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Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer (조기유방암환자의 이차원치료계획과 삼차원치료계획의 방사선조사범위의 차이)

  • Jo, Sun-Mi;Chun, Mi-Son;Kim, Mi-Hwa;Oh, Young-Taek;Kang, Seung-Hee;Noh, O-Kyu
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.177-183
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    • 2010
  • Purpose: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Materials and Methods: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. Results: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. Conclusion: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.

Treatment Outcome and Analysis of the Prognostic Factors of High Grade Glioma Treated by Postoperative Radiotherapy (고악성도 신경아교종의 수술 후 방사선 치료 성적과 예후인자 분석)

  • Lee, Sun-Min;Park, Young-Je;Yoon, Won-Sup;Lee, Suk;Yang, Dae-Sik;Jeong, Yong-Gu;Kim, Chul-Yong
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.117-124
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    • 2010
  • Purpose: To analyze the postoperative radiotherapy results and prognostic factors in patients with WHO grade 3 and 4 gliomas. Materials and Methods: A total of 99 patients with malignant gliomas who underwent postoperative radiotherapy between 1988 and 2007 were enrolled in this study. Total resections, subtotal resections ($\geq$50%), partial resections (<50%), and biopsies were performed in 16, 38, 22, and 23 patients, respectively. In total there were 32, 63 and 4 WHO grade 3, 4, and unspecified high grade gliomas, respectively. The biologically equivalent dose was in the range of 18.6 to $83.3\;Gy_{10}$ (median dose, $72.2\;Gy_{10}$). We retrospectively analyzed survival rate, patterns of failure, prognostic factors, and adverse effects. Results: The median follow-up time was 11 months and there were 54 patients (54.5%) with local failure. The one and 2-year survival rates were 56.6% and 29.3%, respectively, and the median survival duration was 13 months. The one and 2-year progression-free survival rates (PFS) were 31.3% and 18.2%, respectively, and the median PFS was 7 months. The prognostic factors for overall survival were age (p=0.0001), surgical extents (subtotal resection, p=0.023; partial resection, p=0.009; biopsy only, p=0.002), and enhancement of tumor in postoperative imaging study (p=0.049). The factors affecting PFS were age (p=0.036), tumor enhancement of the postoperative imaging study (p=0.006). There were 3 patients with grade 3 and 4 side effects during and after radiotherapy. Conclusions: In addition to age and surgical extents, tumor enhancement of the postoperative imaging study was included in the prognostic factors. The most common relapse patterns were local failures and hence, additional studies are needed to improve local control rates.

The Optimal Combination of Major Nutrients Computed by the Homès Systematic Variation Technique II. Determination of the Optimal Combination of Cations K:Ca:Mg in Fertilization on the Various Grassland Soils (Homes 방법(方法)에 의(依)한 다량요소(多量要素)의 적정시용(適正施用) 비율(比率) 결정(決定)에 관(關)한 연구(硏究) II. 초지토양별(草地土壤別) 음(陰)이온 N : Ca : Mg 적정시용(適正施用) 비율(比率))

  • Jung, Yeun-Kyu;Yoon, Sang-Gi;Weinberger, P.
    • Korean Journal of Soil Science and Fertilizer
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    • v.14 no.1
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    • pp.37-43
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    • 1981
  • This pot experiment was conducted to find out the optimal fertilization ratio of the cations(K: Ca: Mg) in various soil conditions. Soil samples were collected from uncultivated mountains and hills where development for grass lands is under consideration. The optimum ratios were computed by the Homes systematic variation technique. The results were summarized as follows : 1. The optimum fertilization ratios of the cations (K : Ca : Mg) for the high yields of grass-clover mixed sward at various areas were obtained (Table 4) 2. The relatively high optimum fertilization ratios of K in Daegu and Taegwalryong, Ca in Unbong, and Mg in Cheju district gave the high yields of clover in mixed sward. They were positively related to the low contents of the above cations in the soils or the relatively low content ratio comparing with other cations. 3. The yields of clover in mixed sward were seriously affected by the changes in both the fertilization ratio and total concentration of cations comparing to those of the grass yields. As a consequence, total yields, quality, and botanical composition of the mixed sward were also affected. 4. The antagonis among the cations K, Ca, and Mg was known from the point of mineral contents of grass and clover. 5. The equivalent ratio K/(Ca+Mg) or grass was greatly increased by the range of 2.4 and 3.3 in the K-group treatment, which was higher than the critical level 2.2 of grass tetany, otherwise that. of clover by the range of 0.9 and 1.2. Therfore, it may be concluded that if the botanical composition of grass/legume sward is optimum, the incidence of grass tetany can be eliminated.

