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류마티스 관절염의 질병 활성도 결정에 있어서 손목 자가공명영상의 유용성
김효열 ( Hyo Youl Kim ),김진안 ( Jin An Kim ),이수곤 ( Soo Kon Lee ),홍천수 ( Chein Soo Hong ),서진석 ( Jin Suck Suh ) 대한류마티스학회 1995 대한류마티스학회지 Vol.2 No.1
연구목적: 다양한 경과와 예후를 보이는 만성 염증성 다관절 질환인 류마티스 관절염에서 질병 경과와 치료 반응 정도를 결정하는 객관적인 기준이 필요하다. 최근 자기공명영상이 류마티스 관절염에서 병변의 염증 상태와 골의 미란성 병변을 관찰하는데 유용한 것으로 소개도어지고 있어 저자 등은 류마티스 관절염 환자에 있어서 자기공명영상 촬영이 질병 활성도를 반영할 수 있는지 여부와 그 유용성을 알아보고자 하였다. 대상 및 방법: 1992년 7월부터 연세의료원 류마티스 크리닉에서 추적 관찰 중인 15명의 류마티스 관절염 환자를 대상으로 손목관절의 일반 방사선 촬영과 여러 촬영기법의 자기공명영상 촬영을 시행하여 미란의 수를 관찰한 미란점수를 방사선 지표로 질병 활동도와 연관이 있는 것으로 알려진 임상 및 검사실 지표와 상관관계를 검정하였다. 결과: 손목관절의 미란점수로 나타낸 방사선 지표가 일반 방사선영상과는 달리 자기공명영상에서 적혈구침강속도 및 혈청 IgG와 유의한 상관관계를 보였다(p<0.05). 그러나 이 지표는 환자의 주관적 통증평가와 의사의 임상 평가인 손의 악력, Ritchie 지수 등과 연관성이 없었다. 자기공명영상은 특히 초기 류마티스 관절염에서 일반 방사선영상에는 관찰되지 않는 골 미란까지 관찰할 수 있어 유용하였고, 자기공명영상의 촬영방법으로 지방신호 억제 T2 강조영상 조영증강영상이 일반 방사선 촬영보다 우월하였다(p<0.05). 결론: 현재로서는 높은 비용과 긴 촬영시간이 제한점이 되고 있지만 앞으로 이런 문제만 해결된다면 손목 자기공명영상은 류마티스 관절염의 질병 활성도 측정에 유용하게 사용되어질 수 있으며, 더 나아가서는 약물의 치료효과 판정에도 도움을 얻을 수 있을 것으로 추측한다. Objective: To investigate whether the findings of wrist magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) is representative of their disease activity. Methods: MRI and plain radiographs were performed on the wrists of 15 patients with RA. Four MRI techniques were used; T1 weighted spin echo image (T2WI), chemical fat suppression T2 weighted image (FS-T2WI) and Gadolinium-DTPA contrast enhanced T1 weighted image (CE-T1WI). Erosion scores used as radiologic index were calculated from total counts of bone erosion in all coronal planes of wrist MRI and plain radiographs. This erosion score was compared with the clinical indices (Ritchie index, grip strength, visual analogue pain scale) and laboratory indices (ESR, CRP, hemoglobin, immunoglobulins). Results: MRI erosion score of the wrist in patients with RA significantly correlated with ESR and serum IgG level, but did not correlate with global clinical indices such as grip strength and Ritchie index. MRI was especially useful in early detection of erosive bone change. Special MR images such as fat suppres-sion and Gd-DTPA enhanced images were superior to plain radiographs and conventional MR images in detecting the erosive lesion of carpal bones. Conclusions: Wrist MRI is useful in early detection of erosive bone change and may be an important tool for the measurement of disease activity in RA. We prospect that it could be used to assess the progression of the disease and the response of drug therapy.
소성 후 주수냉각한 폐 벤토나이트의 포졸란 반응성에 관한 실험적 연구
김효열(Kim Hyo-Youl),강병희(Kang Byeung-Hee) 대한건축학회 2003 大韓建築學會論文集 : 構造系 Vol.19 No.3
This study is the fundamental report to propose the capability of discarded Bentonite that is cooled by using water after heat-treatment as concrete mineral admixture. The experiments such as pozzolan reaction test and mortar test are excuted. As a result of pozzolan reaction test, discarded Bentonite reveals pozzolan reaction capability by heat-treatment, and especially, pozzolan reaction ability of discarded Bentonite is superior in the situation of 500℃∼700℃?60min. As a result of mortar test, compressive strength of mortar using discarded Bentonite by heat-treatment is superior in the case of 500℃, 600℃, 700℃?60min to plain mortar. Especially, in the case of 600℃?60min, as strength activity index is measured at 114%, it can be applied to concrete mineral admixture. But, flow of mortar using discarded Bentonite by heat-treatment is decreased.
