• 핵의학기술
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• 제15권2호
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• pp.60-64
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• 2011

Brain의 질병을 평가하는 유용한 검사방법 중의 하나인 brain perfusion SPECT는 환자의 움직임으로 인한 검사의 실패확률이 높아 one day method를 사용하지 못하고 two days method를 사용해야 하는 경우가 많다. 본 연구에서는 image registration을 사용하여 검사의 실패확률을 줄이고 one day method로 검사를 시행할 수 있는지 image registration을 적용할 경우 검사의 신뢰성을 알아보고자 하였다. Jaszczak phantom에 준비된 방사성동위원소 $^{99m}Tc$을 insert에 111 MBq/mL가 되도록 분배하여 넣고 나머지 background에 3,145 MBq/mL가 되도록 넣어 1:8의 비율로 phantom을 제작하고 Hoffman 2-D brain phantom과 cylindrical uniform phantom에는 111 MBq/mL가 되도록 만든다. 완성된 phantom은 기본 위치에서 frame 당 5 sec씩 총 120 frame을 획득하여 영상을 얻었다. 또 Phantom과 환자의 데이터를 가지고 original 영상과 registration 영상, registration 시행한 후에 original 영상을 subtraction한 영상과 registration하지 않은 영상에서 subtraction한 영상 간의 임의의 같은 위치에 ROI를 설정하고 영상에서 counts 차이를 알아보았다. 실험 결과 약간의 counts 차이를 보였으나 이것은 실험시간이 경과함에 따른 RI의 decay와 phantom의 구조물이 없는 cylindlical phantom에서 조차 약간의 counts의 차이를 보이는 바로 미루어 봤을 때 실험 결과 나온 counts의 차이는 적다고 할 수 있을 것이다. 따라서 registration을 활용하여 brain perfusion SPECT의 단점들을 개선하고 정확한 진단에 도움을 줄 수 있을 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제62권10호
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• pp.400-404
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• 2019

Background: An increase in the numbers of patients with gastrointestinal symptoms has recently been observed. Purpose: To investigate the effects of proton pump inhibitor (PPI) therapy on intestinal inflammation in children and adolescents as confirmed by clinical manifestations and objectively assessed by fecal calprotectin (FC) level measurement. Methods: Consecutive children (aged 3-18 years) who presented with gastrointestinal symptoms and were treated with or without PPI for at least 1 month were enrolled. Patients were divided into PPI and non-PPI groups. The PPI group was further subdivided by treatment duration and type of PPI used. Stool samples were collected for FC evaluation at baseline and after treatment and clinical data and FC levels were compared between the groups. Results: Fifty-one patients (15 boys, 36 girls) were enrolled in the study. The PPI group included 37 patients, while the non-PPI group included 14 patients. Clinical symptoms were not significantly different. FC levels and laboratory results, including C-reactive protein levels, white blood cell count, and absolute neutrophil count, were not statistically different before versus after PPI treatment. After treatment, FC levels decreased to 8.1 mg/kg (-575.4 to 340.3 mg/kg) in the PPI group and increased to 5.6 mg/kg (-460.0 to 186.9 mg/kg) in the non-PPI group compared to those before treatment (P=0.841). The number of patients with increased FC levels was not significantly different between the 2 groups (48.6% vs. 64.3%, P=0.363), similar to that observed in patients with an FC level > 50 mg/kg (24.3% and 7.1%, P=0.250). PPI therapy type and duration did not affect the FC levels (P=0.811 and P=0.502, respectively). Conclusion: Although we aimed to confirm the evidence of intestinal inflammation due to PPI use in children and adolescents through clinical symptoms and FC measurement, no significant changes were observed.

• 대한치과마취과학회지
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• 제12권3호
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• pp.157-163
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• 2012

Background: The major goal of dental management before and after liver transplantation is the prevention of bacteremia from an oral source that could lead to systemic infection. However dental treatment in liver transplant patients have the risk of infection and bleeding. so it is needed special dental consideration. Methods: 42 liver transplant candidates who visited department of Advanced General Dentistry in Yonsei University College of dentistry from March 1, 2010 to February 29, 2012 were selected. The clinical data of those patients were analyzed; coagulation status such as PT, INR, aPTT, platelet count before and 6 months after liver transplantation, dental infectious foci, time interval between dental visit and operation date of liver transplantation. Results: Before liver transplant, the patient's PT and INR was prolonged, and the platelet count was lower than normal range. But 6 months later from liver transplantation, most of the figures turned into a normal range. The dental infection foci were chronic periodontitis, dental caries, chronic apical periodontitis, root rest et al but we did extraction of 6 root rest before liver transplantation and postponed other treatment after liver transplantation due to bleeding and infection risk of patients. Because of insufficient interval between dental visit and operation date, 64.3% of patients could not finish the dental treatment. Conclusions: The patients before liver transplantation have the risk of bleeding. The treatment of those patient should be removal of only factors that can cause dental infections after transplantation and other treatment must be postponed until the stable period of the transplant that patient's condition has improved.

