Prevention of Adjacent Segmental Disease after Fusion in Degenerative Spinal Disorder: Correlation between Segmental Lumbar Lordosis Ratio and Pelvic Incidence–Lumbar Lordosis Mismatch for a Minimum 5-Year Follow-up

Whoan Jeang Kim,Chang Hyun Ma,Sang Ha Kim,Yeon Seung Min,Jae Won Lee,Shann Haw Chang,Kyung Hoon Park,Kun Young Park,Dae Gun Song,Won Sik Choy 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.4

Study Design: Retrospective study. Purpose: Associations among risk factors related to adjacent segmental disease (ASD) remain unclear. We evaluated the risk factors and segmental lordosis ratio to prevent ASD developing after lumbar spinal fusion. Overview of Literature: Risk factors related to ASD development are age, sex, obesity, pre-existing degeneration, number of fusion segments, and decreased postoperative lumbar lordosis (LL). However, the associations among these factors are still unclear and should be clearly identified. Methods: We retrospectively reviewed data on 274 patients who underwent lumbar spinal fusion of three segments or below for lumbar degenerative disease from January 2010 to December 2012, with over 5 years of follow-up. Patients with preoperative sagittal vertical axis (SVA) >5 cm were excluded due to sagittal imbalance. A total of 37 patients with ASD and 40 control patients (CTRL) were randomly selected in a similar distribution of matching variables: age, sex, and preoperative degenerative changes. Sex, age, number of fusion segments, radiologic measurements, L4–5–S1/L1–S1 LL ratio, and spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and SVA) were analyzed. Logistic regression was used to analyze the correlation between PI–LL mismatch and L4–5–S1 segmental lordosis rate. Results: No significant difference was found between ASDs and CTRL groups regarding age, sex, number of fusion segments, fusion method, and preoperative and postoperative spinopelvic parameters (PI, SS, PT, and LL). However, regarding the L4–5–S1/L1–S1 lordosis ratio, 50% (p=0.045), 60% (p=0.031), 70% (p=0.042), 80% (p=0.023), and 90% (p=0.023) were statistically significant; <20% (p=0.478), 30% (p=0.223), and 40% (p=0.089) were not statistically significant. In the postoperative PI–LL <10 group, ASD occurred less frequently than in the PI–LL >10 group, and the difference was statistically significant (p=0.048). Conclusions: Patients with a postoperative L4–5–S1/L1–S1 lordosis ratio >50% had less occurrence of ASD. Correcting LL according to PI and physiologic segmental lordosis ratio is important in preventing ASD.

Endoscopy and Imaging Modalities/Basic Science of Gastrointestinal Disorders/Miscellaneous : Changing Pattern Of Digestive And Liver Disease In Korea, 1990-2006 Year; A Single Center Study

( Jung Hyun Kwon ),( Sang Woo Kim ),( In Sik Chung ),( Myung Gyu Choi ),( Kwan Woo Nam ),( Jung Pil Suh ),( Jae Hyuck Chang ),( Won Haing Hur ),( Yu Kyung Cho ),( Jae Myung Park ),( In Seok Lee ) 대한소화기학회 2007 SIDDS Vol.9 No.-

Background/Aims: Westernization in many Asian countries have changed lifestyles and diets, so once rare diseases have now become prevalent. The aim of this study is to investigate the changing pattern of digestive and liver disease in Korea, from 1990 to 2006. Methods: We extracted data specific gastrointestina (GI) disease based on the International Classification of Diseases code from the in-patients records at the Kangnam St. Mary`s Hospital in 1990, 1996 and 2006. This hospital is a tertiary-care hospital in Seoul, Korea, which has a capacity of 800 beds. Results: The admission rate for GI disease increased between 1990 and 2006. Overall in-patients were 1,623 persons in 1990, 2,368 persons in 1996 and 4,166 persons in 2006. The mean age of in-patients increased as time went by. A stomach cancer was the most common diagnosis during all periods, but its prevalence has decreased. Colon cancer ranked the 7th in 1990, but markedly increased and now ranks the second. The third was a hepatocellular carcinoma. The bile duct and gallbladder cancer, pancreas and esophageal cancer ranking followed with little interval change. In cases of cancer patients, a regular admission dramatically increased for chemotherapy. The number of patients admitted with pre-malignant neoplasm of stomach and colon increased remarkably with the development of endoscopy. The liver transplant, inflammatory bowel discase, and reflux esophagitis emerged form mid-1990s with greater frequencies, yet much below the levels found in the West. The admission rate for peptic ulcer, especially ulcer bleeding remained relatively stable, despite a decreased rate for ulcer perforation. Liver cirrhosis, hepatitis, cholelithiasis with cholecystitis-cholangitis, appendicitis, hemorrhoid and gastritis all decreased. Conclusions: The stomach cancer is the leading cause of admission, despite a recent decline. Colon cancer showed a marked rise. The liver transplant, inflammatory bowel disease and reflux esophagitis were new diagnosis with an increased tendency.

