종단으로 짧은 횡단성척수염의 임상적, 진단검사, 자기공명영상, 전기 생리학적 소견 : 종단으로 광범위한 횡단성척수염과의 비교연구

권석범 순천향대학교 2011 국내박사

배경 및 목적 급성횡단성척수염은 운동마비, 감각이상, 자율신경계 기능이상 등의 증상을 일으키는 척수에 생기는 부분적 염증성 질환이다. 종단으로 광범위한 횡단성척수염은 척수MRI에서 3개 이상의 척수분절을 침범하는 광범위한 척수병변을 보이는 증후군이다. 서양에서는 종단으로 광범위한 횡단성척수염이 있는 경우 전형적인 다발성경화증은 매우 드물며 시신경척수염의 특징적인 소견의 하나로 간주하게 되며 국내의 한 연구에서도 종단으로 광범위한 횡단성척수염은 재발성척수염이나 시신경척수염의 소견으로 받아들여진다. 반면, 종단으로 짧은 횡단성척수염은 척수MRI에서 3개 미만의 척수분절을 침범하는 짧은 척수병변을 보이는 증후군으로 국내에서 임상적, 검사실 검사, 신경생리학 검사, 신경영상학적 소견에 대한 이해가 부족하다. 이 연구의 목적은 종단으로 짧은 횡단성척수염 환자와 종단으로 광범위한 횡단성척수염 환자의 기초 자료, 임상 소견, 검사실검사 소견, 영상학적 소견을 비교하여 종단으로 짧은 횡단성척수염을 이해하는 것이다. 대상 및 방법 특발성급성횡단성척수염의 진단은 횡단성척수염 컨소시엄 작업그룹 기준(2002)에 따랐다. 처음으로 특발성급성횡단성척수염으로 진단된 모든 환자는 추적관찰기간을 거쳐 4가지의 최종진단인 단발성척수염, 재발성척수염, 시신경척수염, 다발성경화증으로 구분하였다. 단발성척수염은 특발성급성횡단성척수염이 단 1회 병발한 경우로 다른 중추신경계에 임상적 혹은 영상학적으로 침범된 증거가 없는 경우로 하였다. 재발성척수염은 특발성급성횡단성척수염의 첫 증상발현 이후로 1회 이상의 횡단성척수염의 병발이 있었던 경우로 정의하였다. 시신경척수염의 진단은 Wingerchuck 등에 의해서 제안된 기준(2006)에 따랐으며, 다발성경화증의 진단은 2005년에 개정된 McDonald 기준에 따랐다. 특발성급성횡단성척수염 환자를 종단으로 짧은 횡단성척수염 환자와 종단으로 광범위한 횡단성척수염 환자로 구분하여 두 군으로 나누었고, 이 양군의 나이, 성별, 재발여부, 임상소견, 최종진단, 추적관찰 중 마지막 방문시의 장애등급, 뇌척수액검사소견, 신경생리검사소견, 신경영상소견을 비교하였다. 결과 2005년 1월부터 2009년 12월까지 처음으로 특발성급성횡단성척수염으로 진단되어 한림대 의료원에서 입원치료를 실시한 연속적인 환자 63명을(남자/여자, 29/12, 종단으로 짧은 횡단성척수염 환자: 41명)를 대상으로 하였다. 추적관찰기간은 48주 – 122주(평균 30.5 개월)였다. 종단으로 짧은 횡단성척수염 환자군과 종단으로 광범위한 횡단성척수염 환자군의 최종진단의 분포는 의미 있는 차이를 보였다(P=0.003). 추적관찰기간 마지막에 결정된 종단으로 짧은 횡단성척수염군의 최종진단은 단발성척수염이 21명(51.2%), 재발성척수염이 5명(12.2%), 다발성경화증이 15명(36.6%)이었고 시신경척수염은 없었다. 종단으로 광범위한 횡단성척수염군의 최종진단은 단발성척수염이 8명(36.4%), 재발성척수염이 7명(31.8%), 시신경척수염이 4명(18.2%), 다발성경화증이 3명(13.6%)이었다. 종단으로 짧은 횡단성척수염은 근력저하는 덜 심했지만 의미 있지는 않았다(P=0.054). 종단으로 짧은 횡단성척수염은 괄약근 이상증상이 심하지 않았고(P=0.001) 마지막 방문시 실시한 장애상태도 덜 심했다(EDSS, 2.8 vs 5.6, P=0.001). 자기공명영상소견에서, 종단으로 짧은 횡단성척수염군은 종단으로 광범위한 횡단성척수염군에 비해 주로 외측이나 후측에 국한된 병변을 보였고(68.3% vs 13.6%, P=0.0001), 조영증강병변이 있는 경우가 더 적었으며(58.5% vs 95.5%, P=0.003), T1강조영상에서 저음영 병변도 없었다(0% vs 13.6%, P=0.039). 뇌MRI에서 양군의 차이는 없었지만, 종단으로 짧은 횡단성척수염군에서 뇌병변이 더 많은 경향은 있었다(LSTM: 46.3%, LETM: 22.7%). 뇌척수액검사 소견, 시각유발전위검사와 체성감각유발전위검사는 양군에서 차이가 없었다. 올리고클론띠는 양군에서 모두 음성이었으며, 항시신경척수염 항체는 12명중에서 3명이 양성을 모였고 이 3명은 모두 종단으로 광범위한 횡단성척수염군이었고 시신경척수염으로 최종진단 되었다. 결론 급성횡단성척수염의 원인은 임상소견, 척수와 뇌MRI, 뇌척수액검사 소견에 따라 감별이 되며 결국 이전에 특발성급성횡단성척수염 환자에게 최종 진단이 부여된다. 또한, 이러한 급성횡단성척수염 환자는 종국에 보다 특수한 질환으로 판명되느냐의 결정은 시간을 두고 추적관찰을 하는 것이 필요하다. 처음으로 진단된 특발성급성횡단성척수염 환자를 척수MRI상 침범된 척수분절의 길이에 따라 나누어 진행하는 진단적 접근을 통하여, 저자는 종단으로 짧은 횡단성척수염이 종단으로 광범위한 횡단성척수염과 임상소견, 장기적 경과, 검사실소견, 신경영상소견에서 차이가 있음을 알 수 있었다. 이러한 소견들은 종단으로 짧은 횡단성척수염 또는 종단으로 광범위한 횡단성척수염을 가지고 있는 국내 급성횡단성척수염환자의 진단과 치료에 대한 예측에 도움을 줄 수 있을 것이다. Background and purpose Acute transverse myelitis (ATM) is a focal inflammatory disorder of the spinal cord, resulting in motor, sensory, and autonomic dysfunction. Longitudinally extensive transverse myelitis (LETM) is a syndrome showing extensive spinal cord lesions on MRI, involving three or more vertebral segments. It is rare in patients with typical multiple sclerosis (MS) in Western countries and is also regarded as a characteristic feature of neuromyelitis optica (NMO) in Western countries or recurrent myelitis in Korea. On the contrary, longitudinally short transverse myelitis (LSTM), a syndrome showing short spinal cord lesions on MRI, involving less than three vertebral segments is not fully understood for clinical features, laboratory