뇌암 및 두경부암 체적변조방사선치료시 Jaw-Tracking 기법의 선량학적 유용성 평가

김희성,문재희,김군주,서정민,이정진,최재훈,김성기,장인기,Kim, Hee Sung,Moon, Jae Hee,Kim, Koon Joo,Seo, Jung Min,Lee, Joung Jin,Choi, Jae Hoon,Kim, Sung Ki,Jang, In-Gi 대한방사선치료학회 2018 대한방사선치료학회지 Vol.30 No.1

목 적 : 체적변조회전방사선치료(VMAT)는 종양의 모양에 맞게 균일하면서도 정밀한 방사선 조사를 하면서 동시에 정상조직의 방사선 손상위험을 줄이는 장점이 있어 뇌암, 두경부암 및 전립선암 등의 종양과 정상장기가 가까운 암의 치료에 사용되고 있다. 본 연구의 목적은 뇌암 및 두경부암 환자의 VMAT 방사선 치료 시 Jaw-Tracking technique(JTT)의 선량학적 유용성을 평가하고자 한다. 대상 및 방법 : 본원에서 VMAT 치료기법으로 방사선치료를 받은 뇌암 및 두경부암 환자 8명을 선택하였다. 환자의 종양 및 정상 장기의 윤곽그리기(contouring) 정보를 Velocity(Varian, USA)의 deformable registration을 이용하여 Rando phantom에 fusion하였다. Varian Eclipse(ver 15.5, Varian, USA)를 사용하여 Jaw-Tracking 사용 유무를 제외하고 환자 치료 시 사용한 beam parameter와 동일하게 치료계획을 진행하였다. 평가 지표로써 target과 OAR의 최대선량, 평균선량을 사용하여 비교하였고 치료계획 검증을 위해 Portal dosimetry를 시행하였다. 결 과 : JTT를 사용했을 경우는 Static-Jaw technique(SJT)을 사용하였을 경우보다 OAR의 상대 선량이 각각 평균선량은 5.24 %, 최대선량은 7.05 % 감소한 것으로 나타났다. 다양한 OAR에서 평균선량과 최대선량의 감소의 범위는 각각 0.01~3.16 Gy, 0.12~6.27 Gy로 나타났다. Target의 경우는 JTT의 경우가 SJT보다 GTV, CTV, PTV의 최대선량이 각각 0.17 %, 0.43 %, 0.37 % 감소하였으며, 평균선량은 0.24 %, 0.47 %, 0.47% 감소하였다. 감마분석은 3 %/3 mm, 통과율 95 % 이상을 통과 기준으로 설정하였고 JTT, SJT 통과율은 각각 $98{\pm}1.73%$, $97{\pm}1.83%$이었다. 실험에 적용된 모든 OAR의 선량을 비교해 보았을 때, JTT을 사용하였을 경우가 SJT보다 MLC 외에 추가적인 jaw 차폐로 인하여 선량이 유의미하게 줄어들었다는 것을 알 수 있었다. 결 론 : VMAT 치료계획을 이용한 방사선 치료시 뇌암, 두경부암과 같이 종양과 정상 장기가 인접한 경우와 MLC를 통한 누설선량을 증가시킬 수 있는 넓은 조사야 및 높은 에너지의 사용을 필요로 하는 방사선 치료 시 JTT를 적용함으로써 종양주변 정상조직의 피폭선량을 낮추고 이로 인해 PTV의 target coverage를 높일 수 있을 것이라 판단된다. Purpose : Volumetric Modulated Arc Therapy(VMAT) has the advantage of uniformly and precisely irradiating the tumor to the shape of the tumor while reducing the risk of radiation damage to normal tissues. such as brain cancer, head and neck cancer and prostate cancer, It is being used for treatment. The purpose of this study is to evaluate the usefulness of the Jaw-Tracking technique(JTT) in VMAT for brain and head and neck cancer. Materials and Methods : We selected eight patients with brain and head and neck cancer(4 Brain, 4 head and neck) who were treated with the VMAT treatment technique. Contouring information of the patient's tumor and normal organ was fused to the Rando phantom using the deformable registration of Velocity(Varian, USA). A treatment plan was developed using the Varian Eclipse(ver 15.5, Varian, USA) with the same patient actual beam parameters except for the use of jaw-tracking. As the evaluation index, the maximum dose and mean dose of target and OAR were compared and a portal dosimetry was performed for the treatment plan verification. Results : When using JTT, the relative dose of OAR decreased by 5.24 % and the maximum dose by 7.05 %, respectively, compared with the Static-Jaw technique(SJT). In the various OARs, the mean dose and maximum dose reduction ranges ranged from 0.01 to 3.16 Gy and from 0.12 to 6.27 Gy, respectively. In the case of the target, the maximum dose of GTV, CTV, PTV decreased by 0.17 %, 0.43 %, and 0.37 % in JTT, and the mean dose decreased by 0.24 %, 0.47 % and 0.47 %, respectively. Gamma analysis The JTT and SJT passing rates were $98{\pm}1.73%$ and $97{\pm}1.83%$ on the basis of 3 % / 3 mm, respectively. Comparing the doses of all OARs applied to the experiment, it was found that the use of JTT resulted in a significant decrease in dose due to additional jaw shielding besides MLC than SJT. Conclusion : In radiation therapy using VMAT treatment plan, we can apply JTT in the case of adjacent tumor and normal organs such as brain cancer and head and neck cancer, and in radiotherapy required large field and high energy caused increase leakage dose through MLC. It is considered that the target dose of PTV can be increased by lowering the dose of normal tissue surrounding the tumor.

