• The Korean Journal of Physiology
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• 제23권2호
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• pp.253-261
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• 1989

장기적으로 소금량을 다르게 섭취시킴에 따라서, 체내의 Na 대사에 관여하는 호르몬인 aldosterone, atrial natriuretic peptide (ANP) 및 renin 분비와 신장의 배설 반응에 나타나는 변화를 정상 혈압쥐 Wistar와 spontaneously hypertensive rat (SHR)에서 비교하고자 실험하였다. 생후 7주의 숫쥐인 Wistar와 SHR에게 저염과 고염 식이 (각각 2, 25 mmol Na/100 g diet)를 6주간 먹였다. 그 후 ether 마취하에서 대퇴 동맥과 정맥 및 방광에 관을 삽입한 후, restraining cage에 넣었다. 수술회복 후 안정시 뇨와 혈액을 채취한 후, 0.9% saline을 30분동안 체중의 3%되게 정맥주입(혈장량 증가)하고 뇨와 혈액을 채취하였다. 혈장의 호르몬을 방사면역법으로 측정하였다. Wistar와 SHR의 저염, 고염 식이군의 성장률에는 유의한 차이가 없었다. Wistar 저염과 고염군의 평균 동맥혈압은 각각 113과 110 mmHg로 차이가 없었으며, SHR의 동맥압은 141과 149mmHg로 고염군이 높았다. 저염식이군에서 혈장 aldosterone농도는 고염군보다 월등히 높았고, ANP 농도는 차이가 없었으며, renin은 고염군보다 낮았다. 혈장량 증가 이후 혈장 aldosterone은 모든 군에서 $30{\sim}40%$정도 감소하였고, renin은 $30{\sim}60%$정도 감소하였다. 혈장량 증가 이후 ANP는 증가하였는데 고염군에서의 증가도가 저염군에서보다 월등히 높았다. 혈장량 증가 이전의 Wistar군의 혈장 aldosterone과 renin의 대조치 값은 SHR보다 유의하게 높았고, ANP 농도는 차이가 없었다. 그러나 혈장량 증가 이후의 Wistar와 SHR의 aldosterone과 renin의 감소정도는 유의한 차이가 없었으나, ANP의 증가도는 Wistar가 SHR보다 높은 경향을 보였다. 호르몬들 중에서 혈장 aldosterone과 renin사이에는 양의 대수함수 관계가 있으며, 기울기는 고염군이 저염군보다 유의하게 높았다. 혈장량 증가 이후에 나타나는 뇨량과 소금 배설률의 증가 정도는 고염군과 저염군 사이에 차이가 없었다. 그러나 SHR이 Wistar보다 더 심한 이뇨와 Na 배설항진 반응을 보였다. 이상의 결과는 소금 섭취량에 따라서 aldosterone, ANP 및 renin의 분비 조절이 다르며, 정상 혈압과 고혈압쥐 사이에서도 차이가 있음을 시사해 주고 있다.

• 핵의학기술
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• 제17권2호
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• pp.3-9
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• 2013

