• Title/Summary/Keyword: Neurosurgery

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The Usefulness of F-18 FDG Whole Body PET in the Evaluation of Postoperative Recurrence of Cancer (수술 후 암 재발 판정에 있어서 전신 F-18 FDG-PET의 유용성)

  • Kang, Won-Jun;So, Young;Jeong, Jae-Min;Kwark, Cheol-Eun;Lee, Dong-Soo;Kang, Soon-Bem;Jung, Hee-Won;Kim, Kwang-Hyun;Park, Jae-Gahb;Lee, Myung-Chul;Koh, Chang-Soon;Chung, June-Key
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.3
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    • pp.372-380
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    • 1997
  • The purpose of this study was to evaluate the usefulness of whole body F-18 FDG PET scan for detecting postoperative recurrence of cancer. One hundred four cancer patients after operation were enrolled(14 brain tumor, 15 head and neck cancer, 23 gynecologic cancer, 16 gastrointestinal cancer, 16 thyroid cancer, and 20 other cancers). Besides conventional images(CI) including CT and MRI, F-18 FDG PET scan was obtained on ECAT EXACT 47 scanner(Siemens-CTI), beginning 60 minutes after injection of 370MBq(10mCi) of F-18 FDG. Regional scan was also obtained with emission image. Transmission images using Ge-68 were carried out for attenuation correction in both whole body and regional images. Findings of PET, and CI were confirmed by pathology or clinical follow up. The sensitivity and specificity of PET for detecting recurrence were 94% and 92%, respectively. Contrarily, the sensitivity and specificity of CI were 78% and 68%. CI results were negative and PET results were positive in 11 cases. The biopsy or clinical follow-up of those cases confirmed recurrence of tumor. False negative cases of CI were frequent in patients with gynecologic cancers. Also we measured the serum concentration of tumor markers in patients with gynecologic cancer(CA125), thyroid cancer(thyroglobulin), and colorectal cancer(CEA). The sensitivity and specificity of tumor markers were 71% and 84%, respectively, We conclude that F-18 FDG PET can be used valuably in detecting recurrent foci of a wide variety of malignancy compared to conventional diagnostic methods.

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Efficacy Assessment of Endovascular Stenting in Patients with Unilateral Middle Cerebral Artery Stenosis Using Statistical Probabilistic Anatomical Mapping Analysis of Basal/Acetazolamide Brain Perfusion SPECT (기저/아세타졸아미드 국소뇌혈류 SPECT의 확률 뇌지도 분석을 이용한 일측 중대뇌동맥 협착환자에서 시행한 스텐트 삽입술의 효용성 평가)

  • Kim, Hae-Won;Won, Kyoung-Sook;Zeon, Seok-Kil;Lee, Chang-Young
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.4
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    • pp.280-286
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    • 2009
  • Purpose: The aim of this study was to evaluate the hemodynamic changes after endovascular stenting in patients with unilateral middle cerebral artery (MCA) stenosis using statistical probabilistic anatomical mapping (SPAM) analysis of basal/acetazolamide (ACZ) Tc-99m ECD brain perfusion SPECT. Materials and Methods: Eight patients (3 men and 5 women, 64.8$\pm$10.5 years) who underwent endovascular stenting for unilateral MCA stenosis were enrolled. Basal/ACZ Tc-99m ECD brain perfusion SPECT studies were performed by one-day protocol before and after stenting. Using SPAM analysis, we compared basal cerebral perfusion (BCP) counts and cerebrovascular reserve (CVR) index of the MCA territory before stenting with those after stenting. Results: After stenting, no patient had any complication nor additional stroke. In SPAM analysis, 7 out of the 8 patients had improved BCP counts of the MCA territory and 7 out of the 8 patients had improved CVR index of the MCA territory after stenting. Before stenting, the mean BCP counts and CVR index in the affected MCA territory were 47.1$\pm$2.2 ml/min/100 g and -2.1$\pm$2.9%, respectively. After stenting, the mean BCP counts and CVR index in the affected MCA territory were improved significantly (48.3$\pm$2.9 ml/min/100 g, p =0.025 and 0.1$\pm$1.3%, p =0.036). Conclusion: This study revealed that SPAM analysis of basal/ACZ brain perfusion SPEG would be helpful to evaluate hemodynamic efficacy of endovascular stenting in unilateral MCA stenosis.

