Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Purpose: The use of two adjacent radiation beams to treat a lesion that is larger than the maximum field of a machine may lead to higher or lower dose distribution at the junction than expected. Therefore, evaluation of the junction dose is crucial for radiotherapy. Volumetric modulated arc therapy (VMAT) can effectively protect surrounding normal tissues by implementing a complex dose distribution; therefore, two adjacent VMAT fields can effectively treat large lesions. However, VMAT can lead to significant errors in the junction dose between fields if setup errors occur due to its highly complex dose distributions. Methods: In this study, setup errors of ±1, ±3, and ±5 mm were assumed during radiotherapy for treating large lesions in the lower abdomen, and their effects on the treatment dose distribution and target coverage were analyzed using gamma pass rate (GP) and homogeneity index (HI). All studies were performed using a computational simulation method based on our radiation treatment planning software. Results: Consequently, when the setup error was more than ±3 mm, most GP values using a 3%/3-mm criterion decreased by <90%. GP was independent of the direction of the field gap (FG), whereas HI values were relatively more affected by negative values for FG. Conclusions Therefore, the size and direction of setup errors should be carefully managed when performing dual-isocentric VMATs for large targets.

Background: The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. Methods: From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. Results: Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6–73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. Conclusion This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results: A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by −7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusions Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.

Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results: A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by −7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusions Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.

PURPOSE: The purpose of this study was to examine the effect of lifestyle intervention on the development of fatigue, nutritional status and quality of life of patients with gynecologic cancer. METHODS: A nonequivalent control group quasi-experimental design was used. Participants were 49 patients with gynecologic cancer. They were assigned to the experiment group (n=24) or the control group (n=25). The lifestyle intervention for this study consisted of physical activity, nutritional education, telephone call counseling, health counseling, monitoring for lifestyle, and affective support based on Cox's Interaction Model of Client Health Behavior and was implemented for six weeks. RESULTS: Significant group differences were found for fatigue (p =.037), nutritional status (p =.034) and social/family well-being (p =.035) in these patients with gynecologic cancer. CONCLUSION: Results indicate that this lifestyle intervention is effective in lessening fatigue, and improving nutritional status and social/family well-being. Therefore, nurses in hospitals should develop strategies to expand and provide lifestyle interventions for patients with cancer.
Adult ; Aged ; Antineoplastic Agents/therapeutic use ; *Fatigue ; Female ; Genital Neoplasms, Female/drug therapy/*psychology ; Health Behavior ; Health Education ; Humans ; *Life Style ; Middle Aged ; *Nutritional Status ; Proportional Hazards Models ; *Quality of Life ; Surveys and Questionnaires