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유방암 방사선치료에서 변형영상정합기법을 이용한 선량비교
원영진(YoungJin Won),김종원(JongWon Kim),김정훈(JungHoon Kim) 대한방사선과학회 2017 방사선기술과학 Vol.40 No.1
The purpose of this study is to reconstruct the treatment plan by applying CBCT and DIR to dose changes according to the change of the patient s motion and breast shape in the large breast cancer patients and to compare the doses using TWF, FIF and IMRT. CT and CBCT were performed with MIM6 to create DIRCT and each treatment plan was made. The patient underwent computed tomography simulation in both prone and supine position. The homogeneity index (HI), conformity index (CI), coverage index (CVI) to the left breast as planning target volume (PTV) were determined and the doses to the lung, heart, and right breast as organ at risk (OAR) were compared by using dose-volume histogram and the unique property of each organ. The value of HI of the PTV breast increased in all treatment planning methods using DIRCT, and CVI and CI were decreased in the treatment planning methods using DIRCT. 본 연구는 거대유방암 환자대상으로 환자의 움직임과 모양의 변화에 따른 선량변화를 콘빔단층촬영영상(CBCT) 과 변형영상정합기법(DIR)을 적용하여 적응형방사선치료계획을 재구성하여 기존에 사용된 쐐기접선조사기법(TWF) 과 종속조사면 병합치료방법(FIF) 그리고 세기조절방사선치료계획(IMRT)을 이용하여 선량비교평가를 시행하고자 하였다. CT와 CBCT를 MIM6 사용하여 변형영상정합기법영상(DIRCT)을 만들어 각각의 치료계획을 시행하였다. 계 획표적체적(PTV)은 왼쪽 유방이고 균질성지표(HI), 적합성지표(CI), 조사범위지표(CVI)의 값을 확인하였다. 관심 장기(OAR)는 반대쪽 유방, 폐 그리고 심장이며 평균선량, 최대선량과 장기 특성에 따른 기타 지표들을 비교 분석하였다. PTV인 유방의 HI 값은 DIRCT를 이용한 모든 치료계획방법에서 증가하였으며, CVI, CI의 결과에서는 DIRCT를 이용한 치료계획방법에서 모두 감소하였다. 폐에서의 평균선량과 최대선량은 DIRCT 이용한 IMRT 치료 계획방법이 다른 치료계획보다 증가함을 보였으며, 심장의 평균선량과 최대선량은 DIRCT를 이용한 TWF와 FIF는 감소했으며, 오히려 IMRT의 결과는 증가하였다. 유방암 방사선치료 시 환자의 움직임과 셋업 오차로 인해 유방모양의 변경을 감암했을 때 TWF와 IMRT보다 FIF 방법을 이용했을 때 반대편 유방과 심장, 폐의 피해선량을 효과적으로 감소시킬 수 있을 것으로 사료된다.
Clinical outcome of early relaparotomy after elective open repair of abdominal aortic aneurysms
Youngjin Han,Tae-Won Kwon,Gi-Young Ko,Hojong Park,Ji Yoon Choi,Yong-Pil Cho 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.88 No.3
Purpose: The aim of this study was to retrospectively evaluate the association of need for early relaparotomy with clinical outcomes after elective open repair of abdominal aortic aneurysms (AAAs). Methods: A total of 292 consecutive patients who underwent elective open AAA repair at Asan Medical Center from January 2001 to December 2010 were included in this study, and we compared the demographics, clinical characteristics, related risk factors, and clinical outcomes of early relaparotomy versus nonrelaparotomy patients. Results: The incidence of early relaparotomy during a single hospital stay was 4.1% (n = 12), and the most common causes were bowel ischemia (n = 5, 41.7%) and postoperative bleeding (n = 3, 25.0%). Among the demographics and clinical characteristics significantly associated with relaparotomy were: age (P = 0.025), chronic obstructive pulmonary disease (COPD) (P = 0.010), number of RBC units transfused during the AAA repair (P = 0.022) and in the following week (P = 0.005), and length of intensive care (P < 0.001) and overall hospital stay (P < 0.001). On multivariate analysis, presence of COPD (P = 0.009) and number of RBC units transfused during the AAA repair (P = 0.006) were statistically significantly associated with relaparotomy. Furthermore, early relaparotomy was associated with perioperative (within 30 days) (P = 0.048) and overall in-hospital mortality (P = 0.001). Conclusion: Early relaparotomy has an adverse effect on clinical outcomes: increased mortality and hospital length of stay. Presence of COPD and need for RBC transfusion are associated with early relaparotomy.
S-211 Identification of a novel gene variant of SCN1B in a Korean patient with Brugada syndr ome
( Won Kyeong Jeon ),( Youngjin Cho ),( Il-young Oh ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Brugada syndrome (BS) is inheritable disease characterized by typical ECG morphologies of right bundle-branch block and ST segment elevation of right precordial leads without any structural heart disease. The change of transmembrane ion current is a major pathophysiological mechanism of BS which can lead to sudden cardiac death. Many genetic mutations of various ion channels were reported. We described here the case of a Korean patient with a novel gene variant of SCN1B first reported in the world. In May 2015, 51-year-old male transferred to emergency room of Seoul National University Bundang hospital. He was already resuscitated after five times of shock by public emergency response team from initial rhythm of ventricular fibrillation. Brain CT, coronary CT, and echocardiography was normal. While reviewing medical records, his treadmill test done 11 years ago was found out. It showed spontaneous changes on ECG, which was compatible with Brugada pattern type I. He was clinically diagnosed as BS and implantable cardiac defibrillator was inserted. Genetic analysis was performed and the result showed missense mutation of 35th codon (exon 1) in SCN1B from cytosine to adenine which resulted amino acid change from alanine to glutamic acid (SCN1B c.35C>A (p.A12E)) (Figure). This might cause anatomical or functional change in beta1-subunit of sodium channel which can cause fatal arrhythmia. According to Leiden Open Variation Database, ClinVar Database and Korean Reference Genome Database, this is a novel gene mutation never reported before.
Won, Jiyu,Oh, Youngjin,Park, Jongcheol,Park, Jae Young,Jo, Min-Sik,Kim, Donghyun The Optical Society 2012 Applied optics Vol.51 No.13
<P>In this paper, we report the development of an optical sensor network (OSN) based on piezoelectrically actuated corner cube retroreflectors (PA-CCRs). PA-CCRs were fabricated by microelectromechanical systems processes and assembled by aligning horizontally actuated mirrors and vertical side walls in a holder, which allows mass production. Fabricated PA-CCRs showed a tilting angle by more than 1.5 deg at 5 V bias voltage. A 3 dB cutoff frequency was measured to be in the range of 3.5 kHz. To show the feasilbility, an OSN was established based on fabricated PA-CCRs for on-off keying passive transmission links. The results demonstrated data transmission at a rate up to 5 kb/s.</P>