뇌동정맥기형에서 선형가속기를 이용한 방사선 수술 후의 임상적 결과

임수미,이레나,서현숙,Lim, Soo-Mee,Lee, Re-Na,Suh, Hyun-Suk 한국의학물리학회 2010 의학물리 Vol.21 No.3

선형가속기를 이용하여 single-fraction stereotactic radiosurgery (SRS)를 시행하였던 뇌동맥 기형 치료 환자 25예 중 13예의 임상결과와 혈관조영술 소견에 대해 알아보고자 하였다. 2002년부터 2009년까지 뇌동정맥 기형으로 SRS를 시행하였던 25명 중 추적 혈관조영술이 시행된 기간이 12개월 이상인 환자 15명(남자 6명, 여자 9명)을 대상으로 하였으며 후향적으로 MRI와 혈관조영술에서 동정맥기형 핵의 크기와, 위치, 파열유무, 추적기간 동안의 합병증 유무, 혈관조영술에서의 변화를 분석하였다. 평균 30개월(12~89개월) 동안 추적 혈관조영술이 시행되었던 15명의 환자 (평균나이 33세, 14~56세) 중 모든 환자에서(100%) 동정맥기형이 완전 소실되었고 3명(20%)에서 유출정맥만이 동맥기 촬영에서 확인되었다. 추적기간 중 1명에서 경련이 있었으며 출혈이나 뇌부종에 의한 임상증상이 있었던 환자는 없었다. 동정맥기형 핵의 부피는 평균 4.3 cc (SD 3.7 cc, 범위 0.69~11.7 cc)였으며 방사선 조사 선량은 평균 17 Gy (12~20 Gy)였다. 동정맥기형의 위치는 대엽이 11예, 기저핵이 1예, 뇌교가 1예, 소뇌가 2예였다. 9예는 파열, 나머지 6예는 비 파열 예였다. 선형가속기를 이용한 뇌동정맥기형 방사선 치료의 성적은 추적기간을 4년 이상으로 할 때 높은 완치율을 보이며 동맥기에 유출정맥이 남아 있을 경우 유출정맥이 완전히 소멸될 때까지 추적 관찰이 요구된다. The purpose of this study was to analyze the effect of single-fraction stereotactic radiosurgery (SRS) for the treatment of 15 cases of cerebral arteriovenous malformations (AVMs). Between 2002 and 2009, of the 25 patients who had SRS for the treatment of cerebral AVM, 15 patients (6 men, 9 women) taken a digital subtraction angiography (DSA) over 12 months after SRS were included. We retrospectively evaluated the size, location, hemorrhage of nidus, angiographic changes on follow-up on the MR angiography and DSA, and clinical complications during follow-up periods. At a median follow-up of 24 months (range 12-89), complete obliteration of nidus was observed in all patients (100%) while residual draining veins was observed in 3 patients (20%). There was no clinical complication during the follow-up period except seizure in 1 patient. The mean nidus volume was 4.7cc (0.5~11.7 cc, SD 3.7 cc). The locations of nidus were in cerebral hemisphere in 11 patients, cerebellum in 2 patients, basal ganglia in 1 patient, and pons in 1 patient respectively. 9 cases were hemorrhagic, and 6 cases were non-hemorrhagic AVMs. The SRS with LINAC is a safe and effective treatment for cerebral AVMs when the follow up period is over 4 years. However, it is recommended to continue to follow up until the draining vein on arterial phase of follow up DSA disappears completely.

