• Clinical and Experimental Pediatrics
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• 제64권11호
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• pp.582-587
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• 2021

Background: Syncope is a common problem in children and adolescents. However, a large proportion of syncope cases have no underlying cause. Purpose: This study aimed to identify the factors affecting the severity of syncope using tissue Doppler imaging (TDI). Methods: This retrospective study included 61 children and adolescents with syncope who underwent echocardiography. The head-up-tilt test (HUT) was performed when there was a more severe syncopal event. We compared the echocardiographic findings between the execute HUT and nonexecute HUT, negative HUT result and positive HUT result, and normal electrocardiogram (ECG) and abnormal ECG groups. Data were analyzed using an unpaired t test post hoc analysis. Results: In the execute and nonexecute HUT groups, the odds ratios were 0.55 for medial E/E' (P=0.040) and 0.64 for lateral E/E' (P=0.049). Comparison of the results of the decreased, normal, and increased groups for lateral E/E' revealed a significant difference in the execution HUT and nonexecute HUT groups (overall, P=0.004; decreased vs. increased, P=0.003; normal vs. increased, P=0.050). Conclusion: Medial E/E' and lateral E/E' were decreased in patients with severe syncopal events. These findings suggest that the presence of left ventricular diastolic deterioration may cause hypoperfusion even in the absence of organic causes and, consequently, increase syncope severity and frequency. The TDI measured by echocardiography can be used as an index to predict syncope recurrence and/or severity.

• The Korean Journal of Physiology
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• 제12권1_2호
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• pp.35-40
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• 1978

경사대에 의한 수등적체위 변화시 분시 호흡수, 혈액 pH, $PCO_2$ 및 $PO_2$의 변화를 관찰하고 다음과 같은 성적을 얻었다. 체위변화시 호흡수는 기립위에서는 수평대조치에 비해 감소하고 도립위에서는 많은 증가를 보였다. 혈액 pH는 기립위에서 수평대조치에 비해 동맥혈은 0.2%가 증가되었고 정맥혈은 0.3%가 감소하였다. 도립위에서는 수평대조치와 거의 변화가 없는 값을 나타내었다. $PCO_2$는 기립위에서 수평대조치에 비해 동맥혈은 8.3%, 정맥혈은 0.3%가 감소되었고 도립위에서는 동맥혈은 20.1%가 감소되고 이것은 통계적으로 의의있는 변화였다. 정맥혈은 7%가 감소되었다. $PO_2$는 기립위에서 동맥혈은 2%가 증가, 정맥혈은 21.7%가 감소되었으며 이것은 통계적으로 의의있는 변화였다. 도립위에서는 동맥혈은 11.4%가 증가되고 정맥혈은 14.1%가 감소되었다. 도립위에서 동맥혈의 $PO_2$가 증가 되는 원인은 도립중의 과도호흡하에 의한 것이라 사료되며 정맥혈의 $PO_2$의 감소는 도립중의 근육수축에 연유하는 산소소비량의 증가가 그 원인이라고 사료된다. 또 도립위에서 $PO_2$가 감소하고 수소ion의 감소가 예상됨에도 불구하고 pH가 증가하지 않는것은 산소소비가 증가되고 정맥혈의 $PO_2$가 감소되는 것으로 봐서 염기성해당으로 젖산이 증가된것이 아닌가 생각된다.

• Annals of Clinical Neurophysiology
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• 제12권2호
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• pp.61-65
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• 2010

Background: Orthostatic hypotension (OH) refers to a fall in systolic blood pressure (BP) of 20 mmHg or more, or in diastolic BP of 10 mm Hg or more within 3 minutes of standing up. The head-up tilt test (HUT) is the most useful, but potentially invasive test for the diagnosis of OH. The purpose of this study was to identify the usefulness of spontaneous baroreflex sensitivity (sBRS). Methods: Ninety one patients with orthostatic intolerance, in whom the HUT data were available, were included in the study. Patients were classified into HUT-positive (group I) and HUT-negative (group II) group. Twenty five healthy volunteers served as normal controls, and were designated as group III. In all subjects, beat-to-beat BP and heart rate were recorded using BeatScope 1.1a. We collected the 50 sBRS data in each patient in a supine position. The average value of one to ten of 50 sBRS data was defined as sBRS10, one to twenty as sBRS20, one to thirty as sBRS 30, one to forty as sBRS 40, and one to fifty as sBRS 50. Differences in sBRS10 and sBRS50 levels were statistically analyzed and compared between groups I, II, and III. Results: No significant difference in the sBRS50 level was found between Groups II and III. sBRS50 was significantly lower in Group I than in Groups II and III (p<0.05), and the same pattern of differences was observed for sBRS40, sBRS30, sBRS20, and sBRS10. Conclusions: Patients with OH showed significantly lower sBRS levels than HUT-negative patients or normal controls. Our study implies that a supine-position sBRS would provide additional diagnostic information for OH.