DRG 지불제도 도입에 따른 의료보험청구 행태 변화

강길원,박형근,김창엽,김용익,하범만,Kang, Gil-Won,Park, Hyoung-Keun,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

난소의 호산성 투명세포암종 - 1예의 보고 -

하창원,고재수,명나혜,조경자,박상윤,김미경,장자준 대한병리학회 1992 Journal of Pathology and Translational Medicine Vol.26 No.5

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

중장년층에서의 외상성 견관절 탈구

이광원,류창수,김하용,안재훈,염진섭,김환정,최원식 대한견.주관절학회 2000 大韓肩.주關節學會誌 Vol.3 No.2

수직적 치조제 증강술후 발생하는 골흡수량에 관한 연구

전하룡(Ha-Ryong Jeon),김종원(Jong-Won Kim),권호범(Ho-Beom Kwon),이동환(Dong-Hwan Lee),홍종락(Jong-Rak Hong),김창수(Chang-Soo Kim) 대한구강악안면외과학회 2006 대한구강악안면외과학회지 Vol.32 No.3

Purpose: This study presents radiographic and laboratory analysis and comparison of bone resorption rate of grafted endochondral bone and intramembranous bone on the aspect of height and volumetric change. Patients and Methods: 18 partially edentulous patients who needed alveolar ridge augmentation for implant placement during the years 2002 to 2004 were selected for this study. Group A consisted of 5 males & 3 females who were treated with intraoral(intramembranous) bone and Group B consisted of 8 males & 2 females who were treated with iliac(endochondral) bone. Non-standard periapical X-ray was taken at day 1, 2 month, 4 months, 8 months after the surgery. Resorption rate of grafted bone were measured on these X-rays and compared. Also we calculated volume of grafted bone with models which was fabricated at 1.5 months, 6 months. Results: There was bone resorption in both groups. Group B showed more bone resorption than Group A. In Group A, the resorption rate according to the radiographic measurements was 9.81 %, and resorption rate according to volumetric measurement was 16.5 %. In group B, the resorption rate according to the radiographic measurements was 15.9 %, and resorption rate according to volumetric measurement was 30.6 %. Significant difference is on radiographic resorption of post-op 2, 4, 8 months on two groups (P < 0.05). Also significant difference is on volume resorption on two groups (P < 0.05) Conclusion: We found that more bone resorption occurred with iliac(endochondral) bone and when we use intraoral bone, that bone can maintain their vitality for alveolar ridge augmentation.

