일과성전기억상실증의 국소 뇌혈류 변화 : Statistical Parametric Mapping을 이용한 Tc-99m ECD SPECT분석 Statistical Parametric Mapping analysis of Tc-99m ECD SPECT

이승재,양동원,손영민,김범생,정용안,손형선,주라형 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

Background & Objectives:Transient global amnesia (TGA) is a clinical syndrome characterized by sudden memory loss of recent events, transient inability to retain new information, and retrograde amnesia in the absence of other neurological signs and symptoms, resolving within 24 hours. This study investigated alterations in regional cerebral blood flow (rCBF) in patients with TGA by using statistical parametric mapping 99 (SPM99). Methods:5 patients with TGA and 9 age-matched normal control subjects were evaluated. Tc-99m-ethyl cysteinate dimer (ECD) SPECT were performed within 1 to 4 days of the event to measure the regional CBF, and SPM99 were applied to the objective analysis of SPECT data between two groups. Follow-up ECD SPECT was done at 49 to 107 days (mean 76.8) after the previous SPECT to evaluate the long term changes of the regional CBF. Results:The SPM analysis of SPECT images revealed significantly decreased rCBF in the left superior temporal gyrus, the left parietal supramarginal gyrus and the left thalamus (corrected p=0.01) and increased CBF in the contralateral mirror regions in patients with TGA. Follow-up SPECT showed persistent rCBF changes in the same regions. Conclusions:We demonstrate decreased perfusion in the left cerebral hemisphere and increased perfusion in the right cerebral hemisphere in patients with TGA. This reciprocal change of rCBF might suggest that imbalanced neuronal activity between two hemispheres may be important in the pathogenesis of the TGA. Also, the abnormal rCBF changes appeared to last long after the complete recovery of clinical manifestation of TGA.

컴퓨터를 이용한 혈액학 교육시스템의 개발

이기형,손보라,윤희석,조원덕,김승택 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.1

연구목적 : 전통적인 의학교육 시스템은 최근 개발되고 있는 여러 가지 영상 진단법 등 시각적 자료를 전달하는데 한계가 있으며, 이러한 한계는 모든 분야에 걸쳐서 나타나지만 특히 혈액학이나 심장학 등 시각적인 자료가 진단에 필수적인 분양에서 두드러진다고 할 수 있다.본 연구는 혈액학 교육에 사용되던 기존의 강의실 교육에 시각적 자료가 첨부된 CD-ROM을 개발하여 혈액학 교육 시스템을 개선하기 위한 것이다. 대상 및 방법 : 기존의 혈액학 교육에 있어서 필수적으로 강의 되어오던 자료를 수집하여 체계적으로 정리하였다.강의 자료에 따라서 필요한 영상 자료를 충북대학교 병원에 입원한 혈액질환 환자들의 검사 자료로부터 수집하여 컴퓨터를 기반으로 한 의학영상 처리 및 분석시스템을 통하여 이미지 파일로 변형하였다.또한 입원 환자들 중 대표적인 증례들을 수집하여 실제 임상 진료와 유사한 형태의 증례를 통한 학습을 할 수 있도록 하였다. 결과: 본 CD-ROM은 혈액학 교육에 필요한 대부분의 영역을 포함한다 각 질환의 병태생리, 진단, 임상양상, 치료 및 예후 등 전통적으로 강의되어 오던 강의록에 이미지 파일로 변형된 영상 자료를 필요한 곳마다 링크시켰다.따라서 학습자는 특별한 장치 없이 텍스트 및 영상을 한 화면에서 볼 수 있어 전통적인 교육 시스템에 비하여 시,공간적인 장점을 갖는다 할 수 있다.또한 입원 환자들로부터 수집된 증례를 통하여 실제 임상 진료와 매우 유사한 경험을 하도록하여 교육효과를 증대시켰다. 결론: 혈액학 교육에 있어서 멀티미디어적 효과를 극대화시켜 질환의 병태생리 등 강의실 교육자료뿐 아니라 진단에 필수적인 시각적 자료를 손쉽게 접할 수 있는 CD-ROM의 개발로 전통적인 강의방법이 갖는 한계를 개선시킬 수 있을 것으로 기대된다. Purpose : The traditional medical education system has its limitations in effectiveness of conveying informations in multiple modalities used in diagnosis of patients with hematologic diseases.This study was performed to develop such a multimedia system using computer based CD-ROM, which includes visual assistant systems, several hematological case studies as well as the traditional text-wise education systems. Materials and Methods: The informations about hematologic diseases were compiled and organized.The main visual data was peripheral blood smears, bone marrow data, and several laboratory results accrued from patients admitted to Chungbuk National University Hospital.Each visual data were transformed through computer-based medical image processing and analyzing system and saved as to JPEG files.Case studies were also acquired from admitted patients and the laboratory data of that patients were used unmodified as possible as. Results : The CD-ROM covers almost all kinds of hematologic diseases that must be included in ordinary medical education courses.The text part includes pathophysiology, diagnosis, clinical features, treatment and prognosis of each hematologic diseases.The essential visual data were linked to each text part and accessible with ease, by one click.Case studies were simulated to actual clinical settings and presented step by step from diagnoses to treatments. Conclusion: A multimedia approach for the study of hematologic diseases has been developed and available in CO-ROM format.This system has advantage over traditional education system in conveying all kinds of visual data which is essential in educating hematologic disorders.

