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돼지에서 초저체온 순환정지 하의 역행성 뇌관류시 뇌대사, 혈류역학 지표, 뇌조직 소견 및 혈청 내 neuron-specific enolase의 변화
김경환,안혁,Kim, Kyung-Hwan,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.6
Background: Retrograde cerebral perfusion(RCP) is currently used for brain protection during aorta surgery, however, for the safety of it, various data published so far are insufficient. We performed RCP using pig and investiaged various parameters of cerebral metabolism and brain injury after RCP under deep hypothermia. Material and Method: We used two experimental groups: in group I(7 pigs, 20 kg), we performed RCP for 120 minutes and in group II (5 pigs, 20 kg), we did it for 90 minutes. Nasopharyngeal temperature, jugular venous oxygen saturation, electroencephalogram were continuously monitored, and we checked the parameters of cerebral metabolism, histological changes and serum levels of neuron-specific enolose(NSE) and lactic dehydrogenase(LDH). Central venous pressure during RCP was mainained in the range of 25 to 30 mmHg. Result: Perfusion flow rates(ml/min) during RCP were 130$\pm$57.7(30 minutes), 108.6$\pm$55.2(60 minutes), 107.1$\pm$58.8(90 minutes), 98.6$\pm$58.7(120 minutes) in group I and 72$\pm$11.0(30 minutes), 72$\pm$11.0(60 minutes), 74$\pm$11.4(90 minutes) in group II. The ratios of drain flow to perfusion flow were 0.18(30 minutes), 0.19(60 minutes), 0.17(90 minutes), 0.16(120 minutes) in group I and 0.21, 0.20, 0.17 in group II. Oxygen consumptions(ml/min) during RCP were 1.80$\pm$1.37(30 minutes), 1.72$\pm$1.23(60 minutes), 1.38$\pm$0.82(90 minutes), 1.18$\pm$0.67(120 minutes) in group I and 1.56$\pm$0.28(30 minutes), 1.25$\pm$0.28(60 minutes), 1.13$\pm$0.26(90 minutes). We could observe an decreasing tendency of oxygen consumption after 90 minutes of RCP in group I. Cerebrovascular resistance(dynes.sec.cm-5) during RCP in group I incrased from 71370.9$\pm$369145.5 to 83920.9$\pm$49949.0 after the time frame of 90 minutes(p<0.05). Lactate(mg/min) appeared after 30 minutes of RCP and the levels were 0.15$\pm$0.07(30 minutes), 0.18$\pm$0.10(60 minutes), 0.19$\pm$0.19(90 minutes), 0.18$\pm$0.10(120 minutes) in group I and 0.13$\pm$0.09(30 minutes), 0.19$\pm$0.03(60 minutes), 0.29$\pm$0.11(90 minutes) in group II. Glucose utilization, exudation of carbon dioxide, differences of cerebral tissue acidosis between perfusion blood and drain blood were maintained constantly during RCP. Oxygen saturation levels(%) in drain blood during RCP were 22.9$\pm$4.4(30 minutes), 19.2$\pm$4.5(60 minutes), 17.7$\pm$2.8(90 minutes), 14.9$\pm$2.8(120 minutes) in group I and 21.3$\pm$8.6(30 minutes), 20.8$\pm$17.6(60 minutes), 21.1$\pm$12.1(90 minutes) in group II. There were no significant changes in cerebral metabolic parameters between two groups. Differences in serum levels of NSE and LDH between perfusion blood and drain blood during RCP showed no statistical significance. Serum levels of NSE and LDH after resuming of cardipulmonary bypass decreased to the level before RCP. Brain water contents were 0.73$\pm$0.03 in group I and 0.69$\pm$0.06 in group II and were higher than those of the controls(p<0.05). The light microscopic findings of cerebral neocortex, basal ganglia, hippocampus(CA1 region) and cerebellum showed no evidence of cerebral injury in two groups and there were no different electron microscopy in both groups(neocortex, basal ganglia and hippocampus), but they were thought to be reversible findings. Conclusion: Although we did not proceed this study after survival of pigs, we could perform the RCP successfully for 120 minutes with minimal cerebral metabolism and no evidence of irreversible brain damage. The results of NSE and LDH during and after RCP should be reevaluated with survival data.