연속회분식 반응기를 이용한 축산 폐수의 생물학적 고도 처리 운전 인자 도출에 관한 연구

김창원,최명원,이해군,이해일,하지연 부산대학교 환경문제연구소 1998 環境硏究報 Vol.16 No.-

축산폐수는 고농도의 유기탄소 뿐만아니라 영양염류를 포함하는 대표적인 고농도 폐수이며 적절히 처리되어지지 못할 경우 심각한 담수의 부영양화와 연안의 적조를 야기할 수 있다. 이러한 축산폐수를 보다 경제적이며 기술적으로 처리하기 위해 본 연구에서는 연속회분식반응기(SBR)을 이용한 축산폐수의 고도처리에 적용할 수 있는 운전인자와 운전기법을 연구하였다. 초기 암모니아와 유기탄소부하를 달리하며 정해진 주기로 운전하는 네 가지 전형적인 회분식 실험과 원수를 연속으로 주입하면서 간헐 폭기로 운전하는 세 가지의 변형회분식 반응 실험을 통하여 전형적인 SBR에서 비 질산화 속도에 가장 많은 영향을 미치는 인자가 초기 pH 와 유리 암모니움 농도이며 최적 초기 암포니아성 비 질소 부하율은 0.1 ~ 0.15 kg NH_4^+-N /kg VSS 근처이며 이때 비 질산화율은 0.06 kgNH_4-N/ kg MLVSS·day로 관찰되었으며, 변형 SBR로 운전하는 경우 최소 35%에서 최대 65% 까지 탈질용 외부기질 주입량을 절감할 수 있었다. Piggery wastewater is a representative of high strength wastewater which contents not only high concentration organic carbon but also nutrients. From this reason piggery wastewater could be cause a serious eutrophication of fresh water and red tide in coastal areas if not properly treated. In this study to treat these piggery wastewater technically and more economically, the operation parameters and methods for advanced treatment using Sequencing Batch Reactor (SBR) were investigated. Four sets of experiments were conducted on laboratory scale typical SBR (Fill in a time) with fixed cycle and different till ratio to evaluate most proper initial loading of organic carbon and nitrogen and three sets of experiments on laboratory scale inodified SBR (Fill continuously) with intermittent aeration. As results the nitrification rate was most sensitively affected by intial pH and free ammonia concentration and in typical SBR operation most profit initial specific nitrogen loading were investigate around 0.1~0.15kg NH_4^+-N /kg VSS and in this range the average specific nitrification rate was 0.06 kg NH_4-N/ kg MLVSS·day. And in modified SBR operation with most profit specific nitrogen loading rate the cost of external denitrification cost were saved minimum 35% to maximum 65% each experimental sets.

정상과 만성염증성 활막배양세포에서 Corticotropin releasing hormone(CRH)이 cyclooxygenaase-1(COX-1)과 cyclooxygenase-2(COX-2) mRNA발현에 미치는 영향

정운원,이승관,이창규,조경진,김성욱,하주희,서장훈 高麗大學校 倂設 保健大學 保健科學硏究所 2000 保健科學論集 Vol.26 No.1

Corticotropin-releasing hormone(CRH) is a major regulator of the hypothalamic-pituitaryadrenal axis(HPA). In inflammatory stress, the cytokines TNF-, IL-6 stimulate the production of CRH, a 41 amino acids neuropeptide, in the hypothalamus. The release of CRH leads to pituitary production of adrenocorticotropic hormone, followed by glucocorticoid secretion by the adrenal cortex. Glucocorticoids suppress namy components of the inflammatory process. Recently, CRH and CRH receptor were reported to be located in the periphery such as Immune system and chronic inflammatory sites as rheumatoid arthritis (RA). Cyclooxygenase consisted of two isoforms, COX-1 and COX-2, converts arachdonate to prostaglandins(PGs) which are important mediators of inflammation. insymoviocyte in RA, it was described that COX-2 mRNA was markedly increased by inflammatory agents, PMA or IL-1 and COX-1 transcripts were not modulated. We examined the modulation of COX by immune CRH in cultured normal and rheumatoid synoviocytes. Our results were shown that COX-1 mRNA expression decreased with the each stimulation of PMA and IL-1 in normal synoviocyte. In RA synoviocyte, PMA and IL-1 were increased mRNA expression of COX-1. In simultaneous treatment with CRH, PMA group was decreased, but IL-1 group was increased mRNA expression of COX-1. COX-2 mRNA expression was slightly increased by the treatment with PMA and highly increased by IL-1. After CRH treatment, PMA and IL-1 addictively increased COX-2 mRNA expression. We think that these results are contributed to the influence of increased cANP by CRH on the promoter of COX-2 in normal and synoviocytes. Because many cytokines, neuropeptides, and signal transduction pathways are involved in chronic inflammation, the exact role of CRH on inflammation is not fully elucidated. To achieve this goal, further experiments are needed.