Effect of Driving Simulator Training on Patients' Driving Performance and Self-Efficacy with Paraplegia due to Spinal Cord Injury

원재경,이상헌 대한치료과학회 2023 대한치료과학회지 Vol.15 No.2

Objective: The purpose of this study was to investigate the effect of driving simulator training on the driving performance and self-efficacy of paraplegic patients with spinal cord injury. Method: Driving simulator training was provided to 12 participants with within subjects design, three sessions of basic driving, seven sessions of driving on the driving simulator. After training, performance time and operational performance scores, self-efficacy were analyzed. Results: This study found that the intervention by the driving simulator had statistically significant effects on driving time, performance error, ‘Sudden start’, ‘No neutral gear when stopping’, and ‘Speed violation’ and ‘Social self-efficacy’ of paraplegic spinal cord injury patients (p<.05). Conclusion: Driving simulator training can be a strategy to improve driving performance and social self-efficacy of paraplegic patients with spinal cord injury. Also, patients need sufficient sessions more than 10 times of driving simulator training.

Epithelial Cysts in the Intrapancreatic Accessory Spleen that ClinicallyMimic Pancreatic Cystic Tumor- A Report of Two Cases -

원재경,이유정,강경훈 대한병리학회 2005 Journal of Pathology and Translational Medicine Vol.39 No.6

Cystic lesions in the accessory spleen are extremely rare and they present a challenging clinical differential diagnosis. We report here on two cases of epithelial cyst of intrapancreatic accessory spleen that mimicked pancreatic cystic tumor. In both cases, the patients underwent distal pancreatectomy under the impression of a benign cystic tumor of the pancreas. Unilocular or multilocular cysts in the pancreas tail were observed, and these were later shown to be epithelial cysts in the accessory spleen located within the pancreatic tail. The cysts were lined by columnar, cuboidal or stratified squamous epithelium.

Pharmacological Unmasking Microarray Approach-Based Discovery of Novel DNA Methylation Markers for Hepatocellular Carcinoma

정남희,원재경,김백희,Kyung Suk Suh,장자준,강경훈 대한의학회 2012 Journal of Korean medical science Vol.27 No.6

DNA methylation is one of the main epigenetic mechanisms and hypermethylation of CpG islands at tumor suppressor genes switches off these genes. To find novel DNA methylation markers in hepatocellular carcinoma (HCC), we performed pharmacological unmasking (treatment with 5-aza-2´-deoxycytidine or trichostatin A) followed by microarray analysis in HCC cell lines. Of the 239 promoter CpG island loci hypermethylated in HCC cell lines (as revealed by methylation-specific PCR), 221 loci were found to be hypermethylated in HCC or nonneoplastic liver tissues. Thirty-three loci showed a 20% higher methylation frequency in tumors than in adjacent nonneoplastic tissues. Correlation of individual cancer-related methylation markers with clinicopathological features of HCC patients (n = 95) revealed that the number of hypermethylated genes in HCC tumors was higher in older than in younger patients. Univariate and multivariate survival analysis revealed that the HIST1H2AE methylation status is closely correlated with the patient’s overall survival (P = 0.022 and P = 0.010, respectively). In conclusion, we identified 221 novel DNA methylation markers for HCC. One promising prognostic marker, HIST1H2AE, should be further validated in the prognostication of HCC patients.

Molecular Testing of Brain Tumor

박성혜,원재경,김성익,이유진,박철기,김승기,최승홍 대한병리학회 2017 Journal of Pathology and Translational Medicine Vol.51 No.3