• 한국의료질향상학회지
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• 제17권1호
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• pp.79-88
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• 2011

Background : Evidence-based guidelines are now used for enteral nutrition(EN) in neurosurgical intensive care unit patients who mostly depend on EN. This study compared and analyzed the nutritive conditions of patients before and after they underwent guideline based nutritional interventions in order to determine whether using these guidelines improved their calorie supply. Methods : Data on the patients' nutritional requirements, maximum calorie supply through EN, serum albumin level, and total lymphocyte count were collected and analyzed using SAS version 9.1.3. All the statistical analyses were performed at a significance level of P<0.05. Result : The maximum calorie supply through EN was $923.1{\pm}359.7$ kcal before the intervention and $1254.4{\pm}196.3$ kcal after the intervention; this difference was statistically significant(P<0.05). The ratio of nutritional requirements to maximum calorie supply through EN was $55.5{\pm}22.4%$ and $74.2{\pm}13.9%$ before and after the intervention, respectively; this difference was statistically significant(P<0.05). This indicates a 19% increase in the ratio after the nutritional intervention. The serum albumin level also significantly increased from $2.7{\pm}0.6g/dL$ before the intervention to $3.2{\pm}0.4g/dL$ after the intervention(P<0.05). The total lymphocyte count slightly increased from $1267.7{\pm}728.2cells/mm^3$ before the intervention to $1801.9{\pm}1211.5cells/mm^3$ after the intervention; this difference was not statistically significant. Conclusion : The results showed that using the evidence-based feeding guidelines for interventions increased the calorie supply and improved the patients' nutritive conditions from moderate malnutrition to mild malnutrition.

• Tuberculosis and Respiratory Diseases
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• 제79권1호
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• pp.31-36
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• 2016

Background: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. Methods: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean${\pm}$standard deviation age of $71.2{\pm}11.1years$ and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were $71.2{\pm}8.3years$ and $71.2{\pm}11.1years$, respectively. Results: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). Conclusion: Thus, five factors-acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH-can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1719-1723
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• 2014

Background: The current study was aimed to elucidate the association of thymidylate synthase (TYMS) 5'-UTR 28bp tandem repeat and cytosolic serine hydroxymethyltransferase (cSHMT) C1420T polymorphisms with acute leukemia in South Indian subjects. A total of 812 subjects [523 healthy controls, 148 acute lymphoblastic leukemia (ALL) cases and 141 acute myeloid leukemia (AML) cases] were screened for TYMS 5'-UTR 28bp tandem repeat and cSHMT C1420T using PCR-AFLP and PCR-with confronting two-pair primers (CTPP) approaches. TYMS 5'-UTR 2R allele frequencies of controls, ALL and AML cases were 35.3%, 28.0% and 30.1% respectively. This polymorphism conferred protection against ALL (OR: 0.71, 95%CI: 0.53-0.96) while showing no statistically significant association with AML (OR: 0.79, 95%CI: 0.58, 1.07). The cSHMT variant allele (T-) frequencies of ALL and AML cases (6.42% and 5.68% respectively) were significantly lower compared to controls (58.3%). This polymorphism conferred protection against ALL (OR: 0.049, 95%CI: 0.029-0.081) and AML (OR: 0.043, 95%CI: 0.025-0.074). The TYMS 5'-UTR 2R2R genotype was associated with a lower total leukocyte count, smaller percentage of blasts, and more adequate platelet count compared to 2R3R and 3R3R genotypes in ALL cases. No such genotype-dependent differences were observed in AML cases. ALL cases carrying the cSHMT C1420T polymorphism showed higher disease free survival compared to those with the wild genotype. To conclude, the TYMS 5'-UTR 28bp tandem repeat reduces risk for ALL while cSHMT C1420T reduces risk for both ALL and AML. Both also influence disease progression in ALL.

• Asian Pacific Journal of Cancer Prevention
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• 제17권1호
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• pp.215-217
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• 2016

Background: Chronic lymphocytic leukemia (CLL) is the most frequent form of leukemia in Europe and North America, and it mainly affects older individuals. Many approaches are implemented in the management of CLL from a watch and wait (W&W) strategy to chemotherapeutic regimens. We here reviewed our clinical practice for the relevance of the W&W strategy in Lebanese CLL patients. Materials and Methods: A total of 95 patients with CLL diagnosed in four institutions in Lebanon, between 1992 and 2013, were selected and their files were reviewed. Characteristics of these patients were noted including age, sex, RAI and Binet scores, CBC values, presence of hepatomegaly or splenomegaly, performance of bone marrow biopsy or peripheral blood flux cytometry for diagnosis, adoption of W&W strategy, different chemotherapeutic regimens and the indications for treatment. Results: Some 38 patients (40%) diagnosed with CLL were women and 57 (60%) were men with a mean age of 65.1 years [36-89]. Of the total, 50.5%, 17.2%, 14%, 7.5% and 10.8% had an RAI score at diagnosis of 0, 1, 2, 3 and 4, respectively, while 65.6%, 17.2% and 17.2% had Binet scores of I, II and III. The mean lymphocyte count at diagnosis was $39885/mm^3$ [1596-290000], the mean hemoglobin level was 12.7 g/dl [6.2-17] and the mean platelet count was $191255/mm^3$ [14000-458000]. While 26.3% of patients with CLL had splenomegaly, only 7.4% had hepatomegaly. Some 33.7% had undergone a bone marrow biopsy, 66.3% flow cytometry of circulating blood and 5.3% a lymph node biopsy. Overall, the W&W was adopted in 62.4% (58) of patients with a mean duration of 37.7 months [3-216]. The W&W was used in 82.6%, 73.3%, 46.2%, 14.3% and 0% of patients having RAI scores of 0, 1, 2, 3 and 4, respectively, and, it was used in 80%, 46.7% and 6.25% with Binet scores of I, II and III. The most frequent indication for treatment was anemia and thrombocytopenia, accounting for 32.7% of cases. The most frequently used chemotherapeutical regimens were chlorambucil until the end of the last century and flufarabine-cyclophosphamide-rituximab during the last decade. Conclusions: This retrospective review of CLL clinical practice showed an important implementation of the W&W strategy with a long duration, especially in early stage cases with low RAI or Binet scores.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1403-1407
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• 2015

