• Title/Summary/Keyword: pulse cycle

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Bortezomib Treatment for Refractory Antibody-Mediated Rejection Superimposed with BK Virus-Associated Nephropathy during the Progression of Recurrent C3 Glomerulonephritis

  • Do, Wonseok;Lee, Jong-Hak;Kim, Kyung Joo;Han, Man-Hoon;Jung, Hee-Yeon;Choi, Ji-Young;Park, Sun-Hee;Kim, Yong-Lim;Kim, Chan-Duck;Cho, Jang-Hee;Yang, Youngae;Kim, Minjung;Hwang, Inryang;Kim, Kyu Yeun;Yim, Taehoon;Kim, Yong-Jin
    • Korean Journal of Transplantation
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    • v.32 no.3
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    • pp.57-62
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    • 2018
  • A 38-year-old man, who underwent a second kidney transplantation (KT), was admitted because of antibody-mediated rejection (AMR) complicated by BK virus-associated nephropathy (BKVAN). He was placed on hemodialysis at the age of 24 years because of membranoproliferative glomerulonephritis. At the age of 28 years, he underwent a living donor KT from his father; however, 1 year after the transplantation, he developed a recurrence of the primary glomerular disease, resulting in graft failure 2 years after the first KT. Ten years later, he received a deceased-donor kidney with a B-cell-positive-cross-match. He received 600 mg of rituximab before the KT with three cycles of plasmapheresis and immunoglobulin (0.5 g/kg) therapy after KT. During the follow-up, the first and second allograft biopsies at 4 and 10 months after KT revealed AMR with a recurrence of primary glomerular disease that was reclassified as C3 glomerulonephritis (C3GN). He received a steroid pulse, rituximab, plasmapheresis, and immunoglobulin therapies. The third allograft biopsy demonstrated that the BKVAN was complicated with AMR and C3GN. As the azotemia did not improve after repeated conventional therapies for AMR, one cycle of bortezomib ($1.3mg/m^2{\times}4\;doses$) was administered. The allograft function stabilized, and BK viremia became undetectable after 6 months. The present case suggests that bortezomib therapy may be applicable to patients with refractory AMR, even in cases complicated with BKVAN.

The Variation of Tagging Contrast-to-Noise Radio (CNR) of SPAMM Image by Modulation of Tagline Spacing (Tagline 간격의 조절을 통한 SPAMM 영상에서의 Tagging 대조도 대 잡음비의 변화)

  • 강원석;최병욱;최규옥;이상호;홍순일;정해조;김희중
    • Progress in Medical Physics
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    • v.13 no.4
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    • pp.224-228
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    • 2002
  • Myocardial tagging technique such as spatial modulation of magnetization (SPAMM) allows the study of myocardial motion with high accuracy. However, the accuracy of the estimation of tag intersection can be affected by tagline spacing. The aim of this study was to investigate the relationship between tagline spacing of SPAMM image and tagging contrast-to-noise ratio (CNR) in in-vivo study. Two healthy volunteers were undergone electrocardiographically triggered MR imaging with SPAMM-based tagging pulse sequence at a 1.5T MR scanner. Horizontally modulated stripe patterns were imposed with a range from 3.6 to 9.6 mm of tagline spacing. Images of the left ventricle(LV) wall were acquired at the mid-ventricle level during cardiac cycle with FE-EPI (TR/TE = 5.8/2.2 msec, FA= 10$^{\circ}$. Tagging CNR for each image was calculated with a software which developed in our group. During contraction, tagging CNR was more rapidly decreased in case of narrow tagline spacing than in case of wide tagline spacing. In the same heart phase, CNR was increased corresponding with tagline spacing. Especially, at the fully contracted heart phase, CNR was more rapidly increased than the other heart phases as a function of tagline spacing. The results indicated that the optimization of tagline spacing provides better tagging CNR in order to analyze the myocardial motion more accurately.

