전국 10개 종합병원 중환자실 환자의 직장내 Vancomycin-resistant Enterococci(VRE) 보균율, 보균의 위험요인 및 유전적 다양성 조사

정희진,송준영,엄중식,김우주,최선주,최정현,이혁,정문현,이광미,신동현,손보라,최종성,우흥정,권정아,이경원,최강원,박승철 대한감염학회 2002 감염 Vol.34 No.5

관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

한국인에서 혈소판 당단백 Ⅱb/Ⅲa 유전자 다형성과 관동맥 성형술 후 재 협착과의 관계

이민수,이정우,김보영,임대승,강정아,김정희,김윤철,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.2

Platelet aggregation is the final pathway of acute coronary syndrome such as acute myocardial infarction and unstable angina. Platelet glycoprotein IIb/IIIa is a membrane receptor for fibrinogen and yon Willebrand factor and it plays an important role in platelet aggregation and in the pathogenesis of acute coronary syndrome. It is known that polymorphism of the gene that encoding platelet glycoprotein IIb/IIIa(PI^A1/A2) is strongly related to acute coronary syndrome in Caucasian, but not in Koreans. We investigated relationship between platelet glycoprotein llb/Illa gene polymorphism and restenosis of coronary artery after angioplasty in Koreans. Total 371 patients(M=251. F=120) were enrolled. Angioplasty group comprised 143 patients who underwent coronary angioplasty, and in the angioplasty group, restenosis group comprised with the 65 patients who had restenotic lesion over 50% of luminal diameter in follow-up coronary angiography. Normal group comprised 153 patients who had no significant angiographic lesion and variant angina group comprised 75 patients who were positive in ergonovine test. Genomic DNA was extracted from peripheral arterial blood. To determine the frequency of P1^A1/A2 genotype, polymerase chain reaction(PCR) was done and the product was restricted with Mspl. 3%. agarrose gel electrophoresis showed restriction fragment length polymorphism. Clinical profile and risk factor were also reviewed. Among all 371 patients of study group, genotype of only one patients in restenosis group if is proven to be PI^A1/A2 heterozygote. All patients of normal study group, no restenosis group, and the other patients in restenosis group have an PI^A1 homozygote genotype. In our study, platelet glycoprotein IIb/Illa polymorphism has no relationship with restenosis of the coronary artery after angioplasty in Koreans. But the genotypic frequency of platelet glycoprotein IIb/IIIa gene polymorphism in Koreans is concordant with that of previous studies.

Analysis of in vitro 2D-COSY on Human Brain Metabolites for Molecular Stereochemistry: The Preliminary Results

Bo-Young Choe,Sang-Young Kim,우동철,Eun-Jung Bang,김상수,임향숙,최치봉 한국자기공명학회 2008 Journal of the Korean Magnetic Resonance Society Vol.12 No.1

To investigate the 3-bond connectivity of human brain metabolites by scalar coupling interaction through 2D-correlation spectroscopy (COSY) techniques using high field NMR spectroscopy. All NMR experiments were performed at 298K on Unity Inova 500 or 600 (Varian Inc.) equipped with a triple resonance probe head with z-shield gradient. Human brain metabolites were prepared with 10% D2O. Two dimensional 2D COSY spectra were acquired with 4096 complex data points in t2 and 128 or 256 increments in t1 dimension. The spectral width was 9615.4 Hz and solvent suppression was achieved using presaturation using low power irradiation of the water resonance during 2s of relaxation delay. NMR data were processed using VNMRJ (Varian Instrument) software and all the chemical shifts were referenced to the methyl resonance of N-acetyl aspartate (NAA) peak at 2.0 ppm. Total 10 metabolites such as N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), glutamine (Gln), glutamate (Glu), myo-inositol (Ins), lactate (Lac), taurine (Tau), γ-aminobutyricacid (GABA), alanine (Ala) were included for major target metabolites. Symmetrical 2D-COSY spectra were successfully acquired. Total 14 COSY cross peaks were observed even though there were parallel/orthogonal noisy peaks induced by water suppression. Except for Cr, all of human brain metabolites produced COSY cross peaks. The spectra of NAA methyl proton at 2.02 ppm and Glu methylene proton (CH2(3)) at 2.11 ppm and Gln methylene proton (CH2(3)) at 2.14 ppm were overlapped in the similar resonance frequency between 2.00 ppm and 2.15 ppm. The present study demonstrated that in vitro 2D-COSY represented the 3-bond connectivity of human brain metabolites by scalar coupling interaction. This study could aid in better understanding the interactions between human brain metabolites in vivo 2D-COSY study. Also it would be helpful to determine the molecular stereochemistry in vivo by using two-dimensional MR spectroscopy

