• Radiation Oncology Journal
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• 제29권3호
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• pp.181-190
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• 2011

Purpose: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after definitive radiotherapy in stage III non-small cell cancer patients. Materials and Methods: The medical records were reviewed for 49 patients who completed definitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently. Results: Twenty-five cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location, total radiation dose and chemotherapy were associated with grade ${\geq}2$ radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was significantly related to grade ${\geq}2$ radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), $V_{20}$, $V_{30}$, $V_{40}$, MLDipsi, $V_{20}$ipsi, $V_{30}$ipsi, and $V_{40}$ipsi were associated with grade ${\geq}2$ radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade ${\geq}2$ radiation pneumonitis. Conclusion: Concurrent chemotherapy, MLD and $V_{30}$ were statistically significant predictors of grade ${\geq}2$ radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing definitive radiotherapy. The cutoff values for MLD and $V_{30}$ were 16 Gy and 18%, respectively.

• Spatial Information Research
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• 제8권1호
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• pp.85-99
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• 2000

보호동물사에 대한 서식지 분포정보는 개발압력이 심한 우리나라에서는 서식지 관리에 있어 매우 중요하다. 본 연구는 GIS와 로지스틱 회귀분석을 이용하여 멧돼지의 서식지 적합성모형을 개발하여 서식지 분포도를 작성하고 본 연구의 결과를 토대로 현재 우리나라의 멸종위기종과 야생동물보호종들의 서식지 관리를 위한 기초를 마련하고자한다. 서식지 모형을 구현하기 위한 연구내용 및 방법은 다음과 같다. 첫째, 멧돼지의 서식지 특성을 파악하기 위하여 GIS 자료를 구축하였다. 멧돼지의 위치파악을 위해 원격무선측정기법과 GPS를 이용하였다 둘째, 멧돼지의 서식지 이용과 유용성에 영향을 미치는 환경인자를 파악하기위해 원격무선측정기법과 GPS를 이용하였다. 둘째, 멧돼지의 서식지 이용과 유용성에 영향을 미치는 환경인자를 파악하기 위해 χ²검정(Chi-square test)을 실시하였다. 마지막으로, 최적 서식지의 분포를 예측하기위한 서식지 적합성모형 개발을 위해 로지스틱 회귀분석을 이용하였다. 본 연구의 결과는 다음과 같다. 첫째, 멧돼지의 서식지 이용특성 분석의 결과, 성별 그리고 활동유형별에서는 뚜렷한 차이를 볼 수 없으나, 계절별 그리고 서식지 유형별에서는 서식지 이용특성의 차이가 뚜렷한 것을 볼 수있었다. 둘째, 서식지 유용성 분석의 결과 멧돼지의 서식환경에 영향을 미치는 자연적인 환경요인으로 표고, 향, 임상 그리고 영급이 유의성이 있는 인자로 나타났다. 반면에, 경사, 능선/계곡 , 물 그리고 일사량의 경우 통계적 유의성이 적어 전반적으로 서식지를 결정하는 환경인자라고 볼 수 없었다. 마지막으로, 개발된 서식지 적합성모형의 결과 예측확률 0.5를 기준으로 전제서식지는 75.00%, 커버서식지는 84.26% 의 높은 분류정확도를 나타내었다. 모형검증의 결과 대상지 내부의 경우 전체서식지가 75.00%로 나타나 본 모형이 신뢰성이 있는 것으로 판단되었다.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.78-87
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• 2009

위암 발생률이 높은 우리나라에서는 위암이 발생할 가능성이 높은 고위험군에서 위암 발생 여부를 알 수 있는 생물학적 인자(biological marker)의 개발이 매우 중요한데 가장 많이 연구되는 인자로 혈청 펩시노겐(Pepsinogen)이 있다. 이에 소화기질환을 가지고 있는 환자군과 건강검진센터 수진자를 대상으로 한두 가지 연구에서 혈청 펩시노겐 검사에 영향을 주는 인자를 알아보고 위축성 위염이나 위암 진단에 있어 혈청 펩시노겐 검사의 역할을 알아보았다. 혈청 펩시노겐 검사에 영향을 주는 인자로는 H. pylori 감염이 가장 컸고, 다음으로 성별, 연령이 있었다. 이를 고려한 결과 한국인에서의 내시경적 위축성 위염 진단에 있어서 PG I/II ratio 기준은 H. pylori 감염 여부에 따라 달랐는데 H. pylori 감염이 없는 경우는 PG I/II ratio 6이, H. pylori 감염이 있는 경우는 국제적 기준인 PG I/II ratio 3이 예민도와 민감도에서 우수했다. 또한 한국인에서의 위암이나 위축성 위염 진단에 있어 PG I이나 PG II는 별로 유용하지 않은 반면 PG I/II ratio는 비교적 유용함을 알 수 있었고, 특히 H. pylori 감염이 있는 경우 PG I/II ratio $\leq3$ 이하가 위암 발생위험도 예측에 도움이 되었다. 결과적으로 혈청 펩시노겐을 위암이나 위축성 위염 진단 biomarker로 사용할 때는 기존의 국제적인 기준도 중요하지만 각 나라의 현실에 맞는 기준치 적용을 위해 validation study를 시행하고 사용하는 것이 바람직한 것으로 보인다.

