• International Journal of Heart Failure
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• v.6 no.1
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• pp.22-27
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• 2024

Body fluid monitoring and management are essential to control dyspnea and prevent re-hospitalization in patients with chronic heart failure (HF). There are several methods to estimate and monitor patient's volume status, such as symptoms, signs, body weight, and implantable devices. However, these methods might be difficult to use for reasons that are slow to reflect body water change, inaccurate in specific patients' condition, or invasive. Bioelectrical impedance analysis (BIA) is a novel method for body water monitoring in patients with HF, and the value in prognosis has been proven in previous studies. We aim to determine the efficacy and safety of home BIA body water monitoring-guided HF treatment in patients with chronic HF. This multi-center, open-label, randomized control trial will enroll patients with HF who are taking loop diuretics. The home BIA group patients will be monitored for body water using a home BIA device and receive messages regarding their edema status and direction of additional diuretics usage or behavioral changes through the linked application system once weekly. The control group patients will receive the usual HF management. The primary endpoint is the change in N-terminal prohormone of brain natriuretic peptide levels from baseline after 12 weeks. This trial will provide crucial evidence for patient management with a novel home BIA body water monitoring system in patients with HF.

• The Korean Society of Law and Medicine
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• v.11 no.2
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• pp.239-274
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• 2010

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

• Therapeutic Science for Rehabilitation
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• v.10 no.2
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• pp.95-108
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• 2021

Objective : This study aimed to develop prototypes of "smart stacking cones" by combining ICT to evaluate and train the upper extremity function and dual task performance in patients with central nervous system impairment, and to identify the complementary point to the completion of the device through a usability test. Methods : This prototype comprised of a hardware and software system that enabled the evaluation and training of patients and the management of data obtained from patients' performance. Specific measurement variables were established so that patient performance could be measured correctly. Based on the measurement variables, a the prototype included a 'single task evaluation modes', 'dual task evaluation mode', 'single task training mode', and 'dual task training modes'. Additionally, a usability test was conducted to assess clinical applicability and overall satisfaction for the prototype. Results : The results of the usability test were generally found to be appropriate. The 'content adequacy' in the usability test was the area with the highest level of adequacy and the lowest level of inadequacy. Additionally, overall 'satisfaction' in the usability test was the area with the highest appropriate and inappropriate levels. Hence, the overall satisfaction results were unstable. Conclusion : Future studies should be conducted to identify the clinical effectiveness of the device by applying an upgraded smart stacking cone to an actual patient group.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.90-93
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• 2011

Purpose: A Pixelated BSGI gamma camera has features to enhance resolution and sensitivity and minimize the distance between detector and organs by narrow FOV. Therefore, it is known as useful device to examine small organs such as thyroid, parathyroid and gall bladder. In general, when we would like to enlarge the size of images and obtain high resolution images by gamma camera in nuclear medicine study, we use pinhole collimator. The purpose of this study is to evaluate the usefulness of Pixelated BSGI gamma camera and to compare to it using pinhole collimator in thyroid scan which is a study of typical small organs. Materials and methods: (1) The evaluation of sensitivity and spatial resolution: We measured sensitivity and spatial resolution of Pixelated BSGI with LEHR collimator and Infinia gamma camera with pinhole collimator. The sensitivity was measured by point source sensitivity test recommended by IAEA. We acquired images considering dead time in BSGI gamma camera for 100 seconds and used $^{99m}TcO4-\;400{\mu}Ci$ line source. (2) The evaluation of thyroid phantom: The thyroid phantom was filled with $^{99m}TcO4-$. After set 300 sec or 100 kcts stop conditions, we acquired images from both pixelated BSGI gamma camera and Infinia gamma camera with LEHR collimator. And we performed all thyroid studies in the same way as current AMC's procedure. Results: (1) the result of sensitivity: As a result, the sensitivity and spatial resolution of pixelated BSGI gamma camera were better than Infinia's. The sensitivities of pixelated BSGI and Infinia gamma camera were $290cps/{\mu}Ci$ and $350cps/{\mu}Ci$ respectively. So, the sensitivity of pixelated BSGI was 1.2 times higher than Infinia's (2) the result of thyroid phantom: Consequently, we confirmed that images of Pixelated BSGI gamma camera were more distinguishable between hot and cold spot compared with Infinia gamma camera. Conclusion: A pixelated BSGI gamma camera is able to shorten the acquisition time. Furthermore, the patients are exposed to radiation less than before by reducing amount of radiopharmaceutical doses. Shortening scan time makes images better by minimizing patient's breath and motion. And also, the distance between organ and detector is minimized because detector of pixelated BSGI gamma camera is small and possible to rotate. When patient cannot move at all, it is useful since device is feasible to move itself. However, although a pixelated BSGI gamma camera has these advantages, the effect of dead time occurs over 2000 cts/s since it was produced only for breast scan. So, there were low concentrations in organ. Therefore, we should consider that it needs to take tests to adjust acquisition time and amount of radiopharmaceutical doses in thyroid scan case with a pixelated BSGI gamma camera.