Cortisone이 Generalized Shwartzman Reaction에 미치는 영향
김효열(Hyo Youl Kim),최승옥(Seung Ok Choi),한병근(Byoung Geun Han),이광훈(Kwang Hoon Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2
N/A A generalized Shwartzman reaction(gSr) is characterized by vascular injury with microvascular fibrin deposition, leukocyte aggregation and hemorrhagic lesions in various organs and elicited by endotoxin from gram-negative bacteria. Leukocyte adherence to endothelial cells has been regarded as a pivotal event in this type of neutrophil mediated inflammatory response. Recently, it was described that leukocyte adhesion to endothelium is facilitated by the adhesion molecules, such as LFA-1(CDIIa/CD18) or Mac-1 (CDllb/CD18) binding to intercellular adhesion mole-cule-1(ICAM-1). To investigate the role of cell adhesion molecules in inflammatory vascular injury, the authors examined the expression of cell adhesion molecules, ICAM-1 and CD18, in gSr. Group A(n=5) received two injections of lipopolysaccharide(LPS) from E. coli 055:B5; 200μg/kg and 200μg/kg 24hours apart. Group B(n=5) received one dose of LPS(200μg/l) after glucocorticoid treatment(methylprednisolone, 25mg/kg/ day). Group C(n=5) received single dose of LPS(200μg/kg). The control group(n=3) received two injec-tions saline instead of LPS. Animals were sacrificed four hours after the last dose of LPS or saline, The results were as follows ' 1) Group A and B showed numerous fibrin micro-thrombi, inflammatory cell infiltration and some he-morrhagic change in kidney and lung, but group C and the control group did not show any lesions. In kidney the degree of fibrin deposition by IF was significantly increased in group A and B when compared to group C(p<0.05). 2) ICAM-1 was expressed by vascular endothe-lium including glomerular capillaries and some lym-phocytes in the control group, This expression was increased in group C. But, group A and B was significantly decreased in ICAM-1 expression, especially in kidney comparing with group C and the control group(p<0.05). 3) Group A and B were significantly increased in CD18 expressing cells in glomerulus when compared with the control group(p<0.05). The number of CD18 expressing cells in glomerulus correlated significantly with a degree of fibrin deposition. In conclusion, these results suggest that the development of gSr requires the adhesion of activated inflammatory cells especially neutrophils to vascular endothelium and these are achieved by the interaction of adhesion molecules like ICAM-1 and CD18. Re- placing the LPS with a glucocorticoid also expressing ICAM-1 on endothelium and prepares for leukocyte adhesion to endothelium.
국가필수예방접종 보장범위 확대 시범사업의 정책 내용분석 -국가필수예방접종 공급방식을 중심으로-
김춘배 ( Chun Bae Kim ),안양희 ( Yang Heui Ahn ),차병호 ( Byung Ho Cha ),김효열 ( Hyo Youl Kim ),이석구 ( Sok Goo Lee ),이중정 ( Jung Jeung Lee ),박혜숙 ( Hye Sook Park ),신택수 ( Taek Soo Shin ),현숙정 ( Sook Jung Hyun ),고운영 ( 한국보건행정학회 2008 보건행정학회지 Vol.18 No.3
The purpose of this study was to evaluate comparatively the content of the Expanded National Immunization Program according to the provision method between 2005 and 2006 in Korea. We assessed the impact of the mutually exclusive vaccination policy using the result reports of the 2005 and 2006 Demonstration Project and the related references by the content analysis. The public health centers paid vaccination fees to the private clinic and hospital in the 2005 Demonstration Project in Daegu metropolitan city and Gunpo city. But, the public health centers directly supplied free vaccination services to the children in the 2006 Demonstration Project in Gangneung city, Yangsan city, and Yeongi-gun. The total budgets of 2005 and 2006 Demonstration Project were 6.57 billion won and 0.65 billion won, respectively. The computerized registration rates and timeliness rates of administration of each vaccination had improved all in the 5 Demonstration Project regions. However, the computerized registration rates of most vaccination in Gunpo city were higher than those in the 2006 Demonstration Project regions except hepatitis B. Especially, the computerized registration rate of BCG was 48.3%, but the BCG coverage rate by the follow-up telephone survey was 99.8% in Daegu metropolitan city. The community parents in all the regions were satisfied because of expanding financial and geographical access to immunization coverage. In conclusions, from the aspect of the main outcomes, the implementation of two different financial immunization aids appears to be widely accepted among these parents and to have had an impact on vaccination coverage. In the future, the government must try to enact that the national immunization policy including under-immunised or incompletely immunised groups would be achieved by the affordable method of the public-private dynamics.