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The Role of Plasma B-type Natriuretic Peptide Measurements in the Differential Diagnosis of Acute Dyspnea (급성호흡곤란의 감별진단에서 혈장 B-type Natriuretic Peptide의 역할)

  • Moon, Ji Yong;Bae, Joong Ho;Kim, Tae Hyung;Sohn, Jang Won;Yoon, Ho Joo;Shin, Dong Ho;Park, Sung Soo
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.656-663
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    • 2005
  • Background : The B-type natriuretic peptide (BNP) is a cardiac neurohormone that is specifically secreted from the ventricles in response to volume expansion and a pressure overload. Differentiating congestive heart failure from the pulmonary causes of dyspnea is very important for patients presenting with acute dyspnea. Methods : A retrospective study was carried out on 261 patients who were admitted to the emergency department of Hanyang University Hospital due to acute dyspnea from March to July 2004. The serum BNP levels of the patients were measured using the ELISA method. Results : The BNP levels were 382, 111-1140 pg/ml (median, interquartile range) in the heart failure group (n=119) and 29, 7-81 pg/ml in the non-heart failure group (n=142). The BNP levels according to the subgroups of heart failure were 820, 354-1620 pg/ml, 1650, 239-1990 pg/ml, and 378, 106-1120 pg/ml for the chronic obstructive pulmonary disease (COPD) with combined left heart failure (n=5), cor pulmonale (n=3), and left heart failure groups (n=111), respectively. The BNP levels according to the subgroups of non-heart failure were 39, 21-101 pg/ml, 59, 10-129 pg/ml, and 15, 6-47 pg/ml for the COPD (n=20), other pulmonary diseases (n=56), and other causes groups (n=66), respectively. The BNP levels were significantly different according to the underlying etiology (p<0.001), and were significantly higher in the COPD patients with left heart failure than in those without (p=0.002). When the patients with no cardiovascular risk factor such as diabetes mellitus, hypertension, smoking or renal failure were analyzed, the BNP levels were also significantly higher in the patients with heart failure than in those without(p<0.001). When 133 pg/ml was designated as the BNP cut-off level the sensitivity for predicting heart failure was 73 percent and the specificity was 87 percent. Conclusion : BNP measurements are useful for determining the presence of heart failure in the patients presenting with acute dyspnea. The possibility of heart failure must be seriously considered in patients with high BNP levels even when they have a pre-existing pulmonary disease such as COPD or no risk factors for heart failure.

The Surgical Diagnosis for Detecting Early Gastric Cancer and Lymph Node Metastasis: Its Role for Making the Decision of the Limited Surgery (조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도 및 유용성)

  • Park, Eun-Kyu;Jeong, Oh;Ryu, Seong-Yeop;Ju, Jae-Kyun;Kim, Dong-Yi;Jeong, Mi-Ran;Kim, Ho-Goon;Kim, Hoe-Won;Park, Young-Kyu
    • Journal of Gastric Cancer
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    • v.9 no.3
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    • pp.104-109
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    • 2009
  • Purpose: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. Materials and Methods: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. Results: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. Conclusion: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.

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The Correlation between the Expression of E-cadherin, VEGF-C, VEGF-D and the Real Extent of Lymph Node Metastases using Cytokeratin 18 in Early Gastric Cancer (조기위암에서 E-cadherin, VEGF-C, VEGF-D의 발현과 Cytokeratin 18로 면역화학염색 한 림프절 전이와의 연관성)

