Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. METHODS: In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. RESULTS: Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. CONCLUSION: Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.ope

원판형 대향부연소실 연소방식에 의한 NOx생성저감에 관한 실험적 연구

학위논문(석사)--서울대학교 대학원 :항공우주공학과,1995.Maste

T-wave alternans analysis using hermite model

의공학과/박사[한글]T파 맥동이란, 연속으로 반복되는 두 번째 심박동마다 T파의 크기나 모양이 주기적으로 변하는 현상으로, 최근 급성 심장사를 예측하기 위한 방법으로 연구가 많이 이루어지고 있으며, 임상적 상관관계도 검증되어지고 있다. 눈으로 관찰이 불가능한 T파 맥동은 변화량이 매우 작으며, 이를 분석하기 위해서 스펙트럼 분석법이 가장 많이 쓰인다. 이 방법은 연속적으로 발생한 T파를 2차원 시계열 행렬로 만들고 각 시계열에 대하여 스펙트럼을 계산한 후 스펙트럼들을 평균하여, 0.5주기 심박동의 값을 분석한다. T파 맥동은 심박수가 100회/분 이상인 경우 잘 나타나므로 높은 심박수를 보이는 심전도 신호를 이용하여 분석해야 한다. 심박수를 높이는 방법으로 심실 전기 자극법과 운동 부하 방법이 있다. 심실 전기 자극법은 관혈적인 방법인 반면, 운동 부하 방법은 비관혈적이면서 운동을 통한 교감 신경계의 자극으로 인하여 T파 맥동이 보다 잘 나타나는 것으로 밝혀졌다. 그러나, 운동 부하 방법은 심전도 측정 시 발생하는 잡음 등의 문제로 인하여 T파 맥동 분석에 어려움이 있다. 본 논문에서는 심전도 측정 시 발생하는 잡음의 영향을 없애기 위해, Hermite 모델링을 이용하여 T파 맥동 현상을 분석하였다. 이 모델링은 Hermite 함수를 기본 함수로 사용하여 T파를 직교 변환하는 방법이다. Hermite 함수는 차수에 따른 함수들이 서로 직교하므로 서로 다른 차수의 함수에 T파 특성이 중첩되지 않으며, 함수의 모양 자체도 T파와 유사하여 몇 개의 함수만으로도 T파 모델링이 가능한 장점을 갖고 있다. 또한, 함수의 퍼짐을 나타내는 계수와 함수의 시간 축 이동을 나타내는 계수를 구함으로써 QT 간격에 따른 T파의 변화를 쉽게 모델링 할 수 있다. 정확한 T파를 모델링 하기 위해서는 이 두 계수를 정확하면서도 빠르게 구할 필요가 있으므로 이를 위해 적응 방식을 이용하였으며 최적 값을 효율적으로 구할 수 있었다. 모델링된 각각의 T파는 모델을 구성하는 함수의 특성 계수와 함수의 차수에 따른 가중치로 표현된다. 이와 같은 파라미터들은 T파의 크기와 모양의 변화를 나타내므로 모델링된 함수의 가중치 변화를 이용하여 T파 맥동 현상을 분석한다. T파를 모델링하기 위해 Hermite 함수 4개만을 이용하였으며, T파 에너지의 0.2% 미만의 오차를 갖도록 모델링이 가능하였다. T파 맥동 분석 결과에 잡음이 미치는 영향을 알아보기 위해서 가상 잡음 실험과 측정된 심전도 데이터를 이용하여 T파 맥동을 분석하였고, 분석 결과에 대한 예측률을 구하여 스펙트럼 분석법과 비교하였다. 가상 잡음 실험은 전원 잡음, 근 잡음, 기저선 변동 잡음, 백색 잡음, 기준점 설정 오류에 대하여 실험하였다. 잡음 성분을 첨가하여 T파 맥동을 분석한 결과, Hermite 모델링이 스펙트럼 분석법에 비해 양성 예측률은 각각 43.0%, 10.4%, 46.5%, 9.1%, 15.1% 높았고, 음성 예측률은 각각 50.8%, 7.0%, 59.1%, 67.4%, 8.2% 높았다. 측정된 심전도 데이터에 가상의 T파 맥동을 생성하여 분석한 결과는 안정 상태, 운동 부하 상태, 회복 상태로 구분하였고, 양성 예측률은 스펙트럼 분석법이 각각 2.0%, 3.6%, 2.7% 높았으며, 음성 예측률은 Hermite 모델링이 각각 7.3%, 3.8%, 9.7%로 높았다. MIT-BIH 데이터베이스로부터 얻은 신호를 분석한 결과 421번 데이터의 26분 30초 경에서 육안으로 구분이 되지 않는 맥동 현상이 있음을 Hermite 모델링과 스펙트럼 분석법 모두 검출하였다. T파 맥동이 검출된 구간에서 맥동 신호 대 잡음비 TWAR(T-wave alternans ratio)의 평균값은 Hermite 모델이 11.1, 스펙트럼 분석법이 4.1로 Hermite 모델이 잡음 영향을 적게 받는 것으로 나타났다. 이를 통해 Hermite 모델링 기법은 T파 맥동 분석 시 기존 방식에 비해 매우 유용함을 보여주었으며, 이 기법은 재분극 현상에 의한 T파 형태의 변화를 분석하기에 유용한 수학적 모델로 이용될 수 있다. [영문]The T-wave alternans(TWA) is defined as periodic altering of either size or shape with every two successive heart beats. Recently a number of investigations regarding TWA have been proposed to predict sudden cardiac death, which can also demonstrate TWA''s clinical relationship. Since microscopic TWA has very low variation, spectral analysis is the most frequently used. This method calculates two-dimensional time series matrix obtained by successive t waves and then calculates spectra based on each time series. Finally, an average spectrum is determined in units of 0.5cycles/beat. Since T-wave alternans are well characterized above 100 beats/min, it is necessary to analyze TWA using electrocardiograph (ECG) signals represented by high heart rates. There are two methods to increase heart rate: artrial pacing method and exercise method. The artrial pacing method is invasive, whereas the exercise method is non-invasive. It has been shown that TWA could be more distinctive by stimulating the sympathetic nerve system through exercises. However, there has been difficulty on TWA analysis because of artifacts occurred in measuring of surface ECG. In this study, we applied a Hermite model for assessing TWA and cancelled the effect of artifacts. This model transforms T-waves into the orthogonal form using the Hermite function as a fundamental function. Hermite functions have a feature that each of function with order is orthogonal with each other so that a certain function having some orders of the T-wave feature cannot superpose upon another one, and has an advantage that the shape of its function itself is similar with T-wave so that modeling can be processed using only a few functions. Furthermore, it is straightforward to model T-waves with QT intervals obtained by parameters, which represents spread and shift of function in a time axis.For the purpose of modeling T-wave precisely, we used an adaptive method for matching the requirements of computing parameters both accurately and fast. Consequently, we have obtained optimized value efficiently. Each of modeled T-wave is represented by characteristic parameters composing model and weight factors with order of function. TWA is assessed by means of changes in weight factors of modeled function because such parameters represent changes in amplitude and shape on T-wave. We have applied only 4 Hermite functions for modeling of T-wave. As a consequence, modeling result can be done below 0.2% of T-wave energy. We have also investigated the effect of artifacts on TWA analysis results using simulated artifacts and measured ECG data, and then compared predictive values from analysis with spectral analysis method. We have used simulated artifacts for power-line noise, muscle noise, baseline fluctuation noise, white noise and alinement error. As a result of analyzing TWA with artifact, we have found that positive predictive values of Hermite modeling were higher than that of spectrum method by 43.0%, 10.4%, 46.5%, 9.1% and 15.1% respectively, and negative predictive values were also higher by 50.8%, 7.0%, 59.1%, 67.4% and 8.2% respectively. We have also compared the analysis outcome of simulated TWA imposed into real ECG data with spectrum method. Real measured data have been analyzed in divided condition such as steady-stage, exercise load-stage, and recovery-stage. As a result, spectrum method was higher than Hermite modeling about 2.0%, 3.6%, and 2.7% respectively in positive predictive value, in contrast, Hermite modeling was higher than spectrum method about 7.3%, 3.8%, and 9.7% respectively in negative predictive values. Both Hermite model and spectrum method approach could detect micro level TWA at 26min 30sec in 412th data when MIT-BIH VFDB was applied. It has been shown that average value of T-wave alternans ratio was 11.1 for Hermite model and 4.1 for spectral analysis method, indicating that Hermite model has much less effect of artifacts. For this reason, Hermite modeling technique is very useful for TWA analysis compared with conventional method, also this technique can be used as a mathematical model for analyzing changes in T-wave shape by repolarization phenomenon.ope