The Optimal Activation State of Dendritic Cells for the Induction of Antitumor Immunity (항종양 면역반응 유도를 위한 수지상세포의 최적 활성화 조건)

  • Nam, Byung-Hyouk;Jo, Wool-Soon;Lee, Ki-Won;Oh, Su-Jung;Kang, Eun-Young;Choi, Yu-Jin;Do, Eun-Ju;Hong, Sook-Hee;Lim, Young-Jin;Kim, Ki-Uk;Jeong, Min-Ho
    • Journal of Life Science
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    • v.16 no.6
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    • pp.904-910
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    • 2006
  • Dendritic cells (DCs) are the only antigen presenting cells (APCs) capable of initiating immune responses, which is crucial for priming the specific cytotoxic T lymphocyte (CTL) response and tumor immunity. Upon activation by DCs, CD4+ helper T cells can cross-prime CD8+ CTLs via IL-12. However, recently activated DCs were described to prime in vitro strong T helper cell type 1 $(Th_1)$ responses, whereas at later time points, they preferentially prime $Th_2$ cells. Therfore, we examined in this study the optimum kinetic state of DCs activation impacted on in vivo priming of tumor-specific CTLs by using ovalbumin (OVA) tumor antigen model. Bone-marrow-derived DCs showed an appropriate expression of surface MHC and costimulatory molecules after 6 or 7-day differentiation. The 6-day differentiated DCs pulsed with OVA antigen for 8 h (8-h DC) and followed by restimulation with LPS for 24 h maintained high interleukin (IL)-12 production potential, accompanying the decreased level in their secretion by delayed re-exposure time to LPS. Furthermore, immunization with 8-h DC induced higher intracellular $interferon(IFN)-{\gamma}+/CD8+T$ cells and elicited more powerful cytotoxicity of splenocytes to EG7 cells, a clone of EL4 cells transfected with an OVA cDNA, than immunization with 24-h DC. In the animal study for the evaluation of therapeutic or protective antitumor immunity, immunization with 8-h DC induced an effective antitumor immunity against tumor of EG7 cells and completely protected mice from tumor formation and prolonged survival, respectively. The most commonly used and clinically applied DC-based vaccine is based on in vitro antigen loading for 24 h. However, our data indicated that antigen stimulation over 8 h decreased antitumor immunity with functional exhaustion of DCs, and that the 8-h DC would be an optimum activation state impacted on in vivo priming of tumor-specific CTLs and subsequently lead to induction of strong antitumor immunity.

The Development of Quality Assurance Program for CyberKnife (사이버나이프의 품질관리 절차서 개발)

  • Jang, Ji-Sun;Kang, Young-Nam;Shin, Dong-Oh;Kim, Moon-Chan;Yoon, Sei-Chul;Choi, Ihl-Bohng;Kim, Mi-Sook;Cho, Chul-Koo;Yoo, Seong-Yul;Kwon, Soo-Il;Lee, Dong-Han
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.185-191
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    • 2006
  • [ $\underline{Purpose}$ ]: Standardization quality assurance (QA) program of CyberKnife for suitable circumstances in Korea has not been established. In this research, we investigated the development of QA program for CyberKnife and evaluation of the feasibility under applications. $\underline{Materials\;and\;Methods}$: Considering the feature of constitution for systems and the therapeutic methodology of CyberKnife, the list of quality control (QC) was established and divided dependent on the each period of operations. And then all these developed QC lists were categorized into three groups such as basic QC, delivery specific QC, and patient specific QC based on the each purpose of QA. In order to verify the validity of the established QA program, this QC lists was applied to two CyberKnife centers. The acceptable tolerance was based on the undertaking inspection list from the CyberKnife manufacturer and the QC results during last three years of two CyberKnife centers in Korea. The acquired measurement results were evaluated for the analysis of the current QA status and the verification of the propriety for the developed QA program. $\underline{Results}$: The current QA status of two CyberKnife centers was evaluated from the accuracy of all measurements in relation with application of the established QA program. Each measurement result was verified having a good agreement within the acceptable tolerance limit of the developed QA program. $\underline{Conclusion}$: It is considered that the developed QA program in this research could be established the standardization of QC methods for CyberKnife and confirmed the accuracy and stability for the image-guided stereotactic radiotherapy.

