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Clinical Significance of Creatine Kinase MB mass and Cardiac Troponin I as a Marker of Perioperative Myocardial Infarction After Coronary Artery Bypass Grafting (관상동맥 우회술 후 심근경색의 표지자로서 Creatine Kinase MB 농도와 Cardiac Troponon I의 임상적 의의)

  • 이재진;김응중;이원용;신윤철;지현근
    • Journal of Chest Surgery
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    • v.35 no.1
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    • pp.27-35
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    • 2002
  • Background: A perioperative myocardial infarction(PMI) is one of the major complications after CABG. Among diagnostic methods of PMI, CK-MB activity assays have been increasingly replaced by CK-MB mass assays, which have more sensitive, simple measurement. Also, new cardiac-specific and -sensitive marker, cardiac troponin I(cTnl), has been shown to be a marker of myocardial infarction. We report our evaluation of clinical significance of CK-MB mass and cTnl as a marker of PMI after CABG. Material and Method: We studied 32 patients who underwent CABG at Kangdong Sacred Hospital between April 2000 and April 2001. Postoperative serum CK-MB activity level, serum CK-MB mass, cTnl, electrocardiogram, echocardiogram, and clinical data were recorded prospectively The diagnosis of PMI was defined as positive 2 among 3 or all of the following , by a new Q wave on the electrocardiogram, by serum CK-MB activity higher than 200 lU/L within 72 hours after operation, and by new regional wall motion abnormality on the echocardiogram. Result: After CABG, 3 patients had sustained a PMI according to current diagnostic criteria. As serum CK-MB activity time course, a level of CK-MB activity 12 hours after CABG had very linear correlated significance with serum CK-MB mass 24hours(R=0.946) and cTnl 48 hours(R=0.933) after CABG(p=0.000). As we used a receiver operating characteristics curve(ROC curve) for a diagnostic cutoff value in patients with PMI, serum CK-MB mass levels higher than 30.05 ug/L 24 hours after CABG detected the presence of PMI with an area under the ROC curve of 1.0, a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100%. Also serum cTnl levels higher than 17.15 ug/L 48 hours after CABG detected the presence of PMI with an area under the ROC curve of 0.98, a sensitivity of 100%, a specificity of 96.6%, a positive preclictive value of 75%, and a negative predictive value of 100% Conclusion: We concluded that both the measurement of CK-MB mass and cTnl are the easier, accurate methods as a diagnostic marker of PMT after CABG, also as a proposal of diagnostic cutoff value enables to an early detection of PMI. However, a 1arger number of patient will be needed because of statistic limitation that a small number of participating patients, a small number of PMI.

Thermoradiotherapy in the Treatment of Locally Advanced Nonsmall Cell Lung Cancer (국소 진행된 비소세포성 폐암에서 온열 방사선 병용 치료의 효과)

  • Kay Chul Seung;Choi Ihl Bohng;Jang Jl Young;Choi Byung Ok;Kim In Ah;Shinn Kyung Sub
    • Radiation Oncology Journal
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    • v.14 no.2
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    • pp.115-122
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    • 1996
  • Purpose : To improve the treatment results of locally advanced nonsmall cell lung cancer (NSCLC) patients we treated those patients with regional hyperthermia combined with radiotherapy. And we conducted a retrospective analysis of the results. Material and Methods Thirty two nonsmall cell lung cancer Patients treated at the Department of Radiation Oncology, St. Mary's hospital, Catholic University Medical College were the base of this analysis. Fourteen patients of above them were treated with hyperthermia and radiotherapy of more than 3000 cGy in radiation dose. Radiofrequency capacitive hyperthermia was administered twice weekly immediately after radiotherapy. Total sessions of hyperthermia ranged from 3 to 13 times (mean 7.8). Eighteen patient received an external radiation therapy alone Median radiation dose was 5580 cGy (range, 3000-7000 cGy) in fraction of 180-300 cGy, 5 fractions per week. Results: The results of themoradiotherapy group (HTRT group) were compared with radiation alone group (RT group). There were no complete response (CR) and 12 Partial responses (PR) (CR rate $0\%$, response rate $85.7\%$) in HTRT group, whereas there were 2 CRs, 8 PRs and 8 no responses (CR rate $11.1\%$, response rate $55.6\%$) in RT group. There was significant differece in local response rate of the tumors between RT group and HTRT group (p < 0.05). Overall 2 rear survival rate and mean survival were $7.1\%$ and 10.5 months for HTRT group, and $0\%$ and 8.1 months for RT group. However, by the number of hyperthermia. in cases with more than or equal to 10 sessions of hyperthermia, there were significant improvement in 2 year year survival rate and mean survival ($40.0\%$ and 18.2 months) compared with those in cases with less than 10 sessions of hyperhtemia ($7.4\%$ and 7.4 months) (p < 0.05). Conclusion : Thermoradiotherapy in locally advanced NSCLC patients increased their response rate but not 2 year survival and mean survival, therefore thermoradiotherpy with enough number of hyperthermia is suggested that may be one of the effective palliative treatments of those patients. And in cases with more than 10 sessions of hyperthermia, there showed improved 2 year survival rate and mean survival But the number of the cases was small further study in this aspect is required.

