• 전자공학회논문지SC
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• 제43권3호
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• pp.60-66
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• 2006

본 논문은 photoplethysmography(PPG)와 Laser doppler(LD)를 이용하여 당뇨병 환자의 신경병증을 조기 진단하기 위한 시스템을 구성하여 손가락과 발가락의 혈류량을 측정하고 그 비율을 이용하는 방법을 제안하였다. 당뇨병 환자의 신경병증 진단을 위해 임상에서는 신경전도검사(NCV)가 사용되고 있으나 이 검사는 피부에 전기자극을 가하므로 환자에게 스트레스와 고통을 준다. 이에 본 논문에서는 고통이 전혀 없으며, 비관혈적이고 측정방법이 간단한 PPG와 LD를 이용하여 신경병증 진단법을 제안하였다. PPG가 LD에 비해 손가락 및 발가락의 혈류량 및 온도와의 상관관계, 민감도 및 특이도에서 더 우수하였다. 분석결과 50명의 신경병성 당뇨환자의 혈류비($0.96{\pm}0.20$)가 64명의 정상인의 혈류비($0.46{\pm}0.15$)에 비해 유의하게 높았다(p<0.000). 또한 신경병성 당뇨환자의 발가락 온도($30.5{\pm}1.4^{\circ}C$)가 정상인의 발가락 온도($29.3{\pm}2.0^{\circ}C$)에 비해 유의하게 높았다(p<0.000). 본 연구로부터 도출된 최적 혈류비(0.678)에 대한 측정 방법의 높은 민감도(95.3%)와 특이도(95.3%)를 확인하였다. 마지막으로 신경병성 당뇨환자 그룹의 경우 모두 손가락과 발가락의 온도차가 $4.5^{\circ}C$ 미만이었다.

• Journal of Preventive Medicine and Public Health
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• 제33권1호
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• pp.17-24
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• 2000

Objectives : To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. Methods : Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower(<18.0), moderate(18-53), high$(\geq53)$ exposure group. Results : The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was $18.1{\pm}9.9$, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p<0.05). About half of the children(90 cases, 49.5%) hold the abnormal health status: those were skin pigmentation 38 cases, rash 23 cases, congenital anomaly 15 cases, general weakness 12 cases, purpura 8 cases, visual disturbance 8 cases, etc. These health problems had no association with father's exposure level(p>0.05). Conclusions : These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.

• Annals of Clinical Neurophysiology
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• 제12권2호
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• pp.47-54
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• 2010

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by compression of the median nerve beneath the transverse carpal ligament. CTS can be correctly diagnosed by the patients' description of symptoms and electrophysiological tests that measure nerve conduction through the wrist. Many previous studies reported various risk factors of CTS, such as obesity, diabetes mellitus, thyroid disease and trauma. Obesity is associated with both hyperlipidemia and CTS. This study focused on the relationship between severity of CTS and serum lipid level. Methods: One hundred fourteen patients with CTS and 74 controls were divided into four groups according to the severity; normal, mild, moderate and severe. And then serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were measured in each group. Results: There was a positive correlation between TG and CTS severity (p<0.001). But TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggest that high serum TG may act as an aggravating factor of CTS.

• 한국콘텐츠학회논문지
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• 제10권10호
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• pp.237-245
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• 2010

신경전도검사는 당뇨병성다발신경병증 및 당뇨병의 불현성 신경병증환자를 진단하기위한 중요한 검사이며 신경의 기능을 정량적으로 측정할 수 있는 검사기법이다. 본 연구에서는 당뇨병성다발신경병증 환자에서 보이는 전기생리학적 특징을 평가하기위하여 당뇨병성다발신경병증으로 진단된 120명과 정상대조군 77명의 운동신경전도검사의 결과를 비교?분석하였다. 상지와 하지의 각 운동신경에서 정상기준치에 대해 비정상 값을 보인 비율의 특징을 신경전도속도, 말단잠복기, 복합근육활동전위의 진폭, No potential의 빈도, 전도차단의 항목으로 나누어 분석하였다. 당뇨병성다발신경병증은 상지에 비해 하지를 더욱 침범하는 전신성 탈수초성 말초다발신경병증의 전기생리학적 특징이 관찰되었고, 특히 비골신경에서 비정상의 정도가 심한 것으로 분석되었다. 하지만 전도차단의 특징은 대조군에 비하여 유의한 차이가 없는 것으로 나타났다. 운동신경전도검사의 결과를 분석하여 당뇨병성다발신경병증의 전기생리학적 특징을 분석한 본 연구의 결과 하지의 비골신경이 중요한 지표가 될 수 있음이 확인되었고, 이는 당뇨병성다발신경병증의 중요한 전기생리학적 소견으로 사료된다.