The Effect of Translationally Controlled Tumor Protein (TCTP) of the Arctic Copepod Calanus glacialis on Protecting Escherichia coli Cells against Oxidative Stress (북극 동물플랑크톤 Calanus glacialis TCTP (Translationally Controlled Tumor Protein)가 산화적 스트레스 상태에서 E. coli 세포의 저항성에 미치는 효과)

  • Park, Yu Kyung;Lee, Chang-Eun;Lee, Hyoungseok;Koh, Hye Yeon;Kim, Sojin;Lee, Sung Gu;Kim, Jung Eun;Yim, Joung Han;Hong, Ju-Mi;Kim, Ryeo-Ok;Han, Se Jong;Kim, Il-Chan
    • Journal of Life Science
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    • v.30 no.11
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    • pp.931-938
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    • 2020
  • Translationally controlled tumor protein (TCTP) is one of the most abundant proteins in various eukaryotic organisms. TCTPs play important roles in cell physiological processes in cancer, cell proliferation, gene regulation, and heat shock response. TCTP is also considered an important factor in the resistance to oxidative stress induced by dithiothreitol or hydrogen peroxide (H2O2). Arctic calanoid copepods have a variety of antioxidant defense systems to regulate the levels of potentially harmful reactive oxygen species generated by ultraviolet radiation in the Arctic marine ecosystem. However, information on the antioxidant activity of TCTP in the Arctic Calanus glacialis is still scarce. To understand the putative antioxidant function of the Arctic copepod C. glacialis TCTP (Cg-TCTP), its gene was cloned and sequenced. The Cg-TCTP comprised 522 bp and encoded a 174-amino acid putative protein with a calculated molecular weight of ~23 kDa. The recombinant Cg-TCTP (Cg-r TCTP) gene was overexpressed in Escherichia coli (BL21), and Cg-rTCTP-transformed cells were grown in the presence or absence of H2O2. Cg-rTCTP-transformed E. coli showed increased tolerance to high H2O2 concentrations. Therefore, TCTP may be an important antioxidant protein related to tolerance of the Arctic copepod C. glacialis to oxidative stress in the harsh environment of the Arctic Ocean.

Studies on the Changes in Heart Rate and Blood Pressure Induced by Central Norepinephrine and Clonidine (뇌내(腦內) Norepinephrine, Clonldine에 의한 심박(心搏) 및 혈압변동(血壓變動)에 관한 연구(硏究))

  • Lee, Jung-Chung
    • The Korean Journal of Pharmacology
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    • v.14 no.1_2
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    • pp.13-23
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    • 1978
  • 1) It was attempted to clarify the sites of action of central (either intraventricular or intracisternal) norepinephrine(NE) and clonidine to cause cardiac slowing and hypotension in urethane-anesthetized rabbits. 2) NE produced cardiac slowing but indistinct effect on blood pressure. Clonidine produced cardiac slowing and hypotension. 3) Intraventricular and intracisternal administration of NE, clonidine, phenylephrine and isoproterenol did not make difference in their effects, except that the onset of cardiac slowing by intracisternal NE was more rapid than intraventricular NE. 4) Upon repeated administration of NE at the intervals of about two hours, blood pressure responses changed to the pressor ones, the cardiac slowing unchanged. By this procedure the cardiac slowing as well as the hypotension by clonidine were gradually diminished. 5) Clonidine, when given during the NE effects were persisting, did not produce the lowering of blood pressure and further decrease of heart rate. NE, when given during the clonidine effects were persisting, produced marked elevation of blood pressure but did not produce further decrease of heart rate. 6) After intraventricular administration of regitine or desmethylimipramine, the cardiac slowing effect of NE and the clonidine effects were not observed, whereas NE produced marked elevation of blood pressure. 7) Reserpinized rabbits showed pressor and cardiac accelerating responses to NE; slight pressor, and little cardiac responses to clonidine. 8) It seems that the cardiac slowing by both clonidine and NE as well as the hypotetsion by clonidine are mediated by the presynaptic ${\alpha}$-adrenoceptor in the brain but the pressor responses to NE and clonidine are mediated by other site(s) than the presynaptic ones.