임상용 3T MRI를 이용한 마우스 뇌의 영상

임수미,박은미,Lim, Soo-Mee,Park, Eun-Mi 한국의학물리학회 2010 의학물리 Vol.21 No.4

임상적용 전 단계에서 마우스와 같은 작은 설치류를 이용한 신경학적 실험의 필요성이 높아지면서 임상용 3T MRI를 이용한 마우스 뇌 영상의 요구가 높아지고 있다. 본 연구에서는 임상용 3T MRI를 이용한 마우스 뇌 영상의 가능성과 기술적인 적용과 최적화에 대해 알아보고자 하였다. 20~25g 체중 마우스 3마리에서 임상용 3T MRI를 이용하여 T1 강조영상(T1WI), T2 강조영상(T2WI), FLAIR (Fluid Attenuated Inversion Recovery) 영상, 가돌리늄 조영 T1 강조영상(Gd-T1WI), 확산 강조영상(DWI)을 시행하였다. 대상이 되었던 마우스 1마리는 뇌 경색을 유발시키지 않았으며 2마리는 우측 중대뇌동맥을 결찰하여 일측 뇌경색을 유발하고 1시간, 24시간, 72시간에 각각의 MRI 영상을 시행하였으며 각 영상에서 마우스 뇌의 striatum, 뇌실, 대뇌 피질의 해부학적 구별, 뇌 경색 부위의 진단 가능성 등을 분석하였다. T2WI에서 마우스 뇌의 striatum, 뇌실, 대뇌 피질의 해부학적 구별이 모두 가능하였고 T1WI, FLAIR, DWI 영상에서는 위의 해부학적 경계부위의 해상도는 감소하였다. 뇌경색 부위는 경색 후 1시간, 24시간, 72시간 영상 모두에서 발견되었고 T2WI, FLAIR에서는 24시간, 72시간에서만 구분되었다. 임상용 3T MRI를 이용한 마우스 뇌 영상에서 해부학적 부위의 구별이 가능하였고 특히 DWI를 이용하여 급성기 뇌 경색의 진단이 가능하였다. 앞으로 기술적인 적용과 최적화를 위한 노력이 계속 진행된다면 임상 실험에 큰 도움을 줄 수 있을 것이라 생각된다. The purpose of this study was to explore the potentials of a clinical 3T MRI in mouse brains and technical adaptation and optimization. T1-weighted images (T1WI), T2-weighted images (T2WI), FLAIR (Fluid Attenuated Inversion Recovery) images, Gadolinium enhanced T1-weighted images (Gd-T1WI), Diffusion weighted images (DWI) were acquired in brain of 2 mice (weight 20~25 g) with cerebral infarction by occlusion of right middle cerebral artery, 1 hour, 24 hours, 72 hours after infarction and 1 normal mouse brain using clinical 3T MRI scanner. We analyzed differentiation of striatum, ventricle, cerebral cortex, and possibility of detection of acute cerebral infarction. We could differentiate the striatum, ventricle, cerebral cortex on T2WI and on DWI, FLAIR, T1WI, the differentiation of each anatomy of brain was not definite, but acute cerebral infarction was detected on DWI of 1 hour, 24 hours, 72 hours after infarction and on T2WI, FLAIR of 24 hours, 72 hours after infarction. Clinical 3T MRI can be used in differentiation of anatomy of mouse brains and DWI can be helpul in detection of acute cerebral infarction in acute phase. With technical adaptation and optimization clinical 3T MRI can be useful tool for provide preclinical and clinical small animal studies.

신나무 가지의 Salmonella 균에 대한 항균효과

임수미 ( Soo Mee Lim ),최선은 ( Sun Eun Choi ) 대한보건협회 2013 대한보건연구 Vol.39 No.2

Objectives: Salmonella spp. are one of zoonosis in worldwide, which are well known as a primary cause of infectious enterocolitis and food poisoning. Salmonella spp. are sort of Gram negative bacillus and can occur enterocolitis, hyperthermy, bacteremia, cholera morbus, focal infection, typhus and etc. The aim of this study was to discover new antibacterial activity resorces(material) from natural materials to cure Salmonela spp., a primary cause of intractable disease. Methods: This study was performed with 3 kinds of Salmonella spp. to measure antibacterial effects using minimum inhibitory concentration(MIC) assay to Acer ginnala stem extracts that extracted by 80% acetone and 8 fractions that fracted by liquid column chromatography and thin layer chromatography(TLC). Results: This experiment measured antibacterial effects of herbal specimen and Ampicillin to 3 sorts of Salmonella spp., [S. typhi (ATCC 19943), S. gallinarum (ATCC9184) and S. paratyphi A]. As a result of this experiment, the bark extract from Acer ginnala Maxim., Fr.5 and 6 generally showed superior antibacterial effect compare with Ampicillin and even showed much superior antibacterial effect for particular Salmonella spp[S. gallinarum (ATCC9184)]. Conclusion: The stems of Acer ginnala Maxim. which have superior antibacterial effect can be expected to develop as various fuctional food and cosmetic resources.

