• Tuberculosis and Respiratory Diseases
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• v.54 no.1
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• pp.71-79
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• 2003

Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.43-43
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• 2003

목적 : 남, 여 ADHD 환자에서 뇌 혈류상태의 차이점을 알아보기 위하여, 다른 정신과적 질환이 없는 ADHD 환자의 SPECT 뇌혈류 영상에 대하여 SPM을 통한 뇌 혈류상태의 차이점을 비교분석하였다. 대상 및 방법 : 남자 ADHD 환자군 51 명 (4-11세, 평균 9.0세)과 정상군 8명(6-17세, 평균, 9.6세) 그리고, 여자 ADHD 환자군 13명(6-12세 평균 9.0세)과 정상군 4 명(6-12세 평균 9.0세)의 SPECT영상을 비교분석하였다. 방사성의약품 $^{99m}$ Tc-ECD 0.33mCi/kg을 환자의 정맥내에 주사하고 30분후 잠을 재운상태에서 Multi SPECT3 camera를 이용하여 영상을 기록하였다. Matlab을 이용한 SPM program에서 남여별 ADHD환자의 뇌혈류지도 영상을 비교하였으며, BOLD(blood oxygenation level dependent effect) data plotting을 이용하여 혈류증가율과 감소율을 분석하였다. 결과 : 1) 남자 ADHD환자군의 혈류증가부위의 경우, P<0.02 에서 대상회전 (cingulate gyrus)이 나타나 P<0.05까지 한 부위에서만 나타났으며, 정상군에 비하여 15.61%의 혈류증가율을 나타내었다. 혈류감소부위로는 P<0.004에서 좌측 대뇌 도이랑 (insula gyrus), P<0.005에서 우측 대뇌 측두엽이랑, P<0.007에서는 우측 대뇌 전두엽아래이랑에서 각각 감소되었으며 P<0.01에서는 좌측 대뇌 전두엽 아래이랑에서도 나타났다. ADHD 환자군은 정상군에 비하여 각각의 클러스터에서 평균 14.97-15.28%의 혈류 감소율을 보였다. 뇌 혈류의 증가율과 감소율은 유의 수준변화에 영향을 받지 않았다. 2) 여자 ADHD환자의 혈류증가의 경우 P<0.003에서 소뇌 후엽 중앙부위, P<0.005에서는 좌측 대뇌 변연엽, P<0.009에서는 좌측 대뇌 측두엽 그리고 P<0.02에서는 소뇌 후엽을 비롯하여 9개부분에서 혈류증가 클러스터가 나타났으며, ADHD환자군은 정상군에 비하여 24.68-31.25%의 혈류증가율을 나타내었다. 혈류감소를 나타낸 부위로는 P<0.001에서 좌측 대뇌의 렌즈핵(lentiform nucleus), P<0.003에서 우측 대뇌의 렌즈핵 그리고 P<0.005에서 P<0.01까지 좌측 대뇌 측두엽중심에서 나타났다. 각각의 클러스터에서 평균 혈류감소율은 30.57-30.84%이었다. 결론 : 남여ADHD 환자의 혈류 증가와 감소부위는 서로 일치하지 않았으며 여자의 경우 혈류 증가와 감소율이 남자보다 더 크게 나타나, ADHD환자의 SPECT를 이용한 분석에서 남여환자를 동시에 분석하는 것 보다는 남여환자를 구분하여 실시하는 것이 더욱 정확한 진단정보를 제공할 수 있다고 판단된다.

• Proceedings of the KSMRM Conference
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• 2001.11a
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• pp.137-137
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• 2001

Purpose： The purpose of this study was to identify cerebral cortices related with sexual arousal fro visual sexual stimulation in healthy males using BOLD-based functional MR imaging Method： Sixteen male volunteers with sexually potent(mean age：24) were examined for thi study. Functional MRI was performed on a 1.5T MR scanner(GE Signa Horizon) with birdcage-type head coil. In this study, blood oxygenation level dependent(BOLD) technique was utilized to create fMR image reflecting local brain activities. The BOLD-based fMRI d were obtained from 7 oblique planes using gradient-echo EPI with $90^{\circ}$flip angle, 50ms TE 6000ms TR, $26cm{\times}26$ cm FOV, $128{\times}128$ matrix, and 10mm slice thickness. The sexual stimulation paradigm consisted of two alternating periods of rest and activati and it began with a 1 minute rest, followed by a 2 minute stimulation by a documentary a erotic video film. Brain activation maps were generated by cross-correlation of imag acquired during rest and activation periods. The index of activation was used to compare t number of pixels activated by each task in each volunteer, where the significance of th differences was evaluated by using Students t-test.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.136-141
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• 2012

