Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease

Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.ope

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Background: Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption. Patients and methods: Patients (N=50, 3–12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patientcontrolled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively. Results: Forty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference –1.0, 95% CI –2.0 to –1.0, P=0.001 and median difference –2.0, 95% CI –3.0 to –1.0, P=0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups. Conclusion: Intraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.ope

Pulse pressure variation and pleth variability index as predictors of fluid responsiveness in patients undergoing spinal surgery in the prone position

Background: This study investigated the ability of pulse pressure variation (PPV) and pleth variability index (PVI) to predict fluid responsiveness of patients undergoing spinal surgery in the prone position. Patients and methods: A total of 53 patients undergoing posterior lumbar spinal fusion in the prone position on a Jackson table were studied. PPV, PVI, and hemodynamic and respiratory variables were measured both before and after the administration of 6 mL/kg colloid in both the supine and prone positions. Fluid responsiveness was defined as a 15% or greater increase in stroke volume index, as assessed by esophageal Doppler monitor after fluid loading. Results: In the supine position, 40 patients were responders. The areas under the receiver operating characteristic (ROC) curves for PPV and PVI were 0.783 [95% CI 0.648-0.884, P<0.001] and 0.814 (95% CI 0.684-0.908, P<0.001), respectively. The optimal cut-off values of PPV and PVI were 10% (sensitivity 75%, specificity 62%) and 8% (sensitivity 78%, specificity 77%), respectively. In the prone position, 27 patients were responders. The areas under the ROC curves for PPV and PVI were 0.781 (95% CI 0.646-0.883, P<0.001) and 0.756 (95% CI 0.618-0.863, P<0.001), respectively. The optimal cut-off values of PPV and PVI were 7% (sensitivity 82%, specificity 62%) and 8% (sensitivity 67%, specificity 69%), respectively. Conclusion: Both PPV and PVI were able to predict fluid responsiveness; their predictive abilities were maintained in the prone position.ope