The World Health Organization (WHO) classification of central nervous system (CNS) tumors was revised in 2016 with a basis on the integrated diagnosis of molecular genetics. We herein provide the guidelines for using molecular genetic tests in routine pathological practice for an accurate diagnosis and appropriate management. While astrocytomas and IDH-mutant (secondary) glioblastomas are characterized by the mutational status of IDH, TP53, and ATRX, oligodendrogliomas have a 1p/19q codeletion and mutations in IDH, CIC, FUBP1, and the promoter region of telomerase reverse transcriptase (TERTp). IDH-wildtype (primary) glioblastomas typically lack mutations in IDH, but are characterized by copy number variations of EGFR, PTEN, CDKN2A/B, PDGFRA, and NF1 as well as mutations of TERTp. High-grade pediatric gliomas differ from those of adult gliomas, consisting of mutations in H3F3A, ATRX, and DAXX, but not in IDH genes. In contrast, well-circumscribed low-grade neuroepithelial tumors in children, such as pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and ganglioglioma, often have mutations or activating rearrangements in the BRAF, FGFR1, and MYB genes. Other CNS tumors, such as ependymomas, neuronal and glioneuronal tumors, embryonal tumors, meningothelial, and other mesenchymal tumors have important genetic alterations, many of which are diagnostic, prognostic, and predictive markers and therapeutic targets. Therefore, the neuropathological evaluation of brain tumors is increasingly dependent on molecular genetic tests for proper classification, prediction of biological behavior and patient management. Identifying these gene abnormalities requires cost-effective and high-throughput testing, such as next-generation sequencing. Overall, this paper reviews the global guidelines and diagnostic algorithms for molecular genetic testing of brain tumors.

거대세포종과 유사한 역분화 부분을 가지는 연골육종 -1예 보고-

황필규,원재경,김민아,김한수,이상훈,김종재 대한병리학회 2004 Journal of Pathology and Translational Medicine Vol.38 No.5

Dedifferentiated chondrosarcoma is an uncommon bone tumor, defined as a tumor in which two components -a low-grade chondrosarcoma and a high-grade non-cartilaginous sarcoma-coexist with abrupt interface. We report a rare case of giant-cell rich dedifferentiated chondrosarcoma occurred in the right distal femur shaft of a 60 year-old female. The plain X-ray film showed an irregular radiolucent mass. The T2-weighted MRI revealed a heterogeneous high signal intensity. It was an irregular mass composed of bluish-white, translucent chondroid elements and yellowish solid components with extraosseous invasion. Microscopically, a low-grade chondrosarcoma and a giant-cell rich spindle cell sarcoma with areas resembling giant cell tumor were recognized with abrupt transition. Immunohistochemical staining revealed a S100 protein positivity in chondroid cells and a few spindle cells. CD68 was strongly positive in giant cells. Vimentin was positive in both components and smooth muscle actin was positive in some spindle cells. There was no cytokeratin, desmin and myogenin immunopositivity. It is important to be aware of this rare variant of dedifferentiated chondrosarcoma to avoid the misdiagnosis of more common bone tumors including giant cell tumors.

한국판 갈베스톤 지남력과 기억상실 검사(Galveston Orientation and Amnesia Test)의 신뢰도 및 타당도 연구

이상헌,원재경 한국콘텐츠학회 2023 한국콘텐츠학회논문지 Vol.23 No.6

The aim of this study was to translate Galveston Orientation and Amnesia Test into Korean and to measure psychometric characteristics of Korean-Galveston Orientation and Amnesia Test(K-GOAT). Translating GOAT into Korean was conducted by modified forward/backward translation and cultural adaptation procedure. And then a cross-sectional study of psychometric measures for subacute phase closed head injury patients proceeded. Intrarater reliability(Intraclass correlation coefficient(ICC) 0.829∼1.000), test-retest reliability(ICC 0.873∼1.000), and concurrent validity(Spearman correlation coefficient 0.868∼0.817) were analyzed. All analyses were statistically significant(p<0.01). From these results, K-GOAT admit feasibility in clinical practice to assess orientation and amnesia following closed traumatic brain injury in the Republic of Korea. 본 연구는 갈베스톤 지남력과 기억상실 검사를 한국어로 번안하고 신뢰도 및 타당도를 분석하였다. 연구디자인은 단면연구 방식으로 설계되었으며, 연구자는 수정된 번역 및 역번역 방법으로 갈베스톤 지남력과 기억상실 검사를 번안하고 한국 상황에 맞게 수정하였다. 이후 연구자는 아급성기 폐쇄성 뇌손상 환자를 대상으로 한국판 갈베스톤 지남력과 기억상실 검사의 검사자간 심리계측학적 특성을 분석하였다. 연구 결과에서 검사자간 신뢰도(급간내 상관계수 0.829~1.000), 검사-재검사 신뢰도(급간내 상관계수 0.873~1.000), 동시타당도(스피어만 순위 상관계수 0.868~0.817)는 모두 통계학적으로 유의하였다. 본 연구를 통하여 한국판 갈베스톤 지남력과 기억상실 검사가 개발되어 국내에서 아급성기 폐쇄성 두부손상 환자의 지남력과 기억상실을 검사하는데 사용될 수 있을 것이다.

Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience

박성혜,원재경,김치헌,피지훈,김승기,최승홍,정춘기 대한척추신경외과학회 2022 Neurospine Vol.19 No.3

According to the new 2021 World Health Organization (WHO) classification of tumors of the central nervous system (CNS) the classification of the primary intramedullary spinal cord tumors (IM-SCT) follows that of CNS tumors. However, since the genetics and methylation profile of ependymal tumors depend on the location of the tumor, the ‘spinal (SP)’ should be added for the ependymoma (EPN) and subependymoma (SubEPN). For an evidence-based review, the authors reviewed SCTs in the archives of the Seoul National University Hospital over the past decade. The frequent pathologies of primary IM-SCT were SP-EPN (45.1%), hemangioblastoma (20.0%), astrocytic tumors (17.4%, including pilocytic astrocytoma [4.6%] and diffuse midline glioma, H3 K27-altered [4.0%]), myxopapillary EPN (11.0%), and SP-subEPN (3.0%) in decreasing order. IDH-mutant astrocytomas, oligodendrogliomas, glioneuronal tumors, embryonal tumors, and germ cell tumors can occur but are extremely rare in the spinal cord. Genetic studies should support for the primary IM-SCT classification. In the 2021 WHO classifications, extramedullary SCT did not change significantly but contained several new genetically defined types of mesenchymal tumors. This article focused on primary IM-SCT for tumor frequency, age, sex difference, pathological features, and genetic abnormalities, based on a single-institute experience.

시뮬레이터 훈련이 척수손상 환자의 운전시뮬레이터 도로 주행시간과 주행조작 능력에 미치는 영향: 단일사례 실험연구

이상헌,원재경 대한보조공학기술학회 2023 대한보조공학기술학회지 Vol.15 No.2

목적 : 본 연구는 시뮬레이터 훈련이 척수손상 환자의 운전시뮬레이터 도로 주행시간과 주행조작 능력에 미치는 영향을 알아보고자 하였다. 연구방법 : 본 연구는 단일사례실험연구 AB설계로 진행되었으며, 기초선 3회기, 중재기 10회기를 적용하였다. 기초선 3회, 중재기 5회 도로주행코스(중급) 수행 시 운전시간, 주행조작 능력 자료가 수집되었으며, 연구결과 분석을 위하여 시각적 분석 방법과 평균 ±2*표준 편차를 사용한 양적 분석을 동시에 사용하였다. 결과 : 연구대상자 3명의 총 주행시간은 기초선 A보다 중재기 B에서 3분 내외의 감소하였고, 세 명 모두에서 통계학적으로 의미있는 주행 능력의 향상이 확인되었다. 주행조작능력 또한 오류 점수가 감소하였고, 첫 번째 참여자와 세 번째 참여자의 경우 그 변화가 통계학적으로 유의하였다. 결론 : 본 연구에서 연구대상자의 총 주행시간 및 수행 오류의 감소가 확인되어 운전시뮬레이터 훈련의 효과가 있었다. 이와 같은 결과는 운전시뮬레이터 훈련의 적용 가능성을 뒷받침 한다 Objective : This study examines the effect of driving simulator training on driving time and driving errors in patients with spinal cord injury. Methods : The study was designed as an single-case experiment study AB design, and 3 sessions of the baseline and 10 sessions of the intervention period were applied. Driving time and driving errors were collected with the road driving course (intermediate) of 3 sessions of baseline and 5 sessions of intervention period, and visual analysis method and quantitative analysis using mean and 2*standard deviation were simultaneously used to analyze the research results. Results : The total driving time of the three study participants decreased by 3 minutes in the intervention period B compared to the baseline. The total driving errors also decreased in all three participants, and a statistically significant decrease was shown in the case of the first and third participants. Conclusions : The reduction in total driving time and reduction in driving errors were confirmed in three study subjects, verifying the effectiveness of driving simulator training.

