain was, as pain over middle level, evaluated as 2.79 on full mark of 4.0 and in order of waist (2.97), ankle (2.83), knee (2.82), wrist (2.82), neck (2.79), shoulder (2.70) and elbow (2.62). In addition, 71.97% appealed $2{\sim}3$ cases for the latest 1 week. Owing to subjective symptom, 54.95% drop into hospital or pharmacy, 10.32% made temporary retirement or absence, 7.99% transferred into more comfortable duty and $39.4{\sim}54%$ experienced one or more managing mentioned above. 5. Fulfillment of health promotion life style of subjects was evaluated on full mark of 4.0 and total score was 2.63. Average mark of each area was personal relationship (3.05), self-realization (2.92), stress management (2.63), health control (2.48), physical exercise (2.19) and nutrition management (2.19) and personal relationship was highest and physical exercise and nutrition management were lowest. As general characteristics influencing health promotion life style, gender, residence style and employment period showed significant difference. Male showed higher mark than female and showed higher mark in order of own house, others, lease on deposit base, monthly rent. Subjects with longer employment period showed higher mark with significant difference. 6. Accounting of factor influencing each area of health promotion life style, self-realization showed significance in marriage status, income, residence style and education level and health control in age, residence style and employment period. Physical exercise showed significant difference in gender, age, residence style and employment period and nutrition in gender, age, residence style and employment period. Stress management showed significant difference in residence style and employment period and however not in personal relationship. 7. Health promotion life style relating with existence and kind of pain showed significant difference in all area except personal relationship area. In absence of pain, there was statistically significant high score in all area even in total health promotion life style and all area. Accounting of kind of pain, cases of $1{\sim}2$ kinds of pain and $5{\sim}6$ kinds of pain showed relatively high score and it was lower than mark of subject stated absence of pain. 8. Subjects appeal symptom were classified by symptom region and difference of total and each areas were evaluated. General area (p=0.002), self-realization (p=0.012), health management (p=0.023), physical exercise (p=0.028), nutrition management (p=0.028) and stress control (p=0.001) showed statistically significant difference and not in personal relationship area. Especially, elbow, shoulder and neck area marked high and group appealed pain of knee, arm and elbow, foot and ankle marked low. Based on those results, subjective symptom should be accounted seriously in diagnosis of occupational musculoskeletal disease of laborer and among subjective symptom, general characteristics of gender, age, condition of living, education level and employment period make effect. Generally subject appeal symptom marked lower than subject without symptom appeal and it means that life management of subject appealing musculoskeletal pain make important role in management and treatment of occupational musculoskeletal disease.

• Economic and Environmental Geology
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• v.45 no.6
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• pp.643-659
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• 2012

The Chungju Fe-REE deposit is located in the Kyemyeongsan Formation of the Ogcheon Group. The Kyemyeongsan Formation includes meta-volcanic rocks and pegmatite hosted REE deposit which show different kind of REE-containing minerals. The meta-volcanic rocks hosted REE deposits' main REE minerals are allanite, zircon, apatite, and sphene, whereas the pegmatite hosted REE deposits is mainly composed of fergusonite, and karnasurtite, zircon, thorite. The meta-volcanic rock hosted major REE mineral is allanite as the form of aggregation and contains 23.89-29.19 wt% TREO (Total Rare Earth Oxide), 4.71-9.92 wt% $La_2O_3$, 11.30-14.33 wt% $Ce_2O_3$, 0.11-0.29 wt% $Y_2O_3$, 0.15-0.94 wt% $ThO_2$, as a formula of (Ca, Y, REE, Th)$_{2.095}$(Mg, Al, Ti, Mn, $Fe^{3+})_{2.770}(SiO_4)_{2.975}(OH)$. Accompanying REE in a coupled substitution for $Ca^{2+}$ (M1 site) and $Al^{3+}-Fe^{2+}$ (M2 site) leads to a large chemical variety. Due to the allanite's high contents of Fe, it belongs to Ferrialanite. The pegmatite hosted deposit's domi-nant REE mineral is fergusonite as prismatic or subhedral grains associated with zircon, fluorite and karnasurtite. Geochemical composition of the fergusonite($YNbO_4$) suggests substitution of Y-REE and Y-Th in A-site, and Nb-Ta-Ti in B-site, furthermore the proportion of $Y_2O_3$ and $Nb_2O_5$ is oddly 1:1.5 comparing to the ideal ratio 1:1 and Nb is higher than Y, also A-site Y actively substitutes with REE. Karnasurtite in pegmatite variously ranges 9.16-22.88 wt% $Ce_2O_3$, 2.15-9.16 wt% and $La_2O_3$, 0.44-10.8 wt% $ThO_2$, as a calculated formula (Y, REE, Th, K, Na, Ca)$_{1.478}(Ti, Nb)_{1.304}$(Mg, Al, Mn, $Fe^{3+})_{0.988}$(Si, P)$_{1.431}O_7(OH)_4{\cdot}3H_2O$. Firstly the 870-860 Ma is the initial age of the supercontinent Rhodinia dispersal and subsequent A-1 type volcanism, which contains Fe, REE, and HFS(High Field Strength elements; Nb, Zr, Y etc.) elements in Fe-rich meta-volcanic rocks dominant Kyemyeongsan Formation, might mineralized allanite. Another synthesis is that regional metamorphism at late Paleozoic 300-280 Ma(Cho et al., 2002) might cause allanite mineralization. Also pegmatite REE mineralization highly related to the granite intrusion over the Chungju area in Jurassic(190 Ma; Koh et al., 2012). Otherwise above all, A-1 type volcanism at the same time of the Kyemyeongsan Formation development, regional metamorphism and pegmatite, might have caused REE mineralization. Although REE ore bodies display a close spatial association, each ore bodies display temporal distinction, different mineral assemblage and environment of ore formation.