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Effects of pH and Redox Conditon on Silica Sorption in Submerged soils (담수조건(湛水條件)에서 토양산도(土壤酸度)와 산화환원(酸化還元) 전위(電位)가 토양(土壤)의 규산흡착(珪酸吸着)에 미치는 영향(影響))

  • Lee, Sang-Eun;Neue, Heins Ulitz
    • Korean Journal of Soil Science and Fertilizer
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    • v.25 no.2
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    • pp.111-126
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    • 1992
  • Silica sorption isotherm belonged to the C-type with weak L-type characteristics according to the classification system of adsorption isotherm. Silica sorption isothem fitted well to the Freundlich and Tempkin equation but not to the Langmuir equation. The color interference probably due to $Fe^{2+}$ during spectrometric silca determination by Molybdenum-blue method affected the sorption isotherm in reduced soils or low pH. Four parameters such as the intercept of Freundlich equation, the slope of Tempkin equation, the "Silica reactivity", and the "C-type slope", where the last two parameters were termed in the current study, were examined to assess treatment effects on silica sorption. Among them the "C-type slope" was found out to be the best parameter. The C-type isotherms showed the same high correlation coefficient as Freundlich and Tempkin equation when regressed to the sorption isothem. Plotting the C-type slope on a logarithmic scale vs. the pH showed high linearity. Using the "C-type slope" as a perameter, the pH and soil type affected the silica sorption while the effect of redox condtion was not significant. All Fe and Al extracted by the various reagents, and OM were highly correlated to silica sorption. Among them $Fe_d$ was identified as the highest influencing soil property. Since there is no equivalent reliable method to discriminate the forms of the soil Al-oxides their likely importance remains unclear.

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The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism (중증 폐혈전색전증 환자에서 Urokinase와 Alteplase의 효과 및 출혈 합병증 비교)

  • Yoo, Jung-Wan;Kim, Wongyoung;Choi, Chang Min;Hong, Sang-Bum;Oh, Yeon Mok;Shim, Tae Sun;Lim, Chae-Man;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Koh, Younsuck
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.1
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    • pp.6-12
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    • 2009
  • Background: The efficacy of several thrombolytic agents for treating massive pulmonary thromboembolism (PTE) has been reported to be similar. However, the difference of the bleeding complications caused by two commonly used thrombolytic agents in PTE patients is not well known. The aim of this study was to compare the therapeutic efficacy and the bleeding complications between urokinase and recombinant tissue-type plasminogen activatior (rt-PA, alteplase) in a Korean medical center. Methods: We retrospectively reviewed the clinical data of the patients who were treated with thrombolytic agents (urokinase and alteplase) because of massive PTE. Results: A total of 40 patients were included: 16 (40%) treated with urokinase and 24 (60%) with alteplase. The patients treated with alteplase showed a shorter duration of using vasopressor agents than did the patients who were given urokinase, but the duration of mechanical ventilation, the length of the ICU stay and the hospital stay were not different between the thrombolytic agents. Five patients treated with urokinase and eight patients treated with alteplase died (p=0.565): One patient in the urokinase group and four patients in the alteplase group died due to pulmonary thromboembolism. Bleeding complications after thrombolysis were observed in 3 patients (7.5%) treated with urokinase and in 11 (27.5%) patients treated with alteplase (p=0.079). Major bleeding complication occurred in 2 patients who were treated with alteplase. Conclusion: Urokinase seems to have fewer bleeding complications with an equivalent efficacy, as compared to alteplase, in Korean patients who suffer with massive pulmonary thromboembolism.

A Study of Dosimetric Characteristics of a Diamond Detector for Small Field Photon Beams (광자선 소조사면에 대한 다이아몬드 검출기의 선량특성에 관한 연구)