• Journal of Gastric Cancer
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• 제13권2호
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• pp.93-97
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• 2013

Purpose: Endoscopic submucosal dissection has recently been practiced on a differentiated type of early gastric cancer. However, there is no clear evidence for endoscopic treatments of signet ring cell carcinoma. The aim of this study is to identify the predictive clinicopathological factors for lymph node metastasis in signet ring cell carcinoma for assisting endoscopic submucosal dissection trials. Materials and Methods: A total of 186 patients with early signet ring cell carcinoma who underwent radical curative gastrectomy between January 2001 and September 2009 were enrolled in this study. Retrospective reviews of their medical records are being conducted. Several clinicopathologic factors were being investigated in order to identify predictive factors for lymph nodes metastasis: age, gender, tumor size, type of operation, tumor location, gross type, ulceration, Lauren's classification, depth of invasion, and lymphatic invasion. Results: The lymph node metastasis rate for signet ring cell carcinoma was 4.3% (n=8). Of the 186 lesions with early signet ring cell carcinoma, 91 (48.9%) tumors were larger than 15 mm in size and 40 (21.5%) showed submucosal invasions in the resection specimens. In multivariate analysis, only the lymphatic invasion (P<0.0001) showed an association with lymph node metastasis. To evaluate cutoff values for tumor sizes in the presence of lymph node metastasis, early signet ring cell carcinomas with lymphatic invasions were excluded. In the absence of lymphatic invasion, mucosal cancer with tumor sizes <15 mm had no lymph node metastasis. Conclusions: Endoscopic submucosal dissection can be performed on patients with early signet ring cell carcinoma limited to the mucosa and less than 15 mm.

• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.276-282
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• 2020

Background: Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods: We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results: A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01±2.99 years. The defect size (p=0.002) and fracture type (p=0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p<0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p=0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 ㎠ was obtained (sensitivity, 0.543; specificity, 0.724; p=0.002). Conclusion: The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 ㎠ may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.415-419
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• 2005

Objectives : We wanted to evaluate the relationship between obesity and left colonic adenomatous polyps in Korean adult men. Methods : This study was conducted among 575 adults men (aged between 40 and 69), who had colonoscopy done from January to December 2002 during a routine health examination at Health Promotion Center, Ulsan University Hospital. The patients' colons were examined up to splenic flexure by using fiberoptic colonoscopy. A questionnaire survey on behavioral factors and physical measurements were also done. The body mass index (BMI) and waist-hip ratio (WHR) were used as the indices of obesity. The BMI was categorized into three levels: normal ($BMI{\leq}22.9$), overweight ($23{\leq}BMI{\leq}24.9$), and obese ($BMI{\geq}25.0$). The WHR was categorized into four levels with cutoff points at the 30th, 60th, and 90th percentile of the control group. Age, education, smoking, alcohol use and exercise were controlled for by performing multiple logistic regression analysis. Results : There were 99 cases of colonic adenomatous polyps. Four hundred seventy six subjects with normal colonoscopy findings served as the control. The BMI and WHR were associated with the adenomatous polyps (odds ratio, 1.81 [95% CI=1.02-3.19] for a $BMI{\geq}25.0$ as compared with a $BMI{\leq}22.9$, odds ratio, 3.94 [95% CI=1.77-8.77] for a $WHR{\geq}0.95$ as compared with a $WHR{\leq}0.86$). The BMI was not associated with the risk of adenomatous polyps after additional adjustment was made for the WHR, but the association between the WHR and adenomatous polyps was still positive and independent of the BMI (odds ratio, 4.15 [95% CI=1.63-10.59]). Conclusions : The results support that obesity, and particularly abdominal obesity, can be associated with an increased risk of incurring colonic adenomatous polyps.

