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Emergency department triage and medical process according to alcohol intoxication in brain hemorrhage (응급의료서비스를 통해 내원한 뇌출혈 환자의 주취 유무에 따른 KTAS Level과 검사시간의 차이)

  • Kim, Yong-Joon;Lee, Kyoung-Youl
    • The Korean Journal of Emergency Medical Services
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    • v.24 no.2
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    • pp.99-109
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    • 2020
  • Purpose: Alcohol intoxication is frequently observed in patients with brain hemorrhage. The purpose of this study was to determine whether intoxication affects the Korean Triage and Acuity Stage (KTAS) level and the emergency medical process in emergency departments. Methods: This study was a retrospective observational study enrolled 253 brain hemorrhage patients (47 of those intoxicated) who visited the emergency medical center on public EMS ambulance from January. 1, 2017 to April, 30, 2019. Data were collected through the electronic medical record (EMR). KTAS level and time to computerized tomography (CT) were compared to evaluate whether inebriation affects care and examination processes. All data were analyzed using SPSS program. Results: Of the 47 patients intoxicated patients, 85.1% were male, and 74.5% accompanied by trauma. Initial KTAS level showed significant differences (77.2%; p=.000) when the level 3,4 was not drunk. The average time taken from triage to CT scans showed a significant difference of 24.81±23.72 (min) when the drunken state was not 58.38±56.54 (min)(p=.000). Conclusion: In patients with brain hemorrhage admitted to ED from public EMS, undertriage and delay after initial assessment were detected in inebriated patients. Careful initial evaluation and prompt medical response should be considered for patients transported by EMS.

Computational Study of Human Calcitonin (hCT) Oligomer

  • Pak, Young-Shang;Shin, Jung-Ho;Jang, Soon-Min
    • Bulletin of the Korean Chemical Society
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    • v.30 no.12
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    • pp.3006-3010
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    • 2009
  • We have performed long time REMD simulation on 15-19 residues of human calcitonin hormone (DFNKF) which is known to form highly ordered amyloid fibril. The simulation started from randomly oriented multiple DFNKF strand. Using all-atom level simulations with the generalized Born solvation (GB) model (param99MOD3), we observed spontaneous formation of ${\beta}$-sheet for tetramer. Interestingly, the current simulation gives anti-parallel sheet as a major conformation, consistent with experiments. The major interaction stabilizing the anti-parallel sheet seems to be the inter-strand hydrogen bond.

Usefulness of volumetric BMD measurement by using low dose CT image acquired on L-spine Bone SPECT/CT (L-spine Bone SPECT/CT에서 획득된 저선량 CT 영상을 이용한 용적 골밀도 결과의 유용성)

  • Hyunsoo Ko;Soonki Park;Eunhye Kim;Jongsook Choi;Wooyoung Jung;Dongyun Lee
    • The Korean Journal of Nuclear Medicine Technology
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    • v.27 no.2
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    • pp.99-109
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    • 2023
  • Purpose: CT scan makes up for the weak point of the nuclear medicine image having a low resolution and also were used for attenuation correction on image reconstruction. Recently, many studies try to make use of CT images additionally, one of them is to measure the bone mineral density(BMD) using Quantitative CT(QCT) software. BMD exams are performed to scan lumbar and femur with DXA(Dual-Energy X-Ray Absorptiometry) in order to diagnose bone disease such as osteopenia, osteoporosis. The purpose of this study is to identify the usefulness of QCT_BMD analyzed with low dose CT images on L-spine Bone SPECT/CT comparing with DXA_BMD. Materials and Methods: Fifty five women over 50 years old (mean 66.4 ± 9.1) who took the both examinations(L-spine Bone SPECT/CT with SIEMENS Intevo 16 and DXA scan with GE Lunar prodigy advance) within 90 days from April 2017 to July 2022, BMD, T-score and disease classification were analyzed. Three-dimensional BMD was analyzed with low dose CT images acquired on L-spine Bone SPECT/CT scan on Mindways QCT PROTM software and two-dimensional BMD was analyzed on DXA scan. Basically, Lumbar 1-4 were analyzed and the patients who has lesion or spine implants on L-spine were excluded for this study. Pearson's correlation analysis was performed in BMD and T-score, chi-square test was performed in disease classification between QCT and DXA. Results: On 55 patients, the minimum of QCT_BMD was 18.10, maximum was 166.50, average was 82.71 ± 31.5 mg/cm3. And the minimum of DXA-BMD was 0.540, maximum was 1.302, average was 0.902 ± 0.201 g/cm2, respectively. The result shows a strong statistical correlation between QCT_BMD and DXA_BMD(p<0.001, r=0.76). The minimum of QCT_T-score was -5.7, maximum was -0.1, average was -3.2 ± 1.3 and the minimum of DXA_T-score was -5.0, maximum was 1.7, average was -2.0 ± 1.3, respectively. The result shows a statistical correlation between QCT T-score and DXA T-score (p<0.001, r=0.66). On the disease classification, normal was 5, osteopenia was 25, osteoporosis was 25 in QCT and normal was 10, osteopenia was 25, osteoporosis was 20 in DXA. There was under-estimation of bone decrease relatively on DXA than QCT, but there was no significant differences statistically by chi-square test between QCT and DXA. Conclusion: Through this study, we could identify that the QCT measurement with low dose CT images QCT from L-Spine Bone SPECT/CT was reliable because of a strong statistical correlation between QCT_BMD and DXA_BMD. Bone SPECT/CT scan can provide three-dimensional information also BMD measurement with CT images. In the future, rather than various exams such as CT, BMD, Bone scan are performed, it will be possible to provide multipurpose information via only SPECT/CT scan. In addition, it will be very helpful clinically in the sense that we can provide a diagnosis of potential osteoporosis, especially in middle-aged patients.

