병원 전 심정지의 원인으로써 거미막밑 출혈과 관련된 인자

오지열,오성찬,조석진,김혜진,강태경,류석용 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.3

Purpose: Subarachnoid hemorrhage (SAH) is a common cause of out-of-hospital cardiac arrest (OHCA). Early identification of patients with SAH induced OHCA may be helpful to emergency physicians when making therapeutic decisions. We conducted an investigation of the incidence and characteristics of patients with OHCA caused by non-traumatic SAH. Methods: We conducted a retrospective review of cases of 236 OHCA survivors who had visited the emergency department (ED) of an urban tertiary care university hospital from January 2004 to December 2010. We excluded patients for whom there was an obvious cause or trauma. Clinical characteristics of SAH induced OHCA survivors were compared with those of SAH negative OHCA survivors. Results: A total of 26 patients (19.11%) had been diagnosed with SAH. Compared with SAH negative survivors,SAH positive survivors were more likely to be female (odds ratio OR, 1.262; 95% confidence interval CI, 1.300-9.605),not to have Diabetes mellitus (OR, 0.180; 95% CI, 0.037-0.879), and to have a short duration of CPR time (OR,1.074; 95% CI, 1.003-1.150). Results of the Cardiac Troponin T assay were less likely to be positive in patients with SAH induced OHCA, compared to those with SAH negative OHCA (OR, 0.071; 95% CI, 0.008-0.526). Conclusion: SAH is a more frequent cause of OHCA than originally believed. Immediate brain CT scan is useful in diagnosis of SAH when patient characteristics include:female, non diabetes mellitus, short duration of CPR time,or negative TnT.

급성 거미막하 출혈의 진단: FLAIR MR영상과 조영전 CT와의 비교

최원진,최대섭,김정혜,김순,이현경,오연희,김승현,이성우,김욱년,이규춘,Choi, Won-Jin,Choi, Dae-Seob,Kim, Joung-Hae,Kim, Soon,Lee, Hyeon-Kyeong,Oh, Yoen-Hee,Kim, Seung-Hyeon,Lee, Sung-Woo,Kim, Wook-Nyeon,Lee, Kyu-Chun 대한자기공명의과학회 2001 Investigative Magnetic Resonance Imaging Vol.5 No.2

목적 : 급성 거미막하 출혈의 진단에 있어 CT와 비교하여 fluid-attenuated inversion-recovery (FLAIR) MR영상의 유용성을 평가하고자 하였다. 대상 및 방법 : 증상 발생 3일 이내에 비조영 CT와 FLAIR MR영상을 모두 얻었던 28명의 급성 지주막하 출혈 환자를 대상으로 하였다. 거미막하 공간을 피질구, 실비우스열구, 기저조, 후두와의 4부위로 나누어 각 부위 별로 CT와 FLAIR영상에서 출혈이 보이는 정도를 0(출혈 없음), 1(출혈 의심), 2(뚜렷한 출혈)의 점수로 구분하여 평가하였다. 또한 이들 28명 환자와 대조군 35명의 FLAIR영상을 비교하여 거미막하 공간의 고신호 강도를 기준으로 출혈의 유무를 판정할 경우, FLAIR영상의 민감도, 특이도 및 진단적 정확도를 평가하였다. 결과 : FLAIR영상에서 급성 거미막하 출혈은 모든 환자에서 뇌척수액이나 뇌 실질보다 고신호 강도를 보여 100%의 발견율을 보였다. CT와 비교하여 피질구($1.11{\pm}0.80$ vs $0.70{\pm}0.83$: p(0.05)와 후두와($1.41{\pm}0.74$ vs $0.78{\pm}0.80$: p(0.05)에서 FLAIR영상이 CT보다 통계적으로 유의하게 우수하였다 FLAIR영상에서 거미막하 공간의 고신호 강도를 기준으로 거미막하 출혈 유무를 평가한 결과에서 100%의 민감도, 특이도 및 진단적 정확도를 보였다. 결론 급성 거미막하 출혈의 진단에 FLAIR MR영상은 매우 유용하며, 특히 출혈의 양이 소량인 경우와 후두와의 출혈을 진단하는데 CT보다 우수하다. Purpose : Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. Materials and methods ; We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. Results : FLAIR MR image was superior to CT in detecting SAH in the posterior fossa ($1.41{\pm}0.74{\;}vs{\;}0.78{\pm}0.80$; p<0.05) and cortical sulci ($1.11{\pm}0.80{\;}vs{\;}0.70{\pm}0.83$; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. Conclusion : FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.

