Repetitive Questioning and Writing in a Patient with Transient Global Amnesia

구대림,김진아,남현우 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.4

The Relationship between Obstructive Sleep Apnea and Functional Dyspepsia

구대림,남현우 대한수면연구학회 2020 Journal of sleep medicine Vol.17 No.1

Objectives: Functional dyspepsia is one of the most common functional gastrointestinal disorders. We aimed to investigate the relationship between obstructive sleep apnea (OSA) and functional dyspepsia in patients with the complaint of sleep-disordered breathing. Methods: We prospectively recruited patients who visited the institute for the evaluation of sleep-disordered breathing. All patients underwent overnight polysomnography and submitted their responses to sleep questionnaires. A validated Korean version of the Rome III criteria was used to estimate functional dyspepsia. Functional dyspepsia was classified into two subtypes of epigastric pain syndrome and postprandial distress syndrome. Results: Out of 130 subjects with sleep disturbances, a total of 79 patients (60 men, 19 women) were enrolled. The mean (±standard deviation) age was 46.9±13.4 years. Functional dyspepsia was diagnosed in 8 (10%) patients. Patients with functional dyspepsia showed significantly higher values of Stanford Sleepiness Scale, the proportion of N1 sleep, arousal index, and apnea-hypopnea index compared to patients without functional dyspepsia (p=0.018, p=0.021, p=0.041, and p=0.039, respectively). With respect to OSA severity, 12% of patients with moderate OSA and 22% patients with severe OSA had functional dyspepsia. Severe OSA was significantly associated with a higher proportion of postprandial distress syndrome (p=0.030). Conclusions: Our patients with snoring or OSA revealed that functional dyspepsia is associated with more severe daytime sleepiness and apnea-hypopnea index compared to those without functional dyspepsia. In addition, postprandial distress syndrome was a prevalent subtype of functional dyspepsia in patients with severe OSA.

정상 수면의 생리

구대림,김주한 한양대학교 의과대학 2013 Hanyang Medical Reviews Vol.33 No.4

Sleep is a highly organized and complicated state that is fundamental to life. We have an absolute need to sleep during about one-third of our lives. There are two types of sleep, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is divided into stages 1, 2 and 3 which is representing a degree of relative depth in sleep. Each sleep stage shows unique features including some variations in electroencephalographic waves, eye movements, and muscle tone. Although sleep pattern changes are associated with aging, how sleep physiology and sleep patterns change over an individual’s life span is not well-defined. Circadian rhythms, which are the daily rhythms in physiology and behavior, regulate the sleep-wake cycle. Comprehensive understanding of normal sleep physiology should be very important to better understand not only the effects of sleep related diseases but also the impacts of pathological sleep on various diseases of other systemic organs. This review aims to enhance knowledge focused on normal sleep physiology and its regulation.

두피전극과 경질막밑 전극으로 동시 기록한 발작기 뇌파에서의 뚜렷한 시간차이: 안쪽관자엽간질 환자 1예

구대림,송파멜라,변소영,이정화,유남태,주은연,서대원,홍승철,홍승봉 대한임상신경생리학회 2011 Annals of Clinical Neurophysiology Vol.13 No.2

We present a recordings of 37-year-old woman with simultaneous ictal scalp and subdural electrodes. The ictal rhythm on subdural electrocorticography (ECoG) started earlier (median 24.5 sec) and ended later (median 2.0 sec) compared to ictal rhythm on scalp EEG. Eight ictal ECoG recordings were well localized to left temporal area, whereas ictal scalp EEG recordings were not. Our case shows the obvious timing relations between two recordings, and different electrophysiologic information about localization of ictal onset zone.

항 GQ1b 항체와 연관된 급성 단안성 외안근마비

구대림,박기형,김희태,이규용,이영주 대한신경과학회 2004 대한신경과학회지 Vol.22 No.6

Some authors found the anti-GQ1b IgG antibody in some of their patients with acute postinfectious ophthalmoparesis without ataxia, “atypical MFS” or “acute ophthalmoparesis (AO)”. Antecedent illness, acute ophthalmoparesis, CSF albuminocytologic dissociation, and the anti-GQ1b IgG antibody are useful markers for diagnosing AO. AO can be considered a variant or atypical form of MFS. We report two monocular AO patients who had the anti-GQ1b IgG antibody along with a literature review.

Clinical Usefulness of Intraoperative Motor-Evoked Potential Monitoring during Temporal Lobe Epilepsy Surgery

구대림,이원구,홍승철,서대원 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.3

Background and Purpose We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). Methods We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. Results In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. Conclusions Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.

Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep

구대림,남현우 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.4

Background and Purpose Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. Methods Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20–25% of TST), and excessive REM sleep (>25% of TST). Mul¬tiple logistic regression analyses were applied to the data. The success rate of continuous posi¬tive airway pressure (CPAP) titration was estimated in these groups. Results The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m2, respectively. The 902 patients comprised 684 (76%) men and 218 (24%) wom¬en. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple lo¬gistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence inter¬val, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). Conclusions The AHI is higher and the success rate of CPAP titration is lower in OSA pa¬tients with little REM sleep than those with normal REM sleep.