Development of Formulas for the Estimation of Renal Depth and Application in the Measurement of Glomerular Filtration Rate in Koreans (사구체 여과율 측정을 위한 한국인의 신장 깊이에 관한 방정식 도출과 이용)

  • Yoo, Ie-Ryung;Kim, Sung-Hoon;Chung, Yong-An;Jung, Hyun-Seok;Lee, Hae-Giu;Park, Young-Ha;Lee, Sung-Yong;Sohn, Hyung-Seon;Chung, Soo-Kyo;Kim, Hyun-Mi;Lee, Hyung-Goo
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.5
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    • pp.418-425
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    • 2000
  • Purpose: There is no established formula for estimating renal depths in Korean. As a result, we undertook this study to develop a new formula, and to apply this formula in the calculation of glomerular filtration rate (GFR). Materials and Methods: We measured the renal depth (RD) on the abdominal CT obtained in 300 adults (M:F: 167:133, mean age 50.9 years) without known renal diseases. The RDs measured by CT were compared with the estimated RDs based on the Tonnesen and Taylor equations. New formulas were derived from the measured RDs in 200 out of 300 patients based on several variables such as sex, age, weight, and height by multiple regression analysis. The RDs estimated from the new formulas were compared with the measured RDs in the remaining 100 patients as a control. In 48 patients who underwent Tc-99m DTPA renal scintigraphy, GFR was measured with three equations (new formula, Tonnesen and Taylor equations), respectively, and compared with each other. Results: The mean values of the RDs measured from CT were 6.9 cm for right kidney of the men (MRK), 6.7 cm for left kidney of the men (MLK), 6.7 cm for right kidney of the women (WRK), and 6.6 cm for left kidney of the women (WLK). The RDs estimated from Tonnesen equation were shorter than the ones measured from CT significantly. The newly derived formulas were 12.813 (weight/height)+0.002 (age)+ 2.264 for MRK, 15.344 (weight/height)+0.011 (age)+0.557 for MLK, 12.936 (weight/height)+ 0.014 (age)+1.462 for WRK and 13.488 (weight/height)+0.019 (age)+0.762 for WLK. The correlation coefficients of the RD measured from CT and estimated from the new formula were 0.529 in MRK, 0.729 in MLK, 0.601 in WRK, and 0.724 in WLK, respectively. The GFRs from the new formula were significantly higher than those from the Tonnesen equation significantly, which was the most similar to normal GFR values. Conclusion: We generated new formulas for estimating RD in Korean from the data by CT. By adopting these formulas, we expect that GFR can be measured by the Gates method accurately in Korean.