A phase III, multicentre, randomised, double-blind, active-controlled, parallel-group trial comparing safety and efficacy of HD203, with innovator etanercept, in combination with methotrexate, in patients with rheumatoid arthritis: the HERA study

Bae, Sang-Cheol,Kim, Jinseok,Choe, Jung-Yoon,Park, Won,Lee, Sang-Heon,Park, Yong-Beom,Shim, Seung-Cheol,Lee, Shin-Seok,Sung, Yoon-Kyoung,Choi, Chan-Bum,Lee, So-Ra,Park, HanYu,Ahn, Yongho H. K. Lewis 2017 Annals of the rheumatic diseases Vol.76 No.1

<P>Conclusion The study met the primary objective of demonstrating equivalent efficacy of HD203 and ETN. HD203 was well tolerated, with safety comparable with ETN in this population of patients with RA.</P>

알코올의 섭취가 흰쥐의 혈액과 간의 지질대사에 미치는 영향

이명숙,김영연,김효숙,김매하,전진순,서진숙,송선미,양영재,윤원손,이미라,이효영,정승현 誠信女子大學校 生活文化硏究所 2004 生活文化硏究 Vol.18 No.-

To investigate the effects of ethanol on the lipid metabolism in blood and liver, twenty one male Sprague Dawley rats had orally taken the 25% alcohol and 50% alcohol by 5g per Kg of weight during 3 weeks after the adjusting period. For the energy balance, 85% sucrose and 45% sucrose was added in control group and 25% alcohol group each. The weight was reduced by alcohol treatment according to the levels, otherwise the weight of liver and heart was little increased in alcohol groups rather than in control without significance. Moreover, RBC, WBC, hemoglobin and hematocrit were increased by alcohol treatment according to the levels without significance. Otherwise, adjusted bilirubin levels by 100g of weight was significantly increased by alcohol treatment dose dependently. Alcohol induced RBC degradation and increased circulated bilirubin because of liver damage. For blood lipid profiles, blood cholesterol was increased in 50% of alcohol group compared to that of 25% and control groups, otherwise, blood triglycerides (TG) was increased by 30% in 25% alcohol groups rather than in control but not significantly different. The hepatic lipid composition, cholesterol levels in alcohol treatment groups was lower than those in control. The hepatic TG was not influenced by alcohol treatment. The two reasons of decreasing hepatic lipids were suggested by 85% sucrose of control for energy balance more synthesized cholesterol and TG than those in 25 or 50% alcohol groups, and by cholesterol and TG could not be synthesized because of liver damage from alcohol.