• 대한영양사협회학술지
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• 제11권3호
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• pp.365-374
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• 2005

This study was conducted to compare the validity of obese index among body mass index(BMI), waist to hip ratio(WHR), and waist circumference(WC) and to determine which is the best in relation to cardiovascular risk factors of middle aged Korean(40-64yr).Data from the 1998 Korean Health and Nutrition Survey were used(N=3380). Anthropometric indices and cardiovascular risk factors were measured. Chi-square test, analysis of variance following duncan's multiple range test, partial correlation analysis, and Receiver Operator characteristic(ROC) curves were used in the analysis. There was a significant increasing trend in WHR, systolic blood pressure(SBP), high density lipoprotein cholesterol(HDL), and fasting blood sugar(FBS) with age categories of male and in BMI, WC, WHR, diastolic blood pressure(DBP), SBP, total cholesterol(TC), low density lipoprotein cholesterol(LDL), triglycerol(TG), and FBS with those of female. Specially female had the characteristics of upper body fat and systolic blood pressure risk(p<0.05). Proportions of subjects with lifestyle factors related to cardiovascular risk in overweight or upper body fat group were higher than that of normal group. Higher proportions of subjects were practiced exercise in upper body fat group of male than in other groups. Among 7 cardiovascular risk factors in partial correlation analysis, BMI had the highest correlation coefficient in 6 risk factors in male, whereas WC in 4 risk factors in female. Mean of each obese index according to cardiovascular risk groups except smoker was higher than that of normal(p<0.05). These trends were shown in upper body fat group and female. In ROC analysis of 12 risk factors and health conditions, the largest area under curve among obese indices for risk factors were BMI in male and WHR in female. The optimal cutoff values of each index(BMI: WHR: WC) for one or more cardiovascular risk factors were 23.13: 0.89: 85.35 in male and 23.57: 0.84: 78.35 in female. The results showed that cardiovascular risk factors were prevalent in middle aged Koreans within normal limits of obese indices like another Asians. For the identification of cardiovascular risk factors of middle aged Koreans, BMI for men and WHR for women are appropriate indices. But it is recommended that BMI, WHR, and WC, all three indices should be considered, when using these indices.

• 한국운동역학회지
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• 제31권4호
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• pp.241-248
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• 2021

Objective: The purpose of this study was to investigate the difference in muscle strength, kinematics, and kinetics between injured and non-injured sides of the leg after Achilles Tendon Rupture surgery during walking and running. Method: The subjects (n=11; age = 30.63 ± 5.69 yrs; height = 172.00 ± 4.47 cm; mass = 77.00 ± 11.34 kg; time lapse from surgery = 29.81 ± 10.27 months) who experienced Achilles Tendon Rupture (ATR) surgery participated in this study. The walking and running trials were collected using infrared cameras (Oqus 300, Qualisys, Sweden, 100 Hz) on instrumented treadmill (Bertec, U.S.A., 1,000 Hz) and analyzed by using QTM (Qualisys Track Manager Ver. 2.15; Qualisys, U.S.A). The measured data were processed using Visual 3D (C-motion Inc., U.S.A.). The cutoff frequencies were set as 6 Hz and 12 Hz for walking and running kinematics respectively, while 100 Hz was used for force plate data. Results: In ATR group, muscle strength there were no difference between affected and unaffected sides (p> .05). In kinematic analysis, subjects showed greater ROM of knee joint flexion-extension in affected side compared to that of unaffected side during walking while smaller ROM of ankle dorsi-plantar and peak knee flexion were observed during running (p< .05). In kinetic analysis, subjects showed lower knee extension moment (running at 2.2 m/s) and positive ankle plantar-flexion power (running at 2.2 m/s, 3.3 m/s) in affected side compared to that of unaffected side (p< .05). This lower positive ankle joint power during a propulsive phase of running is related to slower ankle joint velocity in affected side of the subjects (p< .05). Conclusion: This study aimed to investigate the functional evaluation of the individuals after Achilles tendon rupture surgery through biomechanical analysis during walking and running trials. Based on the findings, greater reduction in dynamic joint function (i.e. lower positive ankle joint power) was found in the affected side of the leg compared to the unaffected side during running while there were no meaningful differences in ankle muscle strength and walking biomechanics. Therefore, before returning to daily life and sports activities, biomechanical analysis using more dynamic movements such as running and jumping trials followed by current clinical evaluations would be helpful in preventing Achilles tendon re-rupture or secondary injury.

• 대한간학회지
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• 제24권4호
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• pp.384-391
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• 2018

Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. Methods: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ${\geq}7.9kPa$. Results: A total of 214 patients were included in the analysis, and 62% of them had a BMI ${\geq}25kg/m^2$. During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ${\geq}25kg/m^2$ versus 56% of patients without SF (P<0.05). Conclusions: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

• Tuberculosis and Respiratory Diseases
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• 제86권2호
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.