• The Korean Journal of Pharmacology
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• v.31 no.3
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• pp.299-311
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• 1995

Platelets resemble monoaminergic neurons in several respects, i.e. the uptake of 5-HT and its inhibition, the subcellular storage and release of 5-HT, and the metabolism of aromatic amines brought about by monoamine oxidase. And the 5-HT content of rabbit platelets is well known to be about 40 times higher than that of human platelets. Therefore, this study was carried out to investigate the influences of amitriptyline (AMT) and sertraline (SRT) on the aggregation, contents of signaling second messengers, and protein phosphorylations of rabbit platelets in response to thrombin, 0.25 unit/ml, comparing with those of chlorpromazine (CPZ). Thrombin-induced aggregation was inhibited by SRT $(IC50:4.37{\times}10^{-5}\;M)$, CPZ $(IC50:5.76{\times}10^{-5}\;M)$, and AMT $(IC50:1.15{\times}10^{-4}\;M)$, respectively, and the aggregation by A23187 $(1.0\;{\mu}M)$ or PMA (320 nM) was also inhibited by SRT, CPZ, and AMT. AMT, SRT, and CPZ had little affects on basal contents of platelet $TXB_2$ and $PGE_2$, but all of them inhibited the thrombin-induced increase of $TXB_2$. Thrombin did not change the platelet contents of cAMP and cGMP. CPZ, AMT, and SRT produced the slight decrease of basal cAMP content, and their effects were not affected by thrombin-treatment. But SRT and AMT moderately increased the basal cGMP content, and the cGMP content of thrombin-stimulated platelets was gradually increased by the pretreatment with SRT, AMT, and CPZ. Particularly, the SRT-dependent increase of the cGMP content was notable. Platelet $Ins(1,4,5)P_3$ content was rapidly increased up to a plateau within 10 sec after thrombin-stimulation, AMT, SRT, and CPZ increased the basal $Ins(1,4,5)P_3$ content, and the thrombin-dependent increase was enhanced by pretreatment with CPZ and AMT, but was blunted by SRT. Platelet $[Ca^{2+}]_i$, was rapidly increased up to a peak level within 20 sec after thrombin-stimulation. The increase of $[Ca^{2+}]_i$ was sisnificantly inhibited by AMT, SRT, and CPZ. Thrombin- or PMA-induced phosphorylations of platelet $41{\sim}43\;kDa$ and 20 kDa proteins were significantly inhibited by AMT, SRT, and CPZ. These results suggest that the antiplatelet activities of AMT and CPZ may be considerably attributed to the inhibition of protein kinase C activity, and the activity of SRT may be associated with the inhibitory effect on the thrombin-induced increase of $Ins(1,4,5)P_3$ and the increasing effect on the cGMP content of ptatelets. Therefore, it seems to be evident that AMT and SRT may produce their antidepressant activity, at least, partly through the inhibition of protein kinase C activity or the increase of resting $Ins(1,4,5)P_3$, content and in case of SRT, to a lesser extent, via the increase of cGMP in the brain.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.123-135
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• 2012

