그레이브스 병 치료 후 재발 위험 인자에 관한 연구

이영창,유명희,윤석기,변동원,서교일,김극배 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

연구 배경 : 그레이브스 병에 대한 항갑상선제 치료후 적절한 치료 여부 평가 및 재발 위험성을 예측하기 위하여 여러 가지 예후 판정 인자들이 연구되어 왔으며, 이러한 인자들 중 TRH(thyrotropin-releasing hormone) 자극 시험이 가장 믿을 만한 검사중에 하나로 알려져 있다. 그러나 TRH 자극 검사가 정상으로 나와도 재발하는 경우가 많으며, 현재로는 이러한 경우에 재발을 예측하는 예후 인자에 대한 연구는 전무한 실정이다. 금번 연구에서는 TRH 자극 시험 후 TSH(thyroid stimulating hormone)가 정상적인 반응을 보인 환자를 대상으로 재발 및 관해여부를 예측할 수 있는 인자들을 찾고자 하였다. 대상 및 방법 : 항갑상선제제 치료 종료후 TRH 자극 시험을 시행하였던 그레이브스 병 환자 총 84명 중, 정상적인 TSH 반응을 보이면서 1년 이상 추적 관찰이 가능하였던 32명의 환자를 대상으로 하였다. 처음 진단 시와 치료 종료 시에 T3(triiodothyronine), T4(thyroxine), T3/T4 비, TSH, TRAb, Anti-TPO Ab(anti-thyroperoxidase antibody)를 측정하였으며, 치료 종료 2개월후에는 TRH 자극 검사를 하여 TSH 증가폭(△TSH) 및 유리 T_(3) 증가폭(△FT_(3))을 구하였다. 모든 측정치는 평균±표준편차로 표시하였으며, SPSS software를 이용하여 Student's paired t-test, chi-square test, Wilcoxon signed ranks test를 시행하였고, 유의 수준 0.05 이하를 통계적으로 유의하다고 판단하였다. 결과 1) 총 32명의 환자 중 재발한 환자(Group Ⅰ)는 22명(69%) 이었으며, 재발한 환자(Group Ⅱ)는 10명(31%) 이었다. 2) 진단 초기 총T3 치는 Ⅰ 군에서 342.0±126.2ng/dl, Ⅱ 군에서 493.0 ±142.2 ng/dl로 Ⅱ군에 비해 유의하게 증가되었다(p<0.05). 3) Anti-TPO Ab는 Ⅰ군에서 2.9±4.4, Ⅱ군에서 22.3±22.3 U/mL로 나타나 Ⅱ군에서 유의하게 증가되었다.(p<0.05) 4) 양군에서 치료 종료후 재발시 대부분의 환자가 1년 이내에 재발하였다. 5) TRH 자극· 검사후 유리 T3 증가폭 및 TSH 증가폭은 양군간에 차이가 업ㅅ었다(1.5±0.9 vs 1.2±1.0 pmol/L, 12.54±7.56 vs 11.23±4.21 mU/L, p>0.05) 결론 : TRH 자극 검사후 정상적인 TSH 반응을 보인 환자에서 재발 및 관해여부를 치료 초기 T3 및 치료 종료시 Anti-TPO Ab로 예측할 수 있었으며, 이들 측정치가 증가해 있을수록 재발의 가능성이 많음을 알 수 있었다. 또한 투약 중단후 초기 12개원의 추적기간 동안 관해가 유지되면 그 이후엔 재발의 가능성이 현저히 줄어 들었으며, 이 후 좀더 많은 환자들을 대상으로 하는 장기적인 추적연구가 진행 되어야 할 것으로 사료된다. Background : Many studies were undertaken to find parameters that could predict the clinical course of patients with Graves' disease after withdrawal of antithyroid drugs. In many parameters, TRH (thyrotropin-releasing hormone) stimulation test and T3 suppression test were considered to be one of the most reliable for predicting remission. But recently, some studies showed that the measurement of free T3 and FT3 are to be a more accurate than other thyroid function test. In this study, we measured T_(3), T_(4), T_(3)/T_(4), TSH (thyroid stimulating hormone), TRAb (TSH receptor antibody), FT3 and other known useful parameters to compare the factors influencing the relapse of Graves disease after antithyroid medication. Patients and methods : Among the 84 Graves' disease patients who had done the TRH stimulation test after withdrawal of antithyroid medication, we examined 32 patients who showed normal TSH response and followed up more than one year. T_(3), T_(4), T_(3)/T_(4), TSH and TRAb levels were measured at the time of diagnosis and at the end of therapy. Serum TSH and FT_(3) levels were measured after TRH stimulation, after two months of withdrawal of medication. Statistical evaluation was Performed by SPSS software in combination with Student's Paired t-test, chi-square test, Wlicoxon signed-ranks test. p-value less than 0.05 was considered to be significant. Results 1. In the 32 patients with Graves disease, 10 patients(31%) relapsed(Group Ⅰ) and 22 Patients(69%) remained in remission(Group Ⅱ). 2. Initial serum T3 level was significantly higher in group Ⅰ than group Ⅱ(342.0 ±126.2 vs. 493.0±142.2 ng/dl, p<0.05). 3. Anti-TPO Ab level was significantly higher in group Ⅰ than group Ⅱ(22.3±22.3 vs 2.9±4.4 U/mL, p<0.05). 4. In group Ⅰ and Ⅱ most patients showed relapse within 1 year after antithyroid medication. 5. After TRH stimulation test, serum FT_(3), and TSH level were not significantly different between group I and Ⅱ(p>0.05). 6. Serum T_(4), T_(3)/T_(4), TSH, TRAb levels were not significantly different from group Ⅰ and Ⅱ. Conclusion : In this study, we found increased relapse rate in the patients with Graves' disease whose initial serum T3 and anti-TPO Ab levels were high, so these parameters could be used to predict the relapse of Graves' disease. In the case of more than 12 months remission period after withdrawal of antithyroid medication, no relapse wsa observed in this study, but study should be done in the large population of patients with Graves' disease.