소아에 시행한 복강경 담낭 절제술

김희성,남소현,김대연,김성철,김인구,Kim, Hee-Seong,Nam, So-Hyun,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2006 소아외과 Vol.12 No.2

Laparoscopic cholecystectomy has been increasingly used because of several advantages, less pain, better expectation for cosmesis (requires small incisions), and more rapid recovery compared with open cholecystectomy. Oral intake is tolerated on the day of operation or on the next. In this study, we evaluated the effectiveness and safety of laparoscopic cholecystectomy in children. Nine cases of laparoscopic cholecystectomy for acute and chronic cholecystitis in children were performed at Asan Medical Center between April 2002 and April 2004. Laparoscopic cholecystectomy was performed on a total of 10 patients, but one of them was excluded because of the simultaneous splenectomy for sickle cell anemia. Clinical presentation, operative findings, operation time, length of hospital stay, and postoperative complications were analyzed. Mean age was 10.4 (4.15) years, and only 3 of patients were less than 10 years. One patient was female. In 8 the diagnosis was calculous cholecystitis. Mild adhesions were found in 3 cases and intraoperative bile leakage in 2. There was no conversion to open surgery and there were no vascular, bowel, or bile duct injuries. Mean operation time was 82.2 (20.160) minutes; mean length of hospital stay was 2.1 (1.3) day. There was no postoperative complication. Laparoscopic cholecystectomy in children was remarkably free of side effects and complications and had a short recovery time. Laparoscopic cholecystectomy for cholecystitis is considered to be a standard procedure in children.

현대 미술디자인 세계 - 군산대학교 현대미술연구소 작품을 중심으로 -

김희성,Kim, Hee-Sung 한국패션뷰티학회 2008 한국패션뷰티학회지 Vol.6 No.2

The Institute of Contemporary Art has gathered, arranged and exchanged historical data and a variety of information of art. It also aims at Helping revitalize artistic activities and develop diverse areas of art among regions. This scheme for revitalization of art includes holding seminars, international exhibitions or regional exchange exhibitions, publishing papers, and enhancing art education. This paper provides a view of what the Institute of Contemporary Art at Kunsan University has done so far, pursues better ways for revitalization of artistic activities, and suggests a future-oriented approach for making the institute a place for regional exchange of modem art and design.

구절 동사와 전치사 수반동사의 의미에 따른 음성적 실현

김희성,송지연,김기호,Kim, Hee-Sung,Song, Ji-Yeon,Kim, Kee-Ho 대한음성학회 2007 말소리 Vol.63 No.-

Verb phrase could have two different meanings according to which is followed after verb; adverb or preposition. The meaning of 'verb+adverb' is deduced from a figurative meaning which is idiomatic expression, and 'verb+preposition' is interpreted as the literal meaning. The purpose of this study is to observe how English native speakers and Korean leaners of English distinguish two sentences of the same word strings with acoustic cues like pause and duration. According to the result, as pause was used for meaning distinction, it was likely that the pause length preceding prepositions was longer than that of following adverbs. To distinguish two sentences of the same word strings, all participants seemed to use pause, verb lengthening and adverb/preposition lengthening. Among them, there is a hierarchical significance; in sequence, pause, verb lengthening, adverb/preposition lengthening.

