An assessment of quality of life for early phase after adjuvant radiotherapy in breast cancer survivors: a Korean multicenter survey (KROG 14-09)

Backgrounds: Quality of life (QoL) has become a major concern as the survival time of breast cancer increases. We investigated the changes in QoL through comprehensive categorical analysis, for the first three years after breast cancer treatment including radiotherapy. Methods: A total of 1156 patients were enrolled from 17 institutions. All survivors were grouped according to a surveillance period of 9-15 months (first year), 21-27 months (second year), and 33-39 months (third year) from the end of radiotherapy. The 5-dimensional questionnaire by the EuroQol group (EQ-5D) and the EORTC Quality of Life Questionnaire; breast cancer specific module (QLQ-BR23) were checked by self-administrated method. Results: First, second and third year groups comprised 51.0, 28.9, and 21.0%. In EQ-5D-3 L (3-Likert scale) analysis, pain/discomfort and anxiety/depression categories showed lower QoL. In multivariate analyses of EQ-5D-VAS (visual-analogue scale), categories of pain/discomfort and self-care were improved with time; axillary dissection was a significant clinical factor deteriorates pain/discomfort, self-care and usual activities. In QLQ-BR23 analysis, the lowest scored category was sexual activity, followed by sexual enjoyment, future perspective, and hair loss, and the best scored category was breast symptoms. In multivariate analyses, arm symptoms, breast symptoms and body image were improved with time. Conclusions: Categories of pain/discomfort and self-care in EQ-5D-VAS, arm/breast symptoms and body image in QLQ-BR23 were improved, while categories of anxiety/depression and future perspective BR23 were not, suggesting necessity of psychosocial support. This research provides comprehensive information on the categorical aspects of QoL and changes during early follow-up after breast cancer treatment.ope

Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.ope

Establishment of a Disease-Specific Graded Prognostic Assessment for Hepatocellular Carcinoma Patients with Spinal Metastasis

Background/Aims: Hepatocellular carcinoma (HCC) patients with spinal metastasis (SM) show heterogeneous lengths of survival. In this study, we develop and propose a graded prognostic assessment for HCC patients with SM (HCC-SM GPA). Methods: We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors that significantly affected survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016. Results: We developed the HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status (0-2, 0 point; 3-4, 1 point), controlled primary HCC (yes, 0 point; no, 2 points), and extrahepatic metastases other than bone (no, 0 point; yes, 1 point). Patients were stratified into low (GPA=0), intermediate (GPA=1 to 2), and high risk (GPA=3 to 4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 17.8%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p<0.001). Conclusions: Our newly proposed HCC-SM GPA successfully predicted survival outcomes.ope

