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The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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COMPARISON OF POLYMERIZATION SHRINKAGE AND STRAIN STRESS OF SEVERAL COMPOSITE RESINS USING STRAIN GUAGE (스트레인 게이지를 이용한 수종의 복합레진의 중합수축 및 수축응력의 비교)

  • Kim, Young-Kwang;Yoo, Seung-Hoon;Kim, Jong-Soo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.3
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    • pp.516-526
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    • 2004
  • Polymerization shrinkage of photoinitiation type composite resin cause several clinical problems. The purpose of this study was to evaluate the shrinkage strain stress, linear polymerization shrinkage, compressive strength and microhardness of recently developed composite resins. The composite resins were divided into four groups according to the contents of matrix and filler type. Group I : $Denfil^{TM}$(Vericom, Korea) with conventional matrix, Group II : $Charmfil^{(R)}$(Dentkist, Korea) with microfiller and nanofller mixture, Group III : $Filtek^{TM}$ Z250(3M-ESPE, USA) TEGDMA replaced by UDMA and Bis-EMA(6) in the matrix, and Group IV : $Filtek^{TM}$ Supreme(3M-ESPE, USA) using pure nanofiller. Preparation of acrylic molds were followed by filling and curing with light gun. Strain gauges were attached to each sample and the leads were connected to a strainmeter. With strainmeter shrinkage strain stress and linear polymerization shrinkage was measured for 10 minutes. The data detected at 1 minute and 10 minutes were analysed statistically with ONE-way ANOVA test. To evaluate the mechanical properties of tested materials, compressive hardness test and microhardness test were also rendered. The results can be summarized as follows : 1. Filling materials in acrylic molds showed initial temporary expansion in the early phase of polymerization. This was followed by contraction with the rapid increase in strain stress during the first 1 minute and gradually decreased during post-gel shrinkage phase. After 1 minute, there's no statistical differences of strain stress between groups. The highest strain stress was found in group IV and followed by group III, I, II at 10 minutes-measurement(p>.05). In regression analysis of strain stress, group III showed minimal inclination and followed by group II, I, IV during 1 minute. 2. In linear polymerization shrinkage test, the composite resins in every group showed initial increase of shrinkage velocity during the first 1 minute, followed by gradually decrease of shrinkage velocity. After 1 minute, group IV and group III showed statistical difference(p<.05). After 10 minutes, there were statistical differences between group IV and group I, III(p<.05) and between group II and group III(p<.05). In regression analysis of linear polymerization shrinkage, group II showed minimal inclination and followed by group IV, III, I during 1 minute. 3. In compressive strength test, group III showed the highest strength and followed by group II, IV, I. There were statistical differences between group III and group IV, I(p<.05). 4. In microhardness test, upper surfaces showed higher value than lower surfaces in every group(p<.05).

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A Clinical Study on Transpulmonary Leukostasis and Prophylactic Effects of Steroid in Cardiac Surgery (심장수술시 백혈구의 폐내정체와 스테로이드의 예방적 효과에 관한 연구)