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Electroencephalographic Changes Induced by a Neurofeedback Training : A Preliminary Study in Primary Insomniac Patients (뉴로피드백 훈련에 의한 뇌파 변화 연구 : 일차성 불면증 환자에 대한 예비 연구)

  • Lee, Jin Han;Shin, Hong-Beom;Kim, Jong Won;Suh, Ho-Suk;Lee, Young Jin
    • Sleep Medicine and Psychophysiology
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    • v.26 no.1
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    • pp.44-48
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    • 2019
  • Objectives: Insomnia is one of the most prevalent sleep disorders. Recent studies suggest that cognitive and physical arousal play an important role in the generation of primary insomnia. Studies have also shown that information processing disorders due to cortical hyperactivity might interfere with normal sleep onset and sleep continuity. Therefore, focusing on central nervous system arousal and normalizing the information process have become current topics of interest. It has been well known that neurofeedback can reduce the brain hyperarousal by modulating patients' brain waves during a sequence of behavior therapy. The purpose of this study was to investigate effects of neurofeedback therapy on electroencephalography (EEG) characteristics in patients with primary insomnia. Methods: Thirteen subjects who met the criteria for an insomnia diagnosis and 14 control subjects who were matched on sex and age were included. Neurofeedback and sham treatments were performed in a random order for 30 minutes, respectively. EEG spectral power analyses were performed to quantify effects of the neurofeedback therapy on brain wave forms. Results: In patients with primary insomnia, relative spectral theta and sigma power during a therapeutic neurofeedback session were significantly lower than during a sham session ($13.9{\pm}2.6$ vs. $12.2{\pm}3.8$ and $3.6{\pm}0.9$ vs. $3.2{\pm}1.0$ in %, respectively; p < 0.05). There were no statistically significant changes in other EEG spectral bands. Conclusion: For the first time in Korea, EEG spectral power in the theta band was found to increase when a neurofeedback session was applied to patients with insomnia. This outcome might provide some insight into new interventions for improving sleep onset. However, the treatment response of insomniacs was not precisely evaluated due to limitations of the current pilot study, which requires follow-up studies with larger samples in the future.

Electrocardiographic and Echocardiographic Characterisitics of Wolff-Parkinson-White Syndrome in Preschool Children (학동전 아동에서 Wolff-Parkinson-White 증후군의 심전도 소견에 따른 유형 및 심초음파 소견)