• Annals of Clinical Neurophysiology
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• 제5권2호
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• pp.181-186
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• 2003

Background: Somatosensory evoked potential (SSEP) is valuable for the evaluation of the central pathway. However, peripheral neuropathy sometimes renders the test useless by preventing the conduction from reaching the CNS. We postulated that the peripheral conduction problems could be overcome by proximal stimulation in SSEP and wanted to verify this in the study. Methods: Twenty patients with diabetic sensorimotor polyneuropathy were included. SSEP was elicited by stimulating the median and posterior tibial nerves. We compared the effect of distal and proximal stimulations in each SSEP in the aspect of presence/absence and various latencies of resultant waves. Results: Among the 40 cases, proximal stimulation caused reappearance of subsided waves in 10 cases (25%). In the median nerve SSEP, proximal stimulation made EN1 and CN2 visible which were not evident when distally stimulated. In the posterior tibial nerve SSEP, there was also improvement of forming waves when proximally stimulated. Conclusions: In the diabetic polyneuropathy, proximal stimulation of SSEP is more effective than the conventional distal stimulation in evaluating central pathway.

• 대한간호학회지
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• 제51권3호
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• pp.280-293
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• 2021

Purpose: This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). Methods: This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. Results: The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. Conclusion: The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

• Clinical Pain
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• 제18권2호
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• pp.70-75
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• 2019

Objective: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings. Method: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded. Results: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters. Conclusion: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.

• 전자공학회논문지SC
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• 제44권4호통권316호
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• pp.15-20
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• 2007

현재, 우리나라 당뇨병의 유병률은 빠른 속도로 증가하고 있으며 당뇨병의 유병기간이 길수록 각종 합병증이 발생하여 더욱 심각한 증상을 나타내는데, 그 중 비만 및 고혈당, 당대사장애로 인한 당뇨병성 혈관합병증과 말초 혈관 경화증이 많이 발병하고 있는 실정이다. 따라서 본 연구에서는 광혈류량 측정법(Photoplethysmography)으로 손가락 및 발가락에서 얻어진 맥파의 2차 미분분석을 통해 연령이 비슷한 정상인 50명과 당뇨병으로 확진된 50명의 말초 혈관 탄성도를 객관적으로 비교하고자 하였다. PPG 파형의 2차 미분 분석에 사용되는 평가 인자는 a, b, c, d, e 이고, b/a는 혈관의 탄성도를 의미하며 탄성도가 떨어질수록 b/a의 절대 값은 감소하게 된다. 정상인 50명의 PPG 2차 미분 b/a값은 $-1.09{\pm}0.14$, 당뇨병 환자 50명의 PPG 2차 미분 b/a값은 $-0.81{\pm}0.09$로 정상인에 비해 당뇨병 환장의 말초혈관 탄성도가 감소하였으며, Independent t-test 검정 결과 통계적으로 유의한 차이를 보였다(p<0.05). 본 연구에서는 PPG 파형의 2차 미분 분석을 통하여 정상인과 혈관합병증 발병율이 높은 당뇨병 환자의 말초혈관 탄성도를 비교하였으며, 향후 비침습적이고 간단한 방법으로 당뇨병 환자의 말초혈관 탄성도와 혈관 경화정도를 객관적으로 평가하고 진단함으로써 당뇨병 환자들의 심혈관계질환 사전예방과 치료효과 판정에 도움을 줄 것으로 기대한다.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.317-326
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• 1999