(A) STUDY ON THE COMPUTER TELE-COMMUNICATION SYSTEM FOR SOCIAL EDUCATION

현대사회는 급속히 변화, 발전하고 있으며 그에 따른 가치관의 변화, 기술, 지식 등의 발전속도는 더욱 빨라지고 있다. 이러한 사회의 변화에 효율적으로 대처하기 위한 사회교육의 중요성이 날로 커지고 있으며, 그 방법면에서 창조력과 개성있는 교육, 개인을 존중하는 교육으로서, 개개 학습자의 필요, 흥미, 동기, 능력, 배경 등에 따른 개별화된 학습지도가 더욱 요청된다. 그런 의미에서 컴퓨터 공학의 기술적 발달에 따라 사회교육을 위한 컴퓨터 통신망의 활용에 기대가 모아진다. 본 연구의 목적은 사회교육 활성화의 한 방안으로써 컴퓨터 통신시스템의 적용에 대한 문헌연구를 통하여 사회교육에 보다 효율적이고 다양한 교수를 제공할 수 있는 컴퓨터 통신시스템의 적용 가능성을 탐색하는데 있다. 본 연구에서는 이론적 배경과 사회교육에 컴퓨터 통신시스템의 적용에 관한 외국의 사례를 문헌을 통하여 연구고찰하며, 국내에서는 사회교육에 아직까지 정식으로 적용된 사례가 없어 현재 각종 생활정보를 서비스 해주고 있는 (주) 데이콤과 (주) 한국 PC통신의 담당자와의 면담과 정보 서비스를 받고 있는 사람들을 대상으로 의견조사를 실시한다. 연구내용은 다음과 같다. 1. 사회교육의 개념 및 특징과 목적 및 내용, 제방법 등에 관하여 연구한다. 2. 컴퓨터 통신시스템의 개념 및 기능적 특성, 형태 등에 관하여 연구한다. 3. 실제 컴퓨터 통신시스템을 활용하고 있는 외국의 사례를 고찰한다. 4. 국내에서 각종 생활정보 및 학습정보를 구축, 전송하고 있는 (주) 데이콤과 (주) 한국 PC통신의 사례를 고찰하고, 그 가입자들을 대상으로 의견조사를 한다. 이상의 연구문제를 고찰해 본 결과 다음과 같이 제언한다. 1. 우선, 성인의 교육욕구 충족을 위한 다각적 측면의 연구가 필요하다. 성인의 생물학적, 임상·의학적, 심리적, 행동과학적, 사회적 측면에서의 연구를 통해 성인을 이해하고 도움이 될 수 있도록 유도하는 계기를 마련하는 것이 중요하다. 2. 성인 학습자들에 대한 흥미와 태도, 가치관 등의 요구분석과 더불어 데이터 베이스 구축시 컴퓨터에 대한 성인의 선입견이나 특징을 고려하여 프로그램을 설계해야 한다. 3. 성인들이 학습의 흥미나 관심을 연속화하고 정착시키기 위해 컴퓨터 통신시스템을 활용한 교육에서도 필요에 따라서 수료증이나 자격증 같은 평가를 부여할 수 있는 가능성을 검토해 보아야 한다. 4. 현재 각종 생활정보 및 중·고등학교용 학습 프로그램을 데이터 베이스로 구축, 전송하고 있는 기관에서 양질의 사회교육 프로그램을 제작, 보급, 평가, 관리하는 전문적 체제를 마련하여 성인학습자가 자신이 원하는 학습내용을 원하는 시간에 원하는 분량만큼 학습할 수 있게 되어야 한다. 그러기 위해서는 급속한 컴퓨터 통신기술의 발달에 따른 하드웨어의 풍부한 기능을 잘 활용할 수 있는 질적으로 우수한 교육 프로그램의 개발이 시급하다. 도래하는 컴퓨터 통신기술의 발달을 충분히 활용하기 위해 우수한 소프트웨어의 개발이 무엇보다 중요한 오늘날의 과제가 될 것이다. 적절히 개발된 프로그램은 모든 사람들의 요구에 적절한 교육의 기회를 확대시킬 수 있으며, 시민들이 지역사회에서 완전하게 참가하고 풍요로운 생활을 누릴 수 있게 된다는 의미에서 매우 중요한 일이다. 프로그램의 개발을 위해서는 성인교육 관계 전문가와 기관 등의 협조가 요청된다. 5. 국가의 정책적, 재정적인 지원이 뒤따라야 한다. 사회교육 기관의 육성, 사회교육과 컴퓨터에 관한 전문요원의 양성, 교육자료의 개발, 경비의 보조 등 모든 국민에게 컴퓨터 통신시스템을 활용하여 평생을 통해 교육의 기회가 부여될 수 있도록 노력하여야 한다. 이상과 같은 점이 효과적으로 실행된다면 앞으로 컴퓨터 통신시스템을 활용한 사회교육이 활성화 되어질 것이다.;The modern society is rapidly changing and developing, and as a result, changes in values and the speed of development in technology and knowledge is developing all the more faster. The value of social education which is needed in coping effectively with the aforementioned social changes is becoming greater every day, and in terms of method, individualized learning guidance by each learner&amp;apos;s need, interest, motivation, ability, environment, etc. As education with creativity, personality and respect for the individual is needed even more. Hence, as technological advances are made in the field of computer technology, there are greater expectations for the use of computer tele-communication networks for social education. The purpose of this study is to review the possibility of providing a more effective and diverse instruction in social education aimed for adults by contemplating through literature the possibility of computer tele-communication systems application as way to activate social education as its need is ever increasing in our present day. For this study, literature review is done to study the theoritical backgrounds and foreign case studies, and interviews with the person concerned as well as opinion survey is applied for domestic case study. The major findings of this study can be summarized that social education applied computer tele-communication system is valued superiorly the quality and efficiency, and is in trending development and diffusion in Europe and America. In Korea, various kinds of life information are provided via computer tele-communication system in the early step and superior educational programs will be developed and diffused in days to come. Several suggestions based on the above results are proposed as follows : 1. First, diversified research on the fulfillment of adult educational need is needed, with need analysis regarding the adult learner&amp;apos;s interests, attitudes and values. 2. Educational program must be designed with consider to adult&amp;apos;s preconception and characteristics toward computer. 3. For continuing and fixing adult learner&amp;apos;s interest, it must be considered that confering a certificate of qualification. 4. The development of a high quality educational program needed to learn to fully utilize the many funcions computer offer as computer tele-communication technology os rapidly developing is urgently needed. And a system that social education programs through a computer tele-communication system can be built and managed by an expert in a professional social education institution must be provided. 5. Administrational and financial assistance must be supported. If mentioned above things carry out effectively, social education via computer tele-communication system can be active.목차 논문개요 = ⅶ Ⅰ. 서론 = 1 A. 연구의 의의 및 목적 = 1 B. 연구의 내용, 방법 및 제한점 = 5 C. 용어의 정의 = 6 Ⅱ. 사회교육 = 9 A. 사회교육의 개념 및 특성 = 9 B. 사회교육의 목적 및 내용 = 17 C. 사회교육의 제방법 = 25 Ⅲ. 컴퓨터 통신시스템 = 35 A. 컴퓨터 통신의 개념 및 기능적 특성 = 35 B. 통신시스템의 형태와 전송매체 = 48 C. 컴퓨터 네트워크의 구성형태 및 특성 = 54 Ⅳ. 사회교육에서의 컴퓨터 통신시스템의 활용 = 63 A. 사회교육과 컴퓨터 = 63 B. 사회교육에서의 컴퓨터 통신시스템의 활용현황 = 70 Ⅴ. 결론 및 제언 = 95 참고문헌 = 98 부록 = 105 ABSTRACT = 11