입는 전자기기와 이식용 전자기기를 위한 높은 전기적인 성능의 늘어나는 나노복합체 전극

학위논문(박사) -- 서울대학교대학원 : 공과대학 화학생물공학부(에너지환경 화학융합기술전공), 2022. 8. 현택환.The difference in the mechanical property of soft biological tissue and rigid conventional biomedical devices causes various problems such as immune reaction and degradation of the devices. To overcome these issues, stretchable electronics have been developed. Biomedical devices based on stretchable electronics is soft and stretchable like biological tissues. Electrodes in biomedical devices measure bioelectric signals and can give electrical stimulation to tissues. Nanocomposite of metal nanomaterials and elastomer can exhibit both high electrical conductivity of metal and soft mechanical property of elastomer. The performance of stretchable nanocomposite electrode is determined by the types of metal nanomaterials and the fabrication method of the nanocomposite. In Chapter 1, which is the Introduction chapter, previous studies on the stretchable nanocomposite electrodes are described. Following the Chapter 1, Chapter 2 describes the float assembly method of fabricating nanocomposite electrode. A conductive and elastic nanomembrane was fabricated and it has completely phase-separated structure: One side of the nanomembrane is composed of aligned nanowires and the other side is thin elastomer layer. The extremely high conductivity and stretchability of the nanomembrane is attributed to the unique (hybrid) structure. The nanomembrane can be patterned with photo-patterning method. By stacking the photo-patterned multiple nanomembranes, I fabricated multifunctional wearable devices. In chapter 3, I developed a material strategy for a strain-insensitive nanocomposite under skin deformations. The nanocomposite, which is composed of silver nanomaterials and elastomers, was designed for skin electronics. The silver nanomaterials conjugated with 1-decanethiol exhibit adaptive self-organization behavior inside the elastomer matrix in response to uniaxial and biaxial strains. The combination of the nanomaterials of different dimensions could keep their percolation networks under various strains applied to the nanocomposite. In chapter 4, I synthesized a noble gold nanomaterial for stretchable bioelectrodes. The gold nanomaterial can be synthesized by a simple and scalable method. It has low percolation threshold and dimensions larger than the electron mean free path of gold. I fabricated stretchable nanocomposite electrodes with the gold nanomaterials and thermoplastic polyurethane. The stretchable electrodes exhibited exceptional electrical performance at low weight fraction of the conductive fillers. Platinum was coated on the surface of the gold nanomaterials. By decorating the stretchable electrodes with the platinum-coated gold nanomaterials, I could improve electrochemical properties of the stretchable electrodes.부드러운 생체조직과 단단한 기존의 의료용 전자기기 간의 물리적인 특성의 차이는 면역반응과 기기의 기능 저하 등의 다양한 문제를 일으킨다. 이런 문제를 극복하기 위해서 신축성 전자기술이 개발되고 있다. 신축성 전자기기를 기반으로 만들어진 의료용 전자기기는 생체조직과 같이 부드럽고 늘일 수 있다. 의료용 기기에 사용되는 전극은 생체신호를 읽고 생체조직에 전기자극을 주는 역할을 한다. 금속 나노재료와 탄성체의 나노합성물은 금속의 전기전도성과 탄성체의 부드러운 물리적인 성질 둘 다를 가진다. 늘어나는 나노합성물 전극의 성능은 합성물의 제작방법과 금속나노재료의 종류에 의해 결정된다. 논문의 주제에 대해서 소개를 하는 첫 번째 챕터에서는 늘어나는 합성 전극에 대한 앞선 연구들에 대해서 소개한다. 두 번째 챕터에서는 물위에서 조립을 하는 방법을 사용하여 나노합성물전극을 만드는 방법에 대해서 설명한다. 이 방법으로 만든 전도성이 있고 늘일 수 있는 나노박막은 완전히 상이 분리된 구조로 이루어져 있다. 한 면의 나노박막은 한 방향으로 배열된 나노선으로 이루어져있고, 다른 면은 얇은 탄성체층으로 이루어져 있다. 이 특별한 구조에 의해서 나노박막은 굉장히 높은 전기전도도와 늘어나는정도를 가진다. 나노박막은 빛 감응 패터닝 방법으로 패턴을 만들 수 있다. 패턴을 만든 여러층의 나노박막을 쌓음으로써 나는 복합적인 기능을 가지는 입는 전자기기를 성공적으로 제작하고, 시연하였다. 세 번째 쳅터에서 나는 피부의 변형에 따라서 저항이 변하지 않는 나노합성물을 만드는 방법을 개발하였다. 그 나노합성물은 은 나노재료와 탄성체로 이루어졌으며, 피부위에 사용하는 전자기기를 위하여 디자인 되었다. 1-데칸싸이올을 리간드로 가지고 있는 은 나노재료는 탄성체의 내부에서 한 방향이나 두 방향의 변형하에서 스스로 정렬이 되는 형상을 보였다. 다른 종류의 나노재료를 합쳐서 만든 나노합성물은 다양한 변형 하에서 저항을 일정하게 유지하였다. 네 번째 쳅터에서 나는 신축성 생체전극을 위한 새로운 금 나노재료를 합성하였다. 금 나노재료는 간단하고 규모를 쉽게 키울 수 있는 방법을 통해 합성되었다. 그 나노재료는 낮은 퍼콜레이션 한계를 가지고 있었고, 크기가 금의 전자 평균 이동거리보다 컸다. 나는 이 금 나노재료와 폴리우레탄으로 신축성 나노합성물 전극을 만들었다. 그 신축성 전극은 낮은 전도성 충전재 분율에서도 높은 전기적인 성능을 보였다. 백금을 이 금 나노재료위 위에 코팅하였다. 백금을 코팅한 금 나노재료로 늘어나는 전극의 표면을 덮어줌으로써 나는 신축성 전극의 전기화학적 성능을 향상시킬 수 있었다.Chapter 1. Introduction: Stretchable and conductive nanocomposite electrodes for biomedical applications 1 1.1 Introduction 1 1.2 Conductive fillers for stretchable nanocomposite electrodes 6 1.2.1 Characteristics of conductive fillers for high performance stretchable electrodes 9 1.2.2 Metal nanomaterials for stretchable bioelectrodes 13 1.3 Fabrication techniques for stretchable nanocomposite electrodes 17 1.4 Biomedical applications of stretchable electrodes 22 1.4.1 Wearable devices 22 1.4.2 Implantable devices 26 1.5 Dissertation overview 29 1.6 References 32 Chapter 2. Fabrication of highly conductive and stretchable nanomembrane for skin-electronics 40 2.1 Introduction 40 2.2 Experimental Section 41 2.3 Results and Discussion 47 2.4 Conclusion 72 2.5 References 74 Chapter 3. Ordered organization of nanomaterials in stretchable nanocomposites with strain-insensitive resistance 79 3.1 Introduction 79 3.2 Experimental Section 82 3.3 Results and Discussion 86 3.4 Conclusion 106 3.5 References 107 Chapter 4. Synthesis of highly branched gold nanosheets for stretchable and biocompatible nanocomposite electrodes 116 4.1 Introduction 116 4.2 Experimental Section 120 4.3 Results and Discussion 128 4.4 Conclusion 143 4.5 References 144 Bibliography 152 국문 초록 (Abstract in Korean) 155박