(The)Effects of clothing consumers innate innovativeness on fashion innovativeness and fashion adoption

학위논문(박사)--서울대학교 대학원 :의류학과,2007.Docto

Serotonin Syndrome Following Combined Administration of Dopaminergic and Noradrenergic Agents in a Patient With Akinetic Mutism After Frontal Intracerebral Hemorrhage: A Case Report

BACKGROUND: Serotonin syndrome (SS) is a potentially life-threatening condition that can be caused by use of proserotonergic drugs. Several studies have reported that combined administration of various medications may induce SS. We report a case of SS in a patient who was being treated with dopaminergic and noradrenergic drugs. CASE PRESENTATION: A 55-year-old man with a right frontal intracerebral hemorrhage extending to the left cerebral hemisphere presented with clinical features of akinetic mutism. Three months after onset, dopaminergic (methylphenidate, levodopa/benserazide) and noradrenergic (atomoxetine) drugs were administered to enhance his cognitive function. His cognitive function gradually improved during 8 weeks of dose escalation. One day after the dose of atomoxetine was increased from 40 mg/d to 60 mg/d, the patient developed inducible clonus, rigidity, diarrhea, tachycardia, and hyperthermia, in keeping with a diagnosis of SS. The symptoms and signs suggestive of SS resolved on the day following cessation of all dopaminergic and noradrenergic drugs. CONCLUSIONS: This case demonstrates that medications generally known as dopaminergic or noradrenergic agents could have serotonergic effects via a mechanism that is yet to be fully elucidated. The clinical manifestations of SS can be diverse, ranging from mild to severe and potentially fatal symptoms. When administering a combination of catecholaminergic agents, clinicians should carefully monitor the patient's neurologic status for unexpected adverse reactions.restrictio