허혈성 뇌졸중 환자에서 망막 미세혈관 변성의 의의

구대림,고성호,김현영,이규용,이영주,김희태,김승현,김주한,김명호 대한신경과학회 2006 대한신경과학회지 Vol.24 No.5

Background: Retinal microvascular abnormalities reflect cerebral microvascular changes. However, there is few clinical data on the relationship between retinal microvascular changes and intracranial arterial stenosis or stroke subtypes. We examined the association between white matter changes (WMCs) or large artery stenosis and retinal microvascular changes, stroke subtypes. Methods: We investigated demographic features, retinal microvascular changes, intracranial large arterial stenosis, WMCs and stroke subtypes in 100 acute ischemic stroke patients over 2 years who had taken retinal photography and underwent brain MRI with MR angiography. Retinal photography was evaluated for specific retinal microvascular change by grader using standardized protocol. Intracranial arterial stenosis was defined by MR angiography. WMCs were coded from 1 for normal to 8 for most severe degree. And we defined “White matter lesion” as grade 3 or more. Stroke subtypes were classified by TOAST criteria. Results: Among the retinal microvascular changes, retinal hemorrhage, arteriovenous nicking, focal and generalized arteriolar narrowing and venous congestion were significantly correlated with intracranial large arterial stenosis. There was no relationship between the retinal microvascular changes and stroke subtypes. And only focal arteriolar narrowing was significantly correlated with WML. Conclusions: Retinal microvascular changes seen in patients with ischemic stroke were related to intracranial large arterial stenosis. We might suggest that the pathogenesis of retinal microvascular changes is related to that of large arterial atherosclerosis.

20세기 이후 중국에서의 封建 담론의 추이에 대한 학설사적 검토

대림검(Dai, Linjian) 호서사학회 2021 역사와 담론 Vol.- No.99

봉건의 本義는 ‘封土建國’으로 봉건제의 의미에는 세습, 분권적 영주경제, 귀족정치 등의 개념들이 내포되어 있었다. 秦·漢 이후 지주경제를 기반으로 한 군주집권체제가 확립되자 봉건의 색채는 점점 퇴색된 상황이었지만, 봉건개념의 본의는 크게 변하지 않았다. 본고에서는 이를 古典封建觀이라 했다. 19세기 중기부터 중국에서 거주한 일부 서양인이나 중국 開明 지식인들은 봉건개념을 서양의 정치제도와 연결시킴으로써 넓은 의미에서 그 함의에 가치부여를 하고자 하였다. 그 과정에서 ‘봉건≈퓨덜리즘’이라는 패턴이 부각되었고 뒤이어 일본 지식인에게 알려지게 되었다. 퓨덜리즘은 유럽 중세의 제도로서 중국 삼대의 제도와 일본 막부의 公武合體論과 유사했기 때문에, 일본에서는 메이지시대부터 본격적으로 봉건과 퓨덜리즘을 대역하기 시작했다. 그리고 이러한 일본식 봉건관은 20세기 초에 들어와서 다시 중국 지식인들에 의해 받아들이게 되었다. 본고에서는 이를 半古典封建觀이라 했다. 新文化運動 시기 봉건과 퓨덜리즘 개념의 혼용에 따라 봉건은 ‘전근대’, ‘낙후’ 등 부정적인 이미지의 대명사로서 그 개념이 보편화되기 시작했다. 특히 1920년대 전입된 레닌주의의 영향 하에 개념의 보편화가 확대되어 고전봉건관·半고전봉건관과 구분된 새로운 봉건관이 형성되었다. 본고에서는 이를 新式封建觀이라 했다. 이러한 신식봉건관이 전국에 침투한 과정을 이해하기 위해서는 마오쩌둥(毛澤東)을 주목할 필요가 있다. 그는 비록 최초로 신식봉건관을 지닌 자는 아니었지만 이를 수용하고 재구성하여 자신의 새로운 봉건관을 형성시킴으로써 봉건개념의 보편화에 큰 영향을 미쳤다. 한편 비슷한 시기인 1930년대에는 중국의 사회성격을 규명하기 위한 中國 社會史 論戰이 일어났다. 논전의 결과 봉건을 진·한 이후부터 청말까지의 시기를 지칭하는 표현으로 하는 封建社會論이 본격적으로 확립되었다. 다만 이것은 개혁개방 이래 지속적으로 지식계에서의 비판을 받았으며 오늘까지 그 함의는 계속 수정되고 있는 중이라 할 수 있다. The fengjian(封建), referring to ‘the enfeoffment(封土建國)’ in ancient meaning, also had an implication with the meanings of heredity, lord economy and aristocracy. Not much about its meanings had changed until the middle of the 19th Century, even though the system of fengjian no longer took the leading position because of the continuous consolidation and development of autocratic monarchs in ancient China since the Qin and Han Dynasties. The view of fengjian at that time, therefore, could be regarded as a ‘classical view of fengjian(古典封建觀)’. Since the middle of the 19th Century, however, some of Westerners living in China and Chinese intellectuals began to connect the concept of fengjian with Western political systems to give a broad range of values of its implications. During this process, it was a pattern of ‘fengjian≈feudalism’, which was known to Japanese Intellectuals later, that emerged. As a system in the Middle Ages, feudalism has something in common with the system of Three Dynasties in China, while being similar to the Kobugattairon(公武合體論) in the late Edo Period in Japan. Because of this, fengjian and feudalism formally began to be translated into each other in Japan since the Meiji Restoration. In addition, such Japan’s viewpoints of fengjian were accepted by Chinese intellectuals again as a ‘semiclassical view of fengjian(半古典封建觀)’ at the beginning of the 20th Century. As the concept of fengjian and feudalism was mixed during the New Culture Movement, fengjian became synonymous with ‘pre-modern’ or ‘backwardness’, which implied that the concept of fengjian has begun to be more universal in China. In particular, according to the influence of an introduction of Leninism to China in the 1920s, another view of fengjian distinguished from the classical and semiclassical one was formed, which could be called ‘a universal view of fengjian(新式封建觀)’. It is important to pay attention to Mao Zedong if we want to understand the infiltration of the ‘universal view of fengjian’ into the whole of China. Mao was not the first one to popularize this view, but he finally accepted it and made it into his own point, thus playing a key role in the further popularization of it. Meanwhile, in the 1930s, ‘The Debate on Chinese Social History’ took place to clarify the nature of Chinese society. As a result, fengjian was conceptualized as referring to all dynasties from the Qin to the Qing in China, meaning that the theory of Chinese feudal society was formally established. However, this theory, been criticized by researchers in China after the reform and opening-up, is being revised to this day.

