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소아기 수면무호흡증 환자와 정상 대조군 수면 뇌파의 탈경향변동분석
김의중,안영민,신홍범,김종원,Kim, Eui-Joong,Ahn, Young-Min,Shin, Hong-Beom,Kim, Jong-Won 대한수면의학회 2010 수면·정신생리 Vol.17 No.1
본 연구의 목적은 소아 수면무홉증 환자와 정상 소아의 수면 구조를 비교하고 잘 드러나지 않는 차이를 뇌파의 비선형적 분석을 통해 비교 분석하는데 있다. 코골이 증상을 호소하는 소아 중 수면다원검사를 통해 폐쇄성 수면무호흡 지수가 시간당 1회 이상으로 소아기 폐쇄성 수면무호흡증으로 진단받은 12명(남아 10명, 평균 6.4${\pm}$3.4세)과 정상 대조군으로 연구에 참여한 15명(남아 8명, 평균 6.0${\pm}$2.2세)의 수면다원검사 자료를 비교하였다. 즉, 수면 구조 관련 변인과 뇌파 채널(C3/A2, C4/A1, O1/A2, O2/A1)에서 탈경향변동분석 과정을 거쳐 계산된 축적 지수를 비교하였다. 수면 구조에서는 1단계 수면의 비율이 폐쇄성 수면무호흡증 환아에서 9.3${\pm}4.3$%로 정상 소아의 5.6${\pm}4.3$2.8%보다 유의하게 높았고, 렘수면 입면잠복시간에서 폐쇄성 수면무호흡증 환아가 181.5${\pm}4.3$59.9 분으로 정상 소아의 133.5${\pm}4.3$42.0분보다 유의하게 길었다. 2, 3, 4단계 수면과 렘수면의 비율은 폐쇄성 수면무호흡증 환아와 정상 소아에서 유의한 차이가 없었다. 소아의 수면 뇌파에서 계산된 축적 지수(${\alpha}$)는 장기 시간적 연관성(long-range temporal correlation)의 특징을 갖는 것으로 1단계에서 4단계 수면으로 갈수록 ${\alpha}$ 값이 증가 하였다. 각각의 뇌파 채널에서 폐쇄성 수면무호흡증 환아의 축적 지수는 정상 소아의 축적 지수보다 유의하게 낮았다(C3/A2: 1.36${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.04, C4/A1: 1.37${\pm}4.3$0.04 vs. 1.41${\pm}4.3$0.04, O1/A2: 1.37${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.05, O2/A1: 1.36${\pm}4.3$0.07 vs. 1.41${\pm}4.3$0.05, p<0.05). 폐쇄성 수면무호흡증 환아에서 낮은 ${\alpha}$ 값을 보인 것은 자기조직적 고비성(self-organized criticality)이 줄어든 것으로 뇌 체계에서 자체 기전에 의한 에너지 축적이 감소한 것으로 해석해 볼 수 있다. 8시간에 이르는 수면 뇌파의 정량화가 수면무호흡증과 같은 질병 상태를 반영한다면 향후 연구에서 그 유효성과 범용성을 여러 질병에서 확인해 보아야 할 것이다. Unlike the case of adult obstructive sleep apnea syndrome (OSAS), there was no consistent finding on the changes of sleep architecture in childhood OSAS. Further understanding of the sleep electroencephalogram (EEG) should be needed. Non-linear analysis of EEG is particularly useful in giving us a new perspective and in understanding the brain system. The objective of the current study is to compare the sleep architecture and the scaling exponent (${\alpha}$) from detrended fluctuation analysis (DFA) on sleep EEG between OSAS and normal children. Fifteen normal children (8 boys/7 girls, 6.0${\pm}4.3$2.2 years old) and twelve OSAS children (10 boys/2 girls, 6.4${\pm}4.3$3.4 years old) were studied with polysomnography (PSG). Sleep-related variables and OSAS severity indices were obtained. Scaling exponent of DFA were calculated from the EEG channels (C3/A2, C4/A1, O1/A2, and O2/A1), and compared between normal and OSAS children. No difference in sleep architecture was found between OSAS and normal controls except stage 1 sleep (%) and REM sleep latency (min). Stage 1 sleep (%) was significantly higher and REM latency was longer in OSAS group (9.3${\pm}4.3$4.3%, 181.5${\pm}4.3$59.9 min) than in controls (5.6${\pm}4.3$2.8%, 133.5${\pm}4.3$42.0 min). Scaling exponent (${\alpha}$) showed that sleep EEG of OSAS children also followed the 'longrange temporal correlation' characteristics. Value of ${\alpha}$ increased as sleep stages increased from stage 1 to stage 4. Value of ${\alpha}$ from C3/A2, C4/A1, O1/A2, O2/A1 were significantly lower in OSAS than in control (1.36${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.04, 1.37${\pm}4.3$0.04 vs. 1.41${\pm}4.3$0.04, 1.37${\pm}4.3$0.05 vs. 1.41${\pm}4.3$0.05, and 1.36${\pm}4.3$0.07 vs. 1.41${\pm}4.3$0.05, p<0.05). Higher stage 1 sleep (%) in OSAS children was consistent finding with OSAS adults. Lower $'{\alpha}'$ in OSAS children suggests decrease of self-organized criticality or the decreased piling-up energy of brain system during sleep in OSAS children.