PNF 패턴에서 각도에 따른 Normal Timing의 적용이 체간 근육활성에 미치는 영향
김경환,윤혜진,박성훈,임진우,Kim, Kyung-Hwan,Youn, Hye-Jin,Park, Sung-Hun,Lim, Jin-Woo 대한고유수용성신경근촉진법학회 2015 PNF and Movement Vol.13 No.2
Purpose: The purpose of this study was to analyze the effect of normal timing according to angular motion in PNF patterns on electromyography (EMG) activity in rectus abdominis, internal oblique abdominal muscle, external oblique abdominal muscle, and erector spinae. Methods: Ten healthy adults volunteered to participate in this study. The participants were required to complete following two PNF extremity patterns; upper extremity extension- adduction-internal rotation pattern with $180^{\circ}$, $90^{\circ}$, $30^{\circ}$ and lower extremity flexion- adduction-external rotation pattern with $0^{\circ}$, $60^{\circ}$, $90^{\circ}$. A paired t-test was used to determine the influence of the two PNF patterns on muscle activity in each muscle. Descriptive statistics were used to determine the ratio of local muscle activity to global muscle activity. Results: In terms of their effect on applied normal timing, the upper and lower extremity pattern significantly affected the rectus abdominis, internal oblique, external oblique, and erector spinae (p < .05). The upper extremity pattern (at an extension angle of $30^{\circ}$) and the lower extremity pattern ((at a flexion angle of $90^{\circ}$) influenced the rectus abdominis, internal oblique, external oblique, and erector spinae (p < .05). Conclusion: The effect of the upper and lower extremity patterns on applied normal timing was significant in that these patterns increased trunk muscle activation. The upper extremity pattern (at an extension angle of $30^{\circ}$) and the lower extremity pattern (at a flexion angle of $90^{\circ}$) increased trunk muscle activation. Normal timing is required to increase trunk muscle strength and extremity movement.
일개 병원에서의 일산화탄소 중독증으로 내원한 환자에 대한 분석
김경환,김아진,신동운,노준영,Kim Kyung Hwan,Kim Ah Jin,Shin Dong Wun,Rho Jun Young 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1
Purpose: The frequency of carbon monoxide poisoning has been decreased in the interior of the Korea. But occasionally it is occurred and the risk of exposure is high in working place so far. Because of the characteristics of gas, the detection of exposure and poisoning could be delayed and fatality is high. We should apprehend of carbon monoxide poisoning. So we would report analysis of patients with carbon monoxide poisoning. Methods: A retrospective review of CO poisoned patients visited emergency department from January 2000 to December 2004 was conducted. Results: 24 patients were enrolled. Their average of age was $37.6\pm20.9$ years old and COHb was $19.4\pm13.32\%$. The blood level of initial COHb and mental status on arrival were not correlated each other. The blood level of initial COHb and loss of consciousness were not correlated, too. Initial electrocardiography (EKG) was not correlated with cardiac enzymes such as CK-MB and troponin I. But base excess was correlated with mental status on arrival and complication such as rhabdomyolysis. Hyperbaric oxygen therapy was correlated with base excess and mental status on arrival. Conclusion: The clinical features of carbon monoxide poisoning are nonspecific. For proper diagnosis, it is important that we should consider patient's environment and take patient's history carefully. The blood level of initial COHb does not reflect severity of poisoning accurately. So We should determine the treatment of choice depending on patient's status.