원효와 혜능의 사바즉정토(娑婆卽淨土)

김영미 동아시아불교문화학회 2019 동아시아불교문화 Vol.0 No.40

Sattva have lived in the sahā world filled with endless sufferings. However, Buddha considered this sahā as the utmost bliss. This paper will examine how the sahā world can be taken as the utmost bliss. To contemplate this, you firstly need to figure out what the pure land is and secondly the way to convert the sahā into the pure land. First, if you look at what kind of world sahā and pure land are, the defiled world will be built upon if Avidyā is pursued in the one mind and the pure land will be constructed if initial enlightenment is accompanied. Wonhyo elucidates the foundation of the pure land as the differing characteristics in the two worlds, explaining the same characteristics for the fact that the sense-realms are identical to enlightenment, the fact that enlightenment is the same as the sense-realms, the fact that consciousness is the same as enlightenment to demonstrate that the sahā is the pure land. Second, as for the way to transform the sahā into the pure land, you can get an answer for that in Huineng's assertion that the afflictions are bodhi, that is, the sahā is the pure land. He preaches in detail regarding Sattva with three categories teaching and practice for attaining the Buddhahood and advises them to achieve the stage of clearly penetrating inside and out which is bright but inside and out are not separate. If you have a pure and right mind, your mind is nirvana and the sahā is the pure land. If you abolish your afflictions with wisdom-cognition, you can accomplish the stage in which the conventional truth is the absolute truth. If you're bereaved of form with form, the afflictions are bodhi. On the contrary, if you're attached to it, bodhi is the afflictions. Huineng suggests the wisdom of non-discrimination free from dualistic extremes for the method to annihilate attachment. In this way, Wonhyo and Huineng explain how to convert the mundane world into the pure land. 중생들은 고(苦)가 끊임없는 사바세계(娑婆世界)에서 살고 있다. 그러나 같은 장소인 이 사바가 붓다는 극락(極樂)이라고 했다. 본 논문에서는 사바세계를 어떻게 극락으로 만들 수 있는가를 고찰하려고 한다. 그렇게 하기 위해서는 첫째는 정토(淨土)란 어떤 세계를 말하는지 알아야 하고, 둘째는 사바세계를 정토세계로 만드는 방법을 알아야 한다. 첫째, 사바와 정토가 어떤 세계인지를 살펴보면, 일심(一心)에서 무명(無明)을 따르면 예토(穢土)가 이루어지고, 시각(始覺)을 따르면 정토(淨土)가 나타난다. 원효는 이 두 세계의 부동상(不同相)을 설명하면서 정토의 성립 근거를 밝히고, 동상(同相)을 경동각(境同覺)․각동경(覺同境)․식동각(識同覺)으로 설명하면서 ‘사바즉정토(娑婆卽淨土)’임을 논증하고 있다. 둘째, 사바를 정토로 만드는 방법에 대해서는, 혜능이 ‘번뇌즉보리(煩惱卽菩提)’라고 하여 ‘사바즉정토’를 설하기 때문에 여기에서 답을 찾을 수 있다. 혜능은 삼과법문(三科法門)으로 중생에 대해 자세히 설하고, 안과 밖이 둘이 아닌 밝은 내외명철(內外明徹)의 경지를 이루라고 한다. 마음이 청정하고 바르면 ‘마음즉피안’이므로 ‘사바즉정토’가 이루어진다. 반야(般若)의 지혜(智慧)로서 번뇌를 여윈다면 곧 보리이므로, ‘번뇌즉보리’가 가능하다. 상(相)에 상을 여의면 번뇌가 바로 보리이나, 집착하면 보리가 번뇌이다. 집착을 여의는 방법으로 혜능은 불이(不二)의 관점인 무분별지(無分別智)를 제시한다. 이렇게 원효와 혜능은 현실세계를 정토화하는 방법을 설명하고 있다.

