• 제목/요약/키워드: Suboptimal

검색결과 449건 처리시간 0.024초

위장관 출혈의 영상의학적 진단법 (Radiologic Diagnosis of Gastrointestinal Bleeding)

  • 김세형
    • 대한영상의학회지
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    • 제84권3호
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    • pp.520-535
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    • 2023
  • 위장관 출혈은 단일 질환이 아니라 광범위한 위장 질환의 증상 및 임상적 발현이다. 임상적 양상에 따라 명백한 출혈, 잠재 출혈, 원인 불명 출혈로 나눌 수 있으며, 출혈 위치에 따라 Treiz 인대를 기준으로 상부 또는 하부 위장관 출혈로 분류할 수 있다. 혈관 질환, 용종, 종양, 크론병, 이소성 췌장 및 이소성 위조직 등 다양한 질환이 위장관 출혈을 일으킬 수 있다. 명백한 출혈을 위한 영상 검사기법은 CT 혈관조영술, 고식적 혈관조영술 및 핵의학적 검사 등이 사용된다. 잠재 위장관 출혈을 평가하기 위한 영상검사로는 CT 소장조영술이 주로 사용되며, 위장관을 적절히 팽창해서 영상을 획득해야 위음성 혹은 위양성을 최소화하여 진단능을 높일 수 있다. CT 소장조영술에서 진단이 확실하지 않은 경우, Meckel scan이 보완적으로 사용될 수 있다. 원인 불명 위장관 출혈에 대한 검사는 임상 양상과 임상의 혹은 영상의학과 의사의 선호도에 따라 다양한 검사가 시행될 수 있으며, 이에 대한 추가적인 연구가 필요하다.

The effect of methyltestosterone on in vitro fertilization outcomes: A randomized clinical trial on patients with low ovarian response

  • Venus Haj Aliakbar;Fatemeh Davari Tanha;Firouzeh Akbari Asbagh;Mahbod Ebrahimi;Zahra Shahraki
    • Clinical and Experimental Reproductive Medicine
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    • 제51권2호
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    • pp.158-162
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    • 2024
  • Objective: The aim of this study was to compare the outcomes of in vitro fertilization (IVF) in patients with a poor ovarian response who used methyltestosterone, versus those using a placebo, in an infertility clinic setting. Methods: This clinical trial included 120 women who had undergone IVF with intracytoplasmic sperm injection due to poor ovarian reserve and infertility. The study took place at the Yas Infertility Center in Tehran, Iran, between January 1, 2018 and January 1, 2019. In the intervention group, 25 mg of methyltestosterone was administered daily for 2 months prior to the initiation of assisted reproductive treatment. The control group was given placebo tablets for the same duration before starting their cycle. Each group was randomly assigned 60 patients. All analyses were performed using SPSS ver. 23 (IBM Corp.). Results: The endometrial thickness in the intervention group was 7.57±1.22 mm, whereas in the control group, it was 7.11±1.02 (p=0.028). The gonadotropin number was significantly higher in the control group (64.7±13.48 vs. 57.9±9.25, p=0.001). However, there was no significant difference between the two groups in the antral follicular count. The chemical and clinical pregnancy rates in the intervention group were 18.33% and 15% respectively, compared to 8.33% and 6.67% in the control group. The rate of definitive pregnancy was marginally higher in the intervention group (13.3% vs. 3.3%, p=0.05). Conclusion: The findings of this study suggest that pretreatment with methyltestosterone significantly increases endometrium thickness and is associated with an increase in the definitive pregnancy rate.

이상기상 조건이 배추의 생육 및 세포조직에 미치는 영향 (Effects of Growth and Cellular Tissue under Abnormal Climate Condition in Chinese Cabbage)