Background: New tumour biomarkers are being intensely investigated for malignant mesothelioma (MM). Fibulin-3 is produced in MM but its role remains uncertain. The aim of this study was to evaluate the validity of measuring serum fibulin-3 in the diagnosis and prognosis of MM. Materials and Methods: This prospective study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014. Data from MM patients, including demographic and clinical features, routine laboratory data, levels of serum fibulin-3, and treatment outcomes were defined as potential prognostic factors. The receiver operating characteristic (ROC) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity. Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM. Afterwards, the possible factors identified with univariate analyses were entered into the cox regression analysis. Results: Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls. The results showed that the best cut-off point was 36.6 ng/ml with an AUC (area under the curve)=0.976, sensitivity=93.0% and specificity=90.0. In our study, the initial significant poor prognostic factors were advanced stage, high white blood cell count, high platelet count, high C-reactive protein (p<0.05 for each variable). Later, according to multivariate analysis the results showed only advanced stage as significant parameter (p=0.040). Conclusions: We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM. Also advanced stage was associated with poor MM prognosis.

• Tuberculosis and Respiratory Diseases
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• 제74권1호
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• pp.7-14
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• 2013

Background: Fractional exhaled nitric oxide (FeNO) can be measured easily, rapidly, and noninvasively for the assessment of airway inflammation, particularly mediated by eosinophil, such as asthma. In bronchiectasis (BE), the pathogenesis has been known as chronic airway inflammation and infection with abnormal airway dilatation; however, there are little studies to evaluate the role of FeNO in BE. Methods: From March 2010 to February 2012, 47 patients with BE, diagnosed by high resolution computed tomography (HRCT), performed FeNO, compared with asthma and chronic obstructive pulmonary disease (COPD). All patients carried out a complete blood count including eosinophil count, chemistry, sputum examination, and spirometry, if indicated. A retrospective analysis was performed to elucidate the clinical role of FeNO in BE patients. Results: The mean FeNO levels in patients with BE was $18.8{\pm}1.5$ part per billion (ppb), compared to $48.0{\pm}6.4$ and $31.0{\pm}4.3$ in those with asthma and COPD, respectively (p<0.001). The FeNO levels tended to increase along with the disease severity scores by HRCT; however, it was statistically not significant. FeNO in BE with a co-infection of nontuberculous mycobacteria was the lowest at $17.0{\pm}3.5$ ppb among the study population. Conclusion: FeNO in BE was lower than other chronic inflammatory airway diseases, particularly compared with asthma. For clinical application of FeNO in BE, more large-scaled, prospective studies should be considered.

• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.513-521
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• 1995

연구배경: 세포의 증식능력을 반영한다고 알려진 NORs를 간편한 은염색으로 발현시켜서 AgNORs 수가 정상조직과 종양조직의 비교감별과 종양의 증식능력판단에 유용한지를 알기위하여 파라핀 포매된 편평세포폐암 조직을 이용하여 본 연구를 시행하였다. 방법: 수술로써 절제한 파라핀 포매된 편평세포폐암 조직 36예를 Mourad 등의 방법으로 은염색하였다. 1,000 배 배율하에서 종양조직과 정상조직에서 임의로 100 개씩 세포를 선정해서 핵당 평균 AgNORs수를 구하였다. 결과: 종양조직에서 TNM병기에 따른 핵당 평균 AgNORs수는 유의한 차이가 없었으나 정상조직과 종양조직을 비교허여 정상조직에서는 $1.74{\pm}0.25$, 종양 조직에서는 $4.05{\pm}0.80$으로 종양조직의 핵당 평균 AgNORs수가 정상조직에 비해서 유의하게 높았다(p<0.001). 결론: TNM분류에 따른 각 병기별 종양조직과 인접 정상조직의 핵당 평균 AgNORs수를 비교하여도 각 병기에서 종양조직의 평균 AgNORs수가 정상조직에 비하여 유의하게 높았다(p<0.005).