자발성 뇌지주막하출혈 환자에서 Cardiac Troponin Ⅰ를 이용한 심근손상의 발생율

김용권,류진호,소정일,문원식,전병조,허탁,민용일 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patients with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). Methods : A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. Results : Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). Conclusion : The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.

원인불명의 자발성 뇌지주막하 출혈의 치료대책

조철민,김형동,김기욱,최휴진,김규홍 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

It is well Known that the prognosis of spontaneous SAH(subarachnoid hemorrhage) of undetermined cause is generally favorable. Yet. the natural history and pathogenesis of SAH of undetermined cause remain controversial and patients management is largely empirical. 42 cases of non-traumatic SAH of undetermined cause of a total of 415 cases of SAH treated during a 5-year period(1991-1996) were available for this stydy. What should be done when angiography is negative after SAH? This study was undertaken to present a more definitive menagement in preventing rebleeding after SAH of undetermined cause. This study show that explorative craniotomy for aneurysmal operation is warranted. despite negative cerebral panangiograms. if the patient manifests the classical signs and symptoms of SAH and definite subarachnoid blood in CT(computed tomogram) or durect kynbar oybctyre and any suspicious lesions in cerebral panangiography. particularly the ACoA(anterior communicating artery) region.

The Incidence of Aneurysmal Subarachnoid Hemorrhage in Youngdong District, Korea

Lee, Hyoung-Soo,Kim, Young-June,You, Seung-Hoon,Jang, Yeon-Gyu,Rhee, Woo-Tack,Lee, Sang-Youl The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.42 No.4

Objective : The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. Methods : From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: $54.8{\pm}13.1$ years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. Results : In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: $54.9{\pm}13.2$ years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was $7.8{\pm}1.7$, $10.5{\pm}2.7$, and $9.1{\pm}2.1$ per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was $8.8{\pm}1.4$, $11.2{\pm}1.3$ and $10.0{\pm}1.0$, respectively in the coastal regions of Youngdong district from 1999 to 2006. Conclusion : In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.

Gene Transfer of Cu/ZnSOD to Cerebral Vessels Prevents Subarachnoid Hemorrhage-induced Cerebral Vasospasm

Yun, Mi-Ran,Kim, Dong-Eun,Heo, Hye-Jin,Park, Ji-Young,Lee, Ji-Young,Bae, Sun-Sik,Kim, Chi-Dae The Korean Society of Pharmacology 2005 The Korean Journal of Physiology & Pharmacology Vol.9 No.6

The preventive effects of gene transfer of human copper/zinc superoxide dismutase (Cu/ZnSOD) on the development of cerebral vasospasm after subarachnoid hemorrhage (SAH) were examined usin a rat model of SAH. An experimental SAH was produced by injecting autologous arterial blood twice into the cisterna magna, and the changes in the diameter of the middle cerebral artery (MCA) were measured. Rats subjected to SAH exhibited a decreased diameter with an increased wall thickness of MCA that were significantly ameliorated by pretreatment with diphenyleneiodonium (DPI, $10{\mu}M$), an inhibitor of NAD(P)H oxidase. Furthermore, application of recombinant adenovirus ($100{\mu}l$ of $1{\times}10^{10}$ pfu/ml, intracisternally), which encodes human Cu/ZnSOD, 3 days before SAH prevented the development of SAH-induced vasospasm. Our findings demonstrate that SAH-induced cerebral vasospasm is closely related with NAD(P)H oxidase-derived reactive oxygen species, and these alterations can be prevented by the recombinant adenovirus-mediated transfer of human Cu/ZnSOD gene to the cerebral vasculature.

Gene Transfer of Cu/ZnSOD to Cerebral Vessels Prevents Subarachnoid Hemorrhage-induced Cerebral Vasospasm

Mi Ran Yun,Dong Eun Kim,Hye Jin Heo,Ji Young Park,Ji Young Lee,Sun Sik Bae,Chi Dae Kim 대한생리학회-대한약리학회 2005 The Korean Journal of Physiology & Pharmacology Vol.9 No.6