  • 최석철
    • Biomedical Science Letters
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    • v.2 no.2
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    • pp.133-151
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    • 1996
  • After cardiac surgery, it has been recognized that various complications were associated with injured humoral and cellular immunity by cardiopulmonary bypass(CPB). Especially, in postoperative pulmonary dysfunction, transpulmonary leukostasis followed complement activation and inflammatory responses are major pathogen. Some studies have showed that pretreated-corticosteroids before CPB protected postoperative pulmonary dysfunction. Corticosteroids may inhibit complement and leukocyte activation. On based previous studies, present investigator determined changes of leukocyte counts and transpulmonary leukostasis during cardiac surgery and postoperative periods. For the evaluation of postoperative pulmonary function and edema, $PaO_2$ and chest X-ray were compared between pre-CPB and post-CPB. Fever and other parameters were also observed postoperatively. The aim of this study was to define for the prophylactic effects of corticosteroid(Solu-Medrol: 30mg/kg) on all the researched parameters. This study was prospectively designed with randomized-blind fashion for 50 patients undergoing cardiac surgery. According to the purpose of study, all patients were divided into placebo and steroid group. : Placebo group was 25 patients received normal saline(not corticosteroid), and steroid group was 25patients received corticosteroid(Solu-Medrol: 30mg/kg) before initiation of CPB. The results of study were summarized as follows. 1. Total peripheral leukocyte counts decreased significantly at 5 minutes of CPB in all patients(P<0.01), and began to increase progressively at later periods of CPB with neutrophilia. The significant rise remained at postoperative 7th day(P<0.05). 2. During partial CPB, transpulmonary leukostasis occurred in placebo group(P<0.001), whereas it was prevented in steroid group. 3. In both groups, peripheral lymphocyte counts were stable during CPB, but began to reduce at time of intensive care unit(ICU) and the lymphocytopenia remained until postoperative 3rd day. The lymphocyte counts recovered on postoperative 7th day. 4. In both groups, peripheral counts of monocyte were relatively stable in the early peroid of CPB, and increased gradually in the later periods of CPB. This significant monocytosis remained throughout postoperlative periods(P<0.05). 5. The mean value of postoperative $paO)_2$ was lower than that of pre-CPB in placebo group(P=0.01) but didn't significant in steroid group(P=0.90). In the incidence of pulmonary edema signs and fever, placebo group was higher than steroid group(P=0.001, p=0.01, respectively). However mechanical respiratory supporting and care periods at intensive care unit were not significant difference between two groups(P>.0.05).With the above results, the investigator concluded that leukocyte activation and pulmonary sequestration were caused by cardiac surgery with CPB and demonstrated that high dose corticosteroid will provide prophylactic effect for pulmonary leukostasis and higher neutrophilia. These effects may ameliorate postoperative pulmonary dysfunction and contribute to postoperative less morbidity. However, further study should be performed because postoperative lymphocytopenia continued for 3 days in both groups, which may suspected damage or suppression of cell-mediated immunity with used corticosteroid.

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Estimation of Internal Motion for Quantitative Improvement of Lung Tumor in Small Animal (소동물 폐종양의 정량적 개선을 위한 내부 움직임 평가)

  • Yu, Jung-Woo;Woo, Sang-Keun;Lee, Yong-Jin;Kim, Kyeong-Min;Kim, Jin-Su;Lee, Kyo-Chul;Park, Sang-Jun;Yu, Ran-Ji;Kang, Joo-Hyun;Ji, Young-Hoon;Chung, Yong-Hyun;Kim, Byung-Il;Lim, Sang-Moo
    • Progress in Medical Physics
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    • v.22 no.3
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    • pp.140-147
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    • 2011
  • The purpose of this study was to estimate internal motion using molecular sieve for quantitative improvement of lung tumor and to localize lung tumor in the small animal PET image by evaluated data. Internal motion has been demonstrated in small animal lung region by molecular sieve contained radioactive substance. Molecular sieve for internal lung motion target was contained approximately 37 kBq Cu-64. The small animal PET images were obtained from Siemens Inveon scanner using external trigger system (BioVet). SD-Rat PET images were obtained at 60 min post injection of FDG 37 MBq/0.2 mL via tail vein for 20 min. Each line of response in the list-mode data was converted to sinogram gated frames (2~16 bin) by trigger signal obtained from BioVet. The sinogram data was reconstructed using OSEM 2D with 4 iterations. PET images were evaluated with count, SNR, FWHM from ROI drawn in the target region for quantitative tumor analysis. The size of molecular sieve motion target was $1.59{\times}2.50mm$. The reference motion target FWHM of vertical and horizontal was 2.91 mm and 1.43 mm, respectively. The vertical FWHM of static, 4 bin and 8 bin was 3.90 mm, 3.74 mm, and 3.16 mm, respectively. The horizontal FWHM of static, 4 bin and 8 bin was 2.21 mm, 2.06 mm, and 1.60 mm, respectively. Count of static, 4 bin, 8 bin, 12 bin and 16 bin was 4.10, 4.83, 5.59, 5.38, and 5.31, respectively. The SNR of static, 4 bin, 8 bin, 12 bin and 16 bin was 4.18, 4.05, 4.22, 3.89, and 3.58, respectively. The FWHM were improved in accordance with gate number increase. The count and SNR were not proportionately improve with gate number, but shown the highest value in specific bin number. We measured the optimal gate number what minimize the SNR loss and gain improved count when imaging lung tumor in small animal. The internal motion estimation provide localized tumor image and will be a useful method for organ motion prediction modeling without external motion monitoring system.