Compensatory hypertrophy of the liver after external beam radiotherapy for primary liver cancer

PURPOSE: We investigated whether external beam radiotherapy (EBRT) could induce compensatory liver hypertrophy in liver cancers and assessed related clinical factors. METHODS: A total of 82 consecutive patients receiving EBRT for hepatocellular carcinoma (n = 77) or cholangiocarcinoma (n = 5) from April 2012 to June 2014 were recruited and divided into two subgroups according to tumor location in the right or left lobe. The left lateral and right lobes were considered as unirradiated volumes accordingly. Total liver volume (TLV), nontumor liver volume (NLV), left and right lobe whole volume (LLWV and RLWV, respectively), volume of liver irradiated < 30 Gy (V< 30 Gy), Child-Pugh (CPS) score, future liver remnant (FLR) ratio, and percentage of FLR hypertrophy from baseline (%FLR) were assessed. RESULTS: In the right lobe group, %FLR hypertrophy and LLWV increased significantly at all follow-ups (p < 0.001). %FLR hypertrophy steadily increased until the fourth follow-up. Multivariate analysis showed that the factor associated with maximum %FLR hypertrophy was tumor extent (upper or lower lobe vs. both lobes; p = 0.022). Post-RT treatments including transarterial chemoembolization or hepatic arterial infusion chemotherapy were associated with a CPS increase ≥ 2 (p = 0.002). Analysis of the RT only subgroup also showed a significant increase of %FLR until the fourth follow-up (p < 0.001). In the left lobe group, %FLR hypertrophy and RLWV showed no significant changes during follow-up. CONCLUSION: Significant compensatory hypertrophy of the liver was observed, with a steady increase of %FLR hypertrophy until the fourth follow-up (median: 396 days). Locally advanced tumors extending across the upper and lower right lobe were a significant factor for compensating hypertrophy after EBRT.restrictio

The historical formation and evolution process of the Korean local borrowing institution

