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Korean Clinical Imaging Guidelines for the Appropriate Use of Chest MRI (한국형 흉부 MRI 영상 진단 정당성 권고안)

  • Jiyoung Song;Bo Da Nam;Soon Ho Yoon;Jin Young Yoo;Yeon Joo Jeong;Chang Dong Yeo;Seong Yong Lim;Sung Yong Lee;Hyun Koo Kim;Byoung Hyuck Kim;Kwang Nam Jin;Hwan Seok Yong
    • Journal of the Korean Society of Radiology
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    • v.82 no.3
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    • pp.562-574
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    • 2021
  • MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

Physicochemical and textural properties of thawed pork by vacuum tumbling (진공 텀블링을 이용한 해동 돈육의 이화학적 및 조직학적 특성)

  • Su-Jin Park;Won-Ho Hong;Seung-Min Oh;Chang-Hee Cho;Jiyeon Chun
    • Food Science and Preservation
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    • v.31 no.3
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    • pp.423-432
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    • 2024
  • In this study, a vacuum tumbler with 4 impellers (DVT) was designed and applied for thawing frozen pork (vacuum -60 kPa, jacket 35℃, 1 rpm). Quality characteristics of the thawed pork were compared with those of industrially thawed meat by natural air at room temperature (NAT) and imported vacuum tumbler (IVT). The thawing time for frozen pork (303.36 kg) using DVT (165 min) was much shorter than that of NAT (4,200 min). DVT-thawed pork had lower drip loss (0.85%) than NAT (2.08%). DVT-thawed pork showed a pH of 5.92, a total bacterial count of 1.96±0.02 log CFU/g and no coliforms. Deteriorations in fat (TBARS 0.31±0.01 MDA mg/kg) and protein (VBN 5.67±1.98 mg%) in DVT-thawed pork were significantly lower than those of NAT (p<0.05). DVT-thawed pork had a high water-holding capacity (WHC, 97.5%). The hardness (34.59±0.46 N) and chewiness (188.21±0.17) of cooked DVT-thawed pork were about 5-6 times lower than those of NTA. Microstructure (SEM) showed myofibrillar damage in NAT-thawed pork, whereas dense myofibrillar structure was observed in DVT-thawed pork. DVT was better or similar to IVT in all evaluation parameters. The designed DVT is expected to be used as an efficient thawing method in terms of processing time and yield and to produce thawed meat with high WHC, soft texture, and low spoilage by minimizing tissue damage.

The Comparison of Image Quality and Quantitative Indices by Wide Beam Reconstruction Method and Filtered Back Projection Method in Tl-201 Myocardial Perfusion SPECT (Tl-201 심근관류 SPECT 검사에서 광대역 재구성(Wide Beam Reconstruction: WBR) 방법과 여과 후 역투영법에 따른 영상의 질 및 정량적 지표 값 비교)

  • Yoon, Soon-Sang;Nam, Ki-Pyo;Shim, Dong-Oh;Kim, Dong-Seok
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.122-127
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    • 2010
  • Purpose: The Xpress3.$cardiac^{TM}$ which is a kind of wide beam reconstruction (WBR) method developed by UltraSPECT (Haifa, Israel) enables the acquisition of at quarter time while maintaining image quality. The purpose of this study is to investigate the usefulness of WBR method for decreasing scan times and to compare to it with filtered back projection (FBP), which is the method routinely used. Materials and Methods: Phantom and clinical studies were performed. The anthropomorphic torso phantom was made on an equality with counts from patient's body. The Tl-201 concentrations in the compartments were 74 kBq (2 ${\mu}Ci$)/cc in myocardium, 11.1 kBq (0.3 ${\mu}Ci$)/cc in soft tissue, and 2.59 kBq (0.07 ${\mu}Ci$)/cc in lung. The non-gated Tl-201 myocardial perfusion SPECT data were acquired with the phantom. The former study was scanned for 50 seconds per frame with FBP method, and the latter study was acquired for 13 seconds per frame with WBR method. Using the Xeleris ver. 2.0551, full width at half maximum (FWHM) and average image contrast were compared. In clinical studies, we analyzed the 30 patients who were examined by Tl-201 gated myocardial perfusion SPECT in department of nuclear medicine at Asan Medical Center from January to April 2010. The patients were imaged at full time (50 second per frame) with FBP algorithm and again quarter-time (13 second per frame) with the WBR algorithm. Using the 4D MSPECT (4DM), Quantitative Perfusion SPECT (QPS), and Quantitative Gated SPECT (QGS) software, the summed stress score (SSS), summed rest score (SRS), summed difference score, end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were analyzed for their correlations and statistical comparison by paired t-test. Results: As a result of the phantom study, the WBR method improved FWHM more than about 30% compared with FBP method (WBR data 5.47 mm, FBP data 7.07 mm). And the WBR method's average image contrast was also higher than FBP method's. However, in result of quantitative indices, SSS, SDS, SRS, EDV, ESV, EF, there were statistically significant differences from WBR and FBP(p<0.01). In the correlation of SSS, SDS, SRS, there were significant differences for WBR and FBP (0.18, 0.34, 0.08). But EDV, ESV, EF showed good correlation with WBR and FBP (0.88, 0.89, 0.71). Conclusion: From phantom study results, we confirmed that the WBR method reduces an acquisition time while improving an image quality compared with FBP method. However, we should consider significant differences in quantitative indices. And it needs to take an evaluation test to apply clinical study to find a cause of differences out between phantom and clinical results.