Evaluation of the Fruit Quality Indices during Maturation and Ripening and the Influence of Short-term Temperature Management on Shelf-life during Simulated Exportation in 'Changjo' Pears (Pyrus pyrifolia Nakai) (배 신품종 '창조'의 성숙 중 품질 요인 변화 및 수송온도 환경에 따른 반응성)

  • Lee, Ug-Yong;Choi, Jin-Ho;Ahn, Young-Jik;Chun, Jong-Pil
    • Journal of Bio-Environment Control
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    • v.26 no.4
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    • pp.378-385
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    • 2017
  • In this study, we evaluated the changes of fruit quality indices during fruit development and ripening in Korean new pear cultivar 'Changjo', developed from a cross between 'Tama' and '81-1-27' ('Danbae' ${\times}$ 'Okusankichi') in 1995 and named in 2009, to determine appropriate harvest time and to enhance the market quality and broaden the cultivation area. The fruits of 'Changjo' pears harvested from 132 days after full bloom (DAFB) to 160 DAFB. Fruit growth and quality indices were monitored at 1 week interval by measuring fruit weight, length, diameter, firmness, and taste related quality indices. The calculated fruit fresh weight increased continuously with fruit development and reached to an average of 594g on Sep. 20 (160 DAFB). The ratio of length to diameter declines as fruit maturation progress, resulting in 0.898 for ripe fruit stage as a round oblate shape. Flesh firmness of 'Changjo' pears showed over 30N until 153 DAFB and then decreased abruptly with fruit ripening, reaching a final level of about 26.44N on 160 DAFB. Starch content of fruit sap was also decreased abruptly after 146 DAFB which decreased almost half of the fruits harvested at 139 DAFB. In parallel with the decrease of flesh firmness, ethanol insoluble solids (EIS) content decreased sharply with fruit ripens, only 50% of EIS was detected on the fruits harvested on 160 DAFB when compared to that of the fruits harvested on 139 DAFB (Aug. 30). The maximum value of soluble solids contents was observed in the fruits harvested on 153 DAFB, resulting in $14.2^{\circ}Brix$. The changes of skin color difference $a^*$ which means loss of green color occurred only after 139 DAFB, coincide with the decrease of SPAD value of the fruit skin. The sugars of the 80% ethanol soluble fraction consisted mainly of fructose, sorbitol, glucose and sucrose, also increased during maturation and ripening. Fructose and sucrose contents were larger than those of glucose and sorbitol in flesh tissues. These results were explained that stored starch is converted to soluble sugars during fruit maturation, mainly in fructose and sucrose increasing the sweetness of this cultivar. Total polyphenols were increased up to middle of fruit maturation (146 DAFB) and then decreased continuously until the end of fruit maturation. Consequently, our results suggested that the commercial harvest time of 'Changjo' pears should not be passed 153 DAFB and late harvest of this cultivar would not good for quality maintenance during shelf-life. As a result of the post-harvest low-temperature acclimation experiment during the short-term transportation period, fruits harvested at 146 DAFB tended to maintain higher firmness after 14 days of simulated marketing at $25^{\circ}C$ compared to fruits harvested at 153 DAFB regardless of temperature set. And, the slower the rate of decrease to the final transport temperature of $5^{\circ}C$, the higher the incidence of internal browning and ethylene production. Therefore, in order to suppress the physiological disorder and to maintain the fruit quality when exporting to Southeast Asia in the 'Chanjo' pears, it is desirable to lower the temperature of the fruits within a short time after harvest and to set the harvest time before 146 days after full bloom.

