How Does the Left Ventricle Work? Ventricular Rotation as a New Index of Cardiac Performance

송재관 대한심장학회 2009 Korean Circulation Journal Vol.39 No.9

Although simple cylindrical or ellipsoidal left ventricular (LV) geometry with transverse or circumferential muscle contraction has been traditionally used to estimate LV performance, the estimated LV ejection fraction (EF) with muscle fiber shortening up to 20% is less than 50% of maximum, which is lower than the normal EF observed in routine clinical practice. Thus, oblique fiber orientation and LV rotation, in addition to radial thickening and longitudinal shortening, is predicted as an essential component of effective LV pumping. This was confirmed by animal experiments using surgically implanted markers or invasive sonomicrometry. Demonstration of the muscle band extending from the pulmonary artery to the aorta, which connects the ventricular myocardium, both right ventricle and LV as a continuous band (muscle band theory) provides an anatomical backbone of helical configuration of the cardiac muscle band with descending and ascending segments wrapping the LV apex. Moreover, sequential, non-simultaneous, activation and contraction of the helicoids muscle band contributes to LV rotation or twist motion. Recently, magnetic resonance imaging and speckle tracking echocardiography (STE) techniques have provided an excellent noninvasive way to measure LV rotation and twist, which is expected to contribute to a more thorough evaluation of both LV systolic and diastolic function. Initial animal experiments showed that quantification of apical rotation or LV twist using STE is more accurate for estimating LV systolic function than conventional EF under a variety of LV inotropic conditions, irrespective of coronary ligation. As de-rotation or the untwisting rate can also be measured by STE, the role of ventricular untwisting as a temporal link between LV relaxation and suction can be addressed. Further clinical investigations are needed to determine the real clinical impact of these new indices of LV mechanical function. Although simple cylindrical or ellipsoidal left ventricular (LV) geometry with transverse or circumferential muscle contraction has been traditionally used to estimate LV performance, the estimated LV ejection fraction (EF) with muscle fiber shortening up to 20% is less than 50% of maximum, which is lower than the normal EF observed in routine clinical practice. Thus, oblique fiber orientation and LV rotation, in addition to radial thickening and longitudinal shortening, is predicted as an essential component of effective LV pumping. This was confirmed by animal experiments using surgically implanted markers or invasive sonomicrometry. Demonstration of the muscle band extending from the pulmonary artery to the aorta, which connects the ventricular myocardium, both right ventricle and LV as a continuous band (muscle band theory) provides an anatomical backbone of helical configuration of the cardiac muscle band with descending and ascending segments wrapping the LV apex. Moreover, sequential, non-simultaneous, activation and contraction of the helicoids muscle band contributes to LV rotation or twist motion. Recently, magnetic resonance imaging and speckle tracking echocardiography (STE) techniques have provided an excellent noninvasive way to measure LV rotation and twist, which is expected to contribute to a more thorough evaluation of both LV systolic and diastolic function. Initial animal experiments showed that quantification of apical rotation or LV twist using STE is more accurate for estimating LV systolic function than conventional EF under a variety of LV inotropic conditions, irrespective of coronary ligation. As de-rotation or the untwisting rate can also be measured by STE, the role of ventricular untwisting as a temporal link between LV relaxation and suction can be addressed. Further clinical investigations are needed to determine the real clinical impact of these new indices of LV mechanical function.

점액성 변성에 의한 승모판 일탈증의 병변 특성:심장초음파를 이용한 다기관 전향적 연구

송재관,송종민,김윤정,강덕현,채성철,강흥선,배종화,김기식,심완주,정진원,박종춘,장경식,이재환,성인환,조은주,윤호중,이상철,박승우,하종원,임세중,정남식,김용진,손대원 대한심장학회 2005 Korean Circulation Journal Vol.35 No.12