  • Chu, Jeoung Min;Sim, Hyun Sup;Cho, Soo Chul;Joo, Chan Uhng
    • Clinical and Experimental Pediatrics
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    • v.45 no.9
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    • pp.1097-1105
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    • 2002
  • Purpose : This study was conducted to estabilish the prevalence, clinical features and relationship between ECG findings and echocardiographic findings of Wolff-Parkinsion-White(WPW) syndrome in asymptomatic preschool children. Methods : An electrocardiographic screening study was performed on 77,824 preschool children in Jeonbuk province from April, 1999 to August, 2001. Patients with WPW syndrome underwent echocardiographic study. Results : Twenty three patients with WPW syndrome were discovered by electrocardiographic screening of preschool children. The prevalence rate was 2.9 per 10,000 preschool children and there was no significant sexual difference. Two patients had a history of symptoms related to tachyarrythmia. According to the ECG classification of Rosenbaum et al., five patients were type A and 18 were type B. Utilizing the criteria of Gallagher et al, right anterior, 12 patients; right anteiror paraseptal, four patients; left anteiror, three patients. Nineteen of 23 patients underwent echocardiographic study. Four of five patients with type A WPW syndrome had abnormal early systolic anterior motion of left ventricular posterior wall. Twelve of 14 patients with type B had abnormal interventricular septal motion characterized by early sytolic posterior motion immediately after inscription of the delta wave. Conclusion : The prevalence rate of preschool children in Jeonbuk province was 2.9/10,000. By the classification according to the electrocardiographic findings, the accessory pathway location was dominant right side than left side. In the echocardiographic study, type A WPW syndrome showed abnormal left ventricular posterior wall motion and type B WPW showed abnormal interventricular septal motion.

EFFECT OF SMEAR LAYER ON THE APICAL LEAKAGE OF WARM VERTICAL CANAL FILLING (도말층이 가온 수직가업 근관 충전후 치근단 누출에 미치는 영향)

  • Kwon, Tae-Kyung;Kim, Sung-Kyo
    • Restorative Dentistry and Endodontics
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    • v.23 no.2
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    • pp.561-574
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    • 1998
  • The purposes of this study were to observe the difference in the root canal wall after hand instrumentation or engine-driven Ni-Ti instrumentation under the scanning electron microscope, and to evaluate the apical leakage provided by continuous wave of canal filling technique with or without root canal sealer and smear layer. Twenty recently extracted human maxillary anterior teeth were instrumented with K-type files or engine-driven Ni-Ti files, Quantec series 2000$^{TM}$ and irrigated with 5.25% NaOCl alone or 15% EDT A and final flush of 5.25% NaOCl. After the instrumentation and flushing, teeth were split in half with a knife and a mallet. They were then examined with a scanning electron microscope Forty-four recently extracted human maxillary anterior teeth were divided into four groups with and without smear layer and then warm vertical canal filling using System-B with or without sealer. The extent of leakage was scored after immersion in India ink for 1 week. The results were as follows: 1. No significant difference of smear layer was observed between K-type file-instrumented group and engine-driven Ni-Ti file-instrumented group. 2. A group without smear layer showed significantly less apical leakage than a group with smear layer when sealer was used for the canal filling (p<0.01). 3. There was no significant difference between a group without sealer and smear layer and a group without sealer and with smear layer (p<0.01). 4. In groups without smear layer, a group with sealer showed significantly less apical leakage than a group without sealer (p<0.01). 5. When root canals were irrigated with NaOCl alone, a group with sealer showed significantly less apical leakage than a group without sealer (p<0.01).

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Survey of Heavy Metal Contents and Intake Rates After Decoction in Herbal Medicines Classified by Parts (한약재의 약용부위별 중금속 함량 및 탕 액에서의 이행률 조사)