연구목적: 호흡기에 대한 자율신경 기능도 기도 및 혈관의 평활근, 접막하선의 점액분비. 기관지 순환 혈류조절, 비만 세포의 염증 반응에 관계되는 매개물의 분비등 매우 다양하게 나타나며 이들 자율신경 장애는 기도 폐쇄의 원인으로 작용한다. 천식은 자율신경계 이상이 원인으로 작용하고 특히 부교감신경 기능 항진이 중요한 원인으로 알려져 있다. 저자들은 심혈관계와 호흡기 자율신경 지배가 공통적으로 일어난다는 사실을 기초로 비관혈적이고 안정한 심혈관 지율신경 검사를 실시하여 만성 폐쇄성 폐질환 환자에서 자율신경 장애유무를 알아보았다. 방 법: 대상은 영남대학교 의과대학 부속병원에서 만성 폐쇄성 폐질환으로 진단 받은 환자 20명과 건강진단 센터에서 건강한 것으로 판정 받은 비슷한 나이의 20명을 대조군으로 하였다. 만성 폐쇄성 폐질환은 American Thoracic Society의 정의를 따랐으며 허혈성 심장질환, 부정맥, 당뇨병, 중심성 및 말초성 신경질환 등과 같은 자율신경계에 영향을 미칠 수 있는 질환이 동반된 경우는 제외하였다. 자율신경검사는 Ewing과 Clarke의 방법을 사용하였으며 모든 대상에서 동맥혈 가스분석과 폐기능 검사를 동시에 실시하였다. 결 과: 만성 폐쇄생 폐질환 환자는 건강한 사랑에 비하여 빈번하게 자율신경 장애가 동반되어 있었으며 만성 폐쇄성 폐질환 환자에서 교감신경 장애보다 부교감신경 장애가 더 뚜렷하였다. 만성 폐쇄성 폐질환은 질병 이환 기간이 길거나, 흡연량이 많거나, 폐기능 검사상 $FEV_1$ 및 FVC 감소 정도가 심할수록 그리고 저산소혈증이 심한 경우에 자율신경 장애가 심하였으나 연령, 만성폐쇄성 폐질환의 종류 및 동맥혈 이산화탄소 분압과는 차이가 없었다. 결 론: 만성 폐쇄성 폐질환은 부교감신경 장애가 동반되어 있으며, 부교간신경 장애는 만성 폐쇄성 폐질환의 정도가 심할수록 더 뚜렷하게 나타났다. 이러한 부교감신경 장애는 만성 폐쇄성 폐질환의 원인으로 작용하기보다는 질병의 진행으로 인한 자율신경계의 기능 저하로 생각된다.

• Annals of Clinical Neurophysiology
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• 제12권1호
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• pp.21-26
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• 2010

Background: Although quantitative sensory test (QST) is being used with increasing frequency for measuring sensory thresholds in clinical practice and epidemiologic studies, there has been no age-matched normative data in Korean adults. The objective of this study is to evaluate the value of QST in diabetic polyneuropathy with normal range in Korean adults. Methods: The Computer Aided Sensory Examination IV 4,2 (WR Medical Electronics Co., Stillwater, Minnesota, U.S.A.), with 4,2,1 stepping algorithm was used to determine vibration and cold perception threshold in 70 normal controls and 19 patients with diabetic polyneuropathy aged from 21 to 79 years. The data were used to define age-matched upper and lower normal limits and normal range of side to side difference. We also evaluated the duration of diabetes, serum HbA1C level, and findings of nerve conduction study (NCS) and QST in patients with diabetic polyneuropathy. Results: In normal adults, sensory thresholds slightly increased with age, and a slight side-to-side difference was observed. The diagnostic sensitivity of QST was not higher than NCS in patients with diabetic polyneuropathy (36.8% vs. 42.1%, p=0.716), especially among elderly patients. Conclusions: QST might be used as a complementary test for NCS in the diagnosis of diabetic polyneuropathy. Although the QST is a simple method for the evaluation of peripheral nerve function, there are some limitations. Most of all, because the QST measuring is dependent on the subjective response of patients, the degree of concentration and cooperation of the patients can significantly affect the result. And thus, attention should be paid during the interpretation of QST results in patients with peripheral neuropathy.