• 제목/요약/키워드: Japanese patients

검색결과 195건 처리시간 0.023초

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

  • Guoliang Chen;Fuxin Wei;Jiachun Li;Liangyu Shi;Wei Zhang;Xianxiang Wang;Zuofeng Xu;Xizhe Liu;Xuenong Zou;Shaoyu Liu
    • Korean Journal of Radiology
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    • 제22권7호
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    • pp.1163-1171
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    • 2021
  • Objective: To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. Materials and Methods: Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. Results: The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). Conclusion: For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

("황제내경소문(黃帝內經素問)" 중(中) 사혈(瀉血)에 관한 연구(硏究) (A Study on the Blood-Letting Therapy in Elementary Questions)

  • 이준근
    • 대한한의정보학회지
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    • 제14권1호
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    • pp.19-42
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    • 2008
  • Blood-Letting Therapy is a rational and ecological medical treatment by which we can heal most of the diseases by removing the static blood which precipitates in the blood vessel and blocks the flowing of blood. And the static blood is the generic term for the injurious, bad, dead and precipitated blood which is blocked the capillary vessel. The Yellow Emperor's Canon of Internal Medicine says that "the patient is treated with drugs internally and stone acupuncture externally. "In the old texts, the blood-letting therapy is mentioned as blood-letting, network vessel pricking, bloodletting, pricking, and arousing pulses etc and it is noted down as the method of network vessel pricking in 'On the Application of Needles' of Spiritual Pivot. Nine-pricking therapy, twelve-pricking therapy and five-pricking therapy are recorded in the methods of network vessel pricking and among them, the method of squeezing blood after pricking the affected part is explained as the network vessel pricking. There are four methods of network vessel pricking, pricking, picking, cluster needling and scatter-pricking and they are fluidly applied to the various symptoms of diseases. In 'On Discriminative Treating for Patients of Different Regions' in Elementary Questions, Ki-baek emphasizes "most of the local people, there are black in skin and loose in striate, and their diseases are mostly of carbuncle kind. It is suitable to treat the disease with stone therapy to prick with stone, so the stone therapy is transmitted from the east. "And in 'On the Corresponding Relation Between the Eum and Yang of Man and All Things' in Elementary Questions, when the Emperor asked Ki-Back, he answered "sthenia means the sthenia of evil, and deficiency means the deficiency of healthy energy. When the blood is sthenic, the evil should be discharged by pricking when out letting the blood; deficiency of vital energy is the asthenia of channels and network vessels, so the energy should drain from the channel which is not deficient, to replenish. "And in this case we can use the methods of 'Breaking out the static bloods', 'driving out the static bloods', blood-letting'. With this we can infer that the blood-letting therapy is made use of the important medical treatments from the ancient times. Especially in referring to the principles of treatment in The Yellow Emperor's Canon of Internal Medicine, it mostly alluded to acupuncture therapies and only eleven times to medicinal treatments. This is to verify that the blood-letting therapy formed the foundation of the medical art. In Dong's Therapy of Acupuncture-Moxibustion and Bloodletting, Dong Kyeong-Chang gave emphasis on the points that there must be extravasated bloods without exception in the serious illnesses which is old, unnatural, accompanying acute pains and so we can revive our body‘s sprit by circulating 'gi' and static blood piled up in the network vessel, regulating the weakness and strength, and controling the disharmony of the internal organs. The blood-letting therapy has effect on the orifice in emergency, such as fore draining, freeing network vessels, harmonizing gi and blood, relieving pain, dispersing swelling and concretion, sedation, resolving toxin as well as strengthening the heart, relieving itching. So it has distinguished effect on all kinds of medical treatment to the modern people. But by the change of social customs and the confucianism of confucius - it is widely spread on the period of North and South Dynasties, 'Wi' and 'Jin' in china and the period of the Three States in korea - The blood-letting therapy which was regarded as the most important medicinal treatment withered rapidly. And Confucius accentuated the importance of our body and all its members, loyalty and filial piety and banned any damage of our body under no circumstances. As a result of it, the therapy of blood-letting had a rapid decrease and barely kept itself in existence in both countries. What is worse, at the period of Japanese colonial rule of korea and our nation's founding of early stage, it has been withered by the high-handed policy to change Oriental Medicine into modern medical science. So the therapy of blood-letting barely kept itself in existence in some Buddhist temples. Another case, it has handed down as a old-fashioned quick fix in folk remedies. But all kinds of the contamination of heavy metals and the misuses of antibiotics are widely spread nowadays, which increased diseases of adult people and incurable diseases as modern society unavoidably made its way into a highly industrial society. To make us more miserable, the western medical science - the antibiotics and surgical operation medical science - already reveals itself into a limit. The necessity of a new medical science which can give a security to the patients who are suffering from the diseases of adult people and the incurable diseases is especially come into the force nowadays. In view of the results after bibliographically studying on the blood-letting Therapy in Elementary Questions of the Yellow Emperor's Canon of Internal Medicine, the blood-letting therapy has acted for the important Oriental medicinal science and has been clarified the prominent effects on the diseases of adult people and the incurable diseases. So it is regarded as an appropriate thing that we lay out a determined theory of the blood-letting therapy and of course prevent the unwanted side effects from inappropriate medicinal treatments, and make full use of clinic by elevating the curative value and that we win back our self-respect of medical treatment which is dominated from the western medical science and ultimately contribute to national medical welfare.