핵의학 검사 중 동적 신장검사는 신장기능을 평가하는 가장 대표적인 검사법으로 방사성동위원소를 이용하여 시간에 따른 신장의 기능을 평가하고 소변이 배설에 이르기까지의 질환 평가에 유용하다. 이러한 검사영상의 질 평가 및 정량 분석에서 현재 상용화 된 팬텀은 정적 상황만 재현하고 평가할 수 있기 때문에 동적 팬텀을 통한 시간에 따른 신장의 기능적 상황과 혈류속도, 방사성동위원소의 주입량에 따른 다양한 차이 등을 확인할 수 있는 연구가 미비한 상황이다. 그러므로 본 연구를 통해 동적 신장팬텀 시스템을 제작하여 신장의 동적 흐름을 통한 영상을 재현함으로써 핵의학에서 영상학적으로 유용성을 평가하고자 한다. 신장팬텀은 정상 성인 신장을 기준으로 제작하였고, 동적 상황을 재현하기 위하여 혈류의 속도를 조절할 수 있는 정량 펌프를 적용하였으며, $^{99m}Tc-pertechnate$를 신장팬텀에 방사성의약품이 집적되고 방광으로 배설되도록 제작하였다. 사용된 방사성의약품은 각 신장팬텀에 각각 주입되도록 하였으며, 주입속도, 방사성의약품, 좌우 신장팬텀에 다른 주입속도에 따른 변화를 확인하였다. 획득한 영상의 분석은 전면상과 후면상 각각의 신장과 방광에 관심영역을 그려 분석하였으며, 재현성을 확인하기 위하여 각 10회씩 반복하여 분석하였다. 동일한 조건하에 주입속도 40 mL/min로 고정하여 펌프의 압력을 조절하였을 때 방사성의약품이 2-3분 사이에 신장팬텀에 가장 많이 집적되었다가 방광으로 배출되었다. 각 장비별 사구체 여과율은 각각 SYMBIA 1,091 mL/min, FORTE 1,232 mL/min, ARGUS 1,264 mL/min, INFINIA 1,302 mL/min로 통계적으로 유의한 차이가 있는 것으로 나타났으며, Tmax 값 그리고 T1/2 값 모두에서 장비별 통계적으로 유의한 차이가 있는 것으로 나타났다. 변동계수인 CV 값은 5% 이하로 재현성이 있는 것으로 나타났으며, 그 중에서 SYMBIA가 2.67%로 가장 낮게 나타났고, INFINIA가 4.86%으로 가장 높게 나타났다. 본 연구를 통하여 동적신장팬텀시스템이 실제 임상의 신장동적검사를 유사하게 재현이 가능한 것을 확인할 수 있었다. 특히 신장을 통해 방광으로 배설되는 흐름에 대해 시간에 따른 묘사가 충분하게 재현되었으며, 동적 영상의 질을 확인하는데 기초 자료로 활용이 가능하리라 사료된다. 또한 추후 기능적 영상 분야에 연구 및 정도관리 분야에도 도움이 되리라 여겨진다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2005년도 제30회 춘계학술대회
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• pp.68-70
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• 2005

To precisely localize target in prostate cancer, image-guided radiotherapy was performed using the $ExacTrac^{\circledR}$ x-ray system (Brainlab, Germany) with implanted markers. For three prostate cancer patients, three gold markers were implanted into prostate. Orthogonal portal images were acquired every treatment and CT scans were repeated 3～5 times during the course of treatment. After correcting setup errors calculated by the system, the position of the implanted markers and the distance between them were detected in daily portal images and in CT images, and analyzed retrospectively. Deviation of the relative position of the implanted markers and the distance between them were less than 1 mm in lateral, longitudinal, and vertical direction for three patients, both in portal images and CT images. This study reveals that image-guided radiotherapy using the $ExacTrac^{\circledR}$ system is useful to verify positioning errors and localize prostate target with implanted markers, reducing the planning target volume (PTV) margin as well as irradiation to rectum and bladder.

• Journal of Menopausal Medicine
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• 제24권3호
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• pp.163-168
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• 2018

Objectives: To investigate the rate of postoperative urinary retention (POUR) and identify the risk factors for this complication in women who underwent transvaginal uterosacral suspension surgery. Methods: A retrospective chart review was conducted for 75 women who underwent transvaginal uterosacral suspension surgery with vaginal hysterectomy, repair of cystocele, and levator myorrhaphy with/without transobturator anti-incontinence surgery. POUR was defined as a need for continuous intermittent catheterization on the third day subsequent to removal of the urethral indwelling catheter. Results: Acute POUR was reported in 18 women (24.0%). Thirty-six of the 75 patients (48.0%) had undergone anti-incontinence surgery. Crude analysis revealed significant association between the following variables and the risk of POUR: hypertension, the lower average flow rate in the pressure-flow study (PFS), greater post-void residual (PVR) urine volume in PFS, and PVR >30% of the total bladder capacity (TBC) in PFS. In the logistic regression analysis, PVR >30% of the TBC in PFS was identified as the only significant predictor of POUR (odds ratio, 15.4; 95% confidence interval, 2.5-90.9; P = 0.003). Conclusions: The PVR >30% of the TBC in PFS was identified as the only predictive factor of acute POUR in women who underwent transvaginal uterosacral suspension surgery.