대학교 재학생에서 Fatigue Severity Scale의 신뢰도 및 타당도 연구

이정현,정현석,임수미,조한별,마지영,고은,임주연,이선혜,배수진,이유진,류인균,정도언,Lee, Junghyun H.,Jeong, Hyeonseok S.,Lim, Soo Mee,Cho, Han Byul,Ma, Ji-Young,Ko, Eun,Im, Jooyeon J.,Lee, Sun Hea,Bae, Sujin,Lee, Yu-Jin,Lyoo, In Kyoon,Je 대한생물정신의학회 2013 생물정신의학 Vol.20 No.1

Objectives There are only a limited number of studies on instruments assessing fatigue in university students, although fatigue exerts negative influences on their health and academic performances and fatigue-related complaints are more frequently reported in young adults than middle-aged adults. The aim of this study was to validate the 9-item Fatigue Severity Scale (FSS) among university students including both undergraduate and graduate students in South Korea. Methods A total of 176 university students completed a battery of self-report questionnaires, including the FSS, the Brief Fatigue Inventory (BFI), the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), the Medical Outcomes Study Short Form 36 version 2 (MOS-SF36v2), and the Inclusion of Community in the Self Scale (ICS). The data were collected from February of 2012 to June of 2012. The reliability, convergent validity, divergent validity, and exploratory factor analyses were conducted to assess psychometric properties of the FSS. Results The mean FSS score was 3.20 (standard deviation = 1.43). The FSS demonstrated an excellent internal consistency (Cronbach's ${\alpha}$ = 0.93) and item-total correlations ranged from 0.56 to 0.90. Correlations of the FSS with the BFI (r = 0.71, p < 0.01), BDI-II (r = 0.54, p < 0.01), BAI (r = 0.46, p < 0.01), MOS-SF36v2 physical component summary (r = -0.28, p < 0.01), MOS-SF36v2 mental component summary (r = -0.55, p < 0.01), and ICS (Spearman's rho = -0.07, p = 0.33) showed acceptable convergent and divergent validity. Exploratory factor analysis defined one underlying factor (eigenvalue = 5.67) that explained 93.50% of the total variance. Conclusions To the best of our knowledge, this is the first study to investigate reliability and validity of the FSS in university students. The FSS exhibits good psychometric properties for evaluation of fatigue among university students in South Korea. Since the FSS is easy to administer, score, and interpret, it could be a useful tool in research and practice for assessing fatigue among university students.

정상 성인에서 남녀의 소뇌 구조 차이

김지현,배수진,류근택,강민성,임수미,이선호,이소진,고은,정도언,Kim, Ji-Hyun H.,Bae, Su-Jin,Ryu, Keun-Taik,Kang, Min-Seong,Lim, Soo-Mee,Lee, Sun-Ho,Lee, So-Jin,Ko, Eun,Jeong, Do-Un 대한생물정신의학회 2012 생물정신의학 Vol.19 No.2

Objectives : Although there have been studies that examine sex differences of the brain structures using magnetic resonance imaging, studies that specifically investigate cerebellar structural differences between men and women are scarce. The purpose of current study was to examine sex differences in structures of the cerebellum using cerebellar template and cerebellum analysis methods. Methods : Sixteen men and twenty women were included in the study. A MATLAB based program (MathWorks, Natick, MA, USA), Statistical Parametric Mapping 5 (SPM5) using the spatially unbiased infra-tentorial atlas template (SUIT) as the cerebellum template, was used to analyze the brain imaging data. Results : There was no significant difference in age between men (mean age=28.1) and women (mean age=27.2). Men showed higher gray matter density than women in two left cerebellar areas including the clusters in the lobules IV and V (a cluster located across the lobules IV and V), and the lobule VIIIb (lobules IV and V, t=4.75, p<0.001 ; lobule VIIIb, t=3.08, p=0.004). Conclusions : The current study found differences in cerebellar gray matter density between men and women. The current study holds its significance for applying the template specifically developed for the analysis of cerebellum.

수면장애에서 비침습적 뇌자극술의 치료 효과 고찰 : 경두개자기자극술과 경두개직류전기자극술을 중심으로

김신혜(Shinhye Kim),이수지(Suji Lee),임수미(Soo Mee Lim),윤수정(Sujung Yoon) 대한수면의학회 2021 수면·정신생리 Vol.28 No.2