Purpose: It is essential to minimize the movement of tumor due to respiratory movement at the time of respiration controlled radiotherapy of non-small cell lung cancer patient. Accordingly, this Study aims to evaluate the usefulness of restricted respiratory period by comparing and analyzing the treatment plans that apply free and restricted respiration period respectively. Materials and Methods: After having conducted training on 9 non-small cell lung cancer patients (tumor n=10) from April to December 2011 by using 'signal monitored-breathing (guided- breathing)' method for the 'free respiratory period' measured on the basis of the regular respiratory period of the patents and 'restricted respiratory period' that was intentionally reduced, total of 10 CT images for each of the respiration phases were acquired by carrying out 4D CT for treatment planning purpose by using RPM and 4-dimensional computed tomography simulator. Visual gross tumor volume (GTV) and internal target volume (ITV) that each of the observer 1 and observer 2 has set were measured and compared on the CT image of each respiratory interval. Moreover, the amplitude of movement of tumor was measured by measuring the center of mass (COM) at the phase of 0% which is the end-inspiration (EI) and at the phase of 50% which is the end-exhalation (EE). In addition, both observers established treatment plan that applied the 2 respiratory periods, and mean dose to normal lung (MDTNL) was compared and analyzed through dose-volume histogram (DVH). Moreover, normal tissue complication probability (NTCP) of the normal lung volume was compared by using dose-volume histogram analysis program (DVH analyzer v.1) and statistical analysis was performed in order to carry out quantitative evaluation of the measured data. Results: As the result of the analysis of the treatment plan that applied the 'restricted respiratory period' of the observer 1 and observer 2, there was reduction rate of 38.75% in the 3-dimensional direction movement of the tumor in comparison to the 'free respiratory period' in the case of the observer 1, while there reduction rate was 41.10% in the case of the observer 2. The results of measurement and comparison of the volumes, GTV and ITV, there was reduction rate of $14.96{\pm}9.44%$ for observer 1 and $19.86{\pm}10.62%$ for observer 2 in the case of GTV, while there was reduction rate of $8.91{\pm}5.91%$ for observer 1 and $15.52{\pm}9.01%$ for observer 2 in the case of ITV. The results of analysis and comparison of MDTNL and NTCP illustrated the reduction rate of MDTNL $3.98{\pm}5.62%$ for observer 1 and $7.62{\pm}10.29%$ for observer 2 in the case of MDTNL, while there was reduction rate of $21.70{\pm}28.27%$ for observer 1 and $37.83{\pm}49.93%$ for observer 2 in the case of NTCP. In addition, the results of analysis of correlation between the resultant values of the 2 observers, while there was significant difference between the observers for the 'free respiratory period', there was no significantly different reduction rates between the observers for 'restricted respiratory period. Conclusion: It was possible to verify the usefulness and appropriateness of 'restricted respiratory period' at the time of respiration controlled radiotherapy on non-small cell lung cancer patient as the treatment plan that applied 'restricted respiratory period' illustrated relative reduction in the evaluation factors in comparison to the 'free respiratory period.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.179-186
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• 2016

Purpose : To figure out if the treatment plan for rectum, bladder and prostate that have a lot of interfraction errors satisfies dosimetric limits without adaptive plan by analyzing MR image. Materials and Methods : This study was based on 5 prostate cancer patients who had IMRT(total dose: 70Gy) Using ViewRay MRIdian System(ViewRay, ViewRay Inc., Cleveland, OH, USA) The treatment plans were made on the same CT images to compare with the plan quality according to adaptive plan, and the Eclipse(Ver 10.0.42, Varian, USA) was used. After registrate the 5 treatment MR images to the CT images for treatment plan to analyze the interfraction changes of organ, we measured the dose volume histogram and the changes of the absolute volume for each organ by appling the first treatment plan to each image. Over 5 fractions, the total dose for PTV was $V_{36.25}$ Gy $${\geq_-}$$ 95%. To confirm that the prescription dose satisfies the SBRT dose limit for prostate, we measured $V_{100%}$, $V_{95%}$, $V_{90%}$ for CTV and $V_{100%}$, $V_{90%}$, $V_{80%}$ $V_{50%}$ of rectum and bladder. Results : All dose average value of CTV, rectum and bladder satisfied dose limit, but there was a case that exceeded dose limit more than one after analyzing the each image of treatment. After measuring the changes of absolute volume comparing the MR image of the first treatment plan with the one of the interfraction treatment, the difference values were maximum 1.72 times at rectum and maximum 2.0 times at bladder. In case of rectum, the expected values were planned under the dose limit, on average, $V_{100%}=0.32%$, $V_{90%}=3.33%$, $V_{80%}=7.71%$, $V_{50%}=23.55%$ in the first treatment plan. In case of rectum, the average of absolute volume in first plan was 117.9 cc. However, the average of really treated volume was 79.2 cc. In case of CTV, the 100% prescription dose area didn't satisfy even though the margin for PTV was 5 mm because of the variation of rectal and bladder volume. Conclusion : There was no case that the value from average of five fractions is over the dosimetric limits. However, dosimetric errors of rectum and bladder in each fraction was significant. Therefore, the precise delivery is needed in case of prostate SBRT. The real-time tracking and adaptive plan is necessary to meet the precision delivery.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.86-90
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• 2012

