Purpose: Adrenocortical carcinoma (ACC) is a rare primary carcinoma originating in the adrenal gland with a poor prognosis and a high recurrence rate. This study evaluated the risk factors associated with recurrence in patients with early stage ACC after curative surgical resection. Methods: The present study retrospectively evaluated the risk factors for recurrence in 38 patients with stages 1 and 2 ACC who underwent curative resection between 1995 and 2020. Results: Recurrence was observed in 21 patients (55.3%), with no significant difference between stages 1 and 2 ACC (P = 0.640). The overall recurrence rate was higher in patients who underwent minimally invasive surgery than open adrenalectomy (71.4% vs. 51.6%). Of the 33 patients with gross tumor margins negative for malignancy, 16 (48.5%) experienced tumor recurrence, and all 5 patients with positive and unknown gross resection margins had recurrence.Recurrences were observed in 14 of the 30 patients (46.7%) negative for pathologic resection margins, 6 of the 7 patients (85.7%) with pathologically indeterminate margins, and 1 patient with pathologically positive margins. Conclusion The recurrence rates are high even in patients with early stage ACC, being higher in patients who undergo minimally invasive surgery than open adrenalectomy. Obtaining clear resection margins during surgery may reduce tumor recurrence; however, gross or pathologic margin safety was not a secure factor in preventing recurrence. None of the factors analyzed was a definitive predictor of poor prognosis.

Understanding brain function-related neural circuit connectivity is essential for investigating how cognitive functions are decoded in neural circuits. Trans-synaptic viral vectors are useful for identifying neural synaptic connectivity because of their ability to be transferred from transduced cells to synaptically connected cells. However, concurrent labeling of multisynaptic inputs to postsynaptic neurons is impossible with currently available trans-synaptic viral vectors. Here, we report a neural circuit tracing system that can simultaneously label postsynaptic neurons with two different markers, the expression of which is defined by presynaptic input connectivity. This system, called “cFork (see fork)”, includes delivering serotype 1-packaged AAV vectors (AAV1s) containing Cre or flippase recombinase (FlpO) into two different presynaptic brain areas, and AAV5 with a dual gene expression cassette in postsynaptic neurons. Our in vitro and in vivo tests showed that selective expression of two different fluorescence proteins, EGFP and mScarlet, in postsynaptic neurons could be achieved by AAV1-mediated anterograde trans-synaptic transfer of Cre or FlpO constructs. When this tracing system was applied to the somatosensory barrel field cortex (S1BF) or striatum innervated by multiple presynaptic inputs, postsynaptic neurons defined by presynaptic inputs were simultaneously labeled with EGFP or mScarlet. Our new anterograde tracing tool may be useful for elucidating the complex multisynaptic connectivity of postsynaptic neurons regulating diverse brain functions.

PURPOSE: This study aimed to investigate trends in home-visit nursing care by agencies' characteristics under the national long-term care insurance system. METHODS: Cochran-Mantel-Haenzel tests were conducted, using data drawn from the nationwide long-term care insurance claim database of the Korean National Health Insurance Corporation from 2009 to 2011. RESULTS: The number of home-visit nursing care agencies has decreased continuously since 2009. There were also similar trends in the total amount of service provided by home-visit nursing care agencies, the number of recipients, the number of employees, and payments. This study showed that there were statistically significant differences in the trends in home-visit nursing care by agencies' characteristics. Despite the overall downward trend, there were some increases in the percentage of home-visit nursing care provided by agencies which were established by individuals, located in large cities, and which combined home-visit care with home-visit bathing. CONCLUSION: Home-visit nursing care agencies are responsible for providing community-based healthcare services. For past three years, however, they have not been utilized to their full potential. Understanding the trends in home-visit nursing care by agencies' characteristics is important to develop utilization strategies for home-visit nursing care.
Delivery of Health Care ; Home Nursing ; Insurance, Long-Term Care ; Long-Term Care ; National Health Programs ; Nursing Care

For treatment of Total Skin Electron beam Therapy (TSET), measurement of dose at various conditions is need on the contrary to usual radiotherapy. When treating TSET with modified Stanford technique based on linear accelerator, the energy of treatment electron beam, the spatial dose distribution and the actual doses deposited on the surface of the patient were measured by using EBT2. The measured energy of the electron beam was agreed with the value that measured by ionization chamber, and the spatial dose distribution at the patient position and the doses at several point on the patient's skin could be easily measured by EBT2 film. The dose on the patient that was measured by EBT2 film showed good agreement with the data measured simultaneously by TLD. With the results of this study, it was proven that the EBT2 film can be one of the useful dosimeter for TSET.
Electrons ; Humans ; Particle Accelerators ; Skin

In proton therapy, the analysis of secondary particles is important due to delivered dose outside the target volume and thus increased potential risk for the development of secondary cancer. The purpose of this study is to analyze the influence of secondary particles from proton beams on fluence and energy deposition in the presence of inhomogeneous material by using Geant4 simulation toolkit. The inhomogeneity was modeled with the condition that the adipose tissue, bone and lung equivalent slab with thickness of 2 cm were inserted at 30% (Plateau region) and 80% (Bragg peak region) dose points of maximum dose in Bragg curve. The energy of proton was varied with 100, 130, 160 and 190 MeV for energy dependency. The results for secondary particles were presented for the fluence and deposited energy of secondary particles at inhomogeneous condition. Our study demonstrates that the fluence of secondary particles is neither influenced insertion of inhomogeneties nor the energy of initial proton, while there is a little effect by material density. The deposited energy of secondary particles has a difference in the position placed inhomogeneous materials. In the Plateau region, deposited energy of secondary particles mostly depends on the density of inserted materials. Deposited energy in the Bragg region, in otherwise, is influenced by both density of inserted material and initial energy of proton beams. Our results suggest a possibility of prediction about the distribution of secondary particles within complex heterogeneity.
Adipose Tissue ; Dependency (Psychology) ; Lung ; Population Characteristics ; Proton Therapy ; Protons