  • 이상규;최장선;최준명;이희주;박수형;도경란
    • 생물환경조절학회지
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    • 제22권2호
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    • pp.87-90
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    • 2013
  • 지구 온난화의 영향으로 우리나라는 지난 30년동안 평균기온이 $0.7^{\circ}C$, 겨울철에는 $1.4^{\circ}C$가 상승하였다. 이러한 온난화로 인하여 우리나라에서는 이상기상 현상이 자주 발생하여 채소작물에 피해가 발생한다. 특히 노지에서 많이 재배되고 있는 고추, 배추 및 무는 온난화로 인하여 정식시기를 점점 앞당겨 정식후 갑작스런 저온이 오면 이들 작물의 피해가 크다. 따라서 본 실험은 저온에 따른 배추의 생육특성과 엽 세포조직에 미치는 영향을 구명하고자 실시하였다. '춘광' 배추품종을 화분에 정식한 후 노지 처리구, 무가온 하우스 및 가온하우스 처리구 등 3처리를 하였다. 그 결과, 정식후 50일의 생육은 노지처리구의 초장, 엽수, 엽록소 및 엽면적이 가온 처리구에 비해서 현저하게 떨어졌고, 특히 생체중의 경우에는 가온 처리구에 비해서 노지와 무가온 하우스 처리구가 1/3 수준으로 현저하게 낮았다. 배추의 잎이 10매 정도 생육이 되었을 때 저온에 따른 배추 잎의 피해증상은 영하 $3.0^{\circ}C$ 조건에서는 배추 겉잎에 약간의 수침증상을 보였으나 회복되었다. 그러나 영하 $7.4^{\circ}C$ 조건의 배추 잎은 수침증상이 심하였으며 회복되지 못하고 황색으로 변하면서 결국 잎이 고사하였다. 피해받은 잎의 엽육세포는 영하 $3.0^{\circ}C$ 조건에서는 울타리조직과 해면조직이 약한 붕괴증상을 보였지만 어느정도 형태를 갖추고 있었는데, 영하 $7.4^{\circ}C$ 조건에서는 세포가 동결된 후 해동되는 과정에서 세포의 막구조가 파괴되어 울타리조직과 해면조직이 완전히 붕괴되었기 때문에 세포 형태를 갖추고 있지 않았다. 따라서 배추 정식후 초기 생육 단계에서 영하 $3^{\circ}C$까지는 비닐이나 부직포로 보온, 토양수분 조절, ABA 처리를 하여 동해를 예방할 수 있으나 영하 $7^{\circ}C$의 저온이 발생하면 세포가 파괴되어 회복하기 어렵기 때문에 다시 심거나 또는 다른 작물로 대체하는 것이 좋을 것으로 사료되었다.

노인의 혈중 호모시스테인, 엽산, 비타민 $B_{12}$ 수준 및 영양소 섭취 상태와 신경인지기능과의 관련성 (Relationship among Plasma Homocysteine, Folate, Vitamin $B_{12}$ and Nutrient Intake and Neurocognitive Function in the Elderly)

  • 김희정;김혜숙;김기남;김꽃핀;손정인;김성윤;장남수
    • Journal of Nutrition and Health
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    • 제44권6호
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    • pp.498-506
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    • 2011
  • This study examined the relationship among plasma homocysteine, folate, and vitamin $B_{12}$ levels and neurocognitive function in 118 community-dwelling elderly subjects (mean age, $75.1{\pm}6.7$ years). The Mini-Mental State Examination (MMSE-KC) was used to screen and assess neurocognitive function in the participants. Dietary intake data including the use of dietary supplements were obtained using the 24-hour recall method by well-trained interviewers. Plasma folate and vitamin $B_{12}$ concentrations were analyzed by radioimmunoassay, and homocysteine was assessed by a high performance liquid chromatography-fluorescence method. The proportions of participants with suboptimal levels of plasma folate (< 3 ng/mL), vitamin $B_{12}$ (< 221 pmol/mL), and homocysteine (> $15{\mu}mol/L$) were 16.1%, 5.9%, and 21.2%, respectively. A multiple regression analysis showed that plasma homocysteine was negatively associated with plasma folate and vitamin $B_{12}$ levels. The MMSE-KC test scores were significantly associated with plasma homocysteine and folate, but not with vitamin $B_{12}$, after adjusting for age, gender, body mass index, living with spouse, education, current smoking, energy intake, and chronic diseases such as hypertension, diabetes, thyroid disease, dyslipidemia, stroke, and cardiovascular disease. A general linear model adjusted for covariates revealed that MMSE-KC test scores increased from the lowest to the highest quartiles of vitamin $B_1$, vitamin $B_2$, vitamin $B_6$, vitamin $B_{12}$, and vitamin C intake (p for trend = 0.012, 0.039, 0.014, 0.046, 0.026, respectively). These results indicate that the problem of folate inadequacy and hyperhomocysteinemia are highly prevalent among community-dwelling elderly people and that dietary intake of the B vitamins and vitamin C is positively associated with cognitive function scores.