펀측 상지에 적용된 고유수용성 신경근 촉진법이 반대측 하지의 근 활성도에 미치는 영향
김경환,박지원,배성수,Kim, Kyung-Hwan,Park, Ji-Won,Bae, Sung-Soo 대한고유수용성신경근촉진법학회 2006 PNF and Movement Vol.4 No.1
Purpose: The purpose of this study was to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) applied to the unilateral upper extremity on the muscle activation of contralateral lower extremity. Twenty-two healthy subjects (mean age of 23.7 years) participated in this study. Method : PNF patterns applied on the unilateral upper extremity in all subjects were the flexion/abduction/external rotation and lifting pattern. The hold and appoximation techniques for the irradiation were applied to end range of both patterns. Muscle activations in four patterns were measured in vastus medialis, tibialis anterior, rectus femoris, and gastrocnemius medial muscles of contralateral lower extremity using surface EMG system. Each EMG value in individual muscle was normalized for maximal voluntary contraction. The data were analyzed by one factor analysis of variance with repeated measure test. Result : There were significant differences in the between-subject effect (muscles) and within-subject effect (patterns) in comparison of muscle activation by application of PNF patterns (p<.05). The irradiation led to higher activation in the flexion/abduction/external rotation pattern than that of lifting pattern in all muscles (p<.05). The approximation techniques revealed more activations than these of hold technique in all muscles (p<.05). Conclusion : These results suggest that the application of PNF patterns to the unilateral upper extremity affect on the muscle activation of contralateral lower extremity and increase according to the intensity of resistance. This mechanism of contralateral effect might provide a help to the development of treatment method for the affected side and functional improvement for the patients who have damages of central nervous system or musculoskeletal problems by orthopedic injury.
김경환,안혁,Kim, Kyung-Hwan,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.11
배경: 흉복부 대동맥류는 질환 자체가 광범위하고 수술 중 척수를 포함한 각종 장기의 보호 및 허혈 방지라는 면에서 아직도 수술 합병증이 높은 질환이다. 본 연구에서는 그 동안의 임상경험을 바탕으로 치료성적, 합병증 발생, 사망률 등을 검토하였다. 대상 및 방법: 1990년 1월부터 1999년 12월까지 흉복부동맥류로 수술을 시행한 38명의 환자를 대상으로 의무 기록 검토을 통한 후향적 분석을 시행하였다. 결과: 남자가 22명, 여자가 16명, 평륜 연령은 46.2$\pm$12.3세였고, 크로포드 진단분류 상 1형 이 13례(34.2%), 2형이 19례(50%), 3형이 4례(11%), 4형이 2례(4.8%)였다. 만성 대동맥박리증에 관련된 경우가 29례(76.3%)로 가장 많았고, Marfan 증후군이 동반된 경우가 9례(23.7%)에서 있었다. 원위부 대동맥 관류를 35례에서 시행하였으며, 고동맥-고정맥 심폐바이패스를 31례에서, 좌심방-고동맥 바이패스를 4례에서 시행하였다. 심폐바이패스를 이용한 31례중 4례에서 초저체온하 완전순환정지를 이용하였다. 대동맥 차단 중 복강내 주요 대동맥 분지로의 선택적 관류를 시행하였다. 대동맥류의 최대직경은 평균 8.2$\pm$2.4cm이었고, 동맥류가 파열된 경우는 11례(28.9%)에서 있었다. 전례에서 인조혈관을 이용한 대동맥의 치환술을 시행하였다. 단계적으로 흉복부 대동맥을 겸자하면서 인공혈관을 문합하였고, Adamkiewicz 동맥으로 생각되는 부위의 늑간 동맥을 문합해주었는데, 8번째부터 12번째 흉추 사이의 늑간 동맥 중 역류혈류가 나타나고 상대적으로 내경이 큰 것들을 문합해 주었다. 술 후 조기사망은 3례에서 있었으며, 사인은 심폐기 이탈 실패 (2례), 저혈압 및 산증(1례) 등이었다. 조기 합병증으로는 애성 5례, 출혈 5례, 창상간염 3례, 장기간의 인공호흡기보조가 3례 등이 있었다. 치명적인 조기 합병증인 하지마비는 2례(5.3%)에서 발생하였고, 이 중 1례는 대동맥의 심한 석회화로 늑간동맥을 문합해 주지 못했던 경우였다. 35명의 환자에서 평균 추적기간은 103.1$\pm$6.1 개월, 2년 생존율은 93.8%, 5년 생존율은 86.1%, 8년 생존율은 80.7%였다. 추척기간 동안 4례의 만기사망이 관찰되었고, 사인은 2례에서는 갑작스런 의식소실이 발생하여 규명하기 어려웠으며, 대동맥-식도루 발생에 의한 경우가 1례, 경동맥류 파열에 의한 경우가 1례 등이었다. 만기 합병증으로는 복부 대동맥류(2례), 상행 대동맥 및 대동맥 근부 확장(1례), 대동맥-늑막루(1례), 창상 부위 탈장(1례), 역행성 사정(1례) 등이 있었다. 결론: 저자들은 흉복부대동맥류의 수술에 있어 심폐우 회술 혹은 좌심방-고동맥 바이패스를 통한 원위부 관류 및 저체온법, 수술 시 척수의 혈류공급과 관련된 늑간동맥의 연결 등으로 주요 신경합병증의 발생을 줄이고 좋은 성적을 거두고 있다고 판단하였으며 향후 임상 경험 축적과 함께 보다 정련된 위험인자의 분석이 필요하다고 본다.