  • Kim, Dae Hoon;Yun, Hyo Yung;Song, Young Jin;Ryu, Dong Hee;Min, In Choel;Sung, Rohyun;Lee, Sang Eok
    • Journal of Gastric Cancer
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    • v.8 no.2
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    • pp.70-78
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    • 2008
  • Purpose: VEGF-C and VEGF-D are angiogenetic factors, and abnormal expression of E-cadherin hasa role in the progression of gastric carcinoma. The aim of this study was to evaluate the relationship between the expression of E-cadherin, VEGF-C and VEGF-D with the presence of lymph node metastases (LNM) using cytokeratin 18 in early gastric cancer (EGC). Materials and Methods: Immunohistochemical staining for E-cadherin, VEGF-C and VEGF-D was performed in 49 EGC patients from March 1997 to December 2002. To evaluate the real extent of LNM, 1,562 lymph nodes from 49 patients were re-examined with the use of cytokeratin 18. Results: Eleven (0.7%) LNM were newly found in 12.2% (n=6) of patients. The real LNM rate was 3.6% in mucosal invasive (m) cancer and 38.1% in submucosal invasive (sm). Stage migration was seen in three patients (6.1%). Abnormal expression of E-cadherin was detected in 36.7% of the patients and expression of VEGF-C and VEGF-D was detected in 16.3% and 36.7% of the patients, respectively. Abnormal expression of E-cadherin was significantly correlated with tumor differentiation (P=0.0103) and Lauren classification (P<0.0001). There was no positive relationship of VEGF-C and VEGF-D expression with the clinicopathological findings for EGC including LNM. However, the frequency of lymph node metastases was significantly higher in patients that demonstrated abnormal expression of E-cadherin with positive immunoreactivity of VEGF-C or VEGF-D (P=0.031). Conclusion: In present study, we could not demonstrate a relationship between the presence of LNM and expression of VEGF-C and VEGF-D in EGC. However, VEGF-C or VEGF-D expression, in addition to the abnormal expression of E-cadherin, was correlated with the real extent of LNM in EGC.

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Effect of Volatile Matter and Oxygen Concentration on Tar and Soot Yield Depending on Coal Type in a Laminar Flow Reactor (LFR에서 탄종에 따른 휘발분과 산소농도가 타르와 수트의 발생률에 미치는 영향)

  • Jeong, Tae Yong;Kim, Yong Gyun;Kim, Jin Ho;Lee, Byoung Hwa;Song, Ju Hun;Jeon, Chung Hwan
    • Korean Chemical Engineering Research
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    • v.50 no.6
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    • pp.1034-1042
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    • 2012
  • This study was performed by using an LFR (laminar flow reactor), which can be used to carry out different types of research on coal. In this study, an LFR was used to analyze coal flames, tar and soot yields, and structures of chars for two coals depending on their volatile content. The results show that the volatile content and oxygen concentration have a significant effect on the length and width of the soot cloud and that the length and width of the cloud under combustion conditions are less than those under a pyrolysis atmosphere. At sampling heights until 50 mm, the tar and soot yields of Berau (sub-bituminous) coal, which contains a large amount of volatile matter, are less than those of Glencore A.P. (bituminous) coal because tar is oxidized by the intrinsic oxygen component of coal and by radicals such as OH-. On the other hand, at sampling heights above 50 mm, the tar and soot yields of Berau coal are higher than those of Glencore A.P. coal by reacted residual volatile matter, tar and light gas in char and flame. With above results, it is confirmed that the volatile matter content and the intrinsic oxygen component in a coal are significant parameters for length and width of the soot cloud and yields of the soot. In addition, the B.E.T. results and the images of samples (SEM) obtained from the particle separation system of the sampling probe support the above results pertaining to the yields; the results also confirm the pore development on the char surface caused by devolatilization.