Geant4 (GEometry ANd Tracking) provides various packages specialized in modeling electromagnetic interactions. The validation of Geant4 physics models is a significant issue for the applications of Geant4 based simulation in medical physics. The purpose of this study is to evaluate accuracy of Geant4 electromagnetic physics for proton therapy. The validation was performed both the Continuous slowing down approximation (CSDA) range and the stopping power. In each test, the reliability of the electromagnetic models in a selected group of materials was evaluated such as water, bone, adipose tissue and various atomic elements. Results of Geant4 simulation were compared with the National Institute of Standards and Technology (NIST) reference data. As results of comparison about water, bone and adipose tissue, average percent difference of CSDA range were presented 1.0%, 1.4% and 1.4%, respectively. Average percent difference of stopping power were presented 0.7%, 1.0% and 1.3%, respectively. The data were analyzed through the kolmogorov-smirnov Goodness-of-Fit statistical analysis test. All the results from electromagnetic models showed a good agreement with the reference data, where all the corresponding p-values are higher than the confidence level alpha=0.05 set.
Adipose Tissue ; Magnets ; Proton Therapy ; Protons ; Water

Absorbed dose to water based protocols recommended that plane-parallel chambers be calibrated against calibrated cylindrical chambers in a high energy electron beam with R50>7 g/cm2 (E> or =16 MeV). However, such high-energy electron beams are not available at all radiotherapy centers. In this study, we are compared the absorbed dose to water determined according to cross-calibration method in a high energy electron beam of 16 MeV and in electron beam energies of 12 MeV below the cross-calibration quality remark. Absorbed dose were performed for PTW 30013, Wellhofer FC65G Farmer type cylindrical chamber and for PTW 34001, Wellhofer PPC40 Roos type plane-parallel chamber. The cylindrical and the plane-parallel chamber to be calibrated are compared by alternately positioning each at reference depth, zref=0.6R50-0.1 in water phantom. The DW of plane-parallel chamber are derived using across-calibration method at high-energy electron beams of 16, 20 MeV. Then a good agreement is obtained the DW of plane-parallel chamber in 12 MeV. The agreement between 20 MeV and 12 MeV are within 0.2% for IAEA TRS-398.
Electrons ; Water

Proton therapy facility, which is recently installed at National Cancer Center in Korea, generally produces a large amount of radiation near cyclotron due to the secondary particles and radioisotopes caused by collision between proton and nearby materials during the acceleration. Although the level of radiation by radioisotope decreases in length of time, radiation exposure problem still exists since workers are easily exposed by a low level of radiation for a long time due to their job assignment for maintenance or repair of the proton facility. In this paper, the working environment near cyclotron, where the highest radiation exposure is expected, was studied by measuring the degree of radiation and its duration for an appropriate level of protective action guide. To do this, we measured the radiation change in the graphite based energy degrader, the efficiency of transmitted beam and relative activation degree of the transmission beam line. The results showed that while the level of radiation exposure around cyclotron and beam line during the operation is much higher than the other radiation therapy facilities, the radiation exposure rate per year is under the limit recommended by the law showing 1~3 mSv/year.
Acceleration ; Cyclotrons ; Gamma Rays ; Graphite ; Jurisprudence ; Korea ; Proton Therapy ; Protons ; Radioisotopes

The purpose of study is to investigate whether glass rod detector (GRD) would be suitable for dosimeter of radiotherapy units. A GRD is used for the measurement of the output factors and x-axis beam profiles from Gamma Knife. The output factors measured with GRD from the 14, 8 and 4 mm collimators relative to the 18 mm collimator are 0.980+/-0.013, 0.949+/-0.013 and 0.872+/-0.012, respectively. The output factors obtained with a GRD are within 1.0% in good agreement with the values recommended by the manufacture. The full width at half maximum (FWHM) of x-axis beam profiles measured with GRD are 5.9 mm at a 4 mm collimator.
Glass* ; Radiotherapy

PURPOSE: This study was to design and fabricate a phantom for prostate cancer brachytherapy to validate a developed program applying a 3-film technique, and to compare it with the conventional 2-film technique for determining the location of an implanted seed. MATERIALS AND METHODS: The images were obtained from overlapped seeds by randomly placing a maximum of 63 seeds in the anterior-posterior (AP) position and at -30degrees to 30degrees at 15degrees intervals. Images obtained by use of the phantom were applied to the image processing procedure, and were then processed into the development program for seed localization. In this study, cases were set where one seed overlapped, where two seeds overlapped and where none of the three views resolved all seeds. The distance between the centers of each seed to the reference seed was calculated in a prescribed region. This distance determined the location of each seed in a given band. The location of the overlapped seeds was compared with that of the 2-film technique. RESULTS: With this program, the detection rate was 92.2% (at +/-15degrees), 94.1% (at +/-30degrees) and 70.6% (compared to the use of the 2-film technique). The overlaps were caused by one or more than two seeds that overlapped; the developed program can identify the location of each seed perfectly. However, for the third case the program was not able to resolve the overlap of the seeds. CONCLUSION: This program can be used to improve treatment outcome for the brachytherapy of prostate cancer by reducing the number of errors in the process of reconstructing the locations of perfectly overlapped seeds.
Brachytherapy* ; Image Processing, Computer-Assisted* ; Prostate* ; Prostatic Neoplasms ; Treatment Outcome