Sleep disorders, increasingly prevalent in the general population, induce impairment in daytime functioning and other clinical problems. As changes in cortical excitability have been reported as potential pathophysiological mechanisms underlying sleep disorders, multiple studies have explored clinical effects of modulating cortical excitability through non-invasive brain stimula- tion in treating sleep disorders. In this study, we critically reviewed clinical studies using non-invasive brain stimulation, partic- ularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), for treatment of sleep disor- ders. Previous studies have reported inconsistent therapeutic effects of TMS and tDCS for various kinds of sleep disorders. Specifically, low-frequency repetitive TMS (rTMS) and cathodal tDCS, both of which exert an inhibitory effect on cortical excit- ability, have shown inconsistent therapeutic effects for insomnia. On the other hand, high-frequency rTMS and anodal tDCS, both of which facilitate cortical excitability, have improved the symptoms of hypersomnia. In studies of restless legs syn- drome, high-frequency rTMS and anodal tDCS induced inconsistent therapeutic effects. Single TMS and rTMS have shown differential therapeutic effects for obstructive sleep apnea. These inconsistent findings indicate that the distinctive character- istics of each non-invasive brain stimulation method and specific pathophysiological mechanisms underlying particular sleep disorders should be considered in an integrated manner for treatment of various sleep disorders. Future studies are needed to provide optimized TMS and tDCS protocols for each sleep disorder, considering distinctive effects of non-invasive brain stimulation and pathophysiology of each sleep disorder.

탈수초화 동물 모델과 ¹H 자기공명분광영상

조한별,이수지,박신원,강일향,마지영,정현석,김지은,윤수정,류인균,임수미,김정윤,Cho, Han Byul,Lee, Suji,Park, Shinwon,Kang, Ilhyang,Ma, Jiyoung,Jeong, Hyeonseok S.,Kim, Jieun E.,Yoon, Sujung,Lyoo, In Kyoon,Lim, Soo Mee,Kim, Jungyoon 대한생물정신의학회 2017 생물정신의학 Vol.24 No.1

The proton magnetic resonance spectroscopy ($^1H-MRS$) is a tool used to detect concentrations of brain metabolites such as N-acetyl aspartate, choline, creatine, glutamate, and gamma-amino butyric acid (GABA). It has been widely used because it does not require additional devices other than the conventional magnetic resonance scanner and coils. Demyelination, or the neuronal damage due to loss of myelin sheath, is one of the common pathologic processes in many diseases including multiple sclerosis, leukodystrophy, encephalomyelitis, and other forms of autoimmune diseases. Rodent models mimicking human demyelinating diseases have been induced by using virus (e.g., Theiler's murine encephalomyelitis virus) or toxins (e.g., cuprizon or lysophosphatidyl choline). This review is an overview of the MRS findings on brain metabolites in demyelination with a specific focus on rodent models.

고려 홍삼이 대뇌 백질 미세구조 및 인지기능에 미치는 효과 : 침입 오류를 중심으로

정현석,김영훈,이선호,염아림,강일향,김지은,이정현,반순현,임수미,이선혜,Jeong, Hyeonseok S.,Kim, Young Hoon,Lee, Sunho,Yeom, Arim,Kang, Ilhyang,Kim, Jieun E.,Lee, Junghyun H.,Ban, Soonhyun,Lim, Soo Mee,Lee, Sun Hea 대한생물정신의학회 2015 생물정신의학 Vol.22 No.2

Objectives Although ginseng has been reported to protect neuronal cells and improve various cognitive functions, relationship between ginseng supplementation and response inhibition, one of the important cognitive domains has not been explored. In addition, effects of ginseng on in vivo human brain have not been investigated using the diffusion tensor imaging (DTI). The purpose of the current study is to investigate changes in intrusion errors and white matter microstructure after Korean Red Ginseng supplementation using standardized neuropsychological tests and DTI. Methods Fifty-one healthy participants were randomly allocated to the Korean Red Ginseng (n = 26) or placebo (n = 25) groups for 8 weeks. The California Verbal Learning Test was used to assess the number of intrusion errors. Intelligence quotient (IQ) was measured with the Korean Wechsler Adult Intelligence Scale. Depressive and anxiety symptoms were evaluated using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Hopkins Symptom Checklist-25. The fractional anisotropy (FA) was measured from the brain DTI data. Results After the 8-week intervention, Korean Red Ginseng supplementation significantly reduced intrusion errors after adjusting age, sex, IQ, and baseline score of the intrusion errors (p for interaction = 0.005). Change in FA values in the left anterior corona radiata was greater in the Korean Red Ginseng group compared to the placebo group (t = 4.29, p = 0.04). Conclusions Korean Red Ginseng supplementation may be efficacious for improving response inhibition and white matter microstructure integrity in the prefrontal cortex.

