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Gowoon Yang,Jee Suk Chang,Kyung Hwan Shin,Jin Ho Kim,Won Park,Haeyoung Kim,Kyubo Kim,Ik Jae Lee,Won Sup Yoon,Jihye Cha,Kyu-Chan Lee,Jin Hee Kim,Jin Hwa Choi,Sung-Ja Ahn,Boram Ha,Sun Young Lee,Dong Soo 대한방사선종양학회 2020 Radiation Oncology Journal Vol.38 No.4
Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion: Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.
Factors of spatial distribution of Korean village groves and relevance to landscape conservation
Kim, GoWoon,Kang, Wanmo,Park, Chan Ryul,Lee, Dowon Elsevier 2018 Landscape and urban planning Vol.176 No.-
<P><B>Abstract</B></P> <P>Our study aims to understand the spatial context of community-based landscape systems for conservation planning. To this end, the present study analyzes the factors affecting spatial distribution of Korea’s traditional village groves, which form a distinctive component of Korea’s traditional community-based landscape. Using maximum entropy (MaxEnt) modeling, we identified four strongest contributory factors that affect the current occurrences of village groves. First, the probability of occurrences declined with increasing human population density within a 300 m radius, and, second, it was lower where there was high forest cover (>80%) within a 500 m radius. Third, we found a unimodal pattern for the occurrence probability for precipitation during the coldest quarter with the probability peaking in areas where mean precipitation is 118 mm, while the occurrence probability for mean diurnal temperature range was generally positively correlated. Based on the assumption that spatial analysis could highlight priorities and implications for conservation, our results reveal the importance of understanding the grove landscape as a manifestation of the linkages between nature and humans as well as the importance of modern scientific approaches to manage the spatial elements of traditional landscape systems.</P> <P><B>Highlights</B></P> <P> <UL> <LI> MaxEnt modelling identified distribution factors of Korea’s village groves. </LI> <LI> The probability of grove occurrence had a unimodal relation with population density. </LI> <LI> The probability of grove occurrence was low when forest cover was high (>80%). </LI> <LI> Climatic factors also affected the probability of grove occurrence. </LI> <LI> Conservation efforts should address human effects on community-based landscape. </LI> </UL> </P>
Radiotherapy for initial clinically positive internal mammary nodes in breast cancer
Kim, Jina,Chang, Jee Suk,Choi, Seo Hee,Kim, Yong Bae,Keum, Ki Chang,Suh, Chang-Ok,Yang, Gowoon,Cho, Yeona,Kim, Jun Won,Lee, Ik Jae The Korean Society for Radiation Oncology 2019 Radiation Oncology Journal Vol.37 No.2
Purpose: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.
Lee, Gowoon,Lee, Sangwoo,Ha, Nayoung,Kho, Younglim,Park, Kyunghwa,Kim, Pilje,Ahn, Byeongwoo,Kim, Sunmi,Choi, Kyungho Academic Press 2019 Ecotoxicology and environmental safety Vol.173 No.-
<P><B>Abstract</B></P> <P>Gemfibrozil, a lipid-regulating pharmaceutical, has been widely used for treating dyslipidemia in humans and detected frequently in freshwater environments. Since plasma cholesterol is a precursor of steroid hormones, the use of gemfibrozil may influence the sex hormone balances. However, its endocrine toxicity following long-term exposure is not well understood. The purpose of the present study is to investigate the effects of gemfibrozil on sex hormones and reproductive outcomes in a freshwater fish, following a long-term (155 d) exposure. For this purpose, Japanese medaka embryos (F0) were exposed to a series of gemfibrozil concentrations, i.e., 0, 0.04, 0.4, 3.7, and 40 mg/L for 155 d, and reproductive parameters, sex hormones, and associated gene expressions were assessed. For comparison, a short-term exposure (21 d) was performed separately with adult medaka and measured for sex hormones and related gene expressions. Following the 155 d long-term exposure, the fecundity showed a decreasing pattern. In addition, at 3.7 mg/L gemfibrozil, testosterone (T) level in the female fish was significantly decreased, and the hatchability of F1 fish was significantly decreased. The <I>estrogen receptor</I> (<I>er)</I> or <I>vitellogenin</I> (<I>vtg)</I> genes in gonads and liver were up-regulated. However, plasma cholesterol levels did not show significant changes in both sexes. The observations from the short-term (21 d) exposure were different from those of the long-term exposure. Following the short-term exposure, decreased 17β-estradiol (E2), and 11-ketotestosterone (11-KT) levels along with decrease plasma cholesterol were observed in the male fish. The hormone disruption following the short-term exposure appears to be associated with the hypocholesterolemic activity of gemfibrozil. Our results show that the mechanisms of gemfibrozil toxicity may depend on the exposure duration. Consequences of long-term exposure to other fibrates in the water environment warrant further investigations.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Exposure to gemfibrozil led to sex hormone and reproduction changes in fish. </LI> <LI> Changes in steroidogenesis and cholesterol levels were different by exposure duration. </LI> <LI> Long-term (155 d) exposure from embryo stage caused weak estrogenic responses. </LI> <LI> Short-term adult exposure caused decreased E2 levels. </LI> </UL> </P>