Background and Objectives:We sought to characterize the lesion characteristics of mitral valve prolapse (MVP),which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans Subjects andMethods:497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals fromJan to Dec 2003 were prospectively enrolled in our study. Results:A total of 497 patients (270 males, 54%)were enrolled and their mean age was 52±17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leafletwas present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and thesepatients were younger (37±14 versus 54±16 years, respectively, p<0.05) and had a lower prevalence of chordaerupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was themost frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial(17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%).Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension,severe MR and chordae rupture compared to the older patients (p<0.001, each). Conclusion:The medial partof both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristicswere different according to the patients’ age. 배경 및 목적:점액성변성에 의한 승모판 일탈증(mitral valve prolapse,MVP)이나 건삭파열에 동반된 승모판폐쇄부전(mitral regurgitation,MR)의 임상적 중요성이 점차 증가하고 있지만 한국에서 이 질환의 병변 특성에 관한 보고는 그리 많지 않은 실정이다.방 법:2003년 1월부터 12월까지 국내 13개 대학병원에서 심초음파를 시행하여 MVP로 진단받은 환자들을 전향적으로 등록하였다. 모든 환자의 심초음파 영상과 환자정보들이 연구책임자가 있는 기관으로 보내져 자료분석소위원회에서 분석되었다. 결 과: 총 497명의 환자가 등록되었는데 평균나이는 52±17세 이었고 남자가 270명(54%) 이었다. 심방세동은 81명(16.3%)에서 동반되었다. 우연한 기회에 심잡음이 들려 진단받은 경우가 전체 환자의 47%(234명)으로 가장 많았고 호흡곤란으로 병원을 방문한 경우가 34.4%(171명), 흉통이나 심내막염으로 임상 발현한 경우가 각각 4.2%, 3.6% 있었다. 색도플러에서 grade 4 MR이 있는 경우가 54.7%(272명)으로 가장 많았고, grade 3, 2, 1 MR이 각각 30.2%, 10.7%, 4.2% 있었다. 점액성 병변에 이환된 판막의 두께는 평균 4.0±1.0mm이었다. 승모판 전엽 병변이 170명(34.2%), 후엽 병변이223명(44.9%) 있었으며 점액성 병변이 전후엽 모두 관찰된 경우도 104명(20.9%) 있었다. 승모판엽을 6개의 분절로 나누었을 때 37명(4.7%)이 6개 전체 분절에서 MVP을 보였는데, 다른 환자들에 비해 나이가 젊고(37±14 대 54±16세)당뇨, 고혈압, 건삭파열 및 중등도 이상의 MR 빈도가 의미있게 낮았다(p<0.05). 경식도초음파가 전체 환자의 26.6%인 132명에서 시행되었는데, 일탈증이 확인된 266개의 분절중 posterior medial scallop가 26%로 가장 흔하였고, 그 뒤를 이어 posterior middle scallop(P2)이 18%, medial part of anterior leaflet(A3)가 17%, lateral part of anterior leaflet(A1)이 14%, middle part of anterior leaflet(A2)가 13%, posterior lateral scallop(P1) 12%의 순서였다. 진단연령 45세를 기준으로 나누었을 때 젊은 연령 군에서(177명)단일 분절 병변(55% 대 73%, p<0.001), 고혈압(10% 대 38%,p<0.001), 중등도 이상의 MR(50% 대 68%, p<0.001), 및 건삭파열(19% 대 41%, p<0.001)의 빈도가 더 낮았다.결 론:한국인에서 MVP은 진단 연령에 따라 병변의 특성이 상이하고 판막의 내측에 호발하는 경향을 뚜렷이 보여주고 있음을 확인할 수 있었다.

高感度 放射線畵質의 基本理論

宋在寬 대구보건대학 1984 대구보건대학 論文集 Vol.8 No.-

Medical diagnostic imaging has been greatly widened in its scope of application beyond mere radiography to include also digital radiography, ultrasonography, X-ray computerized tomography (XCT), as well as applications of nuclear magnetic resonance (NMR), and sonic waves. with the achievement of these new developments in modern medicine, specialists have come to expect much higher quality in finished radiographs New methods for the evaluation of radiograph quality have been developed in rapid succession over the years, but the majority of these methods resort to complicated mathematical equations. These complexities seem to circumvent adequate comprehension. This paper has been prepared in the simplest possible terms to provide an understandable coverage of the factors that govern the quality of finished radiographs.

Ergonovine Echocardiography For the Diagnosis of Vasospastic Angina

송재관 한국심초음파학회 2006 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.14 No.1

기계번역을 위한 한국어 특징에 관한 연구

송재관,우근신,박찬곤 청주대학교 산업과학연구소 1999 産業科學硏究 Vol.17 No.1

Morphological analysis is the first work in a natural language processing. Classification of part-of-speech in morphological analysis is surely necessary. There are many researches about it. But, because standard of the classification of part-of-speech is various, it doesn't have consistency. So, syntactic structure of the Korean language is expressed complicatedly, and it declines the efficiency about a machine translation. This study extracts a morphological feature to appear in a part-of-speech tagging with unique standard. it suggests an algorithm of automatic part-of-speech tagging. This algorithm can extract a syntactic structure of the Korean language and minimize the difference of syntactic structure with object language to machine translation. The syntactic structure extracted can form a sentence pattern of object language to machine translation.