Habitat Restoration Initiative for Endangered Species Parnassius bremeri (Lepidoptera: Papilionidae) in Korea (멸종위기종 붉은점모시나비의 서식지 복원구상)

  • Kim, Do-Sung;Park, Seong-Joon;Shin, Young-Kyu;Park, Doo-Sang
    • Journal of the Korean Institute of Landscape Architecture
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    • v.39 no.6
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    • pp.98-109
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    • 2011
  • Habitat restoration initiative is an important factor for the on-site preservation of butterflies. A new habitat necessitates the investigation of the ecology of the butterfly, the landscape of the habitat, the work process, and a cost analysis. In this study, these factors were analyzed through1) re-consideration of the secured results from three years of field work, and 2) a habitat area estimation conducted according to the presence or absence of larvae and adults via a Parnassius bremeri Bremer survey. The investigation of the natural habitat, done for both larvae and adult butterflies found in South Korea, suggested that multiple patches with a minimum size exceeding $300m^2$ and with an average size of about $1,600m^2$were required for survival of this butterfly. Therefore, more than five patches should be considered for butterfly habitat and patches should have similarity to the present habitat environment with transplantation plans for diet plants and honeydew plants. In addition, to activate the migration of the butterfly, cutting down trees that are obstacles to migration, minimizing the distance between patches and the addition of a stepping patch are also required. A patch connectivity analysis showed that patches should be located within 300m of neighboring patches, as the migration of the butterfly will fail if it is more than 600m. Additionally, more than $10,000m^2$ for a single patch or a patch network composed more than five patches over $1,600m^2$ in size were recommended, with a total patch size of $8,000m^2$. Additionally, neighboring multiple patch networks are more desirable than a single habitat in the event a cyclic habitat pattern arises. In this study, we suggest a habitat restoration and optimal prerequisites for a butterfly habitat. It is expected that this research will lead to the creation of a good model for the restoration of butterfly species.

Validation of Satellite SMAP Sea Surface Salinity using Ieodo Ocean Research Station Data (이어도 해양과학기지 자료를 활용한 SMAP 인공위성 염분 검증)

  • Park, Jae-Jin;Park, Kyung-Ae;Kim, Hee-Young;Lee, Eunil;Byun, Do-Seong;Jeong, Kwang-Yeong
    • Journal of the Korean earth science society
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    • v.41 no.5
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    • pp.469-477
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    • 2020
  • Salinity is not only an important variable that determines the density of the ocean but also one of the main parameters representing the global water cycle. Ocean salinity observations have been mainly conducted using ships, Argo floats, and buoys. Since the first satellite salinity was launched in 2009, it is also possible to observe sea surface salinity in the global ocean using satellite salinity data. However, the satellite salinity data contain various errors, it is necessary to validate its accuracy before applying it as research data. In this study, the salinity accuracy between the Soil Moisture Active Passive (SMAP) satellite salinity data and the in-situ salinity data provided by the Ieodo ocean research station was evaluated, and the error characteristics were analyzed from April 2015 to August 2020. As a result, a total of 314 match-up points were produced, and the root mean square error (RMSE) and mean bias of salinity were 1.79 and 0.91 psu, respectively. Overall, the satellite salinity was overestimated compare to the in-situ salinity. Satellite salinity is dependent on various marine environmental factors such as season, sea surface temperature (SST), and wind speed. In summer, the difference between the satellite salinity and the in-situ salinity was less than 0.18 psu. This means that the accuracy of satellite salinity increases at high SST rather than at low SST. This accuracy was affected by the sensitivity of the sensor. Likewise, the error was reduced at wind speeds greater than 5 m s-1. This study suggests that satellite-derived salinity data should be used in coastal areas for limited use by checking if they are suitable for specific research purposes.

Change of Dose Exposure and Improvement of Image Quality by Additional Filtration in Mammography (유방촬영용장치 부가필터에 따른 선량변화 및 화질개선)