기고 - 혹서기 대비 산란계 사양관리 중점사항

김희성,Kim, Hui-Seong 대한양계협회 2013 월간 양계 Vol.45 No.8

고혈압을 동반한 당뇨병에서 유병기간에 따른 뇌졸중 위험도

김희성,Kim, Hee Sung 대한임상검사과학회 2020 대한임상검사과학회지(KJCLS) Vol.52 No.3

Stroke is a major cause of death and disorder, and diabetes mellitus (DM) is a significant risk factor of stroke. This study examined the importance of target blood pressure (<140/<90 mmHg) management in patients with DM. Based on the data of the 6th National Health and Nutrition Examination Survey, a total of 16,389 patients aged 18 to under 80 were assessed through regression analysis to estimate the risk of stroke through blood pressure control. The prevalence of stroke according to the presence or absence of DM was higher in the diabetic group, and a longer duration of DM indicated a higher risk of hypertension and stroke. The hazard ratio of stroke was lower in the maintenance group (0.57) of target blood pressure (<140/<90 mmHg) compared to the high blood pressure group(>140/>90 mmHg). Despite the accompanying treatment for DM and hypertension, the frequency of hypertension increased, and the prevalence of stroke increased after five years of DM. Hence, effective blood pressure management at this time is important. The risk of stroke should be reduced by continuously managing blood pressure in DM. 뇌졸중은 사망발생 및 장애를 일으키는 주요 원인 질환이며, 당뇨병은 뇌졸중의 주요 위험인자이다. 당뇨병 환자가운데 뇌졸중을 동반한 환자에서 적정 혈압 관리의 중요성을 알아보고자 한다. 제6기 국민건강영양조사 자료를 바탕으로 18세 이상 80세 미만자 총 16,389명을 대상으로 회귀분석을 통하여 당뇨병 유병기간에 따른 혈압조절을 통한 뇌졸중의 위험도를 산정하였다. 당뇨병 유무에 따른 뇌졸중의 유병률은 당뇨병 환자 군에서 높았고, 당뇨병의 유병기간이 길어질수록 고혈압과 뇌졸중의 위험도는 상승하였으며, 당뇨병과 고혈압에 대한 치료 비율은 높았다. 고혈압군에 비해 적정 혈압 유지군(<140/<90 mmHg)에서 뇌졸중 위험비(HR)는 0.57 낮았다. 당뇨병과 고혈압에 대한 치료가 동반됨에도 불구하고 고혈압의 빈도는 상승하였고, 당뇨병 유병기간 5년 이후 뇌졸중의 유병률이 상승함에 따라 이 시기의 효과적인 혈압관리가 더욱 중요하다. 당뇨병 환자에서 지속적으로 적정 혈압으로 관리함으로써 뇌졸중 위험도를 낮추는 것이 중요하다.

최근 일반 건강인에 대한 매독 혈청 검사 양성율 - 1995년

김희성,이한승,이민걸,이정복 ( Hee Sung Kim,Han Sung Lee,Min Geol Lee,Jung Bock Lee ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.3

Background: The VDRL is used as a screening test for syphilis worldwide. In addition, reactive rates of the VDRL test are used to estimate the incidence of syphilis. The prevalence of syphilis reported in Korea varies according to the study population, district and time. Reports on prevalence of syphilis indicate that reactive rates of the serologic test for syphilis showed an increasing tendency in the 1960s and has steadily decreased in the 1990s. We have already reported VDRL positive rates periodically since the late 1970s in similar areas with similar population groups and methods in order to standardize the results for accurate analysis of the prevalence of syphilis in Korea. Objective : This study was performed utilizing the VDRL test in order to find out if the decreasing trend of syphilis prevalence is still continuing. Methods : The ser ologic tests for syphilis were carried out on 13,426 apparently normal adults aged twenty-years-old or over(8,250 blood donors in the Seoul area, 2,461 physical examinees examined at Severance Hospital, Yonsei University and 2,715 pregnant women at delivery at Severance Hospital, Yonsei University ) from January to December 1995. We hve performed the VDRL quantitative test in VDRL-reactive persons among blood donors and pregnant women. Results : The reactive rate of the serum VDRL test was 0.2% in 13,426 healthy adults(blood donors.0.2%, physical examinees:0,2%, pregnant women:0.3%). There was a statistically decreasing tendency compared to 0.4% in 1990(p<0.001). The VDRL quantitative test resulted in levels below the 1:2 titer in 92% of the VDRL-reactive physical exarninees and pregnant women. Conclusion . From the comparison of VDRL reactive rates for syphilis in an apparently normal Korean population obtained by the present author group since 1977, i.e., 2.5% in 1977, 1.1% in 1981, 0.6% in 1986, 0.4% in 1990 and 0.2% in 1995, it is clear that the prevalence of syphilis has been rapidly decreasing since the mid 1970s in Korea. (Kor J Dermatol 1997;35(3): 514-519)