Purpose : To investigate the pharmacologic modulation of motor task-dependent physiologic responses by antiplatelet agent, clopidogrel, during hand motor tasks in healthy subjects. Materials and Methods: Ten healthy, right-handed subjects underwent three functional magnetic resonance (fMRI) sessions: one before drug administration, one after high dose drug administration and one after reaching drug steady state. For the motor task fMRI, finger flexion-extension movements were performed. Blood oxygenation level dependent (BOLD) contrast was collected for each subject using a 3.0 T VHi (GE Healthcare, Milwaukee, USA) scanner. $T2^*$-weighted echo planar imaging was used for fMRI acquisition. The fMRI data processing and statistical analyses were carried out using SPM2. Results: Second-level analysis revealed significant increases in the extent of activation in the contralateral motor cortex including primary motor area (M1) after drug administration. The number of activated voxels in motor cortex was 173 without drug administration and the number increased to 1049 for high dose condition and 673 for steady-state condition respectively. However, there was no significant difference in the magnitude of BOLD signal change in terms of peak T value. Conclusion: The current results suggest that cerebral motor activity can be modulated by clopidogrel in healthy subjects and that fMRI is highly senstive to evidence such changes.

• Investigative Magnetic Resonance Imaging
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• v.14 no.2
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• pp.115-120
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• 2010

Purpose : To separate and evaluate the low frequency spontaneous fluctuation BOLD signals from the functional magnetic resonance imaging data using sensorimotor active task. Materials and Methods : Twenty female archery players and twenty three control subjects were included in this study. Finger-tapping task consisted of three cycles of right finger tapping, with a subsequent 30 second rest. Blood oxygenation level-dependent (BOLD) data were collected using $T2^*$-weighted echo planar imaging at a 3.0 T scanner. A 3-D FSPGR T1-weighted images were used for structural reference. Image processing and statistical analyses were performed using SPM5 for active finger-tapping task and GIFT program was used for statistical analyses of low frequency spontaneous fluctuation BOLD signal. Results : Both groups showed the activation in the left primary motor cortex and supplemental motor area and in the right cerebellum for right finger-tapping task. ICA analysis using GIFT revealed independent components corresponding to contralateral and ipsilateral sensorimotor network and cognitive-related neural network. Conclusion : The current study demonstrated that the low frequency spontaneous fluctuation BOLD signals can be separated from the fMRI data using finger tapping paradigm. Also, it was found that these independent components correspond to spontaneous and coherent neural activity in the primary sensorimotor network and in the motor-cognitive network.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.125-130
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• 1997

Separating the patient from hypothermic cardiopulmonary bypass(CPB) before achieving adequate rewarming often results in afterdrop, which can predispose to electrolyte disturbances, arrhythmia, hemodynamic alterations, and shivering-induced increase of oxygen consumption. In an attempt to find an adequate end point temperature of rewarming after hypothermic CPB, 50 pediatric cardiac surgical patients were r ndomly assigned for end point temperature of rewarming of 35.5$^{\circ}C$ (Group 1) or 37t (Group 2), rectal temperature. Thereafter the rectal temperature was measured half, one, four, eight, and 16 hour after arrival to the intensive care unit(ICU), with heart rate and blood pressure. Additionally the rectal temperature was compared with esophageal temperature during CPB, and axillary temperature luring stay in the ICU. Nonpulsatile perfusion with a roller pump was used in all patients and a membrane or bubble oxygenator was used for oxygenation. Both groups were comparable with respect to age, sex, body surface area, total bypass time, and rewarming time. There was no afterdrop in both groups, and there were no statistical differences in the rectal temperatures between two groups. There were also no statistical dilyerences with respect to the heart rate and blood pressure between two groups. At the end of rewarming the esophageal temperature was higher than the rectal temperature. The axil ary temperature measured in ICU was always lower than the rectal temperature. No shivering was noted in all patients. In conclusion, with restoration of rectal temperature above 35.5$^{\circ}C$ at the end of CPB in pediatric patients, we did not observe an afterdrop.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.423-429
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• 2007

Background: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients. Methods: Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of $30cmH_2O$ and a PEEP of $20cmH_2O$ in a 2-minute PCV mode. The venous $O_2$ saturation, central venous pressure, blood pressure, pulse rate, $PaO_2/FiO_2$ ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM. Results: Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean $PaO_2/FiO_2$ ratio was 130.3 before RM. The $PaO_2/FiO_2$ ratio increased by 45% after alveolar RM. The $PaO_2/FiO_2$ ratio reached a peak 60 minutes after alveolar RM. The Pa$CO_2$ increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema. Conclusion: In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.