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A study of symptoms and pathogenesis of hakgil(瘧疾) in the chinese traditional medical literature until chung(淸) dinasty (학질(瘧疾)의 증상(症狀)과 기전(機轉)에 대한 문헌적(文獻的) 고찰(考察) -청대(淸代)까지 중국의서(中國醫書)를 중심(中心)으로-)

  • Ryu, Jeong-A;Park, Chan-Guk
    • Journal of Korean Medical classics
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    • v.12 no.1
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    • pp.168-195
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    • 1999
  • The hakgil is the important disease in the oriental medicine historically. In the preseant time also this disease continually appear all over the world. So purpose of this study is that consider the symptoms and pathogenesis of hakgil(瘧疾) with the point of view of oriental medicine. And in this study, the results are summarized as the followings. 1. The symptos of hakgil(瘧疾). 1) Rigor and heat spasm : The main symptoms of hakgil is the severe and periodical rigor and heat spasm. Generally the rigor first appear and later the heat spasm appear. According to the first and last, severe and weak, the hakgil is classified to hanhak(寒瘧), onhak(溫瘧), danhak(癉瘧), binhak(牝瘧). 2) The regulation of the time of spasm : The spasm occour in the same time daily or one time in two days, three days or several days. And the spasm time is regulary in day or night. 3) The term between the spasm and next one become later or faster. It can be decided that the becoming worse and better in the disease with the signs. 4) The seasonal property Generally the hakgil appear in summer and early autumn. 5) The other kind of hakgil there are five-organ hakgil(五臟瘧), six-kyung hakgil(六經瘧), janghak(瘴瘧), kuihak(鬼瘧), six-gi hakgil(六氣瘧), damhak(痰瘧), sikhak(食瘧), and so on. 6) The pulse condition of the hakgil is chiefly hyun(弦). 2. The pathogenesis of the hakgil 1) The cause of the hakgil The causes of the hakgil first are the seo(暑) or heat(熱) that make the problem in the cycle of five phases(五行). In the consequence, il open the hole of skin so that the pathogenic factors easily invade the humanbody and at the same time the pathogenic factor in the inside easily come out, that make the spasm. In the second time the pathogenic factor of yin(陰) - wind(風), cold(寒), water(水) invade through the opened skin to combine with the factor in the inside. Such condition make the hakgil and the accessory spasm. 2)The pathogenesis of hakgil(瘧疾) (1) The rigor and heat spasm of hakgil(瘧疾) appear because in summer the human body don't accomplish a task of summer because of hot weather or heat, so in autumn the ki(氣) of human body separate into yin(陰) and yang(陽), and the skin of human body is weaken so the saki(邪氣: pathogenic factors) is easily come into the human body. At this time the circulation of ki(氣) is obstructed, so the jungki(精氣: vital substance) apply to straighten the circulation of ki(氣), if the jungki(精氣: vital substance) help the yin(陰) the rigor spasm appear in the opposit direction the jungki(精氣: vital substance) help the yang(陽) the heat spasm appear. (2) The period of circulation of ki(氣) and jungki(精氣: vital substance) is one day, so the general period of spasm of hakgil(瘧疾) is one day, But if the saki(邪氣: pathogenic factors) come into the human body deeply, the jungki(精氣: vital substance) cannot apply 10 straighten the circulation of ki(氣) every day so the period of spasm become longer.

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The Design of 32 Bit Microprocessor for Sequence Control Using FPGA (FPGA를 이용한 시퀀스 제어용 32비트 마이크로프로세서 설계)

  • Yang, Oh
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.40 no.6
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    • pp.431-441
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    • 2003
  • This paper presents the design of 32 bit microprocessor for a sequence control using a field programmable gate array(FPGA). The microprocessor was designed by a VHDL with top down method, the program memory was separated from the data memory for high speed execution of sequence instructions. Therefore it was possible that sequence instructions could be operated at the same time during the instruction fetch cycle. In order to reduce the instruction decoding time and the interface time of the data memory interface, an instruction code size was implemented by 32 bits. And the real time debug operation was implemented for easeful debugging the designed processor with a single step run, PC break point run, data memory break point run. Also in this designed microprocessor, pulse instructions, step controllers, master controllers, BM and BCD type arithmetic instructions, barrel shift instructions were implemented for sequence logic control. The FPGA was synthesized under a Xilinx's Foundation 4.2i Project Manager using a V600EHQ240 which contains 600,000 gates. Finally simulation and experiment were successfully performed respectively. For showing good performance, the designed microprocessor for the sequence logic control was compared with the H8S/2148 microprocessor which contained many bit instructions for sequence logic control. The designed processor for the sequence logic showed good performance.