findings, and MR findings in Korea. The aim of this study was to describe the demographic, clinical, laboratory, and neuroradiologic features of Korean patients with LSTM or LETM. Material and Methods The diagnosis of idiopathic ATM was based on the Transverse Myelitis Consortium Working Group criteria (2002). All ATM Patients were finally classified into four subgroups, depending on their clinical course: monophasic ATM, recurrent myelitis, NMO, and MS. Monophasic ATM refers to the disease with only one clinical attack of ATM and with no clinical or radiological evidence of other CNS lesions. Recurrent myelitis was defined as one or more clinical attacks of transverse myelitis after the first-ever ATM. The NMO diagnosis was based on the criteria proposed by Wingerchuck et al. (2006), and MS was diagnosed using the revised McDonald criteria (2005). We retrospectively analyzed the patient demographics, final diagnoses, clinical impairment at the last clinical visit, ancillary tests including cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), evoked potentials of Korean patients with LSTM or LETM. Results We identified 63 patients (LSTM = 41 (M/F, 29/12); LETM = 22 (M/F, 11/11)) with a first-ever transverse myelitis admitted to our institution from January 2005 to December 2009. The follow-up time ranged from 48 to 122 weeks (mean follow-up 30.5 months). The final diagnoses of first-ever ATM between LSTM and LETM were different (P = 0.003): 21 monophasic myelitis (51.2%), 5 recurrent myelitis (12.2%), no NMO, and 15 MS (36.6%) in LSTM group; 8 monophasic myelitis (36.4%), 7 recurrent myelitis (31.8%), 4 NMO (18.2%), and 3 MS (13.6%) in LETM group. LSTM showed less but not significant motor impairment (P = 0.054). LSTM revealed less severe sphincter dysfunction (P = 0.001) and less severe disability (i.e., lower expanded disability status scale (EDSS) on the last clinical visit, 2.8 vs 5.6, P = 0.001) than LETM. On the MR features, LSTM showed more limited lateral or posterior patterns (68.3% vs 13.6%, P = 0.0001), less contrast enhanced lesions (58.5% vs 95.5%, P = 0.003), no low signal in T1 weighted images (0% vs 13.6%, P = 0.039) than those of LETM. Brain MRI lesions were not different significantly between LSTM and LETM groups, but there was a tendency of more brain MRI abnormalities at LSTM group (LSTM: 46.3%, LETM: 22.7%). CSF study including pleocytosis, protein, and IgG index and visual and somatosensory evoked potentials showed no difference between groups. Oligoclonal bands were all negative at both groups. Three of 12 patients (all with NMO and LETM) were seropositive for anti-NMO antibodies. Conclusion Etiologies of ATM may be differentiated on the basis of clinical, spinal cord and brain MRI, CSF and outcome data, and allow a final diagnosis to be made in previously idiopathic cases. In addition, this ATM patient needs to be monitored over time to determine whether this syndrome will eventually be incorporated within a diagnosis of a more specific disease. Through an approach of a first-ever idiopathic ATM patients via vertebral segment lesion length on spinal MRI, we can find LSTM is different from LETM for clinical findings, long term outcomes, laboratory and neuroradiological findings. These findings may have diagnosic and therapeutic implications for Korean ATM cases with LSTM or LETM.