베체트병 환자의 말초혈액에서 T 림프구의 아형과 T 림프구의 혈관 내피세포에 대한 유착

김희성,방동식,이광훈 ( Hee Sung Kim,Dong Sik Bang,Kwang Hoon Lee ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.5

Background: Behcets disease represents a polysymptomatic, recurrent vasculitis' with a chronic course. Its etiology and pathogenesis still remains unclear. Several immunological abnormalities have been described in this disease and altered cell mediated immunity especially has been suggested to play an important role in the pathogenesis. Recently, suppressor-inducer (naive, CD4-CD45RA+ ) and helper-inducer (memory, CD4-CD45RO+) human T cell subsets have been identified by their relevant monoclonal antibodies. It has heen suspected that human dermal microvascular endothelial cells(HDMEC) are an important part in the pathogenesis of Behcets disease. However, there was no report for HDMEC-T lymphocyte adhesion in Behcets disease, Objective : We have investigated the subpopulation differences in CD4- T lymphocytes and the adhesiveness of T lymphocytes to cultured HDMEC in the presence of IL-1a, or TNF-a using T lymphocytes isolated from normal human subjects and Behcets disease patients respectively. Methods : T lymphocyte subsets were evaluated by the two-color immuno-fluorescence flow cytometric analysis using anti CD4-, CD8-, CD45RA- and CD45RO monoclonal antibodies. The binding assay of T lymphocytes to HDMEC was performed before and after stimulating HDMEC with IL-la or TNF-a. Results : 1. The number of CD4- T cells and the CD4+ to CD8+ ratio decreased in patients with Behcets disease compared to normal controls. 2. In the CD4+ T cell subpopulation, there was a significant decrease in the CD4+CD45RA+cell number with a slight increase in the CD4+ CD45RO+ cell number. 3. After stimulating HDMEC with IL-la and TNF-a, the degree of T lymphocyte-HDMEC adhesion generally increased in an E:T ratio dependent, manner in patients with Behcets disease compared to normal controls. 4. Increased binding of CD4+ CD45RA+ naive T lymphocytes and CD4+CD45RO+ memory T lymphocytes to HDMEC was induced after stimulation with IL-1a and TNF-a in both patients and normal controls. The increasing rate was higher in Behcets disease patients than in normal controls. There was no difference in T lymphocyte-HDMEC adhesion between memory and naive T lymphocytes. Conclusion : From these findings it can be postulated that the decrease in the CD4+CD45RA+ count may lead to the inactivation of CD8 suppressor cells resulting in abnormal immune suppression shown in Behcets disease. Proinflammatory cytokines may also play an integral role in the pathogenesis of Behcet's disease by activating endothelial cells increasing the interaction between T lymphocytes and endothelial cells. Increasing the interaction between T lymphocytes and HDMEC may be indirect evidence of activation of cell-mediated immunity. (Korean J Dermatol 1997;35(5): 883-892)

림프절 세침흡인 세포검사의 진단적 유용성과 한계 - 생검으로 확진한 176 예의 분석 -

김희성,김대수,오영륜,고영혜,이회정,Kim, Hee-Sung,Kim, Dae-Soo,Oh, Young-Lyun,Ko, Young-Hyeh,Ree, Howe-J. 대한세포병리학회 1999 대한세포병리학회지 Vol.10 No.1

The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.

초점 실현과 운율 조작에 대한 음소지각

김희성,신지영,김기호,Kim, Hee-Seung,Shin, Ji-Young,Kim, Kee-Ho 대한음성학회 2006 말소리 Vol.60 No.-

The purpose of this study is to observe how Korean listeners detect a target phoneme with 'Focus' represented by prosodic prominence and question-induced semantic emphasis, and with intonational manipulation. According to the automated phoneme detection task using E-Prime, the Korean listeners detected phoneme targets more rapidly when the target-bearing words were in prominence position and in question-induced position. However, the presence of question-induced semantic emphasis reduced the prominence effect, so two effects interacted: when question-induced emphasis were primarily given as a cue, prominence which was given as secondary cue affected less to fine the new information. Besides, the intonation with manipulation was responded to faster than without manipulation.