• Proceedings of the Korean Vacuum Society Conference
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• 2013.08a
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• pp.273-273
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• 2013

Recently, Point-of-care (POC) testing microdevices enable to do the patient monitoring, drug screening, pathogen detection in the outside of hospital. Immunochromatographic strip (ICS) is one of the diagnostic technologies which are widely applied to POC detection. Relatively low cost, simplicity to use, easy interpretations of the diagnostic results and high stability under any circumstances are representative advantages of POC diagnosis. It would provide colorimetric results more conveniently, if the genetic analysis microsystem incorporates the ICS as a detector part. In this work, we develop a reverse transcriptase-polymerase chain reaction (RT-PCR) microfluidic device integrated with a ROSGENE strip for colorimetric influenza H1N1 virus detection. The integrated RT-PCR- ROSGENE device is consist of four functional units which are a pneumatic micropump for sample loading, 2 ${\mu}L$ volume RT-PCR chamber for target gene amplification, a resistance temperature detector (RTD) electrode for temperature control, and a ROSGENE strip for target gene detection. The device was fabricated by combining four layers: First wafer is for RTD microfabrication, the second wafer is for PCR chamber at the bottom and micropump channel on the top, the third is the monolithic PDMS, and the fourth is the manifold for micropump operation. The RT-PCR was performed with subtype specific forward and reverse primers which were labeled with Texas-red, serving as a fluorescent hapten. A biotin-dUTP was used to insert biotin moieties in the PCR amplicons, during the RT-PCR. The RT-PCR amplicons were loaded in the sample application area, and they were conjugated with Au NP-labeled hapten-antibody. The test band embedded with streptavidins captures the biotin labeled amplicons and we can see violet colorimetric signals if the target gene was amplified with the control line. The off-chip RT-PCR amplicons of the influenza H1N1 virus were analyzed with a ROSGENE strip in comparison with an agarose gel electrophoresis. The intensities of test line was proportional to the template quantity and the detection sensitivity of the strip was better than that of the agarose gel. The test band of the ROSGENE strip could be observed with only 10 copies of a RNA template by the naked eyes. For the on-chip RT-PCR-ROSGENE experiments, a RT-PCR cocktail was injected into the chamber from the inlet reservoir to the waste outlet by the micro-pump actuation. After filling without bubbles inside the chamber, a RT-PCR thermal cycling was executed for 2 hours with all the microvalves closed to isolate the PCR chamber. After thermal cycling, the RT-PCR product was delivered to the attached ROSGENE strip through the outlet reservoir. After dropping 40 ${\mu}L$ of an eluant buffer at the end of the strip, the violet test line was detected as a H1N1 virus indicator, while the negative experiment only revealed a control line and while the positive experiment a control and a test line was appeared.

• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.342-349
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• 2015

Background : Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. Method : A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes ($mRS{\leq}2$) at 3 month were compared across the three method. Results : Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). Conclusion : Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.

• Journal of Internet Computing and Services
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• v.17 no.2
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• pp.59-65
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• 2016

The result of analyzing the cognitive reaction due to the color environment has been applied to various filed especially in medical field. Moreover, the study about the identification of patient's condition and examination the brain activity by collecting the bio-signal based on the color environment is being actively conducted. Even though, there were a variety of experiments by convention the color environment using a light or LED color, it still has a problem that affects the psychological information. Therefore, our proposed system using a HMD (Head Mounting display) to provide a completed color environment condition. This system uses the BMS(Biomedical System) to collect the biometric information which responds to the specific color condition and the human body response information can be measured by the development the Memory and Attention test on Mobile phone. The collection of Biometric information includes electro cardiogram(ECG), respiration, oxygen saturation (Sp02), Bio-impedance, blood pressure will store in the database. In addition, we can verify the result of the human body reaction in the color environment by Memory and Attention application. By utilizing the reaction of the human body information that is collected thought the proposed system, we can analyze the correlation between the physiological information and the color environment. And we also expect that this system can apply to the medical diagnosis and treatment. For future work, we will expand the system for prediction and treatment of Alzheimer disease by analyzing the visualization data through the proposed system. We will also do evaluation on the effectiveness of the system for using in the rehabilitation program.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.309-315
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• 2001