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

New Methods of Pulmonary Rehabilitation

( Seung-won Ra ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

The potential disadvantages of traditional center-based pulmonary rehabilitation (PR) include the availability of transportation system, limited access to PR services, and the difficulty of maintaining long-term adherence. The emergence of new methods of PR can complement traditional PR and provide a greater personalization of programs, making PR more accessible and acceptable to patients with chronic respiratory diseases. COVID-19 pandemic has greatly prompted a rapid transition to home-based or telerehabilitation. It has become more important than ever in this COVID-19 era to exploit digital technologies. The essential components of PR, however, should be delivered in these new models. Hybrid models combining in-person and virtual exercise training can be optimized to enhance the effect of PR while decreasing the risk of contagious infection. In this lecture, evidence-based benefits of telerehabilitation and home-based models using digital technologies will be reviewed and how they can be incorporated into clinical practice will be discussed. The highly advanced information technology and fast network in South Korea can be harnessed to have the new models of PR adopted rapidly.

Perioperative Management of Antithrombotic Therapy in Patients with VTE

( Seung Won Ra ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Whole lung lavage using a rapid infusion system to treat a patient with pulmonary alveolar proteinosis

( Seung Won Ra ),( Soon Eun Park ),( Hyung Kwan Lee ),( Il Sang Han ),( Se Hun Park ) 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.1

Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient’s symptoms improved without the occurrence of any complications.

The Safety and Efficacy of CKD-497 in Patients with Acute Upper Respiratory Tract Infection and Bronchitis Symptoms: A Multicenter, Double-blind, Double-dummy, Randomized Controlled Phase 2 Study

( Seung Won Ra ),( Sun Young Kim ),( Yun Young Lim ),( Shin Jung Park ),( Chin Kook Rhee ),( Deog Kyeom Kim ),( Yong Bum Park ),( Chang Youl Lee ),( Hyoung Kyu Yoon ),( Jeong-woong Park ),( Kwang Ha Y 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Botanical medicines used as expectorants and antitussives have proven to be effective while also having excellent safety margins. We aimed at evaluating the efficacy and safety of a new botanical drug, CKD-497, in patients with acute upper respiratory tract infections and bronchitis. Methods In this phase 2 study, 225 patients were enrolled and randomly assigned to one of four treatment groups: placebo (n=55), Synatura® (n=49), CKD-497 200mg (n=68), or CKD-497 300mg (n=53). The study drugs were administered three times daily over the course of 7 days. Primary endpoint was the change in the bronchitis severity score (BSS) from baseline to day 7. Secondary endpoint was evaluated based on clinical response rates on days 4 and 7. A safety analysis was also performed. The Kruskal-Wallis test for intergroup differences and a Chi-square test were applied. Results Between baseline and day 7, the mean BSS scores decreased significantly in each group (P<0.001): 4.04±1.85, 4.31±1.47, 4.09±1.48, and 4.28±1.69. However, neither the CKD-497 nor Synatura® group showed any significant effect on the difference in BSS change (P=0.75). The rate of clinical response was higher in the CKD-497 300mg group as compared to the placebo only on day 4 (18% vs. 36%; P<0.05) and those having more severe bronchitis (phlegm score≥3) showed a significant reduction of total BSS in the Synatura® and CKD-497 groups (P=0.042). No significant adverse events were observed in either of the CKD-497 groups. Conclusion CKD-497 and even the positive control drug had no significant effect on BSS change in this phase 2 clinical trial. However, CKD- 497 300mg had a mild but significant clinical improvement in early bronchitis patients with more severe phlegm. Considering both efficacy and safety, a future study using 300mg of CKD-497 with a shorter-term endpoint is warranted in patients with more severe bronchitis symptoms.

