• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.99-106
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• 1998

Background: Bronchial asthma is a complex disease, which is characterized by spontaneous exacerbations of airway obstruction and persistent bronchial hyperresponsiveness. Animal models have fallen short of reproducing the human disease, particularly in mimicking the spontaneous and persistent airflow obstruction that characterized in asthma. In animals, airflow obstruction is usually assessed by measuring airflow resistance during tidal breathing under such invasive technique as tracheostomy and anesthesia. A noninvasive technique for measuring pulmonary function in small animals is needed to evaluate long-term changes in lung function during the course of experimentally produced disease without sacrificing the animal. Purpose: The purpose of this study was to evaluate early bronchoconstrcition after allergen challenge and airway responsiveness (AR) to inhaled methacholine in nonanethetized, unrestrained guinea pigs. Method: Guinea pig model of asthma was sensitized by subcutaneous injection with ovalbumin and challenged by inhalation of aerosolized ovalbumin(1% wt/vol ovlabumin). Airflow obstruction of conscious guinea pig was measured as specific airway resistance (airway resistance $\times$ thoracic gas volume). Airway resistance and thoracic gas volume of conscious guinea pig were assessed by body plethysmography before challenge and at regular intervals for as long as 30 minutes after challenge. AR to aerosolized methacholine of asthma group was compared with that of control group in body plethysmography. Result: Asthma model<> developed in 13 (65%) among 20 guinea pigs, in which early responses occurred in the airways after the exposure to inhalation with ovalbumin. Airway challenge with ovalbumin caused increase in specific airway resistance, which peaked at 6 minutes and amounted to a $231.5{\pm}30.4%$ increase from baseline. AR to aerosolized methacholine of asthma model increased significantly compared with control group. Conclusion: These results have showed a useful animal model to evaluate early bronchoconstrcition after allergen challenge and airway responsiveness in nonanethetized, unrestrained guinea pigs.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1123-1133
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• 2023

Purpose Our study aimed to evaluate the association between automated quantified body composition on CT and pulmonary function or quantitative lung features in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods A total of 290 patients with COPD were enrolled in this study. The volume of muscle and subcutaneous fat, area of muscle and subcutaneous fat at T12, and bone attenuation at T12 were obtained from chest CT using a deep learning-based body segmentation algorithm. Parametric response mapping-derived emphysema (PRM^emph), PRM-derived functional small airway disease (PRM^fSAD), and airway wall thickness (AWT)-Pi10 were quantitatively assessed. The association between body composition and outcomes was evaluated using Pearson's correlation analysis. Results The volume and area of muscle and subcutaneous fat were negatively associated with PRM^emph and PRM^fSAD (p < 0.05). Bone density at T12 was negatively associated with PRM^emph (r = -0.1828, p = 0.002). The volume and area of subcutaneous fat and bone density at T12 were positively correlated with AWT-Pi10 (r = 0.1287, p = 0.030; r = 0.1668, p = 0.005; r = 0.1279, p = 0.031). However, muscle volume was negatively correlated with the AWT-Pi10 (r = -0.1966, p = 0.001). Muscle volume was significantly associated with pulmonary function (p < 0.001). Conclusion Body composition, automatically assessed using chest CT, is associated with the phenotype and severity of COPD.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.736-745
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• 1998

Background: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatic contribution to chest wall motion. Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. Methods: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(l6 medical students, 12 age-matched control) and 17 COPD patients. Ultrasonographic measurements were performed during tidal breathing and maximal respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducer. Measurements were taken in the supine posture. The ultrasonographic probe was positioned transversely in the midclavicular line below the right subcostal margin. After detecting the right hemidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-mode at this position were made throughout the test. Measurements of diaphragmatic excursion on M-mode tracing were calculated by the average gap in 3 times-respiration cycle. Pulmonary function test(SensorMedics 2800), maximal inspiratory(PImax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. Results: During the tidal breathing, diaphragmatic excursions were recorded $1.5{\pm}0.5cm$, $1.7{\pm}0.5cm$ and $1.5{\pm}0.6cm$ in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients ($3.7{\pm}1.3cm$) when compared with medical students, age-matched control group($6.7{\pm}1.3cm$, $5.8{\pm}1.2cm$, p< 0.05}. During maximal respiratory efforts in control subjects, diaphragm excursions were correlated with $FEV_1$, FEVl/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maximal expiratory pressure), age, and %FVC. In multiple regression analysis, the combination of PEmax and age was an independent marker of diaphragm excursions during maximal respiratory efforts with COPD patients. Conclusion: COPD subjects had smaller diaphragmatic excursions during maximal respiratory efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. These results suggest that diaphragm excursions during maximal respiratory efforts with COPD patients may be valuable at predicting the pulmonary function.