Metabolic Abnormalities in Idiopathic Parkinson's Diseases with Unilateral Symptoms

Choe, Bo-Young,Kim, Moon-Chan,Kim, Bum-Soo,Lee, Jae-Moon Korean Magnetic Resonance Society 2004 Journal of the Korean Magnetic Resonance Society Vol.8 No.1

Authors investigated whether there is a lateral effect of $^1$H MRS observable metabolite ratios between the symptomatic and the nonsymptomatic side in the early stage of Parkinson's disease with unilateral symptom. Localized in vivo $^1$H MR spectroscopy (MRS) was used to measure the metabolite levels in the symptomatic and the nonsymptomatic sides of the lentiform nucleus in Parkinson"s disease with unilateral symptom (N=25). The metabolite ratios of NAA/Cr and Cho/Cr in the symptomatic side were compared with those in the nonsymptomatic side. Significant metabolic lateral effect of NAA/(Cho+Cr) ratio was established between the symptomatic and the nonsymptomatic side of lentiform nucleus in Parkinson's disease with unilateral symptom (p<0.05). The ratio of NAA/(Cho+Cr) homolateral to the sympatomatic side of the patient is also lower than that of the control (P<0.05). On the basis of NAA/Cr ratios of lentiform nucleus between the symptomatic and the nonsymptomatic side, the present $^1$H MRS study shows a significant neuronal laterality in Parkinson's disease with unilateral symptom. In vivo $^1$H MRS may provide a diagnostic marker for neuronal dysfunction in Parkinson's disease with unilateral symptom.

Gadolinium-Enhancement on Fast Spin-Echo MR Imaging : Impact on Diagnosis of Meniscal Tears and Differentiation of Acute and Chronic Ligament Tears

Choe, Bo-Young,Shinn, Kyung-Sub,choi, Kyu-Ho,Jee, Won-Hee,Kim, Jung Man 가톨릭 의과학연구원 1997 가톨릭 의과학연구원 국제학술대회 Vol.1 No.-

In conclusion, our present results showed that FSE pulse sequence could be acceptable in the diagnosis of meniscal tears, and additional FSGE MR imaging could enhance meniscal detectability (i. e., 3% increase in our study). Also, FSGE MR imaging could be useful in differentiating acute from chronic ligament injury.

In Vivo $^1H$ MR Spectroscopic Study on Levodopa-Treated Parkison's Disease

Choe, Bo-Young,Baik, Hyun-Man,Son, Byung-Chul,Kim, Moon-Chan,Kim, Euy-Neyung,Suh, Tae-Suk,Lee, Hyoung-Koo,Shinn, Kyung-Sub Korean Magnetic Resonance Society 2000 Journal of the Korean Magnetic Resonance Society Vol.4 No.1