放射線이 人體에 미치는 影響과 效果

宋在寬 대구보건대학 1987 대구보건대학 論文集 Vol.10 No.-

It is known beyond a shadow of a doubt that ⅹ-rays are harmful. If sufficiently intense they can cause cancer, leukemia, and genetic damage. What is not known for certain is the degree of effect following diagnostic levels of ⅹ-radiation. We do know that the benefits derived from the diagnostic application of ⅹ-rays in medicine are enormous. It is the job of the technologist, along with the radiologist, physicist, and maintenance engineer, to produce high-quality ⅹ-ray studies with a minimum of radiation exposure. This approach can result in the highest benefit and the smallest risk. The effects of ⅹ-rays on humans are the result of interactions at atomic levels. These atomic interactions take the form of ionization or excitation of orbital electrons and result in the deposition of energy in tissue. The deposited energy can result in a molecular change, the consequences of which can be disastrous if the molecule involved is critical. Fig.⑴ summarizes the steps between radiation exposure and latent wholebody injury When an atom is ionized, its chemical binding properties change. If the atom is a constituent of a large molecule, the ionization may result in breakage of the molecule or relocation of the atom within the molecule. The abnormal molecule may in time function improperly or cease to function, which can result in serious impairment or death of the cell. This process is not irreversible. At each stage in the sequence it is possible to recover from radiation damage. Ionized atoms can become neutral again by attracting a free electron. Molecules can be mended by repair enzymes. Cells and tissues can regenerate and recover from the radiation injury. If the radiation injury occurs within minutes or days after radiation exposure, it is classified as an immediate or early of radiation. On the other hand, if the human injury is not observable for many months or years, it is termed a delayed or late effect of radiation. The following outline summarizes the possible early and late human responses to radiation exposure. In addition many other radiation responses have been experimentally observed in animals. Most of the human responses have been observed following rather large radiation doses. But we are cautious and assume that even small doses are harmful.

韓國의 醫療技士 敎育制度에 關한 調査硏究

宋在寬,李建燮,金秉洛,金町洛,趙準錫,許俊,李準逸 대구보건대학 1983 대구보건대학 論文集 Vol.7 No.-

After the investigation on, and the analysis of, the educational system for medical technicians and the present educational situation for medical technologies in this country, the following conclusions were drawn. 1. As of March 1983 the current academic system for education in medical technologies included the regular 4-year college courses and those of the 2-year professional junior college courses. But except in the cases on clinical pathology and physical therapy, at whatever level, had a department for working therapies. 2. The total number of credits needed for graduation from a department of medical technologies was 150 points at a regular 4-year college and 85 to 96 points at a 2-year professional college. The obligatory minimum number of credits for a student at a professional college was set at 80 points and above. 3. As for the number of the educational institutions for medical technologies in this country, there were one regular college and 14 professional colleges, a total of 15 institutions. As many as 14 colleges had departments of clinical pathology, 12 had departments of Radiotechnology, 11 had departments of physical, therapy, 12 had departments of dental technology, and eight had departments of dental hygiene. 4. The total capacity of the professional colleges in admitting new enrollment each year were 1,920 for clinical pathology, 1,552 for radiology, 1,012 for physical therapy, 1,334 for dental technologies, 828 for dental hygiene, an aggregate of 6,646 for all of the professional college departments. 5. The total number of graduates from the 12 professional colleges by department during the period of 1965-83 were 7,595 for clinical pathology, 4,768 for radiology, 2,821 for physical therapy, 3,000 for dental technologies, and 1,787 for dental hygiene, totalling 19,971 for all departments in the professional colleges. 6. In the state examination for licensed medical technicians, 12,446 have passed from among the total of 26,609 participants, representing a 45% passing ratio. By departments the ratios showed 44% for clinical pathology, 39.7% for radiology, 51.2% for physical therapy, 42.5% for dental technology, 72.5% for dental hygiene and 73.1% for working therapy. 7. As for the degree of satisfaction shown by the people in this field, 52.5 percent of the teaching staffs who responded to the questionaires said they were said they were satisfied with their present profession, while the great majority of medical technicians(66%) replied that they were indifferent to the problem. 8. The degree of satisfaction shown by the students on their enrollment in this particular academic field was generally in the framework of indifference(43.7%), but more students(36.4%) were satisfied with their choice than those were not satisfied(14.4%). 9. As for the student's opinions on the lectures and practicing hours, a good many students replied that, among such courses as general science and humanities courses the basic medical courses, the major courses, and practicing hours, the hours provided for the general courses(47.1%) and practicing(47.6%) were insufficient. 10. When asked about the contents of their major courses, comparatively few students(23.6%) replied that the courses were too difficult, where a convincing majority(58.5%) said they were neither difficult nor easy. As for the appropriateness of the number of the present teaching staffs, a great majority(71.0%) of the students replied that the level of the teaching personnel in each particular field was insufficient. 11. Among the students who responded to the poll, good part of them(49.5%) wanted mandatory clinical practicing hours, and the majority of them(64.6%) held the view that the experimental and practicing facilities of their schools were insufficient. 12. On the necessity of the attached hospitals, 71.1% of the teaching staffs and 58.0% of the medical technicians had the opinion that kind of facility was indispensable. 13. As for the qualifications for applicants to the state examination in the licensing system for medical technicians, 52.2% of the teachers and 36% of the medical technicians replied that the present system granting the qualifications according to the apprenticeship period should be abolished. 14. On the necessity of improving the present system for education in medical technologies, an overwhelming majority(94.4% of the teaching staffs, 92.0% of the medical technicians and 91.9% of students) of those polled replied that the present system should be changed for the better. 15. On the method of changes for the present educational system, a great majority(89.4% of the teaching staffs, 80.4% of the medical technicians and 90.1% of the students) said that the system must be changed so that it fits into the reality of the present day. 16. As for the present 2-year program for the professional colleges, 61.6% of the teachers, 72.0% of the medical technicians and 38.8% of the students expressed the hope that the academic period would be extended to four regular years, becoming a full-fledged collegelevels program. 17. On the life-long education system for medical technicians, there was a considerable number of people who expressed the hope that an open university system(38.9% of the teaching staffs, 36.0% of the medical technicians) and a graduate school system would be set up. 18. As for the future prospects for medical technicians as professionals, the optimists and pessimists were almost equally divided, and 41.1% of the teaching staffs, 36.0% of the technicians and 50.5% of the students expressed an intermediate position on this issue.