당뇨병 치료제 metformin에 의한 산화적 스트레스 상태에서 AMPK 매개성 세포사멸 : AMPK에 의한 2상 항산화 효소 유도 억제의 역할

Thesis(master`s)--서울대학교 대학원 :약학과 약물학 전공,2006.Maste

Comparative analysis of changes in physical properties and intracellular composition of various cells using label-free optical diffraction tomography

Label-free optical diffraction tomography (ODT) enables the observation of cells and cellular organelles without the need for fluorescent labels or other preprocessing. It overcomes the constraints associated with conventional cell imaging techniques like fluorescence microscopy or electron microscopy. In the case of electron microscopy or fluorescence microscopy, which provide 2D images, a preprocess of the cell is necessary, which can induce cell invasion and cause changes in the physical and chemical composition inside the cell compared to live cells. However, ODT provides 3D images of cells and cellular organelles, as well as physical parameters such as refractive index, volume, and dry mass, allowing for the characterization of microenvironment changes within cells and internal biological properties without any preprocess applying on cell. In addition, when observing cells with ODT, Various preprocess on cell such as cell fixation, gene modification, immunofluorescence, and various cell trackers for biomarker can be applied to observe cells in different condition. With these preprocess, physical parameters obtained from ODT distinguish various types of cells under different conditions. Label-free cells and cells subjected to various manipulations undergo changes in both morphology and internal composition, which can be quantitatively evaluated through RI rendering by converting these changes into numerical values. Utilizing the advantages of ODT, observation of cells enables the discrimination of physical characteristics between similar cell categories in a live state. Additionally, specific markers within cells can be targeted through labeling, resulting in internal changes that can be quantitatively evaluated. In this study, numeric parameters such as the refractive index and volumes of human stem cells, fibroblasts cell, and HeLa cells were measured using ODT. Differences in refractive index caused by various physical stimuli, such as temperature, cell fixation, GFP protein tagging, and organelle tracking, were also compared. Three types of stem cells (hLD-SCs, hUCM-MSCs, and hiPSC) were campared to fibroblasts. The results revealed that stem cells exhibited widely distributed vesicles with larger volumes and higher mean RI values compared to fibroblasts. After cell fixation and an increase in temperature, a significant overall decrease in the refractive index (RI) value of organelles, such as the nucleus and cytoplasm, was observed. Interestingly, while the RI values of cell nuclei were affected, the RI values of the cytoplasm were barely detected after membrane permeation. Moreover, the expression of GFP and GFP-tagged proteins was found to markedly increase the RI values of organelles in live cells, demonstrating more effective changes in RI compared to chemical fluorescence staining for cell organelles. This method enables the identification of differences between cells without the need for specific biological markers and indirectly assesses the impact of external stimuli on cellular organelles and this information can serve as a valuable reference for future studies that employ other conventional microscopy techniques.Maste

Longitudinal Changes in Renal Function in Patients with Chronic Hepatitis B on Antiviral Treatment