  • Jung, Sam-Ju;Kang, Sung-Tae;Han, Chang-Ho;Kim, Su-Jin;Ko, Suk-Kyung;Kim, Yun-Hee;Kim, Yoo-Kyung;Kim, Bog-Soon;Choi, Byung-Hyun
    • Journal of Food Hygiene and Safety
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    • v.25 no.4
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    • pp.402-409
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    • 2010
  • The study was conducted to estimate the contents of heavy metal in commercial herbal medicines (1047 samples of 132 species) which were collected from markets in Seoul and to analyze the contents of heavy metals of herbal medicines by classifying them by parts. The samples were digested using microwave method. The contents of heavy metal (Pb, Cd, and As) and Hg were determined using Inductively coupled plasma-Mass spectrometer (ICP/MS). And the contents of Hg were obtained by Mercury analyzer. The average values of heavy metal in herbal medicines were as follows [mean (minimum-maximum), mg/kg]; Pb 0.870 (ND-69.200), As 0.148 (ND-2.965), Cd 0.092 (ND-2.010), and Hg 0.007 (ND-0.B7). And the average values of heavy metal by parts in herbal medicines were as follows [mean (minimum-maximum), mg/kg]; Ramulus 2.046 (0.065-4.474), Herba 1.886 (0.048-10.404), Flos 1.874 (0.052-5.393), Cortex 1.377 (0.011-4.837), Radix 1.165 (0.012-70.111), Rhizoma 1.116 (0.016-5.490, Fructus 0.838 (0.017-4.527), Perithecium 0.729 (0.013-4.953), Semen 0.646 (0.006-4.416). The average values of heavy metal of imported herbal medicines except Radix were higher than domestic ones. By decoction of herbal medicines exceeding the tolerances, average intake rates of Pb, As, Cd and Hg were obtained as 6.1%, 40.3%, 4.7%, and 2.2%, respectively.

Evaluation of cardiac function by tissue Doppler imaging in children with cancer (Tissue Doppler imaging을 이용한 소아 종양 환자에서의 심기능 평가)

  • Kim, Yeo Hyang
    • Clinical and Experimental Pediatrics
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    • v.49 no.4
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    • pp.417-423
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    • 2006
  • Purpose : The objectives of this study were to assess ventricular function by tissue Doppler imaging in children who were receiving chemotherapy or who had received chemotherapy, and to apply repeated tissue Doppler imaging to make an early assessment in cardiac toxicity studies. Methods : This study was conducted on 23 oncology patients on-treatment or off-treatment from April 2005 to July 2005 at Dongsan Medical Center, Keimyung University. All patients(group 1) were divided into two groups, fractional shortening(FS) over 29 percent(group 2) and FS under 28 percent (group 3) in the first category. These same patients were also divided into the following groups : group treated with anthracyclin(group 4) and group treated without anthracyclin(group 5). Deceleration time(DT), isovolumic relaxation time(IVRT), FS, peak early diastolic(E), and peak late diastolic (A) velocity of transmitral flow were measured by M-mode and pulsed wave Doppler. Systolic(Sm), peak early diastolic(Em), and peak late diastolic(Am) velocity in apical 4-chamber and 2-chamber views were measured by tissue Doppler imaging. The author calculated a modified Tei index, E/A, E/Em ratio by using measured values. Results : Twenty three patients were enrolled : 12 boys and 11 girls. The average age of patients was 8 years and 4 months. Thirteen out of 23 patients were in the group treated with anthracyclin (group 4) and 6 had FS under 28 percent(group 3). E/Em ratio showed a significant difference between group 1 and control group($6.46{\pm}1.85$ vs $7.06{\pm}1.64$, P<0.05). Other parameters had no difference statistically. Conclusion : This study showed that the change of cardiac function developed earlier in diastolic function than in systolic function, as E/Em ratio reflecting the mean LV diastolic pressure showed a significant difference between the control group and chemotherapy groups. Echocardiography using tissue Doppler imaging is a non-invasive, comfortable and reliable method for post-chemotherapy follow up.

Availability of Cardiac Troponin T as a Marker for Detecting Perioperative Myocardial Damage in Patients with Open Heart Surgery (개심술후 발생한 심근손상에서 진단 표지자로서의 Troponin T의 임상적 유용성)