Authors evaluated alterations of observable metabolite ratios between the cerebral lesion and the contralateral region related to the clinical symptomatic side in levodopa-treated Parkinson's disease (PD) and investigated correlation between age in patients with PD and metabolite ratios of the lesion. Patients with levodopa-treated PD (n = 54) and age-matched normal controls (n = 15) underwent magnetic resonance spectroscopy (MRS) examinations using a stimulated echo acquisition mode (STEAM) pulse sequence that provided 2$\times$2$\times$2 cm3 volume of interest in the selected regions of substantia nigra (SN) and putamed-globus pallidus (PG). To evaluate dependence of metabolite ratios on age, we divided into two groups (i.e., younger and older age). We quantitatively measured N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (Cho), inositols (Ins), and the sum of glutamate (Glx) and GABA levels and obtained proton metabolite ratios relative to Cr using a Marquart algorithm. Compared with the contralateral region, a significant neuronal laterality of the NAA/Cr ratio in the lesion of SN related to the clinical symptomatic side was established (P = 0.01), but was not established in the lesion of PG (P = 0.24). Also, Cho/Cr ratio tended toward significance in the lesion of SN (P = 0.07) and was statistically significant in the lesion of PG(P = 0.01). Compared with that in the younger age group, NAA/Cr ratio in the older age was decreased in the lesion of SN (P = 0.02), while NAA/Cr ratio was not statistically significant in the lesion of PG ( P = 0.21). Significant metabolic alterations of NAA/Cr and Cho/Cr ratios might be closely related with functional changes of neuropathological process in SN and PG of levodopa treated PD and could be a valuable finding for evaluation of the PD. A trend of NAA/Cr reduction, being statistically significant in older patients, could be indicative of more pronounced neuronal damage in the SN of the progressive PD.

Evaluation of Metabolic Abnormality in Brain Tumors by In Viuo $^1$H MR Spectroscopy at 3 Tesla

Choe, Bo-Young,Jeun, Sin-Soo,Kim, Bum-Soo,Lee, Jae-Mun,Chung, Sung-Taek,Ahn, Chang-Beom,Oh, Chang-Hyun,Kim, Sun I.,Lee, Hyoung-Koo Korean Society of Medical Physics 2002 의학물리 Vol.13 No.3

목적 : 성상세포종과 다형성교모세포증과 같은 뇌종양에서 37 양성자 자기공명분광법을 이용한 분광 소견을 알아보고, 이를 정상인 뇌의 분광소견과 비교하여, 그 차이를 알아보고자 하였다. 대상 및 방법 : 대상환자는 가톨릭의대 부속 강남성모병원에서 2001년 1월 1일부터 2002년 6월 1일까지 조직학적으로 확인된 astrocytoma 및 glioblastoma multiforme (GM) 환자들 중에서 양성자 자기공명분광을 시행한 10명의 환자를 대상으로 하였다. 연령분포는 28세에서 73세(평균: 52.2세), 남녀비는 4:6이었다. 양성자 자기공명분광법은 전신용 3T MRI/MRS 시스템(Medinus Co., LTD. Magnus 2.1)과 STEAM (stimulated echo acquisition mode) pulse sequence를 사용하였다. 획득한 자기공명분광 소견은 각각의 군에서 N-acetyla-spartate (NAA), phosphocreatine and creatine (Cr), choline containing compounds (Cho) and lactate (Lac)와 같은 대사물질들을 Cr을 기준으로 대사산물 신호강도의 비율로 상대적으로 계측하였다. 각각의 군에서 상대적인 비율의 평균과 표준편차를 구하여 정상뇌와 뇌종양을 비교하였고, 종합적인 결과는 Student t-test로 통계 처리하였다. 결과 : 양성자 자기공명분광소견상 정상 뇌조직과 뇌종양의 Cho/Cr 평균값은 각각 1.16$\pm$0.15, 1.79$\pm$1.02로 측정되었고, NAA/Cr은 각각 1.67$\pm$0.18, 0.64$\pm$0.38로 측정되었다. Lactate는 정상 뇌조직에서는 거의 발견되지 않은데 비해 뇌종양에서는 모두 관찰되었고 그 양은 3.53$\pm$2.54로 높게 나타났다. 결론 뇌종양(성상세포종, 다형성교모세포증)은 정상 뇌조직에 비해 Cho/Cr 비율이 현저히 증가하였으며, NAA/Cr 비율은 감소하였다. 또한 뇌종양에서는 강한 Lactate signal을 보여 주었다. 양성자 자기공명분광은 뇌종양에 대한 생화학적 정보를 얻을 수 있으므로, 임상적으로 비침습적인 방법을 통한 진단뿐 만 아니라 치료후 효과 판정이나, 뇌종양 재발 등의 감별진단에도 이용할 수 있을 것으로 사료된다. To investigate differences between the metabolic ratios of normal controls and brain tumors such as astrocytomas and glioblastoma multiforme (GM) by proton MR spectroscopy (MRS) at 37 high field system. Using 3T MRI/MRS system, localized water-suppressed single-voxel technique in patients with brain tumors was employed to evaluate spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cr) and lactate. On the basis of Cr, these peak areas were quantificated as a relative ratio. The variation of metabolites measurements of the designated region in 10 normal volunteers was less than 10%. Normal ranges of NAA/Cr and Cho/Cr ratios were 1.67$\pm$018 and 1.16$\pm$0.15, respectively. NAA/Cr ratio of all tumor tissues was significantly lower than that of the normal tissues (P=0.005). Cho/Cr ratio of glioblastoma multiforme was significantly higher than that of astrocytomas (P=0.001). Lactate was observed in all tumor cases. The present study demonstrated that the neuronal degradation or loss was observed in all tumor tissues. Higher grade of brain tumors was correlated with higher Cho/Cr ratio, indicating a significant dependence of Cho levels on malignancy of gliomas. This results suggest that clinical proton MR spectroscopy could be useful to predict tumor malignancy.