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Tc-99m HMPAO Brain SPECT in Patients with Post-Traumatic Organic Mental Disorder (두부외상후 만성 기질성 정신장애 환자에서 Tc-99m HMPAO Brain SPECT 분석)

  • Lee, Kang-Wook;Lee, Jong-Jin;Shong, Min-Ho;Kang, Min-Hee;Ghi, Ick-Sung;Shin, Young-Tai;Ro, Heung-Kyu
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.3
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    • pp.293-300
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    • 1994
  • It is well known that Tc-99m HMPAO brain SPECT can reflect the functional lesions better than X-ray computerized tomography(CT) and magnetic resonance imaging(MRI) in the cerebral disorders. In order to evaluate the clinical utilities of Tc-99m HMPAO brain SPECT in patients with post-traumatic chronic organic mental disorder(OMD), we included 28 patients diagnosed as OMD in department of psychiatry after traumatic head injury. And we compared the results of Tc-99m HMPAO SPECT with those of MRI, EEG and MINI mental status ex amination(MMSE). The results were as follows 1) All patients diagnosed as OMD showed diffuse or focal decreased cerebral perfusion on Tc-99m HMPAO SPECT. 2) Most frequent lesion on brain Tc-99m HMPAO SPECT was decreased perfusion on both frontal lobe. And most frequent lesion on brain Tc-99m HMPAO SPECT showing normal brain MRI result was also decreased both frontal perfusion. 3) Eight of 28 patients showed focal brain MRI lesions(4 small frontal hygroma, 3 small cerebral infarction and 1 cerebellar encephalomalacia) which were not detected in brain Tc-99m HMPAO SPECT. 4) The patients showing less than 20 points on MMSE disclosed abnormal results of EEG more frequently than those disclosing more than 20 points. In conclusion, we think that Tc-99m HMPAO brain SPECT is sensitive method to detect functional lesions of the brains in patients with chronic post-traumatic organic mental disorder.

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Abosrbed Dose Measurements and Phantom Image Ecaluation at Minimum CT Dose for Pediatric SPECT/CT Scan (소아 SPECT/CT 검사를 위한 최저조건에서의 피폭선량측정 및 팬텀의 영상평가)

  • Park, Chan Rok;Choi, Jin Wook;Cho, Seong Wook;Kim, Jin Eui
    • The Korean Journal of Nuclear Medicine Technology
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    • v.18 no.1
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    • pp.82-88
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    • 2014
  • Purpose: The purpose of study was to evaluate radiation dose for pediatric patients by changing tube voltage (kVp) and tube current (mA) at minimum conditions. By evaluating radiation dose, we want to provide dose reduction for pediatric patients and maintain good quality of SPECT/CT images. Materials and Methods: Discovery NM/CT 670 Scanne was used as SPECT/CT. Tube voltages are 80 and 100 kvP. Tube currents are 10, 15, 20, 25 mA. Using PMMA (Polymethyl methacrylate) Phantom, radiation dose which were calculated at center and peripheral dose and SNRD (Signal to Noise Ratio Dose) were evaluated. Using the CT performance phantom, spatial resolution was evaluated as the MTF (Modulation Transfer Function) graph. Jaszczak phantom was used for SPECT image evaluation by CNR (Contrast to Noise to Ratio). Results: Radiation dose using the PMMA phantom was higher peripheral dose than center dose about 7%. SNRD were 7.8, 8.2, 8.3, 8.8, 8.8, 9.9, 9.8, 9.6 for 80 kVp 10, 15, 20, 25 mA, 100 kVp 10, 15, 20, 25 mA. We can distinguish 35, 45, 70, 71, 52, 58, 90, 110 linepair for 80 kVp 10, 15, 20, 25 mA, 100 kVp 10, 15, 20, 25 mA at resolution with MTF. CNR of SPECT images using CT attenuation map were 57.8, 57.7, 57.1, 56.7, 56.6, 56.7, 56.7, 56.7% for 80 kVp 10, 15, 20, 25 mA, 100 kVp 10, 15, 20, 25 mA. Conclusion: In this study, radiation dose for pediatric patients showed decreased low dose condition. And SNRD value was similar in all condition. Resolution showed higher value at 100kVp than 80kVp. for CNR, there was no significant difference. we should take additional study to prove better quality and dose reduction.

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Clinical Significance of Myocardial Uptake on F-18 FDG PET/CT Performed in Oncologic Patients (종양 환자의 F-18 FDG PET/CT에서 관찰된 심근 섭취의 임상적 의미)