이소골 전위 및 골절에서의 고해상 CT 소견

임수미,최혜영,팽미혜,변성완,김미성 梨花女子大學校 醫科大學 醫科學硏究所 2003 EMJ (Ewha medical journal) Vol.26 No.1

목적 : 측두골 외상으로 인한 이소골 전위나 골절의 고해상 CT 소견을 알아보고자 하였다. 대상 및 방법 : 1998년 1월부터 2002년 6월까지 측두골 외상 환자 중 고해상 CT에서 이소골 전위나 골절이 있었던 11명의 환자를 대상으로 하였다. 8명의 환자에서는 필름을, 3명의 환자에서는 PACS를 이용한 고해상 CT를 후향적으로 분석하였고 이소골 전위 및 골절의 분류, 측두골 골절의 분류, 그 외 주위조직의 동반된 이상소견을 알아보았다. 결과 : 11명의 이소골 이상이 있었던 환자 중 침추골 관절 분리가 10예로 가장 많았고 침등골 관절 분리가 4예 있었으며 추골 골절, 침골 골절, 침골의 장각과 두상돌기 전위, 침골돌기가 보이지 않았던 경우가 각각 1예씩 있었다. 측두골 골절은 8예에서 있었으며 종위골절이 7예, 황위골절 1예였고 그 외에도 경동맥관 골절, 경동맥해면루, 접형골과 후두골의 골절이 동반되었다. 필름을 이용한 고해상 CT에서 보다 PACS를 이용한 CT에서 확대 및 창폭(window width) 변화가 가능하여 이소골 평가에 이용하였다. 결론 : 측두골 외상으로 인한 이소골의 전위가 골절은 고해상 CT상 횡단 및 관상면의 정확한 해부학적 지식이 필요하였으며 침추골 관절 분리가 가장 흔하고 측두골의 종위골절이 많이 동반되며 특히 PACS를 이용한 고해상 CT가 이소골 평가에 유용하였다. Purpose : To evaluate the CT findings of ossicular disruption and fracture utilizing high resolution computed tomography(HRCT) of the temporal bone. Materials and Methods : The authors retrospectively reviewed the HRCT scans of 11 patients with ossicular injuries between January 1998 and June 2002 using films in 8 patients, PACS in 3 patients. The type of ossicular injuries, temporal bone fracture, and associated adjacent injuries were evaluated. Results : Among the 11 patients of ossicular injuries, there were 10 cases of incudomalleal disruption, 4 cases of incudostapedial disruption, and 1 case of fracture of malleus, fracture of incus, disruption of long and lenticular process of incus, nonvisualization of processes of incus. The temporal bone fractures were longitudinal in 7 cases, transverse in I case. Other injuries were fracture of the carotid canal, caroticocavemous fistula, fracture of sphenoid and occipital bones. Conclusion : Incudomalleal disruption was the most frequent tupe of ossicular injuries and associated temporal bone fracture was longitudinal type. HRCT using PACS was useful in evaluation of ossicular injuries than films.

수막종에서 근치적 및 수술 후 구제요법으로써 방사선치료의 결과

이지혜,임수미,김명수,서현숙 이화여자대학교 의과학연구소 2013 EMJ (Ewha medical journal) Vol.36 No.2

Objectives: Radiation therapy has multiple roles in the treatment of meningioma although surgery remains the primary treatment of choice. In this retrospective study, we report the results of radiation therapy for meningioma as definitive, postoperative or salvage therapies. Methods: Seventeen patients diagnosed with meningioma were treated with radiation therapy in our institute from May 2000 to October 2009. Radiation therapies were performed as definitive therapies in 8 patients, as postoperative therapies in 5 and as salvage therapies in 4. Nine patients received stereotactic radiosurgery (SRS), 2 patients fractionated stereotactic radiotherapy (FSRT), and 5 patients 3-dimensional conformal radiotherapy (3DCRT). Radiation dose were 12 to 20 Gy for SRS, 36 Gy in 9 fractions for FSRT and 50.4 Gy in 28 fractions for 3DCRT. Follow-up imaging study of computed tomography or magnetic resonance imaging was performed at 6 to 12 months intervals and neurologic exam was performed with an interval less than 6 months. Results: The median follow-up duration was 38 months (range, 12 to 85 months). Tumor progression after radiation therapy developed in one patient. The reduction of tumor volume measured on follow-up images were more than 20% in 4 patients and minimal change of tumor volume less than 20% were observed in 12 patients. Peritumoral edema developed in 4 patients and disappeared without any treatment. One patient had radiation necrosis. Conclusion: Our experience is consistent with the current understanding that radiotherapy is as an effective and safe treatment modality for meningiomas when the tumor cannot be resected completely or when recurred after surgery.