자세변화에 따른 PNF 패턴이 체간 근육활성에 미치는 영향
김경환,윤혜진,박성훈,임진우,Kim, Kyung-Hwan,Youn, Hye-Jin,Park, Sung-Hun,Lim, Jin-Woo 대한고유수용성신경근촉진법학회 2016 PNF and Movement Vol.14 No.1
Purpose: The purpose of this study was to analyze the effects of proprioceptive neuromuscular facilitation (PNF) patterns on electromyography (EMG) activity in the rectus abdominis, internal abdominal oblique, external abdominal oblique, and erector spinae according to position changes. Methods: Ten healthy adults volunteered to participate in the study. The subjects were required to complete exercises that followed two PNF extremity patterns, namely, an upper extremity extension-adduction-internal rotation pattern and a lower extremity flexion-adduction-external rotation pattern. The exercises were applied in the supine, side-lying, and sitting positions. Repeated measure one-way ANOVA and post-hoc Bonferroni correction were used to determine the influence of the patterns on muscle activity for each muscle, and descriptive statistics were then used to determine the local/global muscle ratios. Results: The upper extremity pattern had a significant effect on the rectus abdominis and erector spinae in the supine position, and on the internal oblique and external oblique in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.05, and a high ratio of 1.01 was shown for the internal oblique/external oblique in the sitting position. The lower extremity pattern had a significant effect on the rectus abdominis in the side-lying position and on the internal oblique, external oblique, and erector spinae in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.83 in the sitting position and a high ratio of 1.30 for the internal oblique/external oblique in the side-lying position. Conclusion: The PNF pattern increases local muscle activation in an unstable position. Therefore, when the pattern is used for intervention purposes, trunk stability and varied position changes should be taken into account.
안드로이드 플랫폼 상에서 동기화가 고려된 통합 커서의 설계 및 구현
김경환,하주호,원종필,이의성,김주민,손진호,Kim, Kyung-Hwan,Ha, Jo-Ho,Won, Jong-Pil,Lee, Uee-Song,Kim, Joo-Min,Son, Jin-Ho 대한임베디드공학회 2011 대한임베디드공학회논문지 Vol.6 No.3
Android platform provides a content provider and a cursor mechanism to access the internal SQLite engine. Content providers not only store and retrieve data but also make it accessible to applications. Applications can only share data through content provider, since there's no common storage area that Android packages can access. Cursor is an interface that provides random read-write access to the result set returned by a database query. However, this cursor possesses two major limitations. First, a cursor does not support a join clause among cursors, since the cursor can only access a single table in the content provider. Second, the cursor is not capable of creating user-customized field in the predefined content providers. In this paper, we propose the unified cursor architecture that merges several cursors into a single virtual cursor. Cursor translation look-aside buffer (TLB), column windowing mechanism and virtual data management are the three major techniques we have adopted to implement our structure. And we also propose a delayed synchronization method between an application and a proposed unified cursor. An application can create a user-customized field and sort multiple tables using a unified cursor on Android platform.