• 한국전문물리치료학회지
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• 제13권2호
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• pp.77-84
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• 2006

Although conservative management of congenital muscular torticollis (CMT) has been well documented, relatively little is known about the response to the treatment. The purposes of this case report were to describe the use of a therapeutic approach based on motor development in physical therapy intervention for an infant with CMT and to report the result of the treatment. The patient was a 20-day-old baby boy with left CMT presenting muscular mass in the left sternocleidomastoid muscle. The angle of the lateral head tilt was 20 degrees. The size of muscular mass was 5.3 mm in ultrasonography. Intervention included ultrasonic therapy, soft tissue massage, passive and active range of motion exercises, motor developmental therapy, and parent instruction. The procedures of motor developmental therapy and changes in the amount of lateral head tilt were documented using photography. The size of the mass was decreased to .3 mm before the 5-month follow-up. The patient also maintained a midline head position in the supine position and a midline head alignment during all functional activities. A therapeutic approach based on motor development is a beneficial method for reducing an asymmetrical head and neck position, and facilitating normal development as a component of physical therapy intervention.

• The Korean Journal of Physiology
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• 제7권1호
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• pp.13-21
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• 1973

An attempt was made to study circulatory and respiratory responses to the passive tilt. Anesthetized dogs were tilted from horizontal to upright $(+90^{\circ})$ and head down $(-90^{\circ})$ position. The arterial blood pressure was decreased in the upright position and was decreased slightly in the head down position comparing to that in the horizontal position. Cardiac index also decreased in the both upright and head down positions. The total systemic vascular resistance was slightly increased in the upright position and was markedly increased in the head down position. The mean pulmonary arterial pressure was significantly decreased in the both upright and head down positions. The total pulmonary vascular resistance was decreased in the both upright and head down positions. Oxygen consumption was slightly decreased in the upright position, whereas it was slightly increased in the head down position. The A-V $O_2$ difference (vol. %) was slightly increased in the upright position and increased in the head down position. From the above results, process of the circulatory compensation to the gravity in the Passive tilting test was discussed. Neuronal cardiovascular regulation to the gravity and tile adaptation of capacitance vessles to hydrostatic stress and oxygen consumption concerning anoxic endurance of the brain were also discussed.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1996년도 추계학술대회
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• pp.217-220
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• 1996

In this paper, we compare three mehods to obtain PSD of HRV - FFT, AR modeling, and residual integration. Using these methods we speculate the balances of the LP and HF powers of HRV at $0^{\circ}$, $45^{\circ}$, $90^{\circ}$ tilt levels of head-up tilt table for young and healthy 24 men. R peaks are located at the highest point of QRS complex detected from modified spacial velocity algorithm. In general FFT is the most fast way to obtain PSD but PSD from FFT has too many peaks and valleies. AR PSD can show frequency of ANS activity effectively but LF component of PSD is often invisible due to interference of VLF power. The residual integration method that decomposes the AR PSD is very efficient way to extract LF component. Applying the above three methods to HRV we can visualize the trend of PSD variations along tilt levels.

• 수산해양기술연구
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• 제41권4호
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• pp.296-305
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• 2005

Acoustic target strength (TS) of 12 commercially important fish species caught in the Korean waters had been investigated and their results were presented. Laboratory measurements of target strength on 12 dominant fish species were carried out at a frequencies of 75 kHz by single beam method under the controlled condition of the water tank with the 241 samples of dead and live fishes. The target strength pattern on individual fish of each species was measured as a function of tilt angle, ranging from $-45^{\circ}$ (head down aspect) to $45^{\circ}$ (head up aspect) in $0.2^{\circ}$ intervals, and the averaged target strength was estimated by assuming the tilt angle distribution as N ($-5.0^{\circ}$, $^15.0{\circ}$). The 75 to fish length relationship for each species was independently derived by a least - squares fitting procedure. Also, a linear regression analysis for all species was performed to reduce the data to a set of empirical equations showing the variation of target strength to fish length and fish species. An empirical model for fish target strength(TS, dB) averaged over the dorsal aspect of 158 fishes of 7 species and which spans the fish length(L, m) to wavelength(${\lambda}$, m) ratio between 6.2 and 21.3 was derived: TS: 27.03 Log(L)-7.7Log(${\kanbda}$)-17.21, ($r^2$=0.59).