The preventive effects of gene transfer of human copper/zinc superoxide dismutase (Cu/ZnSOD) on the development of cerebral vasospasm after subarachnoid hemorrhage (SAH) were examined using a rat model of SAH. An experimental SAH was produced by injecting autologous arterial blood twice into the cisterna magna, and the changes in the diameter of the middle cerebral artery (MCA) were measured. Rats subjected to SAH exhibited a decreased diameter with an increased wall thickness of MCA that were significantly ameliorated by pretreatment with diphenyleneiodonium (DPI, 10μM), an inhibitor of NAD(P)H oxidase. Furthermore, application of recombinant adenovirus (100μl of 1⁓10<SUP>10</SUP> pfu/ml, intracisternally), which encodes human Cu/ZnSOD, 3 days before SAH prevented the development of SAH-induced vasospasm. Our findings demonstrate that SAH-induced cerebral vasospasm is closely related with NAD(P)H oxidase-derived reactive oxygen species, and these alterations can be prevented by the recombinant adenovirus-mediated transfer of human Cu/ZnSOD gene to the cerebral vasculature.

李匡師의 학문 경향과 지식수용 방식에 대하여 − 『圓嶠集選』 수록 雜著‧雜文을 중심으로 −

이승용 동양고전학회 2023 東洋古典硏究 Vol.- No.92

This paper focuses on the fact that although Japjeo(雜著) and Japmun(雜文) are basically written in a style in which miscellaneous opinions or stories are freely written without a fixed format due to the nature of the writing, they are materials that can provide a glimpse into the author's usual thoughts on the subject of interest, insight into it, and academic attitude. Therefore, we looked into Lee Kwang Sah(李匡師)'s academic tendency, knowledge acceptance method, and verification process that had not been paid attention until now. Lee Kwang Sah(李匡師), a member of Ganghwa School(江華學派) and famous calligrapher in the late Joseon Dynasty, paid a lot of attention to the fields of Gyeonghak, historical studies, scripture, and phonology in addition to calligraphy and Chinese poetry, and traces of it could be found in Japjeo(雜著)‧Japmun(雜文) included in 『WonGyojipseon(圓嶠集選)』. As can be seen from Lee Kwang Sah(李匡師)'s remarks, it is undeniable that the academic tendency to criticize ‘Heo(虛)’ and value ‘Sil(實)’ and pursue degree of things and Erudite learning was greatly influenced by Kanghwa study(江華學), which was passed down by Jeong Je du(鄭齊斗) and Yoon soon(尹淳). However, it cannot be asserted that Kanghwa study(江華學) encompasses all of Lee Kwang-sa's academic trends. Individual Lee Kwang Sah(李匡師)'s academic tendency and practice, which are one step away from the category of Kanghwa study(江華學), were most evident in Japjeo(雜著) and Japmun(雜文), which presented their areas of interest and insights. The articles included in Japjeo(雜著) and Japmun(雜文) clearly confirm the academic trend of Lee Kwang-sa, who recognized not only the macroscopic but also the microscopic areas as objects of inquiry. In the article on "Critical Perspective and Logical Approach," Lee Kwang Sah(李匡師)'s rational thinking and meticulous analysis of knowledge and information were seen. In addition, in the article related to "questioning and dialectic of universal knowledge," the process of correcting existing wrong knowledge was closely seen through presenting clear grounds based on reading and academic, not based on unfounded personal experiences. This knowledge acceptance method and verification process are one of the pillars of Lee Kwang Sah(李匡師)'s actual academic trends along with the academic trends represented by Kanghwa study(江華學).

Mathematical Simulation on Thermal Performance of Packed Bed Solar Energy Storage System

아닐쿠마르,김만회 한국수소및신에너지학회 2015 한국수소 및 신에너지학회논문집 Vol.26 No.4

Solar air heaters (SAHs) are simple in design and widely used for solar energy collection devices, and a packed bed is one of typical solar energy storage systems of thermal energy captured by SAHs. This paper presents mathematical modeling and simulation on the thermal performance of various packed bed energy storage systems. A MATLAB program is used to estimate the thermal efficiency of packed bed SAH. Among the various packed bed energy storage systems considered, the wire mesh screen packed bed SAH shows the best thermal efficiency over the entire range of design conditions. The maximum of thermal efficiency of packed bed SAH with wire mesh screen matrices has been found to be 0.794 for Re=2000 - 20000 and ΔT/I=0.002 - 0.02.