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Mini-Wright Peak Flow Meter로 측정한 한국 성인의 최고호기유량의 정상치 (Peak Expiratory Flow in Normal Healthy Korean Subjects Measured by Mini-Wright Peak Flow Meter)

  • 김영삼;안애란;김세규;장준;안철민;오재준;김성규
    • Tuberculosis and Respiratory Diseases
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    • 제50권3호
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    • pp.320-333
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    • 2001
  • 연구배경 : 최고호기유량은 비교적 간단하고, 반복적으로 기도폐쇄의 정도를 양적으로 나타낼 수 있는 수치로, 최근 천식의 치료방침을 결정하는데 있어 최고호기유량 측정의 중요성을 강조하고 있다. 외국에서는 정상 성인에서의 최고호기유량의 추정정상치를 구하기 위한 대규모 단변연구가 시행되었으나 1991년 American Lung Association에서 정한 기준을 정확히 적용하여 추정정상치 뿐만 아니라, 최고호기유량의 정규분포성을 검정하고 정상치의 하한선까지 제시한 대규모 단면연구가 시행되지 않았다. 이번 연구를 통해 정상 성인을 대상으로 한국인에서의 추정정상치를 구해 이전의 연구결과 및 외국인을 대상으로 한 연구결과와 비교하며, 정상치의 하한선을 구함으로써 한국인에서의 최고 호기유량의 특성을 알아보고자 하였다. 방 법 : 1997년 8월부터 2000년 1월까지 세브란스 건강검진센터에 내원한 정상 성인 중 과거에 폐질환을 앓은 적이 있거나, 호흡기 증상을 호소하거나 흡연을 한 적이 없는 남성 233명과 여성 631명을 대상으로 Mini Wright Peak Flow Meter와 Jaeger Master Lab의 폐기능검사기를 이용하여 최고호기유량을 측정한 후 다중회귀분석을 시행하여 정상추정치에 대한 회귀방정식을 구하였다. 또한 최고호기유량의 정규분포성에 대한 검정을 시행한 후 정상치의 하한선에 대한 회귀방정식을 구하고 이를 외국 및 이전에 한국에서 시행한 연구결과와 비교하였다. 결 과 : Mini Wright Peak Flow Meter를 이용하여 측정 한 최고호기유량의 정상추정치 (PEF : L/min)는 남성에서는 $25.117+4.587{\times}$연령(year)-$0.064{\times}$연령$^2+2.931{\times}$신장(cm)이었고($R^2=025$), 여성에서는 $146.942-0.011{\times}$연령$^2+1.795{\times}$신장(cm)+$0.836{\times}$체중(kg)이었다($R^2=0.21$). 최고호기유량의 정상치의 하한선은 남성에서는 $25.117+4.587{\times}$연령(year)-$0.064{\times}$연령$^2+1.936{\times}$신장(cm)이었고, 여성에서는 $146.942-0.011{\times}$연령$^2+1.232{\times}$신장(cm)+$0.481{\times}$체중(kg)이었다. 최고호기유량은 정규분포를 하였다. 남성에서 Mini-Wright Peak Flow Meter로 측정한 한국인의 최고호기유량의 정상추정치는 영국인 및 일본인의 수치와 유사하였다. 여성에서 Mini-Wright Peak Flow Meter로 측정한 한국인의 최고호기유량의 정상추정치는 영국인의 수치와 유사하였고 일본인의 수치보다는 높았다. 남성에서는 정상추정치의 71% 이하를 여성에서는 정상추정치의 76% 이하를 비정상적인 수치를 볼 수 있었다. 결 론 : 호흡기질환이 없는 건강한 남성 233명과 여성 631 명을 대상으로 Mini Wright Peak Flow Meter로 최고호기유량을 측정하여 정상추정치 및 정상치의 하한선을 구하였다. 이는 외국인을 대상으로 한 연구결과와 차이를 보였고, 한국인을 대상으로 한 이전 연구결과와도 차이가 있었다. 향후 한국인을 대상으로 한 최고호기유량의 정상추정치에 대한 연구가 계속 진행되어야 할 것이다.