성장기의 쥐와 늙은 쥐 조직의 Glutathione Peroxidase 활성에 대한 Methionine 투여의 효과 (Effect of Methionine Supplementation on Glutathione Peroxidase Activity in Young and Old Murine Tissues)

  • Cha-Kwon Chung
    • 한국식품영양과학회지
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    • 제23권3호
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    • pp.429-435
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    • 1994
  • 자라나는 과정의 젊은 흰쥐와 14개월 된 늙은 흰쥐, 생쥐들을 대상으로 Met 투여에 따른 간, 혈장, 신장, 비장 등의 glutathione peroxidase(GSHPx) 효소 변화를 측정 비교하였다. 성장기의 쥐에 있어서 Se을 Selenite 형태로 투여했을 때 0.5%의 식이 Met 공급은 같은 Se을 Se-Met 형태를 공급했을 때 보다 효소 활성이 증가하였다. 그러나, 14개월 된 늙은 쥐에서는 Met 투여에 대한 효소 활성은 큰 변화가 없었다. 일반적으로 식이 Se 증가는 효소 활성과 거의 정비례하나 1ppm Se 수준 이상에서는 완만하게 증가 또는 거의 정체하는 상태를 보이지만, 늙은 쥐에서는 Se의 식이 수준이 2ppm이 되어도 여전히 효소 활성이 증가하는 경향을 보였다. 성장기의 생쥐 실험에서도 2ppm Se 수준에서의0.3%와 0.8%의 식이 Met 투여는 효소 활성에 큰 영향이 없었다. 그러나 실험식이 투여 18일 경엔 4일째 보다 Met 투여군이 4.2배의 증가를 보인 반면 비투여군은 2.5배의 증가에 머물렀다. 18일경 이후 효소 활성이 감소하여 42일재는 반으로 감소함을 보였다. Se의 생체 활성은 특히 식이 Se 수준이 낮을 때 Met에 의해 증가되는 폭이 컸으며 Se 수준이 높을수록 상대적으로 감소함을 보였다. 위의 제반 결과에서 Met의 요구량이 Se-Met에 의해 대체되고 있음을 짐작할 수 있다. 그러므로 식이 Met 수준 상태에 따라 효소의 활성이 달라질 수 있다는 것을 시사한다.

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Intraoperative Balloon Angioplasty Using Fogarty Artertial Embolectomy Balloon Catheter for Creation of Arteriovenous Fistula for Hemodialysis: Single Center Experience

  • Jin, Moran;Yoon, Young Chul;Wi, Jin Hong;Lee, Yang-Haeng;Han, Il-Yong;Park, Kyung-Taek
    • Journal of Chest Surgery
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    • 제48권2호
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    • pp.120-125
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    • 2015
  • Background: The purpose of this study was to evaluate the use of a Fogarty arterial embolectomy catheter (Fogarty catheter) in intraoperative balloon angioplasty of the cephalic vein, in order to determine its effect on the patency of arteriovenous fistulas (AVFs) created for hemodialysis access. Methods: A total of 156 patients who underwent creation of an AVF were divided into two groups, based whether a Fogarty catheter was used during AVF creation. Group A (89 patients) comprised the patients who underwent balloon angioplasty with a Fogarty catheter during the operation. Group B (67 patients) included the patients in whom a Fogarty catheter was not used during the operation. Patient records were reviewed retrospectively and documented. The patency rate was determined by the Kaplan-Meier method. Results: The records of 156 patients who underwent the creation of an AVF from January 2007 to October 2011 were included. The mean follow-up duration was $40.2{\pm}19.4$ months (range, 1 to 97 months). The patency rates in group A at 12, 36, and 72 months were $83.9%{\pm}3.9%$, $78.3%{\pm}4.6%$, and $76.3%{\pm}4.9%$, respectively, while the corresponding patency rates in group B were $92.5%{\pm}3.2%$, $82.8%{\pm}0.5%$, and $79.9%{\pm}5.7%$, respectively. The patency rates in group B were found to be slightly higher than those in group A, but the difference was not statistically significant (p=0.356). Conclusion: Intraoperative balloon angioplasty of the cephalic vein using the Fogarty catheter is a simple and easily reproducible procedure, and it can be helpful in increasing AVF patency in cases of insufficient runoff or a suboptimal cephalic vein.

부적절한 일차 처치와 연관된 이하선 종양 2례 (Tumors of the Parotidomasseteric Area Associated with Inadequate Primary Treatment: Report of 2 Cases)

  • 송진우;최환준;김미선;안형식;김준혁;이영만
    • Archives of Plastic Surgery
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    • 제33권6호
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    • pp.764-768
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    • 2006
  • Purpose: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. Methods: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. Results: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. Conclusions: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.