The term slit ventricle syndrome(SVS) refers to an episodic occurrence of headache, vomiting, and possibly some degree of impaired consciousness in shunted hydrocephalic children in whom slit-like ventricles are seen on CT scan or MRI. Authors present 6 cases with SVS who were treated at our institute for last 10 years. From 1986 to 1996, 821 patients underwent shunt surgery for hydrocephalus. The etiology of hydrocephalus included brain tumor(140 patients), post-hemorrhagic(62 patients), idiopathic normotensive hydrocephalus(64 patients), post-meningitic( 58 patients), post-traumatic(54 patients), congenital(48 patients), neurocysticercosis(31 patients), and unknown etiology(364 patients). During the mean follow-up duration of 68 months, 232 shunt revisions were performed by a revision rate of 1.28 per patient. The incidence of SVS was 0.7%(6 patients). Most of them have been operated on in infancy. Time interval from the first operation to the development of slit-ventricle syndrome ranged from 4 to 8 years, the mean was 6 years. Shuntogram showed patent shunt in all patients. Two patients with less severe clinical symptoms improved with conservative treatment. These patients were not measured ICP because of good hospital course. One patient showed high ICP and needed only revision with same pressure valve as previous shunt. Low ICP was noted in 3 patients. Pressure augmentation using an anti-siphon device(ASD) or upgrading valve system were necessary in these patients. The authors stress that determining type of SVS is the first step in treatment planning and that the best treatment is a strategy aimed at resolving the specific type of SVS responsible for the symptoms.

• Journal of the Korean Society of Radiology
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• v.6 no.5
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• pp.335-342
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• 2012

This study aims to find a way to control infection of community radiology effectively by calculating the degree of contamination, culture and identifying the flora in radiology of five general hospitals in Gyeongsangbuk-do. Staphylococcus, Micrococcus, Pseudomonas stutzeri, Pseudomonas oryzihabitans were identified as surface flora. These are know to be pathogens of hospital acquired infection and there was no radiology-specific flora. Research subject hospitals were conducting similar infection control education but degree of contamination of each hospital showed significant difference. Difference in degree of contamination according to contact sources were analyzed by Contact sources were classified into technologist-using, patients-using and common-using materials. Analysis of each hospital's degree of contamination showed that patient-using materials were significantly more contaminated than technologist-using and common-using materials (p<0.001). Devices which are similar to each other in monthly average frequency of use showed no significant difference in degree of contamination, but general X-ray devices and chest boards which are used most frequently showed higher degree of contamination than others. In addition, hospital A, B and C which have heavier monthly average caseload showed relatively high degree of contamination on irradiation devices which are used by technologists only or by technologists and patients commonly, office desks and doorpulls. Hence it is considered that intensity of infection control education should be different according to the degree of monthly average caseload. This study provided an opportunity to aware that technologists' feeling of contamination is crucial for infection control of radiology, and the Accupoint ATP public hygiene monitoring system which was used in this study for measuring the degree of contamination was proved to be an effective measuring device for hospital acquired infection management.

• The Korean Society of Law and Medicine
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• v.22 no.4
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• pp.185-210
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• 2021

On September 24, 2021, the new provisions(Article 38-2 of the Medical Service Act) mandatory CCTV installation in operating rooms where the unconscious patient is operating such as general anesthesia. The revised medical law aims to effectively prevent illegal activities that may occur in the operating rooms and to promote appropriate resolution to medical dispute. According to the law, medical institutions operating unconscious patients, such as general anesthesia, must install CCTVs in the operating rooms by September 25, 2023, and film surgical scenes only at the request of patients and their guardians, regardless of the consent of the medical personnel. The bill delegated the legislative device to minimize infringement of fundamental rights to subordinate statutes without stipulating it in the law.(Article 38-2(10)) The most realistic policy plan to minimize the infringement of the fundamental rights of patients is to prepare specific regulations. Therefore, this study examines the legislative background and main contents of the amended CCTV installation bill, and suggests issues to be reviewed when preparing subordinate statutes by analyzing major issues. It was reviewed based on compliance with the principle of minimizing infringement of fundamental rights of information subjects in the operating rooms. The information subjects of CCTV are health professionals and patients. Suggesting issues should be considered when preparing subordinate statutes so that the purpose of the CCTV installation law can be achieved while minimizing infringement of right of self-determination of personal information, personality rights, and human rights. It is hoped that this paper will be referred when discussing subordinate statutes and regulations to contribute minimizing infringement of fundamental rights.