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원위부 진행성 위암에서의 상장간막정맥(14v) 림프절 절제술의 적응증 (Indication of Dissection of the 14v Lymph Node in Advanced Distal Gastric Cancer)

  • 임정택;정오;김지훈;오성태;김병식;박건춘;육정환
    • Journal of Gastric Cancer
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    • 제6권3호
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    • pp.154-160
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    • 2006
  • 목적: 1998년도에 제정된 일본위암학회의 위암취급규약 영문판 제2판에 따르면 원위부 위암에 있어 2군에 속하는 림프절 중 14v (상장간막정맥) 림프절도 포함되어 있으나 조기 위암에서는 14v 림프절의 절제가 제외되는 등 상황과 술자에 따라 선택적으로 절제되고 있다. 저자들은 원위부 진행성 위암에 있어 14v 림프절의 전이 정도를 조사하여 14v 림프절 절제의 필요성에 대해 알아보고 이 림프절의 절제 적응증을 알아보고자 하였다. 대상 및 방법: 2004년 4월부터 2005년 8월까지 서울아산병원 외과 위암팀에서 원위부 위암으로 수술 받은 환자 중 수술장에서 육안적 소견으로 진행성 위암으로 판단된 환자를 대상으로 일본위암학회의 위암취급규약 영문판 2판에 정의된 D2 림프절 곽청술을 시행하고 림프절의 구획을 표기하였다. 각 림프절 구획의 위암 전이 여부를 확인하여 전이율을 계산하고, 6번 림프절의 양성율과 14v 림프절 양성율의 상관 관계와 14v 림프절 양성군과 음성군을 비교하여 14v 림프절 전이를 예측할 수 있는 인자가 있는지 분석하였다 후향적으로 의무기록을 검토하였고 환자의 예후에 대한 장기 추적은 하지 않았다. 결과: 전체 환자는 50명이었고 평균 연령은 56 ($30{\sim}80$)세, 남녀비는 1.63 : 1이었다. 47명(94%)에서 위원위부 절제술과 위십이지장 문합술을 시행하였고 3명(6%)에서는 위원 위부절제술과 위공장문합술을 시행하였다. D2 림프절 곽청술을 시행 후 림프절의 전이율이 가장 높았던 림프절은 3번(위소만부) 림프절과 6번(유문하림프절)이 54%)로 가장높았고 14v 림프절의 전이율은 10%로 다른 2군 림프절 중 7번 9번 림프절의 전이와 비슷하였다. 14v 림프절 양성군과 음성군을 비교하였을 때 전이된 림프절의 수와(평균 25.4개 vs 4.91개, P<0.001) 6번 림프절의 전이된 림프절 수에서(평균 6.5개 vs 1.42개, P<0.001) 차이를 보였고, 14v 양성군은 UICC 병기 3기 이상으로 음성군에 비해 진행된 위암인 경우가 많았다. 결론: 위암의 상태가 진행되어 있고 6번 림프절이 양성일수록 14v 림프절로의 전이 가능성이 높았다. 따라서 수술장 소견에서 3기 이상, 6번 림프절이 양성일 경우 14v 림프절의 절제가 필수이다. 그러나 14v 림프절 절제의 유용성에 대한 판단은 14v 림프절 절제하지 않은 군과 전향적인 연구를 시행하여 재발과 생존율 분석을 통해 이루어져야 할 것이다.

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국민건강보험 발전방향 (Future Direction of National Health Insurance)

  • 박은철
    • 보건행정학회지
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    • 제27권4호
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    • pp.273-275
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    • 2017
  • It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.