  • Loh, John-K.;Park, Sung-Y.;Shin, Dong-O.;Kwon, Soo-I.;Lee, Kil-D.;Kim, Woo-C.;Cho, Young-K.
    • Journal of Radiation Protection and Research
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    • v.24 no.4
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    • pp.195-203
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    • 1999
  • It is difficult to determine dosimetric characteristics for small field photon beams since such small fields do not achieve complete lateral electronic equilibrium and have steep dose gradients. Dosimetric characteristics of small field 4, 6, and 10 MeV photon beams have been measured in water with a diamond detector and compared to measurements using small volume cylindrical and plane parallel ionization chambers. Percent depth dose (PDD) and beam profiles for 6 and 10 MeV photon beams were measured with diamond detector and cylindrical ion chamber for small fields ranging from $1{\times}1\;to\;4{\times}4cm^2$. Total scatter factors($S_{c,p}$) for 4, 6, and 10 MeV photon beams were measured with diamond detector, cylindrical and plane parallel ion chambers for small fields ranging from $1{\times}1\;to\;4{\times}4cm^2$. The $S_{c,p}$ factors obtained with three detectors for 4, 6, and 10 MeV photon beams agreed well ($\pm1.2%$) for field sizes greater than $2{\times}2,\;2.5{\times}2.5,\;and\;3{\times}3\;cm^2$, respectively. For smaller field sizes, the cylindrical and plane parallel ionization chambers measure a smaller $S_{c,p}$ factor, as a result of the steep dose gradients across their sensitive volumes. The PDD values obtained with diamond detector and cylindrical ionization chamber for 6 and 10MeV photon beams agreed well ($\pm1.5%$) for field sizes greater than $4{\times}4\;cm^2$. For smaller field sizes, diamond detector produced a depth-dose curve which had a significantly shallower falloff than that obtained from the measurements of relative depth-dose with a cylindrical ionization chamber. For the measurements of beam profiles, a distortion in terms of broadened penumbra was observed with a cylindrical ionization chamber since diamond detector exhibited higher spatial resolution. The diamond detector with small sensitive volume, near water equivalent, and high spatial resolution is suitable detector compared to ionization chambers for the measurements of small field photon beams.

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The Influence of Attachment Type on the Distribution of Occlusal Force in Implant Supported Overdentures (하악 임플란트 오버덴쳐에서 어태치먼트 종류에 따른 응력분포)

  • Sung, Chai-Ryun;Cho, In-Ho
    • Journal of Dental Rehabilitation and Applied Science
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    • v.25 no.4
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    • pp.375-390
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    • 2009
  • Statement of problem: Implant supported overdenture is accepted widely as a way to restore edentulous ridge providing better retention and support of dentures. Various types of attachment for overdenture have been developed. Purpose: The purpose of this study was to investigate the influence of attachment type in implant overdentures on the biomechanical stress distribution in the surrounding bone, prosthesis and interface between implant and bone. Material and methods: Finite element analysis method was used. Average CT image of mandibular body(Digital $Korea^{(R)}$, KISTI, Korea) was used to produce a mandibular model. Overdentures were placed instead of mandibular teeth and 2mm of mucosa was inserted between the overdenture and mandible. Two implants($USII^{(R)}$, Osstem, Korea) were placed at both cuspid area and 4 types of overdenture were fabricated ; ball and socket, Locator, magnet and bar type. Load was applied on the from second premolar to second molar tooth area. 6 times of finite element analyses were performed according to the direction of the force $90^{\circ}$, $45^{\circ}$, $0^{\circ}$ and unilateral or bilateral force applied. The stress at interface between implants and bone, and prosthesis and the bone around implants ware compared using von Mises stress. The results were explained with color coded graphs based on the equivalent stress to distinguish the force distribution pattern and the site of maximum stress concentration. Results: Unilateral loading showed that connection area between implant fixture and bar generated maximum stress in bar type overdentures. Bar type produced 100 Mpa which means the most among 4 types of attachments. Bilateral loading, however, showed that bar type was more stable than other implants(magnet, ball and socket). 26 Mpa of bar type was about a half of other types on overdenture under $90^{\circ}$ bilateral loading. Conclusions: In any directions of stress, bar type was proved to be the most vulnerable type in both implants and overdentures. Interface stress did not show any significant difference in stress distribution pattern.

Quality Characteristics of Ginseng Seed Oil Obtained by Different Extraction Methods (추출방법에 따른 인삼씨유의 품질특성)