  • 김태이;정태은;이동협;이정철;한승세
    • Journal of Chest Surgery
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    • v.31 no.1
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    • pp.20-27
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    • 1998
  • It is well known that troponin T(below TnT) is present in the myocardial cells and released during myocardial damage, so it`s very specific enzyme to myocardium. Availability of cardiac specific TnT in assessing perioperatively myocardial damage was evaluated from 34 open heart surgery patients. They consisted of 11 ischemic heart, 13 acquired valvular heart and 10 congenital heart cases. Patients were divided into two groups, group A(patients with myocardial damage) and group B(patients without myocardial damage), according to the symptom of chest pain suspecting angina and the ECG findings of ST segment and T wave changes which show myocardial ischemia and injury. Serum TnT levels were measured by enzyme immunoassay method preoperatively, immediately postoperatively, postoperative day 1, day 2, day 3, and day 7. We observed and analyzed the changes of serum TnT levels in two groups and compared the serum TnT levels with CK-MB levels measured at the same time. In group A, serum TnT levels showed 1.37$\pm$0.26$\mu$g/L, 3.16$\pm$0.66$\mu$g/L, 2.39$\pm$0.74$\mu$g/L, 2.49$\pm$0.76$\mu$g/L, and 1.23$\pm$0.60$\mu$g/L, immediate postoperatively, postoperatively day1, day2, day3, and day7, respectively. It was observed there were significant differences compared with those of group B(0.38$\pm$0.04$\mu$g/L, 0.34$\pm$0.05$\mu$g/L, 0.25$\pm$0.03$\mu$g/L, 0.24$\pm$0.04$\mu$g/L, and 0.11$\pm$0.03$\mu$g/L) during identical periods(P<0.01). Serum CK-MB level in group A significantly elevated to 145.04$\pm$35.08 IU/L on the postoperative day 1 compared to group B(31.28$\pm$5.87 IU/L, P<0.05), However, it stiffly decreased from day 2 and returned to preoperative level at day 3. When serum TnT level more than 1.0$\mu$g/L is thought to reflect myocardial damage, serum TnT had 100% of sensitivity and 87% of specificity in diagnosing the postoperative myocardial damage(p<0.01). I conclusion, serum TnT levels increased significantly at very early stage of myocardial damage and persisted much longer period than CK-MB. This suggests that serum TnT has more advantage and availability in assessing the perioperatively myocardial damage than any other tests.

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A Study on Oxygen Reduction Reaction of PtM Electrocatalysts Synthesized by a Modified Polyol Process (수정된 폴리올 방법을 적용하여 합성한 PtM 촉매들의 산소환원반응성 연구)

  • Yang, Jongwon;Hyun, Kyuwhan;Chu, Cheunho;Kwon, Yongchai
    • Applied Chemistry for Engineering
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    • v.25 no.1
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    • pp.78-83
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    • 2014
  • In this research, we evaluated the performance and characteristics of carbon supported PtM (M = Ni and Y) alloy catalysts (PtM/Cs) synthesized by a modified polyol method. With the PtM/Cs employed as a catalyst for the oxygen reduction reaction (ORR) of cathodes in proton exchange membrane fuel cells (PEMFCs), their catalytic and ORR activities and electrical performance were investigated and compared with those of commercial Pt/C. Their particle sizes, particle distributions and electrochemically active surface areas (EAS) were measured by TEM and cyclic voltammetry (CV), while their ORR activity and electrical performance were explored using linear sweeping voltammetries with rotating disk electrodes and rotating ring-disk electrodes as well as PEMFC single cell tests. TEM and CV measurements show that PtM/Cs have the compatible particle size and EAS with Pt/C. When it comes to ORR activity, PtM/C showed the equivalent or better half-wave potential, kinetic current density, transferred electron number per oxygen molecule and $H_2O_2$ production(%) to or than commerical Pt/C. Based on results gained by the three electrode tests, when the PEMFC single cell tests were carried out, the current density measured at 0.6 V and maximum power density of PEMFC single cell adopting PtM/C catalysts were better than those adopting Pt/C catalyst. It is therefore concluded that PtM/C catalysts synthesized by modified polyol can result in the equivalent or better ORR catalytic capability and PEMFC performance to or than commercial Pt/C catalyst.