• Progress in Medical Physics
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• v.20 no.4
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• pp.277-289
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• 2009

Recently, functional MRI has been used to investigate the neurobiological mechanisms of acupuncture and the specificity of acupoint. The group data tend to be regarded as more important than the individual data in the most of previous studies. This study was designed to investigate the effect of the variability of individual data on the group results. A functional MRI (fMRI) of the whole brain was performed in fifteen healthy subjects during placebo and acupuncture stimulations at the ST36 acupoint. After remaining at rest for 30 seconds, the acupuncture was inserted and twisted at the rate of 2 Hz for 45 seconds and then the acupuncture was removed immediately. This process was repeated three times. Individual and group analyses were performed by voxel-based analyses using SPM2 software. Visual inspections of the activation and deactivation maps from individual sessions have shown the large variability across fifteen subjects. This means that the group data reflected the brain activation responses of only a few subjects. We suggest that the individual data should be presented to demonstrate the effect of acupuncture.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.637-647
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• 1999

Background: Ischemia-reperfusion injury is one of the major contributing causes of early graft failure in lung transplantation. It has been suggested that triiodothyronine (T3) may ameliorate ischemia-reperfusion injury to various organs in vivo and in vitro. Predicting its beneficial effect for ischemic lung injury, we set out to demonstrate it by administering T3 into the in situ canine ischemia-reperfusion model. Material and Method: Sixteen adult mongrel dogs were randomly allocated into group A and B. T3 $(3.6\mug/kg)$ was administered before the initiation of single lung ischemia in group B, whereas the same amount of saline was administered in group A. Ischemia was induced in the left lung by clamping the left hilum for 100 minutes. After reperfusion, various hemodynamic parameters and blood gases were analyzed for 4 hours while intermittently clamping the right hilum in order to allow observation of the injured left lung function. Result: Arterial oxygen partial pressure $(PaO_2)$ decreased 30 minutes after reperfusion and recovered gradually thereafter in both groups. In group B the decrease of $PaO_2$ was less marked than in group A. The recovery of $PaO_2$ was faster in group B than in group A. The differences between the two groups were statistically significant from 30 minutes after reperfusion $(125\pm34$ mmHg and $252\pm44$ mmHg, p<0.05) until the end of the experiment $(178\pm42$mmHg and $330\pm37$ mmHg, p<0.05). The differences in the arterial carbon dioxide pressure, airway pressure and lung compliance showed no statistical significance. The malondialdehyde (MDA) level, measured from the tissue obtained 240 minutes after reperfusion, was lower in group B $(0.40\pm0.04\mu$M) than in group A $(0.53\pm0.05\mu$M, p<0.05). The ATP level of group B $(0.69\pm0.07\mu$M/g) was significantly higher than that of group A $(0.48\pm0.07\mu$M/g, p<0.05). The microscopic exami nation revealed varying degrees of injury such as perivascular neutrophil infiltration, capillary hemorrhage and interstitial congestion. There were no differences in the microscopic findings between the two groups. CONCLUSION T3 has beneficial effects on the ischemic canine lung injury including preservation of oxygenation capacity, less production of lipid peroxidation products and a higher level of tissue ATP. These results suggest that T3 is effective in pulmonary allograft preservation.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.987-996
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• 1996

Background : We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods : Twenty-six out of 106 patients with either acute ventilatory failure (VF: $PaCO_2$ > 43 mm Hg with pH < 7.35) or oxygenation failure (OF: $PaO_2/AO_2$ < 300 mm Hg with $pH{\geq}7.35$) requiring mechanical ventilation were managed by NIV (CPAP + pressure suppon, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M : F=7 : $55.4{\pm}14.6$ yrs) and 15 out of 87 cases with OF (17.2%) (M : F=12 : 3, $50.6{\pm}15.6$ yrs) were s uilable for NIY. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of YF and 40% (6/15) of OF were successfully managed on NIV and were weruled from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV ($34{\pm}9$ /min pre-NIV, $26{\pm}6$ /min at 12 hour of NIV, p=0.045), while $PaCO_2$ ($87.3{\pm}20.6$ mm Hg pre-NIV, $81.2{\pm}9.1$ mm Hg at 24 hour of NIV) and pH ($7.26{\pm}0.04$, $7.32{\pm}0.02$, respectively, p <0.05) were both significantly decreased at 24 hour of NIV In NIV for oxygenation failure, $PaCO_2$ were not different between the successful and the failed cases at pre-NIV and till 12 hours after NIV. The $PaO_2/FIO_2$ ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6 : at baseline, 0.5h, 6h, 12h : $120.0{\pm}19.6$, $218.9{\pm}98.3$, $191.3{\pm}55.2$, $232.8{\pm}17.6$ mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9 : $127.9{\pm}63.0$, $116.8{\pm}24.4$, $100.6{\pm}34.6$, $129.8{\pm}50.3$ mm Hg, respectively, p=0.5319). Conclusion : From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rale before the reduction in $PaCO_2$ level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of $PaO_2/FIO_2$ ratio at 0.5h after application is thought to be a predictor of successful NIV.