• Journal of Acupuncture Research
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• v.29 no.1
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• pp.139-150
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• 2012

Objectives : The puropse of this study was to report the availability of Hyeongsang diagnosis compensating for visceral pattern identification in applying Sa-am acupuncture therapy. Methods : Eight cases was presented to substantiate the above. Results : According to the characteristic diagnostic method of Hyeongsang medicine by feature such as face, ears, eyes, nose and mouth shape, There are 8 pattern differentiations, including essence family, Qi family, spirit family, blood family, fish type, bird type, beast(running) type and crust(crustacea) type which are correlated with essence deficiency, heat harassing the heart spirit, Qi stagnation, blood stasis, kidney essence deficiency, intense heart fire, liver blood deficiency and lung Qi deficiency in the established visceral pattern identification, respectively. Eight patients was diagnosed by the above Hyeongsang 8 pattern differentiations, of whom Sinjeonggyeok(kidney reinforcing prescription) was applied to a patient with fish type and essence family to nourish kidney essence, and Giul prescription(Qi stagnation prescription) was given to a patient with Qi family for regulating Qi, and Sanghwa priscription(ministerial fire prescription) was delivered to a patient with Spirit family to clear the heart fire and tranquilize, and Sojangjeonggyeok(small intestine reinforcing prescription) was used for a patient with blood family to nourish blood and remove blood stasis, and Sinjeonggyeok(kidney reinforcing prescription), Simhangyeok(heart heat clearing prescription), Ganjeonggyeok(liver reinforcing prescription) and Pyejeonggyeok(lung reinforcing prescription) were utilized for fish type, bird type, beast(running) type and crust(crustacea) type respectively to reinforce the relevant visceral function. Conclusions : It was suggested that characteristic diagnostic method of Hyeongsang medicine should be helpful for enhancing the accuracy of the established visceral pattern identification, applying Sa-am acupuncture therapy more appropriately.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.685-696
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• 1999

Background : Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the short-term efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. Method : Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednisolone (0.25mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders : (1) improvement of more than one grade in dyspnea index, (2) improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. Result : One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid ($23.8{\pm}16.3%$ vs $7.8{\pm}3.6%$, p<0.05), and less honeycombing in chest HRCT findings (0% vs $9.2{\pm}2.3%$, p<0.001). Conclusion : Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables.

• Tuberculosis and Respiratory Diseases
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• v.66 no.3
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• pp.192-197
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• 2009

Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.593-599
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• 2007

Background: The correlation between levels of brain natriuretic peptide (BNP) and the effect of pulmonary resection on the right ventricle of the heart is not yet widely known. This study aims to assess the relationship between the change in hemodynamic values of the right ventricle and increased BNP levels as a compensatory mechanism for right heart failure following pulmonary resection and to evaluate the role of the BNP level as an index of right heart failure after pulmonary resection. Material and Method: In 12 non small cell lung cancer patients that had received a lobectomy or pnemonectomy, the level of NT-proBNP was measured using the immunochemical method (Elecsys $1010^{(R)}$, Roche, Germany) which was compared with hemodynamic variables determined through the use of a Swan-Garz catheter prior to and following the surgery. Echocardiography was performed prior to and following the surgery, to measure changes in right ventricular and left ventricular pressures. For statistical analysis, the Wilcoxon rank sum test and linear regression analysis were conducted using SPSSWIN (version, 11.5). Result: The level of postoperative NT-proBNP (pg/mL) significantly increased for 6 hours, then for 1 day, 2 days, 3 days and 7 days after the surgery (p=0.003, 0.002, 0.002, 0.006, 0.004). Of the hemodynamic variables measured using the Swan-Ganz catheter, the mean pulmonary artery pressure after the surgery when compared with the pressure prior to surgery significantly increased at 0 hours, 6 hours, then 1 day, 2 days, and 3 days after the surgery (p=0.002, 0,002, 0.006, 0.007, 0.008). The right ventricular pressure significantly increased at 0 hours, 6 hours, then 1 day, and 3 days after the surgery (p=0.000, 0.009, 0.044, 0.032). The pulmonary vascular resistance index [pulmonary vascular resistance index=(mean pulmonary artery pressure-mean pulmonary capillary wedge pressure)/cardiac output index] significantly increased at 6 hours, then 2 days after the surgery (p=0.008, 0.028). When a regression analysis was conducted for changes in the mean pulmonary artery pressure and NT-proBNP levels after the surgery, significance was evident after 6 hours (r=0.602, p=0.038) and there was no significance thereafter. Echocardiography displayed no significant changes after the surgery. Conclusion: There was a significant correlation between changes in the mean pulmonary artery pressure and the NT-proBNP level 6 hours after a pulmonary resection. Therefore, it can be concluded that changes in NT-proBNP level after a pulmonary resection can serve as an index that reflects early hemodynamic changes in the right ventricle after a pulmonary resection.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.558-570
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• 1996