CT 검사 시 관전압과 BMI 변화에 따른 화질 및 피폭평가 (Evaluation of Image Quality and dose with the Change of kVp and BMI in the Liver CT)

  • 김동현;고성진;강세식;김정훈;최석윤;김창수
    • 한국콘텐츠학회논문지
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    • 제13권6호
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    • pp.331-338
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    • 2013
  • 간질환을 주소로 추적검사를 위해 내원한 CT(Computer Tomography, 이하 CT) 검사자를 대상으로 체질량 지수와 관전압 변화에 따른 영상의 화질 및 방사선 피폭선량변화에 대하여 알아보고자 하였다. 2010년 3월부터 2011년 6월까지 부산 P대학병원에 복부 CT 를 검사한 환자 중 체질량지수(Body Mass Index, 이하 BMI)가 25이하인 환자를 대상으로 하였고 대상자는 48명이었다. 영상의 질의 객관적 평가로 신호대 잡음비와 유효선량을 비교하였다. 복부 영상의 화질평가는 영상의학과 의사2명이 한국의료영상품질관리원에서 선정한 임상영상 평가의 기준을 근거로 해 1점에서 20점까지 점수를 매겨 평가하였다. 피폭선량분석에서 CTDIvol값은 관전압이 100kVp일 때 120kVp보다 약44.1%가 감소하였다. 그리고 유효선량은 관전압 100kVp일 때 120kVp보다 약43%가 감소하였다. 영상의 화질 평가는 반복적으로 CT검사를 위해 내원한 총48명의 검사자 영상 중 Good 1명, Excellent 47명으로 평가되었다. 추적검사를 시행하는 환자 중 BMI지수가 25이하인 환자들을 대상으로 저관전압을 적용한 복부 CT검사 시 영상의 질적 저하없이 진단 가치가 있는 영상의 획득과 피폭선량 감소효과를 얻을 수 있다고 사료된다.

Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria

  • Ugwumba, Fred O;Ekwueme, Osa Eloka C;Okoh, Agharighom D
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권11호
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    • pp.4999-5003
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    • 2016
  • The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint(R) lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question "How important to men's health is regular testicular self-examination?" Answers to the questions "Do you think it is worthwhile to examine your testis regularly?" and "Would you be interested in more information on testicular cancer and testicular self-examination?" were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.

Impact of dietary risk factors on cardiometabolic and cancer mortality burden among Korean adults: results from nationally representative repeated cross-sectional surveys 1998-2016

  • Jo, Garam;Oh, Hannah;Singh, Gitanjali M.;Park, Dahyun;Shin, Min-Jeong
    • Nutrition Research and Practice
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    • 제14권4호
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    • pp.384-400
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    • 2020
  • BACKGROUND/OBJECTIVES: Dietary factors are important contributors to cardiometabolic and cancer mortality. We examined the secular trends of nine dietary factors (fruits, vegetables, whole grains, nuts and seeds, milk, red meat, processed meat, sugar-sweetened beverages, and calcium) and the associated burdens of cardiometabolic and cancer mortality in Korea using representative cross-sectional survey data from 1998 to 2016. SUBJECTS/METHODS: Using dietary data from Korean adults aged ≥ 25 years in the Korea National Health and Nutrition Examination Survey (KNHANES), we characterized secular trends in intake levels. We performed comparative risk assessment to estimate the population attributable fraction and the number of cardiometabolic and cancer deaths attributable to each dietary factor. RESULTS: A total of 231,148 cardiometabolic and cancer deaths were attributable to nine dietary risk factors in Korea from 1998 to 2016. Suboptimal intakes of fruits and whole grains were the leading contributors. Although the intakes of fruits, vegetables, and whole grains moderately improved over time, the intake levels in 2016 (192.1 g/d, 225.6 g/d, and 10.9 g/d, respectively) remained far below the optimal levels. Deaths attributable to the low intakes of nuts and seeds (4.5 g/d), calcium (440.5 mg/d), and milk (37.1 g/d) and the high intakes of red meat (54.7 g/d), processed meat (4.7 g/d), and sugar-sweetened beverages (33.0 g/d) increased since 1998. Compared with older age groups (≥ 45 years), more unfavorable changes in dietary patterns were observed in the younger population aged 25-44 years, including more sharply increased intakes of processed meat. CONCLUSIONS: We observed improvement in the intakes of fruits, vegetables, and whole grains and unfavorable changes in the intakes of processed meat and sugar-sweetened beverages over the past few decades. Our data suggest that to reduce the chronic disease burden in Korea, more effective nutritional policies and interventions are needed to target these dietary risk factors.