국내 주요기업의 웹사이트 관리에 관한 탐색적 연구

서창교,권대윤 慶北大學校 出版部 2001 經商論集 Vol.29 No.1

대학에서의 그룹웨어 사용 현황 분석

서창교,윤금희 慶北大學校 經濟經營硏究所 1999 經商論集 Vol.27 No.2

The Effects of Visual Biofeedback Balance Training on Functional Ability in Children with Cerebral Palsy: A Pilot Study

( Chang-kyo Yun ),( Ji-na Yoo ) 대한물리의학회 2016 대한물리의학회지 Vol.11 No.3

PURPOSE: The purpose of this study is to examine the impact of balance training on a three-dimensional balance trainer that provides the up-and-down vertical movement of the knee jointand left-and-right horizontal movement, along with visual feedback on the functional ability of children with spastic cerebral palsy (CPs). METHODS: 8 CPs participated in this study. The experiment was implemented for 40 minutes, three times a week for a total of six weeks. The subjects received general physiotherapy for 15 minutes in each session focused on balance and walking, as based on the neuro-developmental treatment theory. Balance training was performed for 20 minutes on a three-dimensional balance trainer where knee joint movement providing visual feedback is applied. The evaluations were conducted before and after the test, and posture sway was measured using 10 Meter Walking Test (10MWT), Timed Up & Go Test (TUG), and the Good Balance System to evaluate the functional ability and balance of the subjects. RESULTS: 10MWT was not statistically significant (p>.05). On the contrary, TUG and postural sway indicate static balance showed a statistically significant decrease (p<.05). In a static balance test using the Good Balance System, the average moving speedstatistically significantly decreased in the AP and ML directions (p<.05), and the mean velocity moment also significantly decreased (p<.05). CONCLUSION: These findings suggested that balance training using the three-dimensional balance trainer, with the features of visual feedback and up-and-down knee joint movement effects on increasing dynamic and static balance.