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Pharmacological Studies of Cefoperazone(T-1551) (Cefoperazone(T-1551)의 약리학적 연구)

  • Lim J.K.;Hong S.A.;Park C.W.;Kim M.S.;Suh Y.H.;Shin S.G.;Kim Y.S.;Kim H.W.;Lee J.S.;Chang K.C.;Lee S.K.;Chang K.C.;Kim I.S.
    • The Korean Journal of Pharmacology
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    • v.16 no.2 s.27
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    • pp.55-70
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    • 1980
  • The pharmacological and microbiological studies of Cefoperazone (T-1551, Toyama Chemical Co., Japan) were conducted in vitro and in vivo. The studies included stability and physicochemical characteristics, antimicrobial activity, animal and human pharmacokinetics, animal pharmacodynamics and safety evaluation of Cefoperazone sodium for injection. 1) Stability and physicochemical characteristics. Sodium salt of cefoperazone for injection had a general appearance of white crystalline powder which contained 0.5% water, and of which melting point was $187.2^{\circ}C$. The pH's of 10% and 25% aqueous solutions were 5.03 ana 5.16 at $25^{\circ}C$. The preparations of cefoperazone did not contain any pyrogenic substances and did not liberate histamine in cats. The drug was highly compatible with common infusion solutions including 5% Dextrose solution and no significant potency decrease was observed in 5 hours after mixing. Powdered cefoperazone sodium contained in hermetically sealed and ligt-shielded container was highly stable at $4^circ}C{\sim}37^{\circ}C$ for 12 weeks. When stored at $4^{\circ}C$ the potency was retained almost completely for up to one year. 2) Antimicrobial activity against clinical isolates. Among the 230 clinical isolates included, Salmonella typhi was the most susceptible to cefoperazone, with 100% inhibition at MIC of ${\leq}0.5{\mu}g/ml$. Cefoperazone was also highly active against Streptococcus pyogenes(group A), Kletsiella pneumoniae, Staphylococcus aureus and Shigella flexneri, with 100% inhibition at $16{\mu}g/ml$ or less. More than 80% of Escherichia coli, Enterobacter aerogenes and Salmonella paratyphi was inhibited at ${\leq}16{\mu}/ml$, while Enterobacter cloaceae, Serratia marcescens and Pseudomonas aerogenosa were somewhat less sensitive to cefoperagone, with inhibitions of 60%, 55% and 35% respectively at the same MIC. 3) Animal pharmacokinetics Serum concentration, organ distritution and excretion of cefoperazone in rats were observed after single intramuscular injections at doses of 20 mg/kg and 50 mg/kg. The extent of protein binding to human plasma protein was also measured in vitro br equilibrium dialysis method. The mean Peak serum concentrations of $7.4{\mu}g/ml$ and $16.4{\mu}/ml$ were obtained at 30 min. after administration of cefoperazone at doses of 20 mg/kg and 50 mg/kg respectively. The tissue concentrations of cefoperazone measured at 30 and 60 min. were highest in kidney. And the concentrations of the drug in kidney, liver and small intestine were much higher than in blood. Urinary and fecal excretion over 24 hours after injetcion ranged form 12.5% to 15.0% in urine and from 19.6% to 25.0% in feces, indicating that the gastrointestinal system is more important than renal system for the excretion of cefoperazone. The extent of binding to human plasma protein measured by equilibrium dialysis was $76.3%{\sim}76.9%$, which was somewhat lower than the others utilizing centrifugal ultrafiltration method. 4) Animal pharmacodynamics Central nervous system : Effects of cefoperazone on the spontaneous movement and general behavioral patterns of rats, the pentobarbital sleeping time in mice and the body temperature in rabbits were observed. Single intraperitoneal injections at doses of $500{\sim}2,000mg/kg$ in rats did not affect the spontaneous movement ana the general behavioral patterns of the animal. Doses of $125{\sim}500mg/kg$ of cefoperazone injected intraperitonealy in mice neither increased nor decreased the pentobarbital-induced sleeping time. In rabbits the normal body temperature was maintained following the single intravenous injections of $125{\sim}2,000mg/kg$ dose. Respiratory and circulatory system: Respiration rate, blood