폐기능검사 해석에 정상하한치 변화와 새 해석흐름도가 미치는 영향

나승원 ( Seung Won Ra ),오지선 ( Ji Seon Oh ),홍상범 ( Sang Bum Hong ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won D 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2

연구 배경: 폐기능검사를 해석하는데 정상하한치(lower limits of normal) 선정과 해석흐름도 합의가 필수적이다. COPD 국제지침은 FEV1/FVC 정상하한치로 0.7을 사용하여 폐쇄성장애를 진단한다. 한편, 미국흉부학회(ATS)와 유럽호흡기학회(ERS) 공동으로 새 해석흐름도를 제시하였다. `FEV1/FVC 정상하한치 0.7`의 정확성과 새 해석흐름도가 실제 폐기능검사 해석에 어떤 영향을 미치는지 알아 보고자 하였다. 방법: 서울 아산병원의 호흡기검사실에서 2005년 7월 1일부터 11월 30일까지 5개월간 폐활량측정법을 시행한 7362명을 대상으로 하여 `FEV1/FVC 정상하한치 0.7`의 정확성을 평가하였고 새로운 ATS/ERS 해석흐름도에 따르면 폐용적검사가 추가로 필요한 경우가 얼마나 증가하는지 평가하였다. 상기 기간 내에 같은 날 폐용적검사를 시행한 1611명을 대상으로 과거 해석흐름도와 비교하여 새로운 ATS/ERS 해석흐름도를 적용하게 되면 폐쇄성장애로 진단되는 경우가 얼마나 증가하는지 알아보았다. 결과: 1) `FEV1/FVC < 0.7`에 의한 폐쇄성장애 진단은 연령이 증가할수록 민감도는 증가하였으나 특이도는 감소하였고 양성예측도는 감소하였으나 음성예측도는 증가하였다. 2) 새 ATS/ERS 해석흐름도를 적용할 경우 34.5% (2540명/7362명)의 환자가 추가로 폐용적검사가 필요하였다. 3) 새 ATS/ERS 해석흐름도를 적용할 경우, 과거에 제한성질환으로 진단되었던 환자 중 30%(205명/681명)가 폐쇄성질환으로 진단되었고 이는 전체 환자의 13%(205명/1611명)에 해당하였다. 결론: 폐쇄성질환 진단기준으로 `FEV1/FVC < 0.7`을 사용하였을 때 연령에 따라서 민감도와 특이도가 변한다. 또한, 새로운 ATS/ERS 해석흐름도를 실제 환자를 진료하는데 적용하면 폐용적검사를 시행해야 하는 경우가 증가하게 되고 폐쇄성장애로 진단되는 경우가 더 증가하게 된다. Background: To interpret lung function tests, it is necessary to determine the lower limits of normal (LLN) and to derive a consensus on the interpretative algorithm. `0.7 of LLN for the FEV1/FVC` was suggested by the COPD International Guideline (GOLD) for defining obstructive disease. A consensus on a new interpretative algorithm was recently achieved by ATS/ERS in 2005. We evaluated the accuracy of `0.7 of LLN for the FEV1/FVC` for diagnosing obstructive diseases, and we also determined the effect of the new algorithm on diagnosing ventilatory defects. Methods: We obtained the age, gender, height, weight, FEV1, FVC, and FEV1/FVC from 7362 subjects who underwent spirometry in 2005 at the Asan Medical Center, Korea. For diagnosing obstructive diseases, the accuracy of `0.7 of LLN for the FEV1/FVC` was evaluated in reference to the 5(th) percentile of the LLN. By applying the new algorithm, we determined how many more subjects should have lung volumes testing performed. Evaluation of 1611 patients who had lung volumes testing performed as well as spirometry during the period showed how many more subjects were diagnosed with obstructive diseases according to the new algorithm. Results: 1) The sensitivity of `0.7 of LLN for the FEV1/FVC` for diagnosing obstructive diseases increased according to age, but the specificity was decreased according to age; the positive predictive value decreased, but the negative predictive value increased. 2) By applying the new algorithm, 34.5% (2540/7362) more subjects should have lung volumes testing performed. 3) By applying the new algorithm, 13% (205/1611) more subjects were diagnosed with obstructive diseases; these subjects corresponded to 30% (205/681) of the subjects who had been diagnosed with restrictive diseases by the old interpretative algorithm. Conclusion: The sensitivity and specificity of `0.7 of LLN for the FEV1/FVC` for diagnosing obstructive diseases changes according to age. By applying the new interpretative algorithm, it was shown that more subjects should have lung volumes testing performed, and there was a higher probability of being diagnosed with obstructive diseases (Tuberc Respir Dis 2006; 61: 129-136)