Lung Uptake of $^{99m}Tc-sestamibi$ during Routine Gated Exercise SPECT Imaging : Comparison with Left Ventricular Ejection Fraction and Severity of Perfusion Defect (일상적인 운동 부하 게이트 심근 관류 SPECT에서 $^{99m}Tc-sestamibi$ 폐섭취 : 좌심실 구혈률과 관류 결손 정도와의 비교)

  • Jeong, Shin-Young;Lee, Jae-Tae;Bae, Jin-Ho;Ahn, Byeong-Cheol;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.2
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    • pp.83-93
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    • 2003
  • Background: Lung-to-heart uptake ratio (LHR) in $^{201}Tl-chloride$ myocardial perfusion scan is believed to be a reliable marker for left ventricular (LV) dysfunction, but the clinical value of LHR is controversial for $^{99m}Tc-MIBI$ imaging. Furthermore, most of results suggesting lung uptake of $^{99m}Tc-MIBI$ as a potential marker for LV dysfunction used immediate post-stress images, instead of routine images acquired 1 hour after tracer injection. The goal of our study was to investigate whether LHR evaluated with routine gated $^{99m}Tc-MIBI$ imaging can reflect the degree of perfusion defect or left ventricular performance. Subjects and Methods: 241 patients underwent exercise $^{99m}Tc-MIBI$ myocardial SPECT were classified into normal myocardial perfusion (NP, n=135) and abnormal myocardial perfusion (AP, n=106) group according to the presence of perfusion defect. LHR was calculated from anterior projection image taken at 1-hour after injection. Two legions of interest (ROIs) were placed on left lung above LV and on myocardium showing the highest radioactivity. Subjects were classified by left ventricular ejection fraction (LVEF), as Gr-I: >50%, Gr-II: 36-50%, Gr-III: <36% and by summed stress score (SSS), as Gr-A: <4, Gr-B: 4-8, Gr-C: 9-13, Gr-D: >13, LHR was compared among these groups. Results: In NP group(n=135), LHR, were higher in men than women ($men:\;0.311{\pm}0.03,\;women:\;0.296{\pm}0.03,\;p<0.05$). Significant difference, in LHR were found between NP and AP groups both for men and women ($men:\;0.311{\pm}0.03\;vs\;.\;0.331{\pm}0.06,\;women:\;0.296{\pm}0.03\;vs.\;0.321{\pm}0.07.\;p<0.05$). There were weak negative correlation between LHR and LVEF (r=-0.342, p<0.05) and weak positive correlation between LHR and SSS (r=0.478, p<0.05) in men, but not in women (LVEF: r=-0.279, p=0.100, SSS: r=0.276, p=0.103). Increased LHR was defined when for more than mean + 2SD value ($men{\geq}0.38,\;women{\geq}0.37$) of the LHR of the subject with normal perfusion. Increased LHR were observed more frequently in subjects with lower LVEF (Gr-I: 11.1%, Gr-II: 27.0%, Gr-III: 35.4%, p<0.05) and higher SSS(Gr-A: 14.0%, Gr-B: 5.7%, Gr-C: 18.2%, Gr-D: 40.7%, p<0.05). Conclusions: LHRs obtained from routine $^{99m}Tc-MIBI$ gated SPECT images were weakly correlated with LVEF and perfusion defect. Although significant overlaps were observed between normal and abnormal perfusion group, LHRs could be used as an indirect marker of severe perfusion defect or reduced left ventricular function.