태양전지용CuInSe<sub>2</sub>와 CuGaSe<sub>2</sub> 흡수층의 전자구조해석을 위한 표면 청정기술 개발
김경환,최형욱,공석현,Kim, Kyung-Hwan,Choi, Hyung-Wook,Kong, Sok-Hyun 한국전기전자재료학회 2005 전기전자재료학회논문지 Vol.18 No.2
Two kinds of physical treatments were examined for the analysis both of intrinsic surface and interior nature of CuInS $e_2$[CIS] and CuGaS $e_2$[CGS] films grown in separated systems. For the first method, a selenium protection layer which was immediately deposited after the growth of the CIS was investigated. The Se cap layer protects CISe surface from oxidation and contamination during the transport under ambient atmosphere. The Se cap was removed by thermal annealing at temperature above 15$0^{\circ}C$. After the decapping treatment at 2$25^{\circ}C$ for 60 min, ultraviolet photoemission and inverse photoemission measurements of the CIS film showed that its valence band maximum(VBM) and conduction band minimum (CBM) are located at 0.58 eV below and 0.52 eV above the Fermi level $E_{F}$, respectively. For the second treatment, an Ar ion beam etching was exploited. The etching with ion kinetic energy $E_{k}$ above 500 eV resulted in broadening of photoemission spectra of core signals and occasional development of metallic feature around $E_{F}$. These degradations were successfully suppressed by decreasing $E_{k}$ below 400 eV. CGS films etched with the beam of $E_{k}$ = 400 eV showed a band gap of 1.7 eV where $E_{F}$ was almost centered.st centered.
김경환,김기봉,김원곤,김주현,안혁,Kim, Kyung-Hwan,Kim, Ki-Bong,Kim, Won-Gon,Kim, Joo-Hyun,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.5
Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.
슬관절 각도에 따른 교각운동이 하지근 활성도에 미치는 영향
김경환,기경일,윤혜진,Kim, Kyung-hwan,Ki, Kyong-il,Youn, Hye-jin 대한고유수용성신경근촉진법학회 2011 PNF and Movement Vol.9 No.1
Purpose : The purpose of this study was to assess the effects of the lower extremity muscle activity on bridging exercise according to the knee joint angle. Methods : Twenty-five healthy adults volunteered to participate in this study. Subjects were required to complete following four bridging exercises; knee joint flexion $120^{\circ}$, $90^{\circ}$, $60^{\circ}$, $45^{\circ}$. Surface electromyography from selected lower extremity muscles was normalized to maximum voluntary isometric contraction. Muscle activity was measured by QEMG-4 system (LXM 3204, Laxtha Korea). A repeated measures of one-way ANOVA was used to determine the influence of bridging exercise on muscle activity for each muscle and descriptive statistics was used to determine muscle ratio. Results : The biceps femoris of all bridging exercises showed significantly(p<.05). The vastus medialis and lateralis of all bridging exercises showed significant excepted $120^{\circ}$(p<.05). The rectus femoris of all bridging exercises showed no significant. Median of vastus medialis/rectus femoris ratio of $120^{\circ}$ was 2.03, $90^{\circ}$ was 2.16, $60^{\circ}$ was 2.67, $45^{\circ}$ was 4.10. Median of vastus lateralis/rectus femoris ratio of $120^{\circ}$ was 1.70, $90^{\circ}$ was 1.70, $60^{\circ}$ was 2.08, $45^{\circ}$ was 2.58. Median of vastus medialis/vastus lateralis ratio of $120^{\circ}$ was 1.26, $90^{\circ}$ was 1.50, $60^{\circ}$ was 1.52, $45^{\circ}$ was 1.47. Conclusion : Angular motion decreasing with knee joint flexion made increase biceps femoris and vastus medialis activation. This result will be use knee joint stabilizing exercises during bridging or unstable surface training and biceps femoris strength training.