  • Kim, Ji-Eun;Lee, Seul;Yoo, Kyung-Mi;Lee, Kyoung-Hae;Kim, Kyung-Tack;Lee, Myung-Hee;Hwang, In-Kyeong
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.3
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    • pp.439-445
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    • 2014
  • This study aimed to determine the quality characteristics of ginseng seed oil as well as evaluate the efficacy of ginseng seed oil as a food resource. Ginseng seed oil was obtained by different extraction methods; from solvent extraction oil, supercritical fluid extraction oil, and screw pressed extraction oil. Total unsaturated fatty acids were present at 97.72~97.92%. Oleic acid (80.13~81.16%) was the highest, followed by linoleic acid (14.98~15.69%). The total phenol content (mg gallic acid equivalent/100 g oil) was higher in screw pressed extraction oil ($56.32{\pm}1.47$) compared to others. ${\gamma}$-Tocopherol was only present in ginseng seed oil and screw pressed extraction oil showed the highest levels of ${\gamma}$-tocopherol ($5.95{\pm}0.25$ mg/100g oil) among the tested samples. Screw pressed extraction oil showed the greatest oxidative stability with an induction time of 16.58 hours. Acid values and peroxide values of ginseng seed oil increased with increasing storage period. The total phenol and ${\gamma}$-tocopherol contents were higher in screw pressed extraction oil than in other ginseng seed oils, which suggests that screw pressed extraction oil has the greatest oxidative stability.

Quality Characteristics and Glycemic Index of Oatmeal Cookies Made with Artificial Sweeteners (대체감미료를 첨가한 오트밀쿠키의 품질 특성 및 혈당에 미치는 영향)

  • Bang, Son Kwon;Son, Eun-Jung;Kim, Hyo-Jin;Park, Sunmin
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.42 no.6
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    • pp.877-884
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    • 2013
  • This study investigated the optimal composition of sugar and artificial sweeteners in oatmeal cookies. Modified cookies were examined for their quality characteristics and glycemic index in humans. Oatmeal cookies with various amounts of sugar (20, 30, or 40%) were made to the equivalent sweetness of 100% sugar cookies (the control) with sucralose and stevioside. The density and acidity of cookie dough were not significantly different between the different cookie groups. However, baking loss and the spread index were significantly lower in the 100% sugar cookie group compared to cookies supplemented with artificial sweeteners. The color lightness (L value) and redness (a value) were highest in 30% and 100% sugar cookies, respectively. The strength of the cookies was negatively correlated with sugar content. In sensory evaluations, scores for taste, color and texture were higher in 30% and 40% sugar cookies, respectively, but the overall preference was higher in 30% sugar cookies. We therefore tested 30% and 100% sugar cookies for their glycemic index in college students. After overnight-fasted students consumed either 30% or 100% sugar cookies (containing 50 g of carbohydrate in dough weight), blood glucose levels increased 27.8 and 15.7 mg/dL, respectively, at 1 hour from the baseline. However, at 2 hours from the baseline, students who consumed 100% sugar cookies had a remarkably lowered blood glucose levels. Students who consumed 30% sugar cookies did not have as much of a change in blood glucose levels. In conclusion, 30% sugar oatmeal cookies made with sucralose and stevioside can be used to make a low-sugar cookie with a low glycemic index.

The Effects of PBL(Problem-Based Learning) on Academic Resilience, Learning Flow, and Academic Motivation of Nursing Students (문제중심학습이 간호대학생의 학업 탄력성, 학습 몰입, 학업 동기에 미치는 효과)

  • Kang, Myungsuk;Park, Yoon-Jin;Choi, Seonyoung;Lee, Su-Jung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.6
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    • pp.291-298
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    • 2018
  • Purpose: The purpose of this study was to identify the effects of Problem-Based Learning on Academic Resilience, Learning Flow, and Academic Motivation in nursing students. Methods: Research design was a non-equivalent control group pretest-posttest design. The participants were 121 sophomore nursing students from two universities. They were divided into the Problem-Based Learning group (n=61) and Lecture-Based Learning group (n=60). The data were analyzed by Chi-square, paired t-test, and independent t-test. Results: In the PBL group, there was statistically significant improvement in Academic Resilience after intervention (pretest $3.88{\pm}.36$, posttest $4.00{\pm}.38$, p<.001). However, no statistically significant difference was found in the Lecture-Based Learning (LBL) group (pretest $3.86{\pm}.43$, posttest $3.93{\pm}.17$). In terms of Learning Flow, there was statistically significant improvement in the PBL group (pretest $3.31{\pm}.41$, posttest $3.51{\pm}.42$). However, no significant change was identified in the LBL group (pretest $3.45{\pm}.42$, posttest $3.48{\pm}.47$. Academic motivation was improved in the LBL group (pretest $3.32{\pm}.30$, posttest $3.46{\pm}.32$, p=.002) as well as in the PBL group (pretest $3.26{\pm}.23$, posttest $3.47{\pm}.21$, p<.001). Both results were statistically significant. Conclusion: These results suggest that Problem-Based Learning could be more effective for nursing students in improving their academic achievement. Further studies need to be investigated.