스노젤렌(Snoezelen) 프로그램이 대학생의 우울감에 미치는 영향 : 사전 연구

서혜정,원재경,정예지,이성아,이상헌 한국정신보건작업치료학회 2012 한국정신보건작업치료학회지 Vol.2 No.1

목적 : 본 연구는 대학생을 대상으로 스노젤렌 프로그램 적용 시 우울에 미치는 영향을 알아보고자 한다. 연구방법 : 연구 대상자는 20∼24세의 대학생 35명으로, 6∼8명으로 구성된 5개의 그룹으로 나뉘어져 1시간의 스노젤렌 프로그램에 참여하였다. 연구자는 스노젤렌 프로그램 참여 전과 후에 한국판 Beck 우울척도(Beck Depression Inventory-Korean version)와 한국판 우울 형용사 체크리스트(Depression Adjective Checklist-Korean version)로 연구대상자의 우울감 변화를 측정하였다. 자료 분석은 SPSS 19.0을 사용하였고 통계 방법으로 윌콕슨 부호순위검정을 실시하였다. 결과 : 한국판 Beck 우울척도 점수는 프로그램 전 9.05±5.18에서 프로그램 후 3.40±3.05로 감소하였고, 한국판 우울 형용사 체크리스트에서도 프로그램 전에는 16.0±6.25에서 프로그램 후 5.02±3.12로 감소하여 모두 통계적으로 유의한 감소를 보였다(p<.01). 또한 초기 우울상태와 관계없이 두 평가 모두 점수가 통계학적으로 유의미한 감소를 보였다. 결론 : 본 연구를 통하여 스노젤렌 프로그램의 적용이 대학생들의 우울감 감소에 긍정적인 영향을 미친다는 것을 확인하였다. Objective : The purpose of this study was to investigate the effects of Snoezelen program on the decrease depression. Methods : 35 college students were divided 5 groups and received a session of Snoezelen for 1 hours, and they were evaluated with the Beck Depression Inventory-Korean version and Depression Adjective Checklist-Korean version. Before and after the snoezelen program. A statistical analysis was conducted by SPSS version 19.0 with Wilcoxon’s signed rank test. Results : Statistically significant decreases in the scores of Beck Depression Inventory-Korean version and Depression Adjective Checklist-Korean version were found after Snoezelen program. Also two test scores showed statistically significant decrease regardless of depression state before Snoezelen program. Conclusions : The results of this study showed that Snoezelen program had a positive effects on the decrease depression of college students.

Reclassification of Mixed Oligoastrocytic Tumors Using a Genetically Integrated Diagnostic Approach

김성익,이유진,원재경,박철기,최승홍,박성혜 대한병리학회 2018 Journal of Pathology and Translational Medicine Vol.52 No.1

Background: Mixed gliomas, such as oligoastrocytomas (OA), anaplastic oligoastrocytomas, and glioblastomas (GBMs) with an oligodendroglial component (GBMO) are defined as tumors composed of a mixture of two distinct neoplastic cell types, astrocytic and oligodendroglial. Recently, mutations ATRX and TP53, and codeletion of 1p/19q are shown to be genetic hallmarks of astrocytic and oligodendroglial tumors, respectively. Subsequent molecular analyses of mixed gliomas preferred the reclassification to either oligodendroglioma or astrocytoma. This study was designed to apply genetically integrated diagnostic criteria to mixed gliomas and determine usefulness and prognostic value of new classification in Korean patients. Methods: Fifty-eight cases of mixed OAs and GBMOs were retrieved from the pathology archives of Seoul National University Hospital from 2004 to 2015. Reclassification was performed according to genetic and immunohistochemical properties. Clinicopathological characteristics of each subgroup were evaluated. Overall survival was assessed and compared between subgroups. Results: We could reclassify all mixed OAs and GBMOs into either astrocytic or oligodendroglial tumors. Notably, 29 GBMOs could be reclassified into 11 cases of GBM, IDH-mutant, 16 cases of GBM, IDH-wildtype, and two cases of anaplastic oligodendroglioma, IDH mutant. Overall survival was significantly different among these new groups (p < .001). Overall survival and progression-free survival were statistically better in gliomas with IDH mutation, ATRX mutation, no microscopic necrosis, and young patient age (cut off, 45 years old). Conclusions: Our results strongly suggest that a genetically integrated diagnosis of glioma better reflects prognosis than former morphology-based methods.