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A Study of Nursing Manpower Requirements based on the Nursing Times spent in Operating Room of an University Hospital (수술실 간호인력의 수요측정 및 간호제공량분석 - 수술대기시간과 수술시간을 중심으로 -)

  • YooN Ke Sook
    • Journal of Korean Public Health Nursing
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    • v.1 no.1
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    • pp.45-61
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    • 1987
  • This Study was an attempt to estimate the optimum numbers of Operating Room Nursing Manpower by measuring the amount of service hours required by the patients in Operating Room in relation to the service amount actually provided by the nurses. The major concern of this study was placed on the measurement of Nursing Service Requirements by using the Operating Room (O. R) Patient Acuity System recently developed by M. M. Hart to classify the O. R. patients into four groups according to the degree of the complexity of operative procedure and some other elements which increase nursing activities in respect of patient care; Acuity IV group is the one requires nursing services most, on the other hand Acuity I requires least. nu sing The objectives of this study were as follows; 1. To analyze functions of the nursing personnel in O. R. by time unit and to estimate the average time a nurse can activate for productive functions. 2. To measure the actual amount of nursing times provided by nurses to the surgical patients. 3. To develop a patient classification system in order to measure the amount of Nursing services required by the patients. 4. To calculate an appropriate number of nursing manpower to meet the needs of the patients. In order to conduct the research both selected nurses and patients in 'S' University Hospital were Studied by utilizing the O. R. Patient Acuity System as well as the Classification Chart developed by Association of Operating Room Nurses (A. O. R. N) as a means of classifying functions of O. R. nurses. That is; Functions of the 10 selected O. R. nurses observed during the period of June 30 to July 4, 1986, whereas the amount of nursing services required by or provided to the 974 patients who had received surgeries during the period of June 9 to July 4, 1986. The results of this study were as follows; 1) The actual working hours per a nurse averaged 6.7 hours a day. 2) Each nurse's daily routine schedule consists of $71.4\%$ for Technical Functions, $16.1\%$ for Nonprodective Functions, $6.6\%$ for Assessment and Evaluation, $3.9\%$ for Overseeing and Supervision and the rest $2.0\%$ for Patient Preparation respectively. 3) Preoperative waiting time per a patient was 24.1 minutes on the average; for the first case was 10.7 minutes, whereas for the following cases was 32.0 minutes. 4) Total Operation time for the 974 patients during the period of observation for this study amounted to 2759.6 hours, weekly hour was equivalent to 689.9 hours, Whereas daily operation time averaged 130 hours. Meanwhile the average operation time per patient was 2.8 hours ; for the case of Acuity IV was 5.6 hours, 5. 1 hours for the case of Acuity III, 2.3 hours for Acuity II and 1.1 hours for Acuity I. 5) According to the O. R. Patient Acuity System, $64.5\%$ of the whole patients belonged to Acuity II, $23.7\%$ to Acuity III, 11. $3\%$ to Acuity IV and $0.7\%$ to Acuity I respectively. 6) Required amount of nursing times based on the preoperative waiting time and operation time was 7167.8 person hours, which showed that $5.5\%$ of them needed for preoperative nursing care, whereas the rest $94.5\%$ for intraoperative nursing care. In terms of the O. R. Patient Acuity System, $49.7\%$ of total nursing service requirements was needed for Acuity II patients, $27.4\%$ for Acuity III patients, $17.2\%$ for Acuity IV patients and $0.2\%$ for Acuity I patients. 7) The rate of the nursing services provided against the required nursing times was about $81.4\%$ on the average; some departments, like those of Plastic Surgery, Otolaryngology and Ophthalmology whose patients mostly belonged to Acuity II recorded hegher provision rate than average, whereas other departments of Thoracic Surgery. Neurosurgery and Orthopedic Surgery whose patients belonged to Acuity III and Acuity IV as well as Acuity II recorded lower provision rate than average. 8) Subsequently, required numbers of nursing manpower was 10.7 nurses additionally. Based on the above findings the following recommendations will be made; 1) this study recommends, develops. and adopts an accurate and realistic O. R. Patient Acuity System which can help measure the nursing service requirements objectively to elicit the rationales of allocation of nursing personnels. 2) this study proposes storongly place nurses who take the role of preoperative nursing care exclusively for the waiting patients in O. R. and shortening their waiting time by close communication between the designated O. R. and the ward.