조선후기 정부의 海洋認識에 나타난 防禦的 성격: 漂流民에 대한 태도를 중심으로

戴琳劍 진단학회 2019 진단학보 Vol.- No.132

This paper examines the marine awareness and the marine pass prohibition at national level in the Late Joseon Dynasty by focusing on the attitudes of the government toward the drifters. To this end, this paper first sorted out the content and characteristics of the marine pass prohibition in the Late Joseon Dynasty. Until the Early Joseon Dynasty, the government prohibited crossing the border and exploiting the open ocean passage by the marine pass prohibition. The same as it was in the Late part. In the marine pass prohibition, domestic people were prohibited from contacting with the outside world, while foreign ships were prohibited from entering the country. This was related to the borderline awareness formed by the government centering on the naeyang[內洋] and oeyang[外洋]. However, the coastal residents' marine awareness, with the maritime intentionality reflecting the attitude of making active use of the ocean, was different from the government's. Next, this paper explored the government's attitudes toward national drifters and foreign drifters, then clarified how such attitudes related to the marine awareness of the government. According to the conclusion, the government's attitudes toward the drifters, which were related to the marine pass prohibition, showed the defensive maritime policy. Specifically, the government strengthened the control of national drifters while being cautious about foreign drifters. But, on the other hand, such attitudes had also caused the misery of the local residents. As a result, with the opposition between the government's defensive marine awareness and the local residents' maritime intentionality, the multiple characteristics of maritimilty in the Late Joseon Dynasty could be formed. 이 논문은 조선후기 漂流民에 대한 정부의 태도를 중심으로 당시 국가 차원에서의 海洋認識을 海禁 정책의 성격과 함께 살펴보고자 하였다. 이를 위하여 조선후기 해금 정책의 내용과 그 특징을 정리해 보았다. 조선 전기까지 越境 出海를 통제하여 해금을 실시하였으며, 이러한 통제가 후기에 들어가도 지속되었다. 조선후기의 해금책은 대내적으로 백성의 외부와의 접촉을 차단하고 대외적으로 異國船을 막는 데에 작용하고 있었다. 이는 조선후기 정부가 내․외양을 중심으로 형성된 해양 경계 인식과 연관된 것으로 보인다. 하지만 연해 거주민들의 해양인식은 정부의 인식과 같지 않았고 오히려 적극적으로 바다를 이용하려는 바다지향성이 드러났다. 다음에 본국과 외국의 표류민에 대한 정부의 태도를 각각 살펴봄으로써 이러한 태도는 정부의 해양인식과 어떤 연관성이 있었는지를 규명해보았다. 결론적으로, 조선후기 표류민에 대한 정부의 태도는 해금과 연관되어 방어적인 성격을 표출하였다. 이는 주로 본국 표류민에 대한 통제 강화 의식 및 외국 표류민에 대한 신중한 접응 태도를 통해 구체화되었다. 다만 이러한 태도는 다른 면에서 지역민의 생활고를 초래할 수 있었다. 결국 정부의 방어적 해양인식과 지역민의 바다지향성이 상충되면서 조선후기 다중적인 海洋性이 드러난다.