Background : The detection of Collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the dormer may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a Component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. Method : To investigate whether volume difference between slow and forced vital Capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. Results : 1) Average and standard deviation of age, height, weight of patients with airflow limitation was $58.3{\pm}7.24$(yr), $166{\pm}8.0$(cm), $59.0{\pm}9.9$(kg) and those of normal subjects was $56.3{\pm}12.47$(yr), $165.9{\pm}6.9$(cm), $64.4{\pm}10.4$(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was $395{\pm}317ml$ in patients group and $154{\pm}176ml$ in normal group and there was statistically significance between two groups(p<0.05). Sensitivity and specificity were most higher when the cut-off value was 208ml. 3) After bronchodilator inhalation, reversible airway obstructions were shown in 16 cases of patients group, 7 cases of control group(p<0.05) by spirometry or body plethysmography d the differences of slow vital capacity and forced vital capacity in bronchodilator response group and nonresponse group were $300.4{\pm}306ml$, $144.7{\pm}180ml$ and this difference was statistically significant. 4) The difference between slow vital capacity and forced vital capacity before bronchodilator inhalation was correlated with airway resistance before bronchodilator(r=0.307 p=0.05), and the difference between slow vital capacity and forced vital capacity after bronchodilator was correlated with difference between slow vital capacity and forced vital capacity(r=0.559 p=0.0002), thoracic gas volume(r=0.488 p=0.002) before bronchodilator and airway resistance(r=0.583 p=0.0001), thoracic gas volume(r=0.375 p=0.0170) after bronchodilator, respectively. 5) The difference between slow vital capacity and forced vital capacity in smokers and nonsmokers was $257.5{\pm}303ml$, $277.5{\pm}276ml$, respectively and this difference did not reach statistical significance(p>0.05). Conclusion : The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.

• Journal of Physiology & Pathology in Korean Medicine
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• v.18 no.3
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• pp.646-669
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• 2004

By treating skin diseases with Hyungsang medicine and reviewing the clinical cases of them through classifying skin diseases into general care and into Hyungsang medical care, the writer came to the conclusion as followings. The skin is a house of Kyungnak, and it' s a place which Ki comes in and out, which human body controls conditions of his physiological function and which doctors can make a diagnosis from seeing it. The skin is subject to lung and large intestine in the point of organ, but in the point of movement, to spleen and stomach. Skin diseases come from unbalance of Ki and Hyul, mostly from fever in blood and also from Dam, Wind, Dampness and Dryness because of including fire. Generally skin diseases are treated according to classifying into distinctive symptoms, region, cause or time being occurred, and concomitant symptoms. After being divided into man and woman, age and youth, fatness and leanness, Jung Ki Shin Hyul type, visceral figures, Yukkyung shapes on Hyungsang medicine method, the remedy of skin diseases which is combined common meditation with Hyungsang medical method is efficacious. In distinguishing into man and woman, age and youth, man gets sick mainly by drinking liquor and exhausting Jung, woman is taken ill generally by indigestion and Damwha, especially by drinking liquor. Young child gets ill mostly from inherent weakness, but in many cases he is occurred by disturbed digestion, so he must be taken care of ingesting food. The aged becomes ill from weakening, so he must be treated according to reasons of diseases. To fatness and leanness, skin diseases are showed symptoms by weakened Yang, insufficient Yin or excess fever on the theory of upper and lower parts, by unbalance of Ki and Hyul on the theory of left and right, by Dryness and Dampness on the theory of front and rear and by insufficiency of vitality and combined fever on the theory of inside and outside. Therefore doctors must cure the symptoms according to the theory of upper and lower, left and right, front and rear and inside and outside. In type of Jung Ki Shin Hyul, the balances between Jung-Hyul and Shin-Ki are important points. Concretely Jung type comes to easily shortage of Jung or gathering abnormally Dampness and Dam, Ki type is easy to make a mass with Ki or to be deficient of Ki, Shin type comes to press seven emotions togather or to be insufficient of Yin and fever inside, and Hyul type is inclined to be deficient of Hyul and to become feverish or to be deficient of Ki. Therefore on the ground of the above reasons skin diseases come into existence. Inclusively in Jung-Hyul type , Ki must be moved on the base of full Jung-Hyul, so Wukmijiwhangtang or Samultang is prescribed basically. In Shin-Ki type , Jung-Hyul is saved on the base of moving Ki, so Hyangsosan or Yijintang is the proper prescription. Considering the visceral figures, doctors judge for diagnosis and remedy by putting together the elements, that is, great and small sizes of a set of features (eye, ear, mouth, nose), color and temper. The yukkyung types are classified according to many or few of Ki-Hyul, and then skin diseases appear by being inclined toward one side between Ki and hyul, or among the six atmospheric elements(wind, cold, heat, dampness, dryness, and fire). Especially because Yangmyung type is full of much Ki and Hyul, and also has much fever in stomach, he gets skin symptoms frequently. So his prescription is based on taking off fever in stomach, and also he must be careful about regimen certainly.

• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.600-610
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• 2004

Background : The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method : We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients' medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared. Results : Multiple logistic regression analysis identified three independent predictors of mortality: $FEV_1$, APACHE II score and plasma BNP level. The decedents group showed a lower $FEV_1$($28{\pm}7$ vs. $37{\pm}15%$, p=0.005), a higher APACHE II score($22.4{\pm}6.1$ vs. $15.8{\pm}4.7$, p=0.000) and a higher BNP level ($201{\pm}116$ vs. $77{\pm}80pg/mL$, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher's exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL. Conclusion : The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the $FEV_1$ and APACHE II score.