• International Neurourology Journal
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• 제22권4호
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• pp.275-286
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• 2018

Purpose: OnabotulinumtoxinA (BoNT-A) is a promising therapy for treating neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). This systematic review and meta-analysis aimed to carry out an in-depth review and to make an objective estimation of the efficacy and safety of BoNT-A on NDO after SCI. Methods: The PubMed, Embase, and Cochrane databases were searched for all relevant articles published from 2001 to 2016 that referred to NDO, SCI, and BoNT-A or botulinum toxin A. All data were recorded in an Excel spreadsheet by 2 individual reviewers. Review Manager version 5.3 was used to carry out the meta-analysis. Results: This analysis included 17 studies involving 1,455 patients. Compared with placebo and baseline, BoNT-A was effective in increasing maximum cystometric capacity, volume at first involuntary detrusor contraction, cystometric bladder capacity (all P<0.00001), compliance (P=0.001), and the number of patients with complete dryness (P=0.0003), and decreasing detrusor pressure, the number of patients with no involuntary detrusor contractions, the maximum flow rate, the incidence of detrusor overactivity (all P<0.00001), and the number of urinary incontinence episodes (P=0.001). There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa. There were no life-threatening adverse events. Conclusions: BoNT-A is effective and safe in treating NDO after SCI. There were no statistically significant differences between doses of 200 U and 300 U or between injecting into the detrusor and submucosa. However, more high-quality randomized controlled trials are still needed.

• 대한한의학원전학회지
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• 제32권1호
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• pp.133-143
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• 2019

Objectives : In this study, we analyze the medical significance of feces symptoms so that the daily records of the feces of individuals can be not only used as a measure of individual health monitoring in daily life, but also more actively connected to the medical treatment of the Korean Medicine (KM). Methods : Categories and clinically significant attributes for symptoms of Urination and defecation in the KM ontology DB are determined, and connected to KM related dialectical indicators by experts' common criteria including Viscera and Bowels [臟腑], eight principles [八綱], Qi Blood fluid and humor phlegm-retained fluid static blood [氣血津液痰飮瘀血], six excesses [六淫]. Results : The analysis of the symptoms of feces in the Korea Medicine ontology shows that the symptoms of stool in categories of 'stool stiffness', 'blood swelling', 'discomfort' are highly ranked among the overall clinical symptom categories. In the case of urine symptoms, symptoms corresponding to 'urine color,' 'urine discomfort,' and 'urine volume' are the top rankers among other total clinical symptoms. In the case of stool, the relationship between the symptom of stool and the categories of spleen, stomach, and colon is increased as the weighted symptom is considered. The relationship between the symptom of urine and the categories of the small intestine and the bladder is increased in the same way. Conclusions : This study could help better utilize the personal generated health records of feces in clinical practice of Korean Medicine.

• 한국의학물리학회지:의학물리
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• 제29권4호
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• pp.157-163
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• 2018

Plans converted using dose-volume-histogram-based plan conversion (DPC) were evaluated by comparing them to the original plans. Changes in the dose volumetric (DV) parameters of five volumetric modulated arc therapy (VMAT) plans for head and neck (HN) cancer and five VMAT plans for prostate cancer were analyzed. For the HN plans, the homogeneity indices (HIs) of the three planning target volumes (PTV) increased by 0.03, 0.02, and 0.03, respectively, after DPC. The maximum doses to the PTVs increased by 1.20, 1.87, and 0.92 Gy, respectively, after DPC. The maximum doses to the optic chiasm, optic nerves, spinal cord, brain stem, lenses, and parotid glands increased after DPC by approximately 4.39, 3.62, 7.55, 7.96, 1.77, and 6.40 Gy, respectively. For the prostate plans after DPC, the HIs for the primary and boost PTVs increased by 0.05 and 0.03, respectively, and the maximum doses to each PTV increased by 1.84 and 0.19 Gy, respectively. After DPC, the mean doses to the rectum and femoral heads increased by approximately 6.19 and 2.79 Gy, respectively, and those to the bladder decreased by 0.20 Gy when summing the primary and boost plans. Because clinically unacceptable changes were sometimes observed after DPC, plans converted by DPC should be carefully reviewed before actual patient treatment.