  • Cho, Woo Il;Kim, Young Kuen;Lee, Gil Dong
    • Journal of Radiation Protection and Research
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    • v.38 no.2
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    • pp.78-90
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    • 2013
  • Recently, the interest on exposure to radiation is rising. The radiation exposure of mammography is higher in absorbed dose than of X-ray, therefore unnecessary exposure needs to be reduced, and higher image quality is needed. Generally, ray quality of the radiation imaging is an important factor that determines image quality and the amount of ray exposure, and they are affected by tube voltage and added filter. The X-ray energy that is exposed from mammography device is generally a continuous spectrum, which includes low energy that has minute influence on the image quality, and high energy that hinders contrast on image. Currently, molybdenum (Mo) and rhodium (Rh) are the most used added filters for mammography device, and they are used differently according to the energy region of X-ray. This study aims to find out the degree of reduction in exposure dose according to the thickness of aluminum (Al), and to study the changes in image quality and dose when the added filter plates that are made with niobium (Nb) or zirconium (Zr) are used, other than molybdenum (Mo) and rhodium (Rh), the two most used added filters that have similar atomic number and K-absorption regions as Nb and Zr. In this study, single-added filters of molybdenum (Mo), niobium (Nb), and zirconium (Zr) are used, and in some cases, Aluminum (Al) is combined with the single filters. In this case, image quality is considered to be improved depending on the type of added filters, and by using Aluminum (Al) filter together with the others, unnecessary X-ray of low energy would be absorbed, therefore the dose is expected to decrease without any influence when the concentration level becomes identical.

THE EXPRESSION OF MSX GENES DURING EARLY CRANIAL SUTURE EMBRYOGENESIS (두개골 봉합부의 초기 형태발생과정에서 Msx 유전자들의 발현양상)

  • Lee, Sang-Youp;Park, Mi-Hyun;Ryoo, Hyun-Mo;Nam, Soon-Hyeun;Kim, Young-Jin;Kim, Hyun-Jung
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.1
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    • pp.171-180
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    • 2003
  • The development of calvarial bones is tighly co-ordinated with the growth of the brain and needs of harmonious interactions between different tissues within the calvarial sutures. Premature fusion of cranial sutures, known as craniosynostosis, presumably involves disturbance of these interactions. Mutations in the homeobox-containg gene Msx2 cause human craniosynostosis syndrome. Msx genes, which are consist of Msx1, Msx2 and Msx3, are homeobox-containg transcripton factors, and were originally identified as homologue of Drosophila msh(muscle segment homeobox) gene. Msx1 and Msx2 genes, expressed mostly in overlapping patterns at multiple site of tissue interactions during vertebrate development, are associated with epithelial-mesenchymal interactions during organogenesis, targets of BMP and FGF signaling. To elucidate the function of Msx genes in the early morphogenesis of mouse cranial suture, we analyzed the expression of them by in situ hybridization during embryonic(E15-E18) stage, and did vivo experiments in E15.5 mouse using rhBMP-2, rhFGF-2 protein soaked bead. In the sagittal suture, Msx1 was expressed in the mesenchyme of suture and the dura mater, Msx2 was intensely expressed in the sutural mesenchyme and the dura mater. In the coronal suture both of Msx genes were expressed intensely in the sutural mesenchyme and expressed in the periosteum also. Msx1 had a broader expression pattern than Msx2. BMP2 beads induced expression of both Msx1 and Msx2, FGF2 beads induced expression of Msx1, but not Msx2. Taken together, these data suggest that Msx1 and Msx2 genes have important role in regulating the morphogenesis and maintenance of embryonic cranial suture. Both of Msx genes are expressed similarly but because of their upstream signaling, they function dependently or cooperatively according to change of signaling molecule.

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Murine Typhus as a Cause of Acute Respiratory Distress Syndrome in Endemic Area (급성호흡곤란증후군의 원인으로서의 발진열)

