Relining technique for continuous sac enlargement and modular disconnection secondary to endotension after endovascular aortic aneurysm repair

Moon Il Lee,Woo Young Shin,Yun Mee Choe,Jae Young Park,Jang Yong Kim,Yong Sun Jeon,Soon Gu Cho,Kee Chun Hong 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.3

Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully. During follow-up after the relining procedure, the size of aneurysm sac continued to decrease in size. The relining technique is effective mothod for treating endotension.

TITLE : Purification of Human Interferon - alpha from Recombinant E . coli

Jin Kyu Lee,Moon Kee Choe,Kwang Hoe Chung,Sung Bok Paik 생화학분자생물학회 1990 90년도 학술대회 초록 Vol.- No.-

급성 충수염 진단에 있어서 <SUP>99m</SUP>Tc-Ciprofloxacin (Infecton) Imaging의 실험적 연구

정성택(Sung Taek Chung),문연희(Youn hee Moon),최연승(Yun-Seung Choi),허윤석(Yoon Seok Hur),최선근(Sun Keun Choi),이건영(Keon-Young Lee),김세중(Sei Joong Kim),안승익(Seung-Ik Ahn),홍기천(Kee-Chun Hong),최원식(Won Sik Choe),신석환(Seok 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.68 No.1

유전자 재조합 대장균으로부터 인간 Interferon - β

이진규,이석재,최문기,정광희,신광순,백승복 ( Jin Kyu Lee,Jae Lee,Moon Kee Choe,Kwang Hoe Chung,Kwang Soon Shin,Sung Bok Paik ) 생화학분자생물학회 1990 BMB Reports Vol.23 No.2

Glutathione S-transferase ρ (EC 2.5.1.18) has been purified to homogeneity from human erythrocytes. A combination of gel filtration, ion exchange and hydroxylapatite chromatographic procedure yields the specific activity of 20.8 units/㎎. The purified enzyme gives a single band corresponding to 24,000 M.W. on a sodium dodecyl sulfate polyacrylamide gel electrophoresis. The enzyme molecule is characterized to be an acidic protein (pI 4.6) having a dimeric structure with 48,000 M.W. composed of identical size of polypeptide chains. Apparent K_m and V_(max) were determined to be 1.1 mM and 1.0 mmol/1/min for 1-chloro-2,4-dinitro benzene respectively while 0.3 mM and 0.55 mmol/l/min for glutathione. Results obtained from chemical modification studies suggest that essential amino group(s) critically connected to the catalytic function of glutathione S-transferaseρ.

Purification of Human Interferon-${\beta}$ from Recombinant E. coli

이진규,이석재,최문기,정광회,신광순,백승복,Lee, Jin-Kyu,Lee, Seok-Jae,Choe, Moon-Kee,Chung, Kwang-Hoe,Shin, Kwang-Soon,Paik, Sung-Bok 생화학분자생물학회 1990 한국생화학회지 Vol.23 No.2

유전자 재조합 인간 Interferon-${\beta}$를 초음파 처리, 8 M Guanidine-HCl 추출, inclusion body의 용해, 희석, Blue Sepharose CL-6B column chromatography, HPLC gel filtration 방법 등을 이용하여 대장균으로부터 정제하였다. 정제된 IFN-${\beta}$의 specific activity는 $3.1{\times}10^8$ IU/mg이었고 정제도는 1,902이었다. 정제된 IFN-${\beta}$는 환원된 상태와 환원되지 않은 상태에서 SDS polyacrylamide gel electrophoresis 한 결과 모두 단일 띠로 나타났으며 분자량은 18,000 dalton이었다. N-말단 아미노산을 조사한 결과 재조합 인간 IFN-${\beta}$는 천연형 인간IFN-${\beta}$와 같이 N-말단이 methionine임이 밝혀졌다. 전자 현미경을 이용하여 inclusion body 형성을 조사한 결과 IFN-${\beta}$ 유전자를 가지고 있는 대장균에서는 inclusion body의 형성을 확인할 수 있었으나 숙주(wild type)에서는 확인되지 않았다. 최종적으로 정제된 IFN-${\beta}$의 정제도는 HPLC gel filtration 한 결과 99% 이상으로 나타났다. Recombinant human interferon-${\beta}$ was purified to homogeneity from E. coli by methods of sonication, extraction with 8 M Guanidine HCl, solubilization of inclusion body, dilution, Blue Sepharose CL-6B column chromatography and HPLC gel filtration. Specific activity of purified IFN-${\beta}$ was $3.1{\times}10^8$ IU/mg protein and the purification was 1,902 fold. The purified IFN-${\beta}$ was a single band on SDS polyacrylamide gel electrophoresis under reducing condition and non-reducing condition and its molecular weight was estimated to 18,000 dalton. The results of N-terminal analysis showed that recombinant human IFN-${\beta}$ has N-terminal methionine same as natural human IFN-${\beta}$. The inclusion bodies were observed in the E. coli cells harboring IFN-${\beta}$ gene but not observed in the host cells (MM 294). The purity of finally purified IFN-${\beta}$ was more than 99% by HPLC gel filtration.