• The Korean Journal of Physiology
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• 제24권1호
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• pp.51-65
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• 1990

The purpose of the present study was to examine the hemodynamic responses, especially in arterial and skin blood flows, in conjunction with the changes of plasma catecholamine levels as an indirect marker of adrenergic tone during the early stage of head-down tilt (HDT), and to evaluate the early physiological regulatory mechanism in simulated weightlessness. Ten mongrel dogs, weighing8\;{\sim}\;14\;kg, were intravenously anesthetized with nembutal, and postural changes were performed by using the tilting table. The postural changes were performed in the following order: supine, prone, HDT $(-6^{\circ}C)$ and lastly recovery prone position. The duration of each position was 30 minutes. The measurements were made before, during and after each postural change. The arterial blood flow $({\.{Q}})$ at the left common carotid and right brachial arteries was measured by the electromagnetic flowmeter. Blood pressure (BP) was directly measured by pressure transducer in the left brachial artery. To evaluate the peripheral blood flow, skin blood flow $({\.{Q}})$ was calculated by the percent changes of photoelectric pulse amplitude on the forepaw, and skin temperature was recorded. The peripheral vascular resistance (PR) was calculated by dividing respective mean BP values by ${\.{Q}}$ of both sides of common carotid and brachial arteries. Heart rate (HR), respiratory rate (f) and PH, $Po_{2},\;Pco_{2}$ and hematocrit of arterial and venous blood were also measured. The concentration of plasma epinephrine and norepinephrine was measured by radioenzymatic method. The results are summarized as follows: Tilting to head-down position from prone position, HR was initially increased (p<0.05) and BP was not significantly changed. While ${\.{Q}}$ of the common carotid artery was decreased (p<0.05) and PR through the head was increased, ${\.{Q}}$ of the brachial artery was increased (p<0.05) and PR through forelimbs was decreased. ${\.{Q}}$ of the forepaw was initially increased (p<0.05) and then slightly decreased, on the whole revealing an increasing trend. Plasma norepinephrine was slightly decreased and the epinephrine was slightly increased. f was increased and arterial pH was increased (p<0.05). In conclusion, the central blood pooling during HDT shows an increased HR via Bainbridge reflex and an increased ${\.{Q}}$ of the forepaw and brachial ${\.{Q}}$, due to decreased PR which may be originated from the depressor reflex of cardiopulmonary baroreceptors. It is suggested that the blood flow to the brain was adequately regulated throughout HDT $(-6^{\circ}C)$ in spite of central blood pooling. And it is apparent that the changes of plasma norepinephrine level are inversely proportional to those of ${\.{Q}}$ of the forepaw, and the changes of epinephrine level are paralleled with those of the brachial ${\.{Q}}$.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.38-45
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• 2009

Purpose: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. Methods: Surgery was performed on 29 patients and their average age was 4.1 years (from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow - up period was ranged from 2 months to 5.4 years(mean follow - up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. Conclusion: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.

• Clinical and Experimental Pediatrics
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• 제52권7호
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• pp.798-803
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• 2009

목 적 : 실신은 소아와 청소년들에게 흔히 발생되는 증상으로 혈관 미주신경성 실신이 가장 흔한 형태다. 이 연구의 목적은 원인불명의 실신 및 그와 유사한 증상으로 내원한 소아청소년기 환자들에게 기립 경사 검사(head-up tilt test, HUT)의 반응과 진단적 가치를 검토해 보고자 하였다. 방 법 : 2003년 5월부터 2008년 3월까지 전북대학교병원에 실신 및 실신 전 증상을 주소로 HUT를 하고 임상적으로 혈관 미주신경성 실신이 의심되는 160명(남 82명, 여 78명, 7-20세)을 대상으로 임상 양상 및 HUT 결과와 그 반응에 대해 의무기록을 통하여 후향적 조사를 시행하였다. HUT는 70도 경사에서 45분간 시행하였으며 일부는 isoproterenol 0.5-1.0 ug/min 주사를 이용하였으며 이 환아들을 소아군(7-12세, 39명, $10.59{\pm}1.60$세), 청소년군(13-20세, 121명, $15.93{\pm}2.28$세)으로 분류하여 두 군 간의 HUT 양성률과 그 반응유형을 비교해 보았다. 결 과 : 대상 환아 160명 중에서 양성반응인 환아는 92명(57.5%)이었고, 남녀 비는 차이가 없었다. 양성 반응은 혼합형이 70례로 제일 흔한 반응이었고, 혈관억제형이 12례, 무수축을 동반하지 않은 심장억제형이 6례, 무수축을 동반한 심장억제형이 4례이었다. 실신의 원인을 규명하는데 HUT를 비롯하여 혈액흉부 방사선 촬영, 심전도와 24시간 holter 검사 및 운동부하검사, 뇌파 검사, 뇌 단층촬영과 뇌 자기공명검사, 심초음파 검사 등이 시행되었다. 또한 연령대에 따른 HUT의 양성 반응률 비교는 소아군 43.6% (17/39), 청소년군 62% (75/121)이었고, 혼합형 반응이 소아 군에서 15명(38.4%)에서 청소년군 55명(45.0%)으로 청소년군이 더 높은 양성률을 보였으나 두 그룹간의 통계학적으로 의미 있는 차이는 없었다. 결 론 : HUT는 혈관 미주신경성 실신이 의심되는 병력과 진찰 소견이 정상인 소아에서 여러 다른 검사 방법에 우선하여 시행함으로써 실신의 원인을 규명하는데 유용하다.