본 연구에서는 해방 후 지방채 관련 법과 제도의 형성 및 변천 과정에 초점을 두고, 우리나라 지방채 구조의 역사적 형성 및 진화과정을 분석하였다. 분석결과 우리나라의 지방채 제도는 일본의 영향을 받아 제도적으로 발아하였으며, 초기의 제도적 틀이 거의 변하지 않고 현재에 이르고 있는 것으로 나타났다. 특히 우리나라의 지방채 제도는 중앙 의존적인 준보조금 형태의 성격을 띠는 것으로 드러났다. 이러한 특성은 우리나라 지방채 제도에 내재된 독특한 특성으로써, 이러한 특성은 다양한 환경변화에도 불구하고 쉽게 변화하지 않고 지속되어 왔다. 반면 지방재정에서 지방채가 차지하는 규모 또는 비율, 지방채의 지출내역 등은 1980년 이후 복지 등 삶의 질에 대한 관심 등재, 1990년대 지방자치의 부활, 1997년 IMF 사태 등 일련의 사건과 환경 변화에 따라 지속적인 변이와 요동을 보여주는 것으로 나타났다. This study analysed the historical formation and evolution process of the Korean local borrowing institutions. The major finding is that the local borrowing institution has been evolved as historical, endogenous process affected by inherent institutions, especially the history of the Korean centralized government and institutional legacy of the Japanese local finance. The Korean local borrowing maintained quasi-subsidies characteristics dependent upon the central government because of sensitive dependence on initial conditions and institutional legacy or lock in effect. Simultaneously, expenditure details, scale and ratio, activity result of the Korean local borrowing institution have been mutated and fluctuated through learning process by trial-and-error and adaptation over changing environments. In particular, mutation and fluctuation of the local borrowing institution have strongly influenced by interest enlargement about quality of life such as welfare, a local self-governing enforcement, economic crisis such as IMF.지방채 제도의 역사적 형성과 진화 과정 분석 본 논문은 2004년도 학술진흥재단 지원(한국관료제도사 2차 연구)에 지원을 받아 연구된 것임

A Comparison of National Happiness by Country Level: An Empirical Analysis of National Regime, Governance, and Quality of Life

이 논문은 2012년 정부(교육과학기술부)의 재원으로 한국연구재단의 지원을 받아 수행된 연구임 (NRF-2012S1A5A2A01017975).국민행복은 국가에서 국민이 느끼는 복합적이고 다차원적인 개념으로서 국가 안에서 국민들 이 인식하는 삶의 질의 총체이다. 이를 전제로 본 연구에서는 경제수준(1인당GDP), 기대수명, 국가규모(인구규모) 등의 특성을 통제한 상태에서 국가레짐(국가유형)과 거버넌스 수준이 국민 행복(NEF의 Happy Planet Index)과의 관계와 패턴에 대한 패널분석(panel analysis)을 수행 하였다. 그 결과, 국가레짐(국가유형)에 따라서, 거버넌스, 그리고 삶의 질에 미치는 영향은 상이 하며, 패턴의 차이를 보이는 것으로 분석되었다. 이상의 연구결과에 대해 시사점과 더불어, 후속 적 연구의 필요성에 대해서 논의하였다.National Happiness is a complex and multidimensional concept measuring what the people feel in a nation, and is the total quality of life that people perceive. In this study, national regime (national type) and the level of governance were measured by the Happy Planet Index of NEF, with the characteristics of economic level (per capita GDP), and life expectancy, A panel analysis of the patterns and relationships was conducted. As a result, the effects on governance and quality of life differed according to the national regime (country type), and the patterns were analyzed to show the differences. In addition to the implications of this study, the necessity of follow-up research was discussed

Improved oncologic outcomes by ablative radiotherapy in patients with bone metastasis from hepatocellular carcinoma

Purpose: For bone metastasis from hepatocellular carcinoma (HCC), radiotherapy (RT) has been used a palliative treatment with little impact on survival. Currently, ablative RT is popularly used, and a more than palliative effect is expected. Herein, we investigated the clinical efficacy of ablative RT in patients with bone metastasis from HCC. Methods: In total, 530 patients with 887 lesions treated in 1992-2019 were reviewed. Oligometastasis was defined as the presence of < 5 lesions. Total doses were normalized to obtain biologically effective doses (BEDs). The cut-off threshold of the BED was determined via receiver operating characteristics curve analysis. The Kaplan-Meier method was used to calculate overall survival (OS); propensity score matching (PSM) was performed to balance the heterogeneity in cases while comparing BEDs of ≥ 60 and < 60 Gy. Results: The most common site of metastasis was the spine (59%); 59 patients (11%) presented with oligometastasis, and 76.2% of patients showed objective pain palliation after RT. Median OS was 5.1 months for all patients; patients with oligometastasis showed longer OS than those without (9.8 vs. 4.7 months). A Cox proportional hazards model showed that performance status, Child-Pugh class, extraosseous metastasis, primary HCC status, α-fetoprotein level, and radiation dose (BED) were significant prognostic factors. Post PSM, BED was the only treatment-related prognostic factor that remained significant; the median OS durations were 8.1 and 4.4 months when the BEDs were ≥ 60 and < 60 Gy, respectively. Conclusion: Ablative RT improved OS and pain palliation in patients with bone metastasis from HCC.restrictio