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박정호,김유진,노영선,김소라,차원철,신상도 대한의학회 2019 Journal of Korean medical science Vol.34 No.9
Background: Longer transport adversely affects outcomes in out-of-hospital cardiac arrest (OHCA) patients who do not return to spontaneous circulation (ROSC). The aim of this study was to determine the association between the transport time interval (TTI) and neurological outcomes in OHCA patients without ROSC. Methods: We analyzed adult OHCA patients with presumed cardiac etiology and without prehospital ROSC from 2012 to 2015. The study population was divided into 2 groups according to STI (short STI [1–5 minutes] and long STI [≥ 6 minutes]). The primary exposure was TTI, which was categorized as short (1–5 minutes), intermediate (6–10 minutes), or long (≥ 11 minutes). The primary outcome was a good neurological recovery at discharge. Multiple logistic regression analysis was used in each STI group. Results: Among 57,822 patients, 23,043 (40%), 20,985 (36%), and 13,794 (24%) were classified as short, intermediate, and long TTI group. A good neurological recovery occurred in 1.0%, 0.6%, and 0.3% of the patients in the short, intermediate and long TTI group, respectively. Among 12,652 patients with short STI, a good neurological recovery occurred in 2.2%, 1.0%, and 0.4% of the patients in the short, intermediate and long TTI group, respectively. Among 45,570 patients with long STI, a good neurological recovery occurred in 0.7%, 0.5%, and 0.3% of the patients in the short, intermediate and long TTI group, respectively. When short TTI was used as a reference, the adjusted odds ratios (AOR) of TTI for good neurological recovery was different between short STI group and long STI group (AOR [95% confidence interval, 0.46 [0.32–0.67] vs. 0.72 [0.59–0.89], respectively, for intermediate TTI and 0.31 [0.17–0.55] vs. 0.49 [0.37–0.65], respectively, for long TTI). Conclusion: A longer TTI adversely affected the likelihood of a good neurological recovery in OHCA patients without prehospital ROSC. This negative effect was more prominent in short STI group.
박정호,Park, Jung-Ho 대한정형외과스포츠의학회 2005 대한정형외과스포츠의학회지 Vol.4 No.1
관절 연골 손상은 급성 손상과 만성 손상인 퇴행성 관절염으로 구분되며, 급성 손상은 연골 손상의 깊이에 따라서 미세 손상, 연골 골절, 골연골 골절의 세 종류로 구분할 수 있고 각 손상의 종류별로 서로 다른 양상의 치유 반응과 예후를 보인다. 만성 관절 연골 손상은 다양한 원인으로 인해서 발생하며 관절 연골의 전반적인 퇴행성 관절염의 형태를 보인다. 관절 연골 손상 시 초기 손상의 정도가 예후를 결정짓는데 가장 중요하고 이외에도 손상의 크기, 부위, 나이, 활동성, 비만 정도, 하지 정렬 상태등도 예후를 결정하는 중요한 요소들이다. 본 논문에서는 관절 연골 손상 시 발생하는 관절 연골 내의 병태 생리적 변화에 대하여 기술하고 비수술적인 치료 방법을 생역학적인 측면과 생물학적인 측면으로 구분하여 그 효과를 알아보고자 한다. Injury of articular cartilage can be classified into acute injury and chronic degenerative osteoarthritis Acute mechanical trauma on articular cartilage causes injuries that are divided into three distinct types based on the depth of injury: microdamage, chondral fracture, osteochondral fracture and each type has different potential of healing response and long-term prognosis. Articular cartilage undergoes degradation in response to a number of stimuli and eventually degenerative osteoarthritic changes will progress. The extent of initial injury to the articular cartilage is the most important factor affecting the long-term outcome of the healing response and other variables such as the size of lesion, site, age, activity level, obesity, limb alignment are also important factors. In this review, the pathophysiology that occurs within articular cartilage after different injuries and the effect of nonsurgical treatment mainly in physicochemical aspect and biological aspect will be discussed.
아칼라지아와 비아칼라지아성 식도 운동 질환에서의 보툴리눔독소 주입 치료
박정호 대한연하장애학회 2015 대한연하장애학회지 Vol.5 No.1
Botulinum toxin is one of the deadliest nerve poisons known throughout human history. Among seven different biological substances, only subtypes A, B and E have been implicated in human botulinum intoxication. Botulinum toxin A is synthesized intracellularly as an inactive, single-chain polypeptide that is converted to a dichain molecule by proteolysis. The dichain molecule is composed of a heavy chain (molecular weight 100 KDa) and a light chain (50 KDa) linked by a disulfide bond. Light chain of botulinum toxin A irreversibly interferes with acetylcholine (Ach) release by destroying the synaptosome-associated protein of 25 KDa (SNAP-25) and its effect begins 3-5 hours after injection and peak effect appears 2 weeks later. However, neuromuscular blockade by botulinum toxin A is rapidly reversed by axonal sprouting that emerge over 2 to 6 months for a gradual return of neuromuscular function, thereby limiting the duration of efficacy of botulinum toxin A. Recently botulinum toxin A is used therapeutically for a variety of spastic disorders, including strabismus, hemifacial spasm, skin wrinklers and disorders of GI smooth muscle. This review summarized the current state of knowledge concerning the use botulinum toxin in the achalasia and non-achalasia esophageal motility disorder.