Relationship between the quality of life of the caregiver and motor function of children with cerebral palsy

( Chang-kyo Yun ) 물리치료재활과학회 2017 Physical therapy rehabilitation science Vol.6 No.1

Objective: The purpose of this study was to evaluate the relationship between quality of life (QoL) of the caregiver and disease severity with motor function in children with cerebral palsy (CP). Design: Cross-sectional study. Methods: Research data were collected in the Rehabilitation Clinic of Daegu University. The Gross Motor Function Measure (GMFM-88) and the functional independence measure (FIM) were used for assessment by three occupational therapists, and the 36-item short form health survey (SF-36) were applied to the caregivers. One hundred six caregivers of under 18 years who were diagnosed with CP completed a survey and interview. The caregivers` QoL was evaluated using Medical Outcomes Study SF-36. The children`s motor function was scored using GMFM-88 in five dimensions: lying and rolling; sitting; crawling and kneeling; standing and walking, running and jumping and CP`s FIM scores. Results: Out of the 8 domains of the Medical Outcomes Study SF-36, the “physical functioning”, “physical role functioning”, “mental health”, and “bodily pain” domains were significantly correlated to “total” percentage scores of the GMFM-88 (p<0.05). In addition, the “mental health” domain was correlated to each subdomain of the GMFM-88, which includes, “lying and rolling”, and “crawling and kneeling”. Similarly, of Medical Outcomes Study SF-36, “physical functioning”, “bodily pain”, and “mental health” domains were significantly correlated with “transfer” and “locomotion” of FIM scores (p<0.05). Conclusions: This study showed that the QoL of the caregivers were well correlated with the motor function of children with CP. It is also important to support not only physical health but also psychological health of caregivers of children with CP, especially those with severe motor function.

Relationship between the quality of life of the caregiver and motor function of children with cerebral palsy

Yun, Chang-Kyo korean Academy of Physical Therapy Rehabilitation 2017 Physical therapy rehabilitation science Vol.6 No.1

Objective: The purpose of this study was to evaluate the relationship between quality of life (QoL) of the caregiver and disease severity with motor function in children with cerebral palsy (CP). Design: Cross-sectional study. Methods: Research data were collected in the Rehabilitation Clinic of Daegu University. The Gross Motor Function Measure (GMFM-88) and the functional independence measure (FIM) were used for assessment by three occupational therapists, and the 36-item short form health survey (SF-36) were applied to the caregivers. One hundred six caregivers of under 18 years who were diagnosed with CP completed a survey and interview. The caregivers' QoL was evaluated using Medical Outcomes Study SF-36. The children's motor function was scored using GMFM-88 in five dimensions: lying and rolling; sitting; crawling and kneeling; standing and walking, running and jumping and CP's FIM scores. Results: Out of the 8 domains of the Medical Outcomes Study SF-36, the "physical functioning", "physical role functioning", "mental health", and "bodily pain" domains were significantly correlated to "total" percentage scores of the GMFM-88 (p<0.05). In addition, the "mental health" domain was correlated to each subdomain of the GMFM-88, which includes, "lying and rolling", and "crawling and kneeling". Similarly, of Medical Outcomes Study SF-36, "physical functioning", "bodily pain", and "mental health" domains were significantly correlated with "transfer" and "locomotion" of FIM scores (p<0.05). Conclusions: This study showed that the QoL of the caregivers were well correlated with the motor function of children with CP. It is also important to support not only physical health but also psychological health of caregivers of children with CP, especially those with severe motor function.

다른 앉은 자세가 뇌성마비 환자의 복횡근 두께와 앉기 균형에 미치는 영향

윤창교 ( Chang Kyo Yun ),김원복 ( Won Bok Kim ) 한국전문물리치료학회 2014 한국전문물리치료학회지 Vol.21 No.3