  • Cho, Ho-Jin;Cho, Arthur;Lee, Jong-Doo;Kang, Won-Jun
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.6
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    • pp.519-525
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    • 2009
  • Purpose: F-18 fluorodeoxyglucose (FDG) uptake of myocardium is influenced by various factors. Increased glycolysis, and subsequent increased F-18 FDG uptake has been reported in ischemic cardiomyopathy. However, clinical significance of incidentally found myocardial F-18 FDG uptake has not been clarified. We retrospectively reviewed the degree and pattern of myocardial uptake in patients without history of ischemic heart disease who underwent torso F-18 FDG PET/CT for evaluation of neoplastic disease. Materials and Methods: From January 2005 to June 2009, 77 patients who underwent F-18 FDG PET/CT and Tc-99m sestamibi stress/rest SPECT within 3 months were enrolled. Results: Of 77 patients, 55 (71.4%) showed increased F-18 FDG uptake in the myocardium. In this population, 40 showed uniform uptake pattern, while 15 showed focal uptake. In patients with uniform uptake, 17 showed decreased uptake in the septum without perfusion defect on myocardial SPECT. Remaining 23 patients showed uniform uptake, with 1 reversible perfusion defect and 1 fixed perfusion defect. In 15 patients with focal uptake, 9 showed increased F-18 FDG uptake in the base, and only 1 of them showed reversible perfusion defect on myocardial SPECT. In the remaining 6 focal uptake group, 4 had reversible perfusion defect in the corresponding wall, and 1 had apical hypertrophy. Conclusion: We demonstrated that septal defect pattern and basal uptake pattern in the myocardium may represent normal variants. Focal myocardial uptake other than normal variants on oncologic torso F-18 FDG PET/CT with routine fasting protocol may suggest ischemic heart disease, thus further evaluation is warranted.

Usefulness Evaluation of Open Mouth View when PET/CT scan In Tongue Cancer Patients (Tongue Cancer 환자에서 PET/CT 검사 시 Open Mouth 촬영법의 유용성 평가)

  • Kim, Jae Hwan;Yun, Jong Jun;Jung, Ji Wook;Kim, Jung Wook;Hwang, Ju Won;Ji, Hye In
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.2
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    • pp.14-20
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    • 2016
  • Purpose Tongue cancer is 1.8% of all cancer tumors occur in the tongue, it is known that the high incidence enough to account for 75% of oral cancer conducted a PET / CT examination for early diagnosis, metastasis, staging, etc. and. Tongue when PET / CT scan of a cancer patient and a Torso taken to close mouth lesions if the condition was caused due to the overlapping or corresponding artifacts are not clearly observed. The purpose of this study is to evaluate the changes that occur during PET / CT scan with open mouth and its usefulness under. Materials and Methods From June 2015 to March 2016 complained of herein by May 21 had received a diagnosis of tongue cancer underwent PET / CT scan patients were treated with a target (16 males, 5 female). The first was taken to close mouth Torso state, it was taken to add 1 bed open mouth condition. Tumor (T), measuring the Normal Tongue (NT), Lymph Node (LN) standard intake coefficient by setting a region of interest in the (standardized uptake value, SUV) SUVmean, the average value was measured SUVmax, drawn to each region of interest 3 times and Background (Carotid artery) was out of the SUV. In Chapter 3 of the slice to the tumor clearly visible by setting the region of interest to measure the change Tumor size was calculated average value. Gross Image resolution assessment were analyzed statistically through were divided into 1-5 points by the Radiation 7 people in 2, more than five years worked in specialized nuclear medicine compare to proceed with the blind test nonparametric test (wilcoxon signed rank test). (SPSS ver.18) Results $SUV_{mean}$ T's were in close mouth $5.01{\pm}2.70$ with open mouth $5.48{\pm}2.88$ (P<0.05), $SUV_{max}$ were respectively $8.78{\pm}5.55$ and $9.70{\pm}5.99$ (P<0.05). $SUV_{mean}$ in the NT were respectively $0.43{\pm}0.30$ and $0.34{\pm}0.24$ (P=0.20), $SUV_{max}$ was $0.56{\pm}0.34$ and $0.45{\pm}0.25$ (P=0.204). LN $SUV_{mean}$ were respectively $1.62{\pm}1.43$ and $1.69{\pm}1.49$ (P=0.161), $SUV_{mean}$ was $2.09{\pm}1.88$ and $1.99{\pm}1.74$ (P=0.131). Tumor size change is close mouth $4.96{\pm}4.66cm^2$ $5.33{\pm}4.64cm^2$ with 7.45% increase was (P<0.05), gross image resolution evaluation is $2.87{\pm}0.73$, $3.77{\pm}0.68$ with open mouth examinations 30.5% increase was (P<0.05). Conclusion Tumor SUV on the changes that had an increase in open mouth during inspection, the normal tongue and lymph node, but there was no significant difference in the change slightly. It is also one open mouth PET / CT scan will provide improved image to all patients with tongue cancer, but it could be confirmed that similar overall through the blind test, or tumor size changes and showing a high resolution image. It can be the perfect alternative method for problems that occur when the close mouth Open mouth PET / CT scan, but is believed to be through the open mouth to observe the boundary of overlapping or tumor of the oral cavity other structures a little more clearly. Tongue cancer patients how to recommend that the shooting further open mouth PET / CT.