노인 생활 체육 참여자의 중도포기 원인 분석

권석범 우석대학교 2009 국내석사

ABSTRACT The Analysis Dropout out cause of Elderly's Participation in Sport for all Kwon, Seok-Beom Department of Physical Education Graduate School of Education Woosuk University The research which it sees dropout out factor of Elderly's participation in Sport for all is the research against. The elderly's above 65year where it is living in electrification in executed a question investigation in the object. In order to examine difference of the dropout out cause which it follows in the sociodemographic and participation in sport for all it executes t-test and one way ANOVA, In order to know participation of participation in sport for all and dropout out cause it executed correlation and it drew the next conclusion. Frist, Limit of motion participation the man appears more highly the woman than(p<.05), According to occupational presence the elderly's is not occupation appears dropout out cause highly(p<.05), According to age elderly's above 81year dropout out cause appears with the low-end thing(p<.05), Subjective health and the allowance satisfaction is healthy from finance cause and health status cause and it appears with the low-end thing(p<.001). Second, Respects a leisure activity elderly's where it participates to a sports for all dropout out cause appears with the low-end thing(p<.01), Week 1 time elderly's where it participates finance cause and health status cause appears with the low-end thing(p<.01), Above 2years elderly's where it dropout out cause appeared with the fact that the dropout out duration is high(p<.001). Third, Correlation of sports for all and dropout out duration and motivation appears with the fact that from dropout out cause it is correlation with direction of affirmation(p<.01), From participation frequency from A and B correlation appeared with direction affirmation(p<.05).

Abrasive wire electrochemical discharge machinining of glass

권석범 연세대학교 대학원 2015 국내석사

Electrochemical discharge machining (ECDM) is a noncontact machining method that utilizes the thermal energy of spark discharge. ECDM has been used to machine nonconductive brittle, hard materials, such as glass because of its high quality machined surface. However, the low cutting speed of ECDM has limited its application in industrial processes. In industry, abrasive wire (AW) cutting has a higher machining speed than ECDM; however, the machined surface quality produced with AW cutting is several orders of magnitude worse than that using ECDM. In this paper, a machining process that combines AW cutting and ECDM was proposed (AW-ECDM). The experimental setup consisted of a power supply with a transistor circuit, an electrolyte tank, and a wire-guiding device; the wire-guiding device was added to an existing AW cutting machine. The AW was used as the ECDM electrode in the hybrid process. The experimental results of cutting a glass workpiece using AW-ECDM were compared with the conventional AW cutting and ECDM processes. Finally, pulsed power was applied to AW-ECDM to further smooth the machined surface. Experimental results with pulsed power demonstrated a significant improvement in the quality of the machined surface for a specific value of the duty ratio.