Performance Evaluation of Siemens CTI ECAT EXACT 47 Scanner Using NEMA NU2-2001 (NEMA NU2-2001을 이용한 Siemens CTI ECAT EXACT 47 스캐너의 표준 성능 평가)

  • Kim, Jin-Su;Lee, Jae-Sung;Lee, Dong-Soo;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.3
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    • pp.259-267
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    • 2004
  • Purpose: NEMA NU2-2001 was proposed as a new standard for performance evaluation of whole body PET scanners. in this study, system performance of Siemens CTI ECAT EXACT 47 PET scanner including spatial resolution, sensitivity, scatter fraction, and count rate performance in 2D and 3D mode was evaluated using this new standard method. Methods: ECAT EXACT 47 is a BGO crystal based PET scanner and covers an axial field of view (FOV) of 16.2 cm. Retractable septa allow 2D and 3D data acquisition. All the PET data were acquired according to the NEMA NU2-2001 protocols (coincidence window: 12 ns, energy window: $250{\sim}650$ keV). For the spatial resolution measurement, F-18 point source was placed at the center of the axial FOV((a) x=0, and y=1, (b)x=0, and y=10, (c)x=70, and y=0cm) and a position one fourth of the axial FOV from the center ((a) x=0, and y=1, (b)x=0, and y=10, (c)x=10, and y=0cm). In this case, x and y are transaxial horizontal and vertical, and z is the scanner's axial direction. Images were reconstructed using FBP with ramp filter without any post processing. To measure the system sensitivity, NEMA sensitivity phantom filled with F-18 solution and surrounded by $1{\sim}5$ aluminum sleeves were scanned at the center of transaxial FOV and 10 cm offset from the center. Attenuation free values of sensitivity wire estimated by extrapolating data to the zero wall thickness. NEMA scatter phantom with length of 70 cm was filled with F-18 or C-11solution (2D: 2,900 MBq, 3D: 407 MBq), and coincidence count rates wire measured for 7 half-lives to obtain noise equivalent count rate (MECR) and scatter fraction. We confirmed that dead time loss of the last flame were below 1%. Scatter fraction was estimated by averaging the true to background (staffer+random) ratios of last 3 frames in which the fractions of random rate art negligibly small. Results: Axial and transverse resolutions at 1cm offset from the center were 0.62 and 0.66 cm (FBP in 2D and 3D), and 0.67 and 0.69 cm (FBP in 2D and 3D). Axial, transverse radial, and transverse tangential resolutions at 10cm offset from the center were 0.72 and 0.68 cm (FBP in 2D and 3D), 0.63 and 0.66 cm (FBP in 2D and 3D), and 0.72 and 0.66 cm (FBP in 2D and 3D). Sensitivity values were 708.6 (2D), 2931.3 (3D) counts/sec/MBq at the center and 728.7 (2D, 3398.2 (3D) counts/sec/MBq at 10 cm offset from the center. Scatter fractions were 0.19 (2D) and 0.49 (3D). Peak true count rate and NECR were 64.0 kcps at 40.1 kBq/mL and 49.6 kcps at 40.1 kBq/mL in 2D and 53.7 kcps at 4.76 kBq/mL and 26.4 kcps at 4.47 kBq/mL in 3D. Conclusion: Information about the performance of CTI ECAT EXACT 47 PET scanner reported in this study will be useful for the quantitative analysis of data and determination of optimal image acquisition protocols using this widely used scanner for clinical and research purposes.

Evaluation of Multiple System Atrophy and Early Parkinson's Disease Using $^{123)I$-FP-CIT SPECT ($^{123)I$-FP-CIT SPECT를 이용한 다중계위축증 및 조기 파킨슨병에서의 평가)