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Evaluation of Metabolic Abnormality in Brain Tumors by In Viuo $^1$H MR Spectroscopy at 3 Tesla (3T 양성자 자기공명분광에 의한 뇌종양의 대사물질 이상소견)

  • Choe, Bo-Young;Jeun, Sin-Soo;Kim, Bum-Soo;Lee, Jae-Mun;Chung, Sung-Taek;Ahn, Chang-Beom;Oh, Chang-Hyun;Kim, Sun I.;Lee, Hyoung-Koo
    • Progress in Medical Physics
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    • v.13 no.3
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    • pp.120-128
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    • 2002
  • To investigate differences between the metabolic ratios of normal controls and brain tumors such as astrocytomas and glioblastoma multiforme (GM) by proton MR spectroscopy (MRS) at 37 high field system. Using 3T MRI/MRS system, localized water-suppressed single-voxel technique in patients with brain tumors was employed to evaluate spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cr) and lactate. On the basis of Cr, these peak areas were quantificated as a relative ratio. The variation of metabolites measurements of the designated region in 10 normal volunteers was less than 10%. Normal ranges of NAA/Cr and Cho/Cr ratios were 1.67$\pm$018 and 1.16$\pm$0.15, respectively. NAA/Cr ratio of all tumor tissues was significantly lower than that of the normal tissues (P=0.005). Cho/Cr ratio of glioblastoma multiforme was significantly higher than that of astrocytomas (P=0.001). Lactate was observed in all tumor cases. The present study demonstrated that the neuronal degradation or loss was observed in all tumor tissues. Higher grade of brain tumors was correlated with higher Cho/Cr ratio, indicating a significant dependence of Cho levels on malignancy of gliomas. This results suggest that clinical proton MR spectroscopy could be useful to predict tumor malignancy.

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Dosimetric Verifications of the Output Factors in the Small Field Less Than $3cm^2$ Using the Gafchromic EBT2 Films and the Various Detectors (Gafchromic EBT2필름과 다양한 검출기를 이용하여 $3cm^2$ 이하의 소조사면에서 출력비율의 선량검증)

  • Oh, Se An;Yea, Ji Woon;Lee, Rena;Park, Heon Bo;Kim, Sung Kyu
    • Progress in Medical Physics
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    • v.25 no.4
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    • pp.218-224
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    • 2014
  • The small field dosimetry is very important in modern radiotherapy because it has been frequently used to treat the tumor with high dose hypo-fractionated radiotherapy or high dose single fraction stereotactic radiosurgery (SRS) with small size target. But, the dosimetry of a small field (< $3{\times}3cm^2$) has been great challenges in radiotherapy. Small field dosimetry is difficult because of (a) a lack of lateral electronic equilibrium, (b) steep dose gradients, and (c) partial blocking of the source. The objectives of this study were to measure and verify with the various detectors the output factors in a small field (<3 cm) for the 6 MV photon beams. Output factors were measured using the CC13, CC01, EDGE detector, thermoluminescence dosimeters (TLDs), and Gafchromic EBT2 films at the sizes of field such as $0.5{\times}0.5$, $1{\times}1$, $2{\times}2$, $3{\times}3$, $5{\times}5$, and $10{\times}10cm^2$. The differences in the output factors with the various detectors increased with decreasing field size. Our study demonstrates that the dosimetry for a small photon beam (< $3{\times}3cm^2$) should use CC01 or EDGE detectors with a small active volume. And also, Output factors with the EDGE detectors in a small field (< $3{\times}3cm^2$) coincided well with the Gafchromic EBT2 films.