신용위험관리의 실태와 개선방안

권석범 전북대학교 경영대학원 2002 국내석사

당뇨병 환자의 신경병증에서 관찰되는 탈수초기화의 전기생리학적 소견

權錫範 한림대학교 1999 국내석사

Background & Objectives : Diabetic neuropathy is a common complication of diabetes mellitus and one of the most common neuropathies worldwide. The pathogenesis of diabetic neuropathy is unknown, but it is generally ascribed to a complex interaction sequelae of chronic hyperglycemia. Although pathologic studies show both segmental demyelination and axonal loss, the relative importance of segmental demyelination is debated. Conduction block(CB) is a physiologic hallmark of segmental demyclination. If segmental demyelination were a main pathology of neuropathy with diabetes, CB should be common. So we undertook this study to determine the prevalence of CB in diabetic patients. Methods : Fifty-two consecutive diabetic paticnts(M=30, F=22, mean age=57.3±0.9 years).referred to Neurology EMG laboratory underwent routine nerve conduction studies(NCS) including median, ulnar, peroneal, and posterior tibial nerves. Conduction block was defined by two methods. One was > 20% drop in peak-to-peak amplitude and < 15% change in negative-peak duration between proximal and distal stimulation sites. The other was > 50% drop in the amplitude and area. Clinical findings, electrophysiological data, and effectiveness of anti-immune therapy for some patients with CB were reviewed. Results : A total 326 nerves were studied. The criteria for 20% and 50% CB were met in 35 nerves in 19 patients and 7 nerves in 6 patients, respectively(prevalence=10.7%, 2.1%, respectively). Some patients with CB were treated with IVIG or steroid and had a good response. Conclusion : CB in neuropathy with diabetes is not a common finding. The rarity of CB in neuropathy with diabetes suggests that segmental demyelination is not a prominent part of the underlying pathology. CB and good responsiveness to anti-immune therapy in neuropathy with diabetes also suggest alternative or additional causes for neuropathy, such as chronic inflammatory demyelinatiog polyneuropathy.

하와이, 빅 아일랜드의 푸 오오 분출 용암에 대한 암석학적 연구

권석범 경북대학교 대학원 2008 국내석사

The Puu Oo eruption in Hawaii since 1983 is one of the largest eruptions on Hawaii's volcanic history with prominent compositional variation(5.6~10.1wt.% in MgO content). Although intense researches of Hawaiian eruption have been conducted for recent years, there is no up-to-date study on Puu Oo lavas that is erupting hot lavas today. in oder to obtain basic information on the geological characteristics of the eruption including any noticeable change in its petrological trend and magma dynamics, we applied several geological approaches such as field survey, systematic sampling, petrography, mineralogy, and geochemistry. Clinopyroxene and Plagioclase phenocrysts are rarely observed on the thin section, however Olivine crysts are much more obvious in the study area. It indicates that Puu Oo is early stage of magma differentiation. Variation diagram of whole rock composition shows that the elements such as TiO2, Al2O3, SiO2 and Na2O decrease with increasing MgO. In the trace element Sr, Y, Zr and V versus K2O, P18, P19 samples are plotted in primitive area. Variations of the Ni contents during 2003~2006 may suggest a sudden change in magma composition probably caused by new magma injection.

기록 채널에 적응 가능한 PRML 방법 및 구현

권석범 東國大學校 大學院 2002 국내석사

Conventional PRML(partial response maximum likelihood) detector is designed under assumption that we know the priori knowledge corresponding to channel. Proposed PRML detector has the ability to adapt channels using PR equalizer and selected target polynomial of the Viterbi detector. The PR equalizer is applied to adaptive technique and selected target polynomial is decided by PRML detector with minimum error rates. Also, We use the quantization concept to simulate for hardware implementation. These are verified by computer simulation. In the end, the PR equalizer is programmed by CPU(8051 micro controller) and the Viterbi detector is implemented by FLEX chip coded in VHDL.

Abrasive wire electrochemical discharge machining of glass

권석범 Graduate School, Yonsei University 2015 국내석사