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

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.

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.

Clinical Application of Functional MRI : Motor Cortex Activities by Acupuncture

Choe, Bo-Young Korean Magnetic Resonance Society 2002 Journal of the Korean Magnetic Resonance Society Vol.6 No.2

We report a preliminary fMRI evidence of modulation of somatomotor areas by acupuncture in GB34 acupoint. GB34, located in the back of the knee, is known to be effective in recovering motor function after stroke. Using 3T MR scanner, functional MR imaging was performed in five normal volunteers in two stimulation paradigms; acupuncture manipulation on GB34 and sham points. Group analysis form five individuals showed that bilateral sensorimotor areas (BA 3,4,6 and 7) showed stimulation related BOLD signal contrast of approximately 6% whereas very few areas were activated when sham stimulation is given. Our results suggest that acupuncture fMRI study can be safely conducted in 3T environment and stimulation in GB34 modulate the cortical activities of the somatomotor area in human.

Trend of High Field MRI System

Choe, Bo-Young 가톨릭의과학연구원 2000 가톨릭 의과학연구원 국제학술대회 Vol.4 No.-

Neurometabolic Improvement in Parkinson's Disease after Stereotactic Functional Neurosurgery by Follow-up MR Spectroscopy

Choe, Bo-Young,Baik, Hyeon-Man,Jeun, Sin-Soo,Son, Byung-Chul,Kim, Moon-Chan,Kim, Bum-Soo,Lee, Jae-Moon,Lee, Hyoung-Koo,Suh, Tae-Suk Korean Magnetic Resonance Society 2003 Journal of the Korean Magnetic Resonance Society Vol.7 No.1

PURPOSE - To investigate neurometabolism from the brain destructive lesions and striatal putamen-pallidus regions to the clinically worst side in patients with Parkinson's disease after stereotactic functional neurosurgery. METHODS - Using proton magnetic resonance spectroscopy ($^1$H MRS), fifteen patients (7 males and 8 females; mean age 56.5 years; age range 43-67 years) with Parkinson's disease (PD) were studied to measure N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (Cho) and lactate (Lac) levels on the neurosurgical lesions of thalamus, globus pallidus and striatal putamen-pallidus regions in a brain. RESULTS - Brain destructive lesion and striatal putamen-pallidus region in PD compared with controls were highly and significantly related to NAA/Cho ratios reduction, respectively (P =0.002, P =0.04), but showed no difference from the same regions of PD prior to neurosergery (P =0.06, P =0.77). Increased lactate peaks at 1.3 ppm were present in all the cerebral lesions, and these resonances were confirmed at a long TE =136 ms, indicating that these signals distinguished from lipids. CONCLUSIONS - Our results suggest that NAA/Cho ratios may provide as a neurometabolite marker for neurochemical changes in brain surgical lesion, and the ratios might be related to functional change of neuropathophysiological status in the striatal putamen-pallidus region of PD. Increase of lactate signals, being remarkable in surgical lesions, could be consistent with a common consequence of surgical necrosis. Therefore, MR spectroscopy could be a sensitive diagnostic tool in monitoring neurometabolic changes in PD with neurosurgical treatment.

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.

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.

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

Evaluations of Inhomogeneous Shimming in $^1$H MR Spectroscopy

Choe, Bo-Young,Baik, Hyeon-Man,Suh, Tae-Suk,Lee, Hyoung-Koo,Chun, Heung-Jae,Shim, Kyung-Sub Korean Society of Medical Physics 2000 의학물리 Vol.11 No.1

In this study, we investigate the effects of poor shimming on quantitative measurement of ratios of metabolite levels by proton magnetic resonance spectroscopy ($^1$H MRS). Coefficient of variation (COV) of metabolite ratios for point resolved spectroscopy (PRESS) and stimulated-echo acquisition mode (STEAM) spectra was evaluated from a phantom containing in vivo levels of metabolites using a conventional whole body 1.5T MR system and conventional acquisition and analysis protocol. A statistical P-value was also calculated from a linear regression for relationship of metabolite ratios. N-acetylaspartate (NAA)/ creatine (Cr) and NAA/ choline (Cho) had low COV values for the long and short TE spectra (29.1 and 27.5%; 23.8 and 12.6 %), whereas Cho/Cr and Cr/Cho had high COV values (50.0 and 68.6 %; 27.5 and 29.3 %). A linear relationship between NAA/Cr and Cho/Cr, and between NAA/Cho and Cr/Cho revealed the statistical significance in the long and short TE spectra, respectively (P < 0.0001 and P < 0.0001; P = 0.015 and P = 0.005). There was no significant relationship between Cho/NAA and Cr/NAA in the measurement (P = 0.159; P = 0.910). The present study suggested that NAA/Cr and NAA/Cho could be useful for data with poor shimming in $^1$H MR spectroscopy. In conclusion, statistical significance of metabolite ratios indicated that the Cr and Cho levels could be interpreted as a significant alteration factor in the long and short TE spectra, and then should be used with care to provide precise metabolite quantification. 본 연구에서는 양성자 자기공명분광법을 이용하여 대사물질의 양적 비율 산출시 비균질한 자장보정의 영향을 정량평가하였다. 점분해분광법과 자극반향 획득법을 사용하여 대사비율의 변화상수를 전신 1.5T 자기공명장비, 기존 분석방법에 의해 평가하였다. 통게학적 분석방법으로 선형계측방법을 사용하여 P d값을 산출하였다. 결과로서 N-acetylaspartate (NAA)/ creatine (Cr)과 NAA/ choline (Cho) 비율은 긴 TE와 짧은 TE 값에 대해 낮은 COV 값은 나타낸 반면 Cho/Cr과 Cr/Cho 비율은 높은 COV 값을 나타냈다. NAA/Cr과 Cho/Cr 그리고 NAA/Cho과 Cr/Cho 비율은 긴 TE와 짧은 TE 값에 대해 상당한 긴밀한 P값을 나타냈다. (P < 0.0001 and P < 0.0001; P = 0.015 and P = 0.005). 반면 Cho/NAA과 Cr/NAA은 통게Gkr적 유의성이 발견되지 않았다. (P = 0.159; P = 0.910). 본 연구 결과에 의해서 NAA/Cr과 NAA/Cho 비율은 자기공명분광 비율산출에서 자기보정에 관계없이 가장 유용한 방법으로 나타났다. 결론적으로 Cr과 Cho는 정확한 정량측정시 가장 유용한 대사물질로 나타났다.