Metabolic Changes in Patients with Parkinson's Disease after Stereotactic Neurosurgery by Follow-up 1H MR Spectroscopy

Choe, Bo-Young,Baik, Hyun-Man,Chun, Shin-Soo,Son, Byung-Chul,Kim, Moon-Chan,Kim, Bum-Soo,Lee, Hyoung-Koo,Suh, Tae-Suk Korean Magnetic Resonance Society 2001 Journal of the Korean Magnetic Resonance Society Vol.5 No.2

Authors investigated neuronal changes of local cellular metabolism in the cerebral lesions of Parkinsonian symptomatic side between before and after stereotactic neurosurgery by follow-up 1H magnetic resonance spectroscopy (MRS). Patients with Parkinson's disease (PD) (n = 15) and age-matched normal controls (n = 15) underwen MRS examinations using a stimulated echo acquisition mode (STEAM) pulse sequence that provided 2${\times}$2${\times}$2 ㎤ (8ml) volume of interest in the regions of substantia nigra, thalamus, and lentiform nucleus. Spectral parameters were 20 ms TE, 2000 ms TR, 128 averages,2500 Hz spectral width, and 2048 data points. Raw data were processed by the SAGE data analysis package (GE Medical Systems). Peak areas of N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (Cho), inositols (Ins), and the sum (Glx) of glutamate and GABA were calculated by means of fitting the spectrum to a summation of Lorentzian curves using Marquardt algorithm. After blindly processed, we evaluated neuronal alterations of observable metabolite ratios between before and after stereotactic neurosurgery using Pearson product-moment analysis (SPSS, Ver. 6.0). A significant reduction of NAA/Cho ratio was observed in the cerebral lesion in substantia nigra of PD patient related to the symptomatic side after neurosurgery (P : 0.03). In thalamus, NAA/Cho ratio was also significantly decreased in the cerebral lesion including the electrode-surgical region (P : 0.03). A significant reduction of NAA/Cho ratio in lentiform nucleus was not oberved, but tended toward significant reduction after neurosurgery (P = 0.08). In particular, remarkable lactate signal was noted from the surgical thalamic lesions of 6 among 8 patients and internal segments of globus pallidus of 6 among 7 patients, respectively. Significant metabolic alterations of NAA/Cho ratio might reflect functional changes of neuropathological processes in the lesion of substantia nigra, thalamus, and lentiform nucleus, and could be a valuable finding fur evaluation of Parkinson's disease after neurosurgery. Increase of lactate signals, being remarkable in surgical lesions, could be consistent with a common consequence of neurosurgical necrosis. Thus, IH MRS could be a useful modality to evaluate the diagnostic and prognostic implications fur Parkinsons disease after functional neurosurgery.