  • Yoon, Ji Yeol;Lim, Chae Man;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Kim, Hyun Kuk;Woo, Young Dae;Park, Mi Yeoun;Koh, Younsuck
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.4
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    • pp.367-375
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    • 2002
  • Background : Murine typhus is a flea-borne, worldwide Rickettsial disease caused by Rickettsia typhi. Its symptoms are typically mild but sometimes can be fatal. The major clinical features include fever, rash, and headache. Recently, we experienced 6 cases of ARDS associated with a Rickettsia typhi infection. This study was aimed to analyze the attributing factors for fatal murine typhus and to review the characteristics of the patients who showed acute respiratory distress syndrome as the initial presentation. Methods : The medical records of 15 patients diagnosed as murine typhus were reviewed. The diagnosis was made by single titers of 1:512 or higher, or a 4-fold rise with compatible clinical features. Acute Respiratory Distress Syndrome (ARDS) was defined according to the American-European Consensus Conference. The Characteristics between the ARDS group and the non-ARDS group of murine typhus were compared. Results : Six patients developed ARDS as their initial presentation. Two of them were women and three of them had lived urban area. None of Them a showed skin rash. One of them expired during treatment. The time lapse until the commencement of the specific treatment, the lower serum albumin level, the higher serum total bilirubin level, the higher APACHE III score and the higher MOD score were significantly associated with the ARDS group compared to the non-ARDS group. Conclusion : Murine typhus should be considered as one of the etiologies for the ARDS of unknown cause, particularly in an endemic regions. ARDS caused by Murine typhus generally has a good prognosis.

The Adjuvant Effect of Subcutaneous Interferon-gamma in the Treatment of Refractory Multidrug-resistant Pulmonary Tuberculosis (난치성 다제내성 폐결핵에서 피하주사 Interferon-gamma 치료의 효과: 예비연구)

  • Kim, Eun Kyung;Shim, Tae Sun;Lee, Jung Yeon;Oh, Yeon-Mok;Lim, Chae-Man;Lee, Sang Do;Koh, Younsuck;Kim, Dong Soon;Kim, Won Dong;Kim, Woo Sung
    • Tuberculosis and Respiratory Diseases
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    • v.57 no.3
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    • pp.226-233
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    • 2004
  • Background : Interferon-gamma (IFN-${\gamma}$) is a critical cytokine in the defense against a Mycobacterium tuberculosis infection. Even though IFN-${\gamma}$ has occasionally been used in the treatment of refractory multidrug-resistant tuberculosis (MDR-TB) with some promising results, there is still some controversy regarding the therapeutic efficacy of IFN-${\gamma}$. This study was performed to examine the effect of subcutaneous IFN-${\gamma}$ in the treatment of MDR-TB patients. Methods : Six patients with refractory MDR-TB were enrolled in this study. Two million IU of IFN-${\gamma}$ was administered subcutaneously three times a week with the concomitant administration of antituberculous drugs for at least for 28 weeks. During the IFN-${\gamma}$ therapy, the sputum smear and culture, radiological and clinical evaluations were performed every 4 weeks throughout the study period. Results : The mean age of the 6 patients was 37 years (ranges, 15-61 years). The drug susceptibility test to standard antituberculous drugs revealed resistance to an average of 6.8 (${\pm}1.2$) agents including isoniazid and rifampicin. An average of 10.8 (${\pm}1.3$) antituberculous drugs were prescribed before IFN-${\gamma}$ therapy. The culture became negative in 2 patients (33%) after initiating IFN-${\gamma}$ therapy; one at 8 weeks, and the other at 24 weeks. Finally, after stopping the IFN-${\gamma}$ therapy after 28 weeks, the culture became positive again in the two patients who were culture-negative. The other 4 patients who failed in the culture conversion are still on antituberculous treatment except for one who died of tuberculosis. Conclusion : Even though 28 weeks of subcutaneous IFN-${\gamma}$ therapy in combination with antituberculous drugs was successful in inducing the culture-negative conversion in some patients with refractory MDR-TB, the culture became positive again after stopping the IFN-${\gamma}$ therapy. This suggests that subcutaneous IFN-${\gamma}$ therapy may have suppressive effect on tuberculosis only during the IFN-${\gamma}$ therapy period in some patients. Further studies will be needed to determine the optimum dose, the administration route, the duration of therapy, and the predicting factors of the response to adjuvant IFN-${\gamma}$ therapy.