Probability of Early Retirement Among Emergency Physicians

Shin, Jaemyeong,Kim, Yun Jeong,Kim, Jong Kun,Lee, Dong Eun,Moon, Sungbae,Choe, Jae Young,Lee, Won Kee,Lee, Hyung Min,Cho, Kwang Hyun The Korean Society for Preventive Medicine 2018 Journal of Preventive Medicine and Public Health Vol.51 No.3

Objectives: Early retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction. Methods: A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram. Results: Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors. Conclusions: To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

Molecular Biological Identification of Malassezia Yeasts Using Pyrosequencing

( Ji Young Kim ),( Hyung Jin Hahn ),( Yong Beom Choe ),( Yang Won Lee ),( Kyu Joong Ahn ),( Kee Chan Moon ) 대한피부과학회 2013 Annals of Dermatology Vol.25 No.1

Background: A Pyrosequencing assay has been used in identification of fungal species such as Candida or Aspergillus and diagnosis of pathogenic bacteria such as Helicobacter pylori but there has been no report on successful isolation and identification of Malassezia yeasts using the pyrosequencing method. Objective: Examine the applicability and plausibility of the pyrosequencing method in identification of the Malassezia species. Methods: At internal transcribed spacer (ITS) sites 1 and 2, three primers were developed using Pyrosequencing Assay Design Software (Biotage AB). Pyrosequencing was performed on 11 standardstrains and 83 genomic DNA samples obtained from 66 healthy controls aged from 1 to 80. Results: The eleven Malassezia standard species and 83 genomic DNA samples were successfully identified using the pyrosequencing assay. Conclusion: The pyrosequencing method is a new tool for analysis of Malassezia yeasts, and its precision and rapidity suggests its clinical applicability. (Ann Dermatol 25(1) 73∼ 79, 2013)

토모테라피를 이용한 두경부암 방사선치료에서 Aid-pillow 사용에 따른 Pitch와 Yaw의 변화 분석

정재홍,조광환,김용호,문성권,민철기,김은석,이경배,정주영,서태석,최보영,Jung, Jae Hong,Cho, Kwang Hwan,Kim, Yong Ho,Moon, Seong Kwon,Min, Chul Kee,Kim, Eun Seog,Lee, Kyung-Bae,Jung, Joo-Young,Suh, Tae-Suk,Choe, Bo-Young 한국의학물리학회 2013 의학물리 Vol.24 No.1