  • Oh, So-Won;Kim, Yu-Kyeong;Lee, Byung-Chul;Kim, Bom-Sahn;Kim, Ji-Sun;Kim, Jong-Min;Kim, Sang-Eun
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.1
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    • pp.10-18
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    • 2009
  • Purpose: We investigated quantification of dopaminergic transporter (DAT) and serotonergic transporter (SERT) on $^{123}I$-FP-CIT SPECT for differentiating between multiple systemic atrophy (MSA) and idiopathic Parkinson's disease (IPD). Materials and Methods: N-fluoropropyl-$2{\beta}$-carbomethoxy-$3{\beta}$-4-[$^{123}I$]-iodophenylnortropane SPECT ($^{123}I$-FP-CIT SPECT) was performed in 8 patients with MSA (mean age: $64.0{\pm}4.5yrs$, m:f=6:2), 13 with early IPD (mean age: $65.5{\pm}5.3yrs$, m:f=9:4), and 12 healthy controls (mean age: $63.3{\pm}5.7yrs$, m:f=8:4). Standard regions of interests (ROls) of striatum to evaluate DAT, and hypothalamus and midbrain for SERT were drawn on standard template images and applied to each image taken 4 hours after radiotracer injection. Striatal specific binding for DAT and hypothalamic and midbrain specific binding for SERT were calculated using region/reference ratio based on the transient equilibrium method. Group differences were tested using ANOVA with the postHoc analysis. Results: DAT in the whole striatum and striatal subregions were significantly decreased in both patient groups with MSA and early IPD, compared with healthy control (p<0.05 in all). In early IPD, a significant increase in the uptake ratio in anterior and posterior putamen and a trend of increase in caudate to putamen ratio was observed. In MSA, the decrease of DAT was accompanied with no difference in the striatal uptake pattern compared with healthy controls. Regarding the brain regions where $^{123}I$-FP-CIT binding was predominant by SERT, MSA patients showed a decrease in the binding of $^{123}I$-FP-CIT in the pons compared with controls as well as early IPD patients (MSA: $0.22{\pm}0.1$ healthy controls: $0.33{\pm}0.19$, IPD: $0.29{\pm}0.19$), however, it did not reach the statistical significance. Conclusion: In this study, the differential patterns in the reduction of DAT in the striatum and the reduction of pontine $^{123}I$-FP-CIT binding predominant by SERT could be observed in MSA patients on $^{123}I$-FP-CIT SPECT. We suggest that the quantification of SERT as well as DAT using $^{123}I$-FP-CIT SPECT is helpful to differentiate parkinsonian disorders in early stage.

Development of Supplemental Equipment to Reduce Movement During Fusion Image Acquisition (융합영상(Fusion image)에서 움직임을 줄이기 위한 보정기구의 개발)

  • Cho, Yong Gwi;Pyo, Sung Jae;Kim, Bong Su;Shin, Chae Ho;Cho, Jin Woo;Kim, Chang Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.2
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    • pp.84-89
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    • 2013
  • Purpose: Patients' movement during long image acquisition time for the fusion image of PET-CT (Positron Emission Tomography-Computed Tomography) results in unconformity, and greatly affects the quality of the image and diagnosis. The arm support fixtures provided by medical device companies are not manufactured considering the convenience and safety of the patients; the arm and head movements (horizontal and vertical) during PET/CT scan cause defects in the brain fundus images and often require retaking. Therefore, this study aims to develop patient-compensation device that would minimize the head and arm movements during PET/CT scan, providing comfort and safety, and to reduce retaking. Materials and Methods: From June to July 2012, 20 patients who had no movement-related problems and another 20 patients who had difficulties in raising arms due to shoulder pain were recruited among the ones who visited nuclear medicine department for PET Torso scan. By using Patient Holding System (PHS), different range of motion (ROM) in the arm ($25^{\circ}$, $27^{\circ}$, $29^{\circ}$, $31^{\circ}$, $33^{\circ}$, $35^{\circ}$) was applied to find the most comfortable angle and posture. The manufacturing company was investigated for the permeability of the support material, and the comfort level of applying bands (velcro type) to fix the patient's head and arms was evaluated. To find out the retake frequency due to movements, the amount of retake cases pre/post patient-compensation were analyzed using the PET Torso scan data collected between January to December 2012. Results: Among the patients without movement disorder, 18 answered that PHS and $29^{\circ}$ arm ROM were the most comfortable, and 2 answered $27^{\circ}$ and $31^{\circ}$, respectively. Among the patients with shoulder pain, 15 picked $31^{\circ}$ as the most comfortable angle, 2 picked $33^{\circ}$, and 3 picked $35^{\circ}$. For this study, the handle was manufactured to be adjustable for vertical movements. The material permeability of the patient-compensation device has been verified, and PHS and the compensation device were band-fixed (velcro type) to prevent device movements. A furrow was cut for head fixation to minimize the head and neck movements, fixing bands were attached for the head, wrist, forearm, and upper arm to limit movements. The retake frequency of PET Torso scan due to patient movements was 11.06% (191 cases/1,808 patients) before using the movement control device, and 2.65% (48 cases/1,732 patients) after using the device; 8.41% of the frequency was reduced. Conclusion: Recent change and innovation in the medical environment are making expensive medical image scans, and providing differentiated services for the customers is essential. To secure patient comfort and safety during PET/CT scans, ergonomic patient-compensation devices need to be provided. Therefore, this study manufactured a patientcompensation device with vertically adjustable ergonomic ROM according to the patient's body shape and condition during PET Torso scan. The defects in the basal ganglia images due to arm movements were reduced, and retaking was decreased.