pressure, heart rate and ECG of anesthetized rabbits were monitored for 3 hours following single intravenous injections of cefoperazone at doses of $125{\sim}2,000mg/kg$. The respiration rate decreased by $3{\sim}l7%$ at all the doses of cefoperazone administered. Blood pressure did not show any changes but slight decrease from 130/113 to 125/107 by the highest dose(2,000 mg/kg) injected in this experiment. The dosages of 1,000 and 2,000 mg/kg seemed to slightly decrease the heart rate, but it was not significantly different from the normal control. All the doses of cefoperazone injected were not associated with any abnormal changes in ECG findings throughout the monitering period. Autonomic nervous system and smooth muscle: Effects of cefoperazone on the automatic movement of rabbit isolated small intestine, large intestine, stomach and uterus were observed in vitro. The autonomic movement and tonus of intestinal smooth muscle increased at dose of $40{\mu}g/ml$ in small intestine and at 0.4 mg/ml in large intestine. However, in stomach and uterine smooth muscle the autonomic movement was slightly increased by the much higher doses of 5-10 mg/ml. Blood: In vitro osmotic fragility of rabbit RBC suspension was not affected by cefoperazone of $1{\sim}10mg/ml$. Doses of 7.5 and 10 mg/ml were associated with 11.8% and 15.3% prolongation of whole blood coagulation time. Liver and kidney function: When measured at 3 hours after single intravenous injections of cefoperaonze in rabbits, the values of serum GOT, GPT, Bilirubin, TTT, BUN and creatine were not significantly different from the normal control. 5) Safety evaluation Acute toxicity: The acute toxicity of cefoperazone was studied following intraperitoneal and intravenous injections to mice(A strain, 4 week old) and rats(Sprague-Dawler, 6 week old). The LD_(50)'s of intraperitonealy injected cefoperazone were 9.7g/kg in male mice, 9.6g/kg in female mice and over 15g/kg in both male and female rats. And when administered intravenously in rats, LD_(50)'s were 5.1g/kg in male and 5.0g/kg in female. Administrations of the high doses of the drug were associated with slight inhibition of spontaneous movement and convulsion. Atdominal transudate and intestinal hyperemia were observed in animals administered intraperitonealy. In rats receiving high doses of the drug intravenously rhinorrhea and pulmonary congestion and edema were also observed. Renal proximal tubular epithelial degeneration was found in animals dosing in high concentrations of cefoperazone. Subacute toxicity: Rats(Sprague-Dawley, 6 week old) dosing 0.5, 1.0 and 2.0 g/kg/day of cefoperazone intraperitonealy were observed for one month and sacrificed at 24 hours after the last dose. In animals with a high dose, slight inhibition of spontaneous movement was observed during the experimental period. Soft stool or diarrhea appeared at first or second week of the administration in rats receiving 2.0g/kg. Daily food consumption and weekly weight gain were similar to control during the administration. Urinalysis, blood chemistry and hematology after one month administration were not different from control either. Cecal enlargement, which is an expected effect of broad spectrum antibiotic altering the normal intestinal microbial flora, was observed. Intestinal or peritoneal congestion and peritonitis were found. These findings seemed to be attributed to the local irritation following prolonged intraperitoneal injections of hypertonic and acidic cefoperazone solution. Among the histopathologic findings renal proximal tubular epithelial degeneration was characteristic in rats receiving 1 and 2g/kg/day, which were 10 and 20 times higher than the maximal clinical dose (100 mg/kg) of the drug. 6) Human pharmacokinetics Serum concentrations and urinary excretion were determined following a single intravenous injection of 1g cefoperazone in eight healthy, male volunteers. Mean serum concentrations of 89.3, 61.3, 26.6, 12.3, 2.3, and $1.8{\mu}g/ml$ occured at 1,2,4,6,8 and 12 hours after injection respectively, and the biological half-life was 108 minutes. Urinary excretion over 24 hours after injection was up to 43.5% of administered dose.

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