50세 전후의 심근경색증 환자의 경색원인 관동맥 병변과 위험인자에 대한 고찰

송재관,박성욱,박승정,이미화,이근찬,정상식,강덕현,홍명기,김재중 대한순환기학회 1994 Korean Circulation Journal Vol.24 No.6

우편물 무인접수 서비스 방안 연구

송재관,김동호,나동길 대한산업공학회 2012 대한산업공학회 춘계학술대회논문집 Vol.2012 No.5

현대인의 경제활동 증가와 함께 우편산업도 많은 변화를 겪고 있다. 우체국에 접수된 우편물의 표리정리부터 차량 운송, 기계구분으로 이어지는 일련의 내부 프로세스는 물론이고 우편물의 접수 및 배달 시스템도 지금보다 더 다양하고 편리한 시스템을 개발하여 보급함으로서, 우편사업 환경 변화에 능동적으로 대처해야 한다. 이를 위해 상용화된 소량우편물 접수용 무인우편창구 외에도 소·다량 규격우편고객을 겨냥한 무인접수 시스템 및 비규격우편물접수용 장비 등 무인접수 시스템을 개발하여 상용화 하고, 더 나아가 무인우편코너를 공공장소에 설치하여 경제활동인구의 우편접수 편리성을 제고함으로서, 우편처리원가를 절감하여 궁극적으로는 대 국민 우편서비스 향상을 기해야 할 것이다. 본 논문은 이러한 시대적 상황 요청에 대비하고 있는 국.내외 무인 우편접수 시스템 운영현황을 살펴보고 향후 장비를 개발하고 서비스 할 수 있는 방향을 제시하고자 한다.

保健專門大學放射線科 運營에 關한 硏究

宋在寬 대구보건대학 1981 대구보건대학 論文集 Vol.5 No.-

The Korean education system concerning professional scools and junior colleges was changed in 1979, in such a way that we should also make the educational courses of our radiation department search for new directions. It means that we should try to find a more high-dimensional education level compared with our experience gained in the past "education system" through its own characteristics and similarities. To make it possible, I insist that it is necessary for us to introduce a three or five year education system to learn more developed and progressive knowledge. Further more, we should develop our knowledge through the spot-practising education method by constructing an attached general hospital by doing this we will have a new way to provide lively education with more meaningful experiences. We also should deliver an associate bachelor degree flexibly by considering the present education ircumstances and the policy of the "ministry of education", nder a three year educational course. When the five year educational course is adopted, we will be able to train radiation scholars continuously who will devote themselves to the development of the human being. I think it is obvious that we should establish an advisory committee, which will make our education system more efficient and progressive, and which will also undertake the mission of surveying the education system and delivering a certificate(bachelor or associate bachelor) equivalent to the system. I believe the thesis with important logic and position, which many advisory organs impose and hope it to be, will play an important role of assistance for us. If this thesis will serve as a reference for the management of professional schoos, I think I have done a little part of my duties, expecting it to be favored by you.