A Study on Batch-Type Remote Plasma Dry Cleaning Process for Native Oxide Removal (배치식 플라즈마 세정 설비를 이용한 자연산화막 제거 공정)

  • Park, Jae-Young;Yi, Wook-Yeol;Hyung, Yong-Woo;Nam, Seok-Woo;Lee, Hyeon-Deok;Song, Chang-Lyong;Kang, Ho-Kyu;Roh, Yong-Han
    • Proceedings of the Korean Institute of Electrical and Electronic Material Engineers Conference
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    • 2004.11a
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    • pp.247-251
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    • 2004
  • 반도체 소자의 제조에 있어 실리콘 표면에 성장한 자연산화막을 제거하기 위해 일반적으로 습식 세정 기술이 이용되어 왔다. 하지만 소자의 최소 선폭(design rule)이 nano급으로 고집적화 됨에 따라 contact hole 바닥의 자연산화막을 깨끗이 제거하는데 있어서 그 한계를 나타나고 있다. 이에 대한 효과적인 대안 공정으로 가스 건식 세정 기술이 연구되고 있다. 본 논문에서는 한 번에 50매 이상의 웨이퍼를 처리함으로써 생산성 측면에서 월등한 배치식 설비에서 원거리 플라즈마(remote plasma) 장치에서 2.450Hz의 마이크로웨이브(${\mu}$-wave)에 의해 형성시킨 수소라디칼과 $NF_3$ 가스를 이용하여 실리콘에 결함을 주지 않고 자연산화막을 선택적으로 제거하는 공정에 대해 고찰하였다. AFM을 이용한 표면분석, TEM을 이용한 물성분석, 그리고 ToF-SIMS 및 XPS를 이용한 화학 분석을 습식 및 건식 세정을 비교 평가한 결과, 건식 세정 공정이 실리콘 표면에 결함을 주지 않고 자연산화막을 제거 할 수 있음을 확인하였다. 산화막$(SiO_2)$, 질화막$(Si_3N_4)$, 그리고 다결정 실리콘(Poly-Si) 등의 각 막질별 식각 특성을 고찰하였으며, $NH_3$의 캐리어 가스인 $N_2$의 주입량을 조절함으로써 수소라디칼 형성 효율의 개선이 가능하였으며, 이로부터 게이트와 소스/드레인 사이를 절연하기 위해 이용되는 질화막의 식각 선택비를 2배 정도 개선할 수 있었다. nano급 소자에 실장하여 평가한 결과에서 불산(HF)에 의한 습식 세정 방식에 비하여 약 $20{\sim}50%$ 정도의 contact 저항 감소 효과가 있음이 확인되었다.두 소자 모두 $40mA/cm^2$ 에서 이상적인 화이트 발란스와 같은(0.33,0.33)의 색좌표를 보였다.epsilon}_0=1345$의 빼어난 압전 및 유전특성과 $330^{\circ}C$의 높은 $T_c$를 보였고 그 조성의 vibration velocity는 약4.5 m/s로 나타났다.한 관심이 높아지고 있다. 그러나 고 자장 영상에서의 rf field 에 의한 SAR 증가는 중요한 제한 요소로 부각되고 있다. 나선주사영상은 SAR 문제가 근원적으로 발생하지 않고, EPI에 비하여 하드웨어 요구 조건이 낮아 고 자장에서의 고속영상방법으로 적합하다. 본 논문에서는 고차 shimming 을 통하여 불균일도를 개선하고, single shot 과 interleaving 을 적용한 multi-shot 나선주사영상 기법으로 $100{\times}100$에서 $256{\times}256$의 고해상도 영상을 얻어 고 자장에서 초고속영상기법으로 다양한 적용 가능성을 보였다. 연구에서 연구된 $[^{18}F]F_2$가스는 친핵성 치환반응으로 방사성동위원소를 도입하기 어려운 다양한 방사성의 약품개발에 유용하게 이용될 수 있을 것이다.었으나 움직임 보정 후 영상을 이용하여 비교한 경우, 결합능 변화가 선조체 영역에서 국한되어 나타나며 그 유의성이 움직임 보정 전에 비하여 낮음을 알 수 있었다. 결론: 뇌활성화 과제 수행시에 동반되는 피험자의 머리 움직임에 의하여 도파민 유리가 과대평가되었으며 이는 이 연구에서 제안한 영상정합을 이용한 움직임 보정기법에 의해서 개선되었다. 답이 없는 문제, 문제 만들기, 일반화가 가능한 문제 등으로 보고, 수학적 창의성 중 특히 확산적 사고에 초점을 맞추어 개방형 문제가 확

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