본 연구의 목적은 두경부암 환자에서 aid-pillow 사용에 따른 pitch와 yaw의 변화를 분석하고자 하였다. 두경부암 환자 총 14명을 선정하여 aid-pillow 미사용 그룹(without, n=7)과 사용 그룹(with, n=7)으로 나누어 비교 분석하였다. 총 333회의 MVCT 영상을 이용하여 미사용 그룹(153 image set)과 사용 그룹(180 image set) 각각 종축 일치도(translational adjustments (lateral, longitudinal, vertical))와 회전축 일치도(rotational adjustments (pitch, roll, yaw))를 구하였다. Pitch의 변화 즉, 편차는 미사용 그룹 $0.12^{\circ}$이고, 사용 그룹 $0.09^{\circ}$였다. 그리고, yaw는 미사용 그룹 $0.47^{\circ}$이고, 사용 그룹 $0.17^{\circ}$였다. 전반적으로 사용 그룹이 미사용 그룹에 비해 편차가 작았다. 따라서, 토모테라피를 이용하여 두경부암 방사선치료 시 aid-pillow를 사용하여 pitch와 yaw의 변화를 줄임으로써, 치료의 재현성을 높일 수 있을 것으로 사료된다. The aim of this study was to analysis of the pitch and yaw deviations with or without using an aid-pillow for the head and neck cancer on the TomoTherapy. A total of 14 head and neck patients were selected to without-group (n=7) and with-group (n=7). A total of 333 MVCT image sets used to evaluate the translational (lateral, longitudinal and vertical) and rotational adjustments (pitch, roll and yaw) with 153 and 180 MVCT image sets at without- and with-group, respectively. Deviations of without- and with-groups were $0.12^{\circ}$ and $0.09^{\circ}$, respectively at pitch. And, deviations without- and with-groups were $0.47^{\circ}$ and $0.17^{\circ}$, respectively at yaw. In generally, with-group had reduced than without-group for the pitch and yaw deviations. Therefore, using an aid-pillow, it will able to increase the reproducibility of treatment for the head and neck cancer patients on the TomoTherapy.

Development of Independent Target Approximation by Auto-computation of 3-D Distribution Units for Stereotactic Radiosurgery

최경식,오승종,이정우,김정기,서태석,최보영,김문찬,정현태,Choi Kyoung Sik,Oh Seung Jong,Lee Jeong Woo,Kim Jeung Kee,Suh Tae Suk,Choe Bo Young,Kim Moon Chan,Chung Hyun-Tai Korean Society of Medical Physics 2005 의학물리 Vol.16 No.1

정위적 방사선 수술은 한 번에 두 개내 병소에는 고선량의 방사선을 조사하면서, 주위 정상조직에는 최소한의 방사선이 조사되도록 시술하는 치료기법이다. 본 연구는 정위적 방사선 수술시 자동적 치료계획을 수행하기 위하여, 선형가속기와 감마나이프의 다수의 회전중심점을 이용하는 치료계획에 대한 물리적 격자구조에 기반한 새로운 방법을 개발하였다. 최적의 방사선 수술계획은 많은 빔관련 변수들의 조합으로서 만들어진다. 본 연구에서는 선형가속기와 감마나이프 수술시 빔 측면도의 50% 수준에서의 선량분포가 콜리메이터/헬멧의 구멍 크기와 일치하는 점을 이용하여 하나의 회전중심점을 중심으로 선량분포를 구형으로 모델화시켰다. 그리고, 다수의 회전중심점들은 병소내 위치와 크기를 고려한 정육면체 구조와 1×1×1 ㎣의 체적소 단위의 계산에 의해 자동적으로 배치시켰다. 이 기법에 의한 치료계획 방법은 선량체적히스토그램, 선량의 일치성, 선량의 균질성의 병소내 선량분포로서 평가되었다. 그 결과, 새로운 기법은 불규칙한 병소들에 대하여 프로그램 시스템에 의해 빠르게 다수의 회전중심점들을 배치시켰다. 또한, RTOG의 권고사항에 언급된 병소내 선량분포의 일치성, 균질성이 기준을 잘 만족하였고, 병소들은 50% 이상의 등선량 곡선 내에 포함되었다. 이와 같은 성과는 불규칙하게 형성된 병소와 선형가속기나 감마나이프와 같은 다른 치료 장치 기법들에서 특별한 제약없이 보편적으로 적용이 될 수 있을 것으로 생각된다. The stereotactic radiosurgery (SRS) describes a method of delivering a high dose of radiation to a small tar-get volume in the brain, generally in a single fraction, while the dose delivered to the surrounding normal tissue should be minimized. To perform automatic plan of the SRS, a new method of multi-isocenter/shot linear accelerator (linac) and gamma knife (GK) radiosurgery treatment plan was developed, based on a physical lattice structure in target. The optimal radiosurgical plan had been constructed by many beam parameters in a linear accelerator or gamma knife-based radiation therapy. In this work, an isocenter/shot was modeled as a sphere, which is equal to the circular collimator/helmet hole size because the dimension of the 50% isodose level in the dose profile is similar to its size. In a computer-aided system, it accomplished first an automatic arrangement of multi-isocenter/shot considering two parameters such as positions and collimator/helmet sizes for each isocenter/shot. Simultaneously, an irregularly shaped target was approximated by cubic structures through computation of voxel units. The treatment planning method by the technique was evaluated as a dose distribution by dose volume histograms, dose conformity, and dose homogeneity to targets. For irregularly shaped targets, the new method performed optimal multi-isocenter packing, and it only took a few seconds in a computer-aided system. The targets were included in a more than 50% isodose curve. The dose conformity was ordinarily acceptable levels and the dose homogeneity was always less than 2.0, satisfying for various targets referred to Radiation Therapy Oncology Group (RTOG) SRS criteria. In conclusion, this approach by physical lattice structure could be a useful radiosurgical plan without restrictions in the various tumor shapes and the different modality techniques such as linac and GK for SRS.