Effects of Head Acupuncture Versus Upper and Lower Limbs Acupuncture on Signal Activation of Blood Oxygen Level Dependent(BOLD) fMRI on the Brain and Somatosensory Cortex (두침과 상하지 침자극이 뇌와 뇌의 체성감각피질에 미치는 영향에 대한 fMRI Study)

  • Park, Jung-Mi;Gwak, Ja-Young;Cho, Seung-Yeon;Park, Seong-Uk;Jung, Woo-Sang;Moon, Sang-Kwan;Ko, Chang-Nam;Cho, Ki-Ho;Kim, Young-Suk;Bae, Hyung-Sup;Jang, Geon-Ho;Bang, Jae-Seung
    • Journal of Acupuncture Research
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    • v.25 no.5
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    • pp.151-165
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    • 2008
  • Objectives : To evaluate the effects of Head Acupuncture versus Upper and Lower Limbs Acupuncture on signal activation of Blood Oxygen Level Dependent(BOLD) fMRI on the Brain and Somatosensory Cortex. Subjects and Methods : 10 healthy normal right-handed female volunteer were recruited. The average age of the 10 subjects was 30 years old. The BOLD functional MRI(fMRI) signal characteristics were determined during tactile stimulation was conducted by rubbing 4 acu-points in the right upper and lower limbs($LI_1$, $LI_{10}$, $LV_3$, $ST_{36}$). After stimulation of Head Acupuncture in Sishencong($HN_1$), $GB_{18}$, $GB_9$, $TH_{20}$ of Left versus Upper and Lower Limbs Acupuncture($LI_1$, $LI_{10}$, $LV_3$, $ST_{36}$ of Right) and took off needles. Then the BOLD fMRI signal characteristics were determined at the same manner. Results : 1. When touched with cotton buds(sensory stimulation), left Parietal Lobe, Post-central Gyrus, primary somatosensory cortex(BA 1, 2, 3), and primary motor cortex(BA 4) were mainly activated. When $ST_{36}$ was stimulated, Frontal Lobe, Parietal Lobe, Cerebellum, and Posterior Lobe as well as Inter-Hemispheric displaying a variety of regions. 2. In signal activation before and after Head Acupuncture reaction, it showed signal activation after removing the acupuncture needle and right Somatosensory Association Cortex, Postcentral Gyrus, and Parietal Lobe were more activated. 3. In reactions of before and after Upper and Lower Limb Acupuncture, it also showed signal activation after removing the acupuncture needle and bilateral Occipital Lobe, Lingual Gyrus, visual association cortex, and Cerebellum were activated. 4. After acupuncture stimulation, In Upper and Lower Limb Acupuncture Group, left frontal Lobe, Precentral Gyrus and Bilateral parietal lobe, Postcentral Gyrus and Primary Somatosensory Cortex(BA 2) were activated. In Head Acupuncture Group, which has most similar activation regions, but especially right Pre-Post central Gyrus, Primary Somatosensory Cortex(BA 3), Primary Motor Cortex, frontal Lobe and Parietal Lobe were activated. Conclusions : When sensory stimulation was done with cotton buds on four acup-points($LI_1$, $LI_{10}4, $LV_3$, $ST_{36}$), while bilaterally activated, contralateral sense was more dominant. It showed consistency with cerebral cortex function. When $ST_{36}$ was stimulated Frontal Lobe, Parietal Lobe, Cerebellum, Posterior Lobe as well as Inter-Hemispheric were stimulated. In Head Acupuncture, it showed more contralateral activation after acupuncture. In Upper and Lower Limb Acupuncture, it showed typically contralateral activation and deactivation of limbic system after acupuncture stimulation. Therefore, there were different fMRI BOLD signal activation reaction before and after Head Acupuncture vs Upper and Lower Limb Acupuncture which might be thought to be caused by acu-points' sensitivity and different sensory receptor to response acupuncture stimulation.

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