Determination of Hg (II) Ion at a Chemically Modified Carbon Paste Electrode Containing L-Sparteine (L-Sparteine 수식전극을 사용한 Hg (II) 이온의 정량)

  • Euh Duck Jeong;Mi-Sook Won;Yoon-Bo Shim
    • Journal of the Korean Chemical Society
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    • v.35 no.5
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    • pp.545-552
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    • 1991
  • A mercury ion-sensitive carbon-paste electrode (CPE) was constructed with l-sparteine. Mercury (II) ion was chemically deposited by the complexation with l-sparteine onto the CPE. The surface of CPEs was characterized by cyclic voltammetry and anodic stripping voltammetry in an acetate buffer solution, separately. Exposure of CPEs to acid solution could regenerate surface and reuse it for deposition. In 5 deposition/measurement/regeneration cycle, the response was reproducible and in licnear up to $2.0\;{\times}\;10^{-6}$ M with linear sweep voltammetry. In case of using the differential pulse technique, we have obtained the linear response up to $7.0 {\times}10^{-7}$ M with relative standard deviation of ${\pm}5.1$%. The detection limit was $5.0{\times}10^{-7}$ M for 20 minutes of the deposition. We have investigated the interference effect of various metal ions, which are expected to form the complex with ligand. Silver (I) ion of these has interfered with the analysis of Hg (II) ions. However, pretreatment of the silver (I) ion with potassium chloride led to no interference on the analysis of mercury ions in aqueous solution.

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Age-related Changes of the Finger Photoplethysmogram in Frequency Domain Analysis (연령증가에 따른 지첨용적맥파의 주파수 영역에서의 변화)

  • Nam, Tong-Hyun;Park, Young-Bae;Park, Young-Jae;Shin, Sang-Hoon
    • The Journal of the Society of Korean Medicine Diagnostics
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    • v.12 no.1
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    • pp.42-62
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    • 2008
  • Objectives: It is well known that some parameters of the photoplethysmogram (PPG) acquired by time domain contour analysis can be used as markers of vascular aging. But the previous studies that have been performed for frequency domain analysis of the PPG to date have provided only restrictive and fragmentary information. The aim of the present investigation was to determine whether the harmonics extracted from the PPG using a fast Fourier transformation could be used as an index of vascular aging. Methods: The PPG was measured in 600 recruited subjects for 30 second durations, To grasp the gross age-related change of the PPG waveform, we grouped subjects according to gender and age and averaged the PPG signal of one pulse cycle. To calculate the conventional indices of vascular aging, we selected the 5-6 cycles of pulse that the baseline was relatively stable and then acquired the coordinates of the inflection points. For the frequency domain analysis we performed a power spectral analysis on the PPG signals for 30 seconds using a fast Fourier transformation and dissociated the harmonic components from the PPG signals. Results: A final number of 390 subjects (174 males and 216 females) were included in the statistical analysis. The normalized power of the harmonics decreased with age and on a logarithmic scale reduction of the normalized power in the third (r=-0.492, P<0.0001), fourth (r=-0.621, P<0.0001) and fifth harmonic (r=-0.487, P<0.0001) was prominent. From a multiple linear regression analysis, Stiffness index, reflection index and corrected up-stroke time influenced the normalized power of the harmonics on a logarithmic scale. Conclusions: The normalized harmonic power decreased with age in healthy subjects and may be less error prone due to the essential attributes of frequency domain analysis. Therefore, we expect that the normalized harmonic power density can be useful as a vascular aging marker.

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Quasi-breath-hold (QBH) Biofeedback in Gated 3D Thoracic MRI: Feasibility Study (게이트 흉부자기 공명 영상법과 함께 사용할 수 있는 의사호흡정지(QBH) 바이오 피드백)

  • Kim, Taeho;Pooley, Robert;Lee, Danny;Keall, Paul;Lee, Rena;Kim, Siyong
    • Progress in Medical Physics
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    • v.25 no.2
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    • pp.72-78
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    • 2014
  • The aim of the study is to test a hypothesis that quasi-breath-hold (QBH) biofeedback improves the residual respiratory motion management in gated 3D thoracic MR imaging, reducing respiratory motion artifacts with insignificant acquisition time alteration. To test the hypothesis five healthy human subjects underwent two gated MR imaging studies based on a T2 weighted SPACE MR pulse sequence using a respiratory navigator of a 3T Siemens MRI: one under free breathing and the other under QBH biofeedback breathing. The QBH biofeedback system utilized the external marker position on the abdomen obtained with an RPM system (Real-time