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Performance State and Improvement Countermeasure of Primary Health Care Posts (보건진료소(保健診療所)와 업무실태(業務實態)와 개선방안(改善方案))

  • Park, Young-Hee;Kam, Sin;Han, Chang-Hyun;Cha, Byung-Jun;Kim, Tae-Woong;Gie, Jung-Aie;Kim, Byong-Guk
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.353-377
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    • 2000
  • This study was performed to investigate the performance state and improvement countermeasure of Primary Health care Posts(PHPs). The operation reports of PHPs(1996 330 PHPs, 1999 313 PHPs) located in Kyongsangbuk-Do and data collected by self-administered questionnaire survey of 280 community health practitioners(CHPs) were analyzed. The major results were as follows: Population per PHP in 1999 decreased in number compared with 1996. But population of the aged increased in number. The performance status of PHP in 1999 increased compared with 1996. A hundred forty one community health practitioners(50.4%) replied that the fiscal standing of PHP was good. Only 1.4% replied that the fiscal standing of PHP was difficult. For the degree of satisfaction in affairs, overall of community health practitioners felt proud. The degree of cooperation between PHP and public health institutions was high and the degree of cooperation of between PHP and private medical institutions was high. The degree of cooperation between PHP and Health Center was significantly different by age of CHP, the service period of CHP, and CHP's service period at present PHP. Over seventy percent of CHPs replied that they had cooperative relationship with operation council, village health workers, community organization. CHPs who drew up the paper on PHP's health activity plan were 96.4 % and only 11.4% of CHPs participated drawing up the report on the second community health plan. CHPs who grasped the blood pressure and smoking status of residents over 70% were 88.2%, 63.9% respectively and the grasp rate of blood pressure fur residents were significantly different according to age and educational level of CHP. CHPs received job education in addition continuous job education arid participated on research program in last 3 years were 27.5%, respectively. CHPs performed the return health program for residents in last 3years were 65.4%. Over 95% of CHPs replied that PHPs might be necessary and 53.9% of CHPs replied that the role of PHPs should be increased. CHPS indicated that major reasons of FHPs lockout were lack of understanding for PHP and administrative convenience, CHPs were officials in special government service governors intention of self-governing body. CHPs suggested number of population in health need such as the aged and patients with chronic disease, opinion of residents, population size, traffic situation and network in order as evaluation criteria for PHP and suggested results of health performance, degree of relationship with residents, results of medical examination anti treatment, ability for administration and affairs in order as evaluation criteria for CHP. CHPs replied that the important countermeasures for PHPs under standard were affairs improvement of PHPs and shifting of location to health weakness area in city. Over 50% of CHPs indicated that the most important thing for improvement of PHPs was affairs adjustment of CLIP. And CHPs suggested that health programs carried out in priority at PHP were management of diabetes mellitus and hypertention. home visiting health care, health care for the aged. The Affairs of BLIP should be adjusted to satisfy community health need and health programs such as management of diabetes mellitus and hypertention, home visiting health care, health care for the aged should be activated in order that PHPs become organization reflecting value system of primary health care.

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