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Detecting and Tracking Changes of Mechanical Characteristics of the Trabecular and Cortical Bone in the Lumbar Vertebrae of an OVX Rat - Use of In-Vivo Micro-CT and Micro-FE Analysis - (난소 절제술을 시행한 흰쥐 등뼈의 해면골과 피질골의 구조적 특성 추적관찰 및 기계적 특성 분석 - 생체 내 미세단층촬영 시스템과 미세 유한요소법 적용 -)

  • Ko, Chang-Yong;Woo, Dae-Gon;Lee, Tae-Woo;Lee, Beob-Yi;Tack, Gye-Rae;Kim, Han-Sung
    • Journal of the Korean Society for Precision Engineering
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    • v.24 no.1 s.190
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    • pp.110-117
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    • 2007
  • This study investigated changes of mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae of the ovariectomised (OVX) rat. In previous researches, there were many studies for morphology of osteoporotic bones based on Micro-Computed Tomography (Micro-CT). However, there were few studies for detecting and tracking changes of mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae of the OVX rat. For this study, the 4th lumbar of the OVX rat (female Sprague-Dawley) was utilized as a specimen. An OVX rat was scanned at week 0 (just before surgery), at week 4, and week 8 after surgery. Micro-finite element (${\mu}-FE$) analysis was used to investigate mechanical characteristics of the trabecular and cortical bone in the lumbar vertebrae for an OVX rat. When the OVX rat (at week 8) was compared with the OVX rat (at week 0), the structural modulus of cortical and trabecualr bone was decreased by 52% and 99%, respectively. This study showed the change of mechanical characteristics of cortical bone as well as trabecular bone of an OVX rat. Detecting and tracking changes of mechanical characteristics could greatly contribute to an experiment test for the trabecular and cortical bone in the lumbar vertebrae of an OVX rat by using In-vivo Micro-CT.

Characterization and Tissues Distribution of Vinculin, Agouti-relating Protein and Melanocortin 4 Receptor Genes in Rainbow Trout, Oncorhynchus mykiss

  • Yoon, Jong-Man
    • Development and Reproduction
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    • v.14 no.4
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    • pp.261-268
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    • 2010
  • As in the O. mykiss electrophoretic profiles of RNA, the signals of each RNA sample from 9 individual tissues such as liver, muscle, brain, heart, pituitary gland, kidney, intestine, spleen and gill similar to positive control were obtained. The tissue distributions of the complimentary DNA (cDNA) of O. mykiss four genes were analyzed using quantitative real-time PCR with primer sets for tissue expression analysis. In this rainbow trout species, author obtained bands of various sizes, ranged from 700 bp to 1,400 bp. A dissociation curve was made at the end of each run to make sure that there was no non-specific amplification. Supplementarily, the Ct of each DNA was compared. The Ct values of vinculin with rainbow trout tissues were determined in a manner similar to those for agouti-related protein (AgRP) and melanocortin receptors (MC4R I and MC4R II). Further, obtained Cts for standard curve of each DNA were affected by specific product (vinculin, AgRP and MC4R II genes). After several experiments with four individual genes of rainbow trout, author estimated a variation ratio of the mean Ct value of the DNA extracted using the comparative CTt method was 37.27, and the standard deviation was 5.33. The correlation coefficient between the Ct values and the concentration of cDNA was -0.98, -0.99, -0.91 and -0.86, respectively (vinculin, AgRP, MC4R I and MC4R II genes). Since this correlation showed high linearity, the straight line obtained was used as a standard for the O. mykiss tissues reared in aquarium. A PCR efficiency of 100% is ideally achieved when the slopes are close to the theoretical value of -3.31. According to quantification method, the results of quantification are strongly affected by the DNA fragmentation. The size of most DNA fragments obtained from various tissues of rainbow trout used in the experiment was approximately 100 bp. According to the four slopes, an efficiency of nearly 100% was estimated for four genes detection methods. Additionally, further analysis with more individuals and primers will be required to fully establish optimization in rainbow trout.