Background: Patients with chronic hepatitis B (CHB) on nucleos(t)ide analogues (NUCs) often experience renal function decline. Conflicting results regarding the impact of NUC use and renal function have recently been reported. We aimed to examine longitudinal changes in renal function according to the NUC treatment type compared with untreated patients. Methods: From 2014 to 2022, 10,642 patients with CHB were retrospectively analyzed. The primary outcome was chronic kidney disease (CKD) progression, which was defined as a minimum one-stage elevation. Propensity score (PS) matching was employed for outcome comparisons. Results: In the PS-matched cohort of 1,996 pairs, the NUC-treated group (7.6/100 person-years [PYs]) had a significantly higher CKD progression risk than the untreated group (4.4/100 PYs), with a hazard ratio (HR) of 1.70 (P<0.001). The tenofovir disoproxil fumarate (TDF)-treated group (7.9/100 PYs) showed a 1.76-fold increased CKD progression risk compared with the untreated group (4.5/100 PYs) in the PS-matched cohort (P<0.001). Both the entecavir (ETV)- and tenofovir alafenamide (TAF)- treated groups showed CKD progression risks comparable to those of the untreated group in the PS- matched cohorts of 755 and 426 pairs, respectively (P=0.132 and P=0.120, respectively). No significant CKD progression risk was found between the ETV- (6.0/100 PYs) and TAF-treated (5.2/100PYs) groups in the PS-matched cohort of 510 pairs (P=0.118). Conclusion: NUC-treated patients, especially those on TDF, faced a higher CKD progression risk than untreated patients. ETV- and TAF-treated patients presented comparable CKD progression risks to untreated patients. No difference was observed between ETV and TAF in the risk of CKD progression.|연구배경: 뉴클레오시(티)드 유사체(Nucleos(t)ide, NUC)를 복용하는 만성 B 형 간염 환자는 종종 신기능 저하를 경험한다. 최근 NUC 복용이 신기능에 미치는 영향에 대해 상충된 결과가 보고되었다. 이에 본 연구는 치료하지 않는 만성 B형 간염 환자와 NUC 종류에 따른 신기능의 종단적 변화를 알아보고자 하였다. 연구방법: 2014 년부터 2022 년까지 만성 B 형 간염 환자 10,642 명을 후향적으로 분석하였다. 일차 결과는 만성 신질환의 진행으로, 최소 한 단계 이상의 신기능 악화로 정의하였다. 성향점수 매칭(Propensity score matching) 방법을 사용하여 비치료군과 NUC 종류에 따른 치료군을 각각 비교하였다. 연구결과: 1,966 쌍의 성향점수(PS) 일치 코호트에서 NUC 치료군(7.6/100 인년)의 만성 신질환 진행 위험 비율은 비치료군(4.4/100 인년)보다 유의하게 높았으며, 위험비(hazard ratio)는 1.70 이었다(p<0.001). 테노포비르 디소프록실 푸마르산염(TDF) 치료군(7.9/100인년)은 PS 일치된 비치료군(4.5/100인년)과 비교하여 1.76배 높은 만성 신질환 진행 위험을 보였다(p<0.001). 엔테카비르(ETV)와 테노포비르 알라페나미드(TAF) 치료군은 PS 일치 코호트 755쌍과 426쌍에서 모두 비치료군과 비슷한 만성 신질환 진행 위험을 보였다(각각 p=0.132 와 p=0.120). 엔테카비르(ETV) 치료군(6.0/100 인년)과 테노포비르 알라페나미드(TAF) 치료군(5.2/100 인년)을 비교한 PS 일치 코호트 510쌍에서는 유의미한 만성 신질환 진행 위험 차이는 확인되지 않았다(p=0.118). 연구결론: NUC 치료군, 특히 테노포비르 디소프록실 푸마르산염(TDF) 치료군이 비치료군보다 만성 신질환 진행 위험이 유의미하게 높았다. 엔테카비르(ETV) 및 테노포비르 알라페나미드(TAF) 치료군은 비치료군과 비슷한 만성 신질환 진행 위험을 보였다. 엔테카비르(ETV)와 테노포비르 알라페나미드(TAF) 치료군 사이에는 유의미한 차이가 관찰되지 않았다.Maste

정확한 위상 합성과 심층 신경망 기반 QSM을 이용한 흑질의 SMWI 영상 개선

학위논문 (석사)-- 서울대학교 대학원 : 공과대학 전기·정보공학부, 2018. 8. 이종호.Visibility of nigrosome 1, a subregion of substantia nigra is used as an MR imaging biomarker of Parkinsons disease. In this work, we introduced two algorithms for SMWI imaging of substantia nigra. First, we suggested Multi-Channel Phase Combination using Multi-Echo (MCPC-ME), a strategy to calculate and correct phase offsets in multi-echo GRE data. MCPC-ME provided a more accurate estimation of voxel-wise phase offsets particularly in low SNR regions by utilizing phase information from all echoes. Second, we applied QSMnet, a deep neural network for QSM reconstruction, to produce QSM image used in SMWI processing. QSM of nigrosome 1 was reconstructed to have comparable SMWI contrast with 5.4 times faster reconstruction speed compared to the conventional QSM reconstruction algorithm.초 록 i List of Figures iii Chapter 1. Introduction 1 1.1 Introduction 1 1.1.1 Parkinsons disease and SMWI image 1 Chapter 2. Phase Combination using MCPC-ME 5 2.1 Introduction 5 2.2 Background 5 2.2.1 Preliminary 5 2.2.2 MCPC-C 6 2.2.3 MCPC-3D 6 2.2.4 MCPC-ME 7 2.3 Methods 7 2.3.1 Data acquisition 7 2.3.2 Data processing 8 2.3.3 Data analysis 8 2.4 Results 9 2.5 Discussion 17 Chapter 3. SMWI with iLSQR-trained QSMnet 19 3.1 Introduction 19 3.2 Methods 21 3.2.1 Data acquisition 21 3.2.2 QSMnet 22 3.2.3 Data processing 24 3.2.4 Data Analysis 27 3.3 Results 28 3.4 Discussion 36 Chapter 4. Conclusion 42 References 44 Abstract 47Maste