The purpose of this study was to investigate the activity of the transverse abdominal muscle resulting from changed posture by measuring the thickness of the transverse abdominal muscle in a supine posture, a slouched sitting posture, and an erect sitting posture. The subjects of the study were 28patients with cerebral palsy. All their transverse abdominal muscles at the end of inhalation were measured at supine, slouched sitting (S sitting) and erect sitting (E sitting) postures by using ultrasonography, and then their dynamic sitting balance was measured at S sitting and E sitting postures by using BioRescue. For the statistical analysis, the Kruskal-Wallis test and the Wilcoxon signed-rank test were used to compare the differences among each the postures. The results were asfollows. The thickness of the transverse abdominal muscle when comparing the supine posture and the S sitting posture showed no statistically significant difference. But the E sitting posture showed a statistically significant difference as compared with the others. In addition, the dynamic sitting balance in comparing the S sitting and E sitting postures showed a significant difference. In conclusion, the E sitting posture has a more positive effect on postural control and balance than generally taking the S sitting posture, for the sitting posture of a patient with cerebral palsy. It is suggested that patients with cerebral palsy mainly experiencing a sedentary life or being in a wheelchair should be seated in the E sitting posture during their daily life, and it may be necessary to continue to monitor and manage the proper E sitting posture.

A Cognitive Media Sharing System Using D2D Communication and Ultrasonic Sensor

Yun-gi Park,Jae-hyun Lim,Hyun-sik Kim,Chang-kyo Lee,Chul-min Kim,Jeongwook Seo 한국정보통신학회 2016 2016 INTERNATIONAL CONFERENCE Vol.8 No.1

The Distribution of Barbiturates in Model Membranes of Total Lipids and Total Phospholipids Extracted from Brain Membranes

(Chang Sik Park),(Seong Moon Lee),(In Kyo Chung),(Jin Bom Kim),(Woo Sung son),(Hye Ock Jang),(Il Yun) 생화학분자생물학회 2000 BMB Reports Vol.33 No.3

The distribution of barbiturates in the model membranes of total lipids (SPMVTL) and total phospholipids (SPMVPL) extracted from synaptosomal plasma membrane vesicles was determined by employing a fluorescent probe technique. The two fluorescent probes 2-(9-anthroyl)stearic acid and 12-(9-anthroyl)stearic acid were utilized as probes for the surface and the hydrocarbon interior of the outer monolayer of the SPMVTL and SPMVPL, respectively The Stern-Volmer equation of fluorescent quenching was modified to calculate the relative distribution. The analysis of preferential quenching of these probes by barbiturates indicates that pentobarbital, hexobarbital, amobarbital and Phenobarbital are predominantly distributed on the surface area, while thiopental sodium has an accessibility to the hydrocarbon interior of the outer monolayer of the SPMVTL and SPMVPL. From these results, it is strongly suggested that the more effective penetration into the hydrocarbon interior of the outer monolayer of the membrane lipid bilayer could result in a higher general anesthetic activity

Effects of Local Anesthetics on the Rate of Rotational Mobility of Phospholipid Liposomes

Yun,Il,Kim,Dae-Gyeong,Chung,Yong-Za,Kim,Bong-Sun,Choi,Chang-Hwa,Cho,Goon-Jae,Jang,Hye-Ock,Chung,In-Kyo The Korea Science and Technology Center 2000 BMB Reports Vol.33 No.3

Using fluorescence probes, 2-(9-anthroyloxy) stearic acid (2-AS) and 12-(9-anthroyloxy) stearic acid (12-AS), we determined the differential effects of local anesthetics (tetracaine-HCl, bupivacaine-HCl, lidocaine-HCl, prilocaine·HCl and procaine-HCl) on the differential rotational rate between the surface (in carbon number 2 and its surroundings including the head group) and the hydrocarbon interior (in carbon number 12 and its surroundings) of the outer monolayer of the total phospholipid fraction liposome that is extracted from synaptosomal plasma membrane vesicles. The anisotropy(r) values for the hydrocarbon interior and the surface region of the liposome outer monolayer were 0.051±0.001 and 0.096±0.001, respectively. This means that the rate of rotational mobility in the hydrocarbn interior is faster than that of the surface region. Local anesthetics in a dose-dependent manner decreased the anisotropy of 12-AS in the hydrocarbon interior of the liposome outer monolayer, but increased the anisotropy of 2-AS in the surface region of the significant disordering effects on the hydrocarbon interior, but have significant ordering effects on the surface region of the liposome outer monolayers.