Purpose: We studied the need for distal clavicle resection by comparing rotator cuff tear patients who underwent non-surgical treatment with and without acromioclavicular joint pathology. Materials and Methods: 45 cases that had been under follow up care for at least 9 months after receiving rotator cuff repair in our hospital between Jan. 2005 and Jun. 2011 had been studied. Acromioclavicular joint pathology group and control group were classified by physical examination and MRI findings. The temporal changes in shoulder joint abduction, internal and external rotation strength, ASES and KSS score of the two groups were measured and analyzed. Results: The acromioclavicular joint pathology complicated rotator cuff injury group's strength measurements for abduction, internal rotation, external rotation were each 8.05 (${\pm}4.54$), 11.33 (${\pm}6.05$), 10.24 (${\pm}5.27$) preoperatively and improved to 13.26 (${\pm}5.50$), 17.51 (${\pm}6.80$), 15.60 (${\pm}5.37$) post operatively while the KSS score and ASES score were each 49.07 (${\pm}15.28$) and 48.65 (${\pm}13.27$) preoperatively, improving to 84.48 (${\pm}10.96$) and 84.65. (${\pm}9.86$). The measurements for the group without complicating acromioclavicular pathology are as follows. The strength for abduction, internal rotation, external rotation was each 6.42 (${\pm}3.11$), 7.59 (${\pm}4.81$) and 7.93 (${\pm}4.49$) preoperatively, improving to 15.85 (${\pm}7.35$), 19.18 (${\pm}9.14$), 16.95 (${\pm}5.70$) post operatively, while the KSS score and ASES score each went from 42.12 (${\pm}6.43$) and 41.37 (${\pm}7.42$) to 83.44 (${\pm}6.30$) and 83.17 (${\pm}7.01$) respectively. The measurements for the two groups, however, did not show a statistically significant difference (p>0.05). Conclusion: Analysis of the rotator cuff injury groups with and without AC joint pathology showed that both groups had improved strength, ASES and KSS scores with no statistical difference difference among the groups. As such, it thought that conservative treatment is an acceptable alternative to distal clavicle resection.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.1-8
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• 2013

Purpose: A selection of proper energy in treatment planning is very important because of having different dose distribution in body as photon energy. In generally, the low energy photon has been used in intensity-modulated radiation therapy (IMRT) for head and neck (H&N) cancer. The aim of this study was to evaluate the effect of partially used high energy photon at posterior oblique fields on IMRT plan for H&N cancer. Materials and Methods: The study was carried out on 10 patients (nasopharyngeal cancer 5, tonsilar cancer 5) treated with IMRT in Seoul National University Bundang Hospital. CT images were acquired 3 mm of thickness in the same condition and the treatment plan was performed by Eclipse (Ver.7.1, Varian, Palo Alto, USA). Two plans were generated under same planing objectives, dose volume constraints, and eight fields setting: (1) The low energy plan (LEP) created using 6 MV beam alone, (2) the partially used high energy plan (PHEP) created partially using 15 MV beam at two posterior oblique fields with deeper penetration depths, while 6 MV beam was used at the rest of fields. The plans for LEP and PHEP were compared in terms of coverage, conformity index (CI) and homogeneity index (HI) for planning target volume (PTV). For organs at risk (OARs), $D_{mean}$ and $D_{50%}$ were analyzed on both parotid glands and $D_{max}$, $D_{1%}$ for spinal cord were analyzed. Integral dose (ID) and total monitor unit (MU) were compared as addition parameters. For the comparing dose to normal tissue of posterior neck, the posterior-normal tissue volume (P-NTV) was set on the patients respectively. The $D_{mean}$, $V_{20Gy}$ and $V_{25Gy}$ for P-NTV were evaluated by using dose volume histogram (DVH). Results: The dose distributions were similar with regard to coverage, CI and HI for PTV between the LEP and PHEP. No evident difference was observed in the spinal cord. However, the $D_{mean}$, $D_{50%}$ for both parotid gland were slightly reduced by 0.6%, 0.7% in PHEP. The ID was reduced by 1.1% in PHEP, and total MU for PHEP was 1.8% lower than that for LEP. In the P-NTV, the $D_{mean}$, $V_{20Gy}$ and $V_{25Gy}$ of the PHEP were 1.6%, 1.8% and 2.9% lower than those of LEP. Conclusion: Dose to some OARs and a normal tissue, total monitor unit were reduced in IMRT plan with partially used high energy photon. Although these reduction are unclear how have a clinical benefit to patient, application of the partially used high energy photon could improve the overall plan quality of IMRT for head and neck cancer.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1200-1206
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• 2003

Purpose : This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). Methods : Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. Results : There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in $PaCO_2$. However, the control group showed a slight $CO_2$ retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. Conclusion : Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.