마이크로스트립 구조의 해석을 위한 MoM 대각 및 비대각 행렬요소들의 수치계산
김의중,오병희,이영순,조영기 한국전자파학회 2002 한국전자파학회논문지 Vol.13 No.1
일반적인 마이크로스트립 구조의 해석을 위해 closed-form 그린함수를 이용한 공간영역 모멘트법을 사용하는 경우, 모멘트 행렬의 대각 및 비대각 요소들을 계산하기에 보다 효율적인 기법을 제안하고자 한다. 본 논문에서 제안된 기법의 타당성 확인을 위해 동축선 급전된 마이크로스트립 안테나를 해석한 결과를 기존 논문들의 결과와 비교 제시하였다. When a spatial method of moments(MoM) is used in conjunction with closed-form Greens functions for the analysis of a general microstrip structures of thin or thick substrate, an efficient technique fur the evaluation of MeM off-diagonal matrix elements as well as diagonal elements is proposed. In order to check the validity of the present method, performance is demonstrated for the example of a coaxially-fed microstrip antenna and the present results are compared with the previous results.
김의중,최병관,최창화 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.6
Objective : The fusion procedure can be an option on reoperative HNP cases. It is done routinely or on case-bycase basis. There have been no clear guideline and results about the instability rate that really needs fusion procedure. This study is done to clarify the need of fusion procedure and prognosis in the reoperation of lumbar disc herniation by regarding stability rate. Methods : Total 27 cases with reoperative lumbar disc surgery were reviewed. Instability was tested preoperatively with X-ray findings which method was proposed by Dupuis in 1976. All operative procedures were done under microscopic magnification. The laminectomy and facetectomy amount was measured by the difference between the pre and postoperative X-ray findings. The stability test and final outcome were rated at least 6 months after the reoperation. The final results were categorized into excellent, good, fair, poor group according to the back, leg pain, walking ability, restriction of average daily life and use of analgesics. Results : The average translation were 4.95%(flexion) with 5.04%(extension) for lumbar joints and 3.39%(flexion) with 4.17%(extension) for lumbosacral junction. Average flexion angulation were -2.3 for lumbar joints and 9.1 for lumbar sacral junction. The average amount of removed facet joint was 10.2%. Average 68.1% of facet joint remains after the reoperation. Conclusion : Fusion procedure is needed only in limited cases of recurrent disc herniation for the reason of possible instability. Routine fusion procedure should be avoided regarding stability problem. In literatures, the fusion rates shows extreme ranges from 0 to 100 % according to the authors. The prognosis was comparable with previous reports where most of the average good or excellent outcomes were ranging 60~70% of the cases without fusion procedures.