• 한국임상수의학회지
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• 제40권2호
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• pp.104-112
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• 2023

The change in the position of the abdominal organs due to movement by respiration is one of the reasons behind inaccurate irradiation of organs during radiotherapy (RT). Although studies in human medicine have revealed on the respiratory movements of abdominal organs, there is little information and no reference data for dogs. The purpose of this study was to establish the reference values of abdominal organs movement in various postures using computed tomography (CT), and to compare the movements of organs between dorsal recumbency and ventral, right and left lateral recumbency during respiration. CT images for kidney, adrenal gland, medial iliac lymph node, urinary bladder, gallbladder, liver, stomach, and thoracic and lumbar vertebral body of five beagle dogs were acquired. The movements of organs were evaluated by comparing the end-expiratory and end-inspiratory images. Movements of the organs were evaluated by dividing it into right-to-left, dorsal-to-ventral, and cranial-to-caudal directions. The movements of abdominal organs according to the change in postures and respiration were establish. The movement of the bilateral organs was the least when the organs were in the downward position (p < 0.017). The movement of cranial-to-caudal direction was greater than the movement of the other directions in most of the organs. Data obtained in this study may be useful in selecting the appropriate posture that can reduce the movements of organs to be treated with RT, and the data could be useful for setting the planning target volume to consider the movements of the abdominal organs by respiration.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.27-34
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• 2024

Purpose: The ability to concentrate urine becomes an important index in determining nocturnal enuresis (NE) treatment. The aim of our study was to investigate first-morning urine osmolality (Uosm) changes at the end of treatment compared to before treatment in children with NE. Methods: A total of 71 children with NE were divided into two groups according to the level of first-morning Uosm before treatment: high group (≥800 mOsm/kg) and low group (<800 mOsm/kg). Baseline parameters were obtained from uroflowmetry, frequency volume charts for at least 2 days, and a questionnaire for lower urinary tract symptoms. All patients were basically treated with standard urotherapy and medication. The first-morning Uosm was measured twice, before treatment and at the end of treatment. Results: The response rate was higher in the low group after 3 months of treatment than in the high group (P=0.041). However, there was no difference between the two groups at the end of the treatment. In the high group, the first-morning Uosm at the end of treatment did not show a significant change compared to before treatment. In contrast, the first-morning Uosm increased in the low group at the end of treatment (P<0.001). However, it was still lower than that of the high group (P=0.007). Conclusions: The ability to concentrate nocturnal urine improved at the end of treatment compared to before treatment in the low Uosm NE children. In addition, NE improved faster in the low Uosm group before treatment than in the high group.

• 한국방사선학회논문지
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• 제9권7호
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• pp.449-457
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• 2015

전립선암의 방사선치료에서 토모테라피와 용적변조회전치료(volumetric modulated arc therapy, VMAT)의 치료계획에 따른 유용성 평가를 위해 흡수선량, 선량체적곡선(dose volume histogram, DVH), 치료효율성, MapCHECK2를 이용한 선량 검증 정확도 결과를 각각 비교 분석하였다. 대상으로는 2014년 7월부터 12월까지 H 대학병원 방사선종양학과에서 토모테라피 치료를 받은 전립선암 환자 중 12명을 무작위로 선택하였다. 흡수선량과 DVH를 분석한 결과 종양조직과 방광에서 두 방사선 치료계획이 근소한 차이를 나타냈지만 처방선량의 오차범위인 -5%에서+3%안에 포함됐고 정상조직 부작용 확률 권고치인 견딤선량 범위를 넘지 않았다. 치료시간은 2.5배 짧고 MU(monitor unit)도 10.3배 작아 VMAT가 치료효율성이 높았다. 선량정확도는 모두 95% 이상의 통과기준에 포함 되었으며 VMAT가 2.3% 더 높게 나타났다. 토모테라피와 VMAT 모두 종양조직에 적합한 선량이 흡수되었으며 정상조직의 견딤선량 범위를 넘지 않아 선량분포특성에서 큰 차이는 없었다. 하지만 치료시간이 짧고, total MU가 낮아 치료효율성이 좋고 선량 검증의 정확도 또한 우수한 VMAT를 선택하는 것이 치료에 더 유용할 것으로 사료된다.