Canine MR Images from 3T Active-Shield MRI System

Choe, Bo-Young,Park, Chi-Bong,Kang, Sei-Kwon,Chu, Myoung-Ja,Kim, Euy-Neyng,Lee, Hyoung-Koo,Suh, Tae-Suk Korean Society of Medical Physics 2001 의학물리 Vol.12 No.2

목적: 수의 영상진단을 위하여 3T 능동차폐형 자석을 장착한 전신용 자기공명영상장비를 이용하여 고해상도의 개 두뇌, 척추, 복부 및 골반 자기공명영상을 획득하였다. 대상 및 방법: 128 MHz의 공명주파수를 갖는 RF코일을 사용하여 정상 개 및 환축으로부터 스핀에코와 고속 스핀에코 펄스시퀀스를 적용하였다. 전형적인 펄스시퀀스의 매개변수는 512$\times$512 matrix, 20 cm FOV, 3 mm 절편두께, 1 NEX를 사용하였다. 특히 T1 강조영상을 위하여 TR=500 ms, TE=10 혹은 17.4 ms을 사용하였으며, T2 강도영상을 위하여 TR=4000 ms, TE=108 ms을 사용하였다. 결과: 3T의 신호대잡음비는 기존 1.5T에 비하여 2.7배 정도 향상되었다. 본 연구에서 획득한 고해상도의 자기공명영상은 기존의 20cm FOV, 5m의 절편두께와 256$\times$256 해상도의 영상에 비하여 4배이상 증가하였다 3T 자기공명영상은 매우 미세한 혈관 구조물을 표출하는데 도움을 주며, 또한 백질과 회질의 상당한 대조도를 제공하여 주었다. 결론: 본 연구결과에서 3T로부터 얻은 자기공명영상은 기존 1.5T 영상에서 얻은 영상에 비하여 더 높은 해상도와 민감도를 제공하여 주었다. 3T 고자장 자기공명영상에 나타난 증가된 신호대잡음비는 생체 조직단위의 영상을 획득하는데 유용하였다. 이러한 고해상도의 자기공명영상은 비침습적인 방법으로서 미세조직의 이상유무를 진단하는데 있어서 향후 더욱 임상에 도움을 주리라 예상한다. 향후 자기공명영상은 수의 진단방사선분야에 새로운 장을 열어줄 수 있으리라 기대한다. For veterinary imaging diagnosis, we obtained MR images of the canine brain, spine, kidney and pelvis from 3T MRI system which was equipped with the world first 3T active shield magnet. Spin echo (SE) and fast Spin Echo (FSE) images were obtained from the canine brain, spine, kidney and pelvis of normal and sick dogs using a homemade birdcage and transverse electromagnetic (TEM) resonators operating in quadrature and tuned to 128 MHz. In addition, we employed a homemade saddle shaped RF coil. Typical common acquisition parameters were as follows: matrix=512$\times$512, field of view (FOV)=20cm, slice thickness=3 w, number of excitations (NEX)=1. For T1-weighted MR images, we used TR=500 ms, TE=10 or 17.4 ms. For T2-weighted MR images, we used TR=4000 ms, TE=108 ms. Signal to noise ratio (SNR) of 3T system was measured 2.7 times greater than that of prevalent 1.57 system. The high resolution images acquired in this study represent more than a 4-fold increase in in-plane resolution relative to conventional images obtained with a 20 cm field of view and a 5 mm slice thickness. MR images obtained from 3T system revealed numerous small venous structures throughout the image plane and provided reasonable delineation between gray and white matter The present results demonstrate that the MR images from 3T system could provide better diagnostic quality of resolution and sensitivity than those of 1.5T system. The elevated SNR observed in the 3T high field magnetic resonance imaging can be utilized to acquire images with a level of resolution approaching the microscopic structural level under in vivo conditions. These images represent a significant advance in our ability to examine small anatomical features with noninvasive imaging methods. Moreover, MRI technique could begin to apply for veterinary medicine in Korea.