Rotation Errors of Breast Cancer on 3D-CRT in TomoDirect

정재홍,조광환,문성권,배선현,민철기,김은석,여승구,최진호,정주영,최보영,서태석,Jung, Jae Hong,Cho, Kwang Hwan,Moon, Seong Kwon,Bae, Sun Hyun,Min, Chul Kee,Kim, Eun Seog,Yeo, Seung-Gu,Choi, Jin Ho,Jung, Joo-Yong,Choe, Bo Young,Suh, Tae Korean Society of Medical Physics 2015 의학물리 Vol.26 No.1

The purpose of this study was to analyze the rotational errors of roll, pitch, and yaw in the whole breast cancer treated by the three-dimensional radiation therapy (3D-CRT) using TomoDirect (TD). Twenty-patient previously treated with TD 3D-CRT was selected. We performed a retrospective clinical analysis based on 80 images of megavoltage computed tomography (MVCT) including the systematic and random variation with patient setup errors and treatment setup margin (mm). In addition, a rotational error (degree) for each patient was analyzed using the automatic image registration. The treatment margin of X, Y, and Z directions were 4.2 mm, 6.2 mm, and 6.4 mm, respectively. The mean value of the rotational error for roll, pitch, and yaw were $0.3^{\circ}$, $0.5^{\circ}$, $0.1^{\circ}$, and all of systematic and random error was within $1.0^{\circ}$. The errors of patient positioning with the Y and Z directions have generally been mainly higher than the X direction. The percentage in treatment fractions in less than $2^{\circ}$ at roll, pitch, and yaw are 95.1%, 98.8%, and 97.5%, respectively. However, the edge of upper and lower (i.e., bottom) based on the center of therapy region (point) will quite a possibility that it is expected to twist even longer as the length of treatment region. The patient-specific characters should be considered for the accuracy and reproducibility of treatment and it is necessary to confirm periodically the rotational errors, including patient repositioning and repeating MVCT scan. 본 연구의 목적은 토모다이렉트 3D-CRT (TD 3D-CRT)을 이용한 유방암 방사선치료에서 회전축(roll, pitch, and yaw) 오차를 분석하고 자 하였다. TD-3DCRT로 치료가 종료된 유방암 환자 총 20명을 선정하였고, 총 80회의 MVCT 영상을 바탕으로 시스템(systematic), 임의(random) 오류를 포함한 환자위치잡이 오차(patient setup errors)와 치료 여백(treatment margin, mm)을 후향적으로 분석하였다. 또한, 각 환자에 대한 회전축 오차 분석은 자동영상정합(automatic image registration)을 이용하였다. X, Y, Z 방향에 대한 치료여백은 각각 4.2 mm, 6.2 mm, 6.4 mm였다. 회전축 오차에 대한 평균 각도(degree)는 roll, pitch, yaw가 각각 0.3도, 0.5도, 0.1도였고, 시스템과 임의 오류는 모두 1도 이내였다. 전반적으로 환자 위치잡이 오차는 Y와 Z방향에서 X에 비하여 높게 나타났다. 본 연구에서 회전축 오차 각도가 2도 이내는 roll, pitch, yaw에서 각각 95.1%, 98.8%, 97.5% 분포였다. 그러나, 치료영역의 길이가 길어짐에 따라 치료 중심지점을 기준으로 상부와 하부의 가장자리(Edge)가 틀어지게(Twisted)될 가능성이 높아질 수 있다. 따라서 치료의 정확성과 재현성을 위하여 각 환자의 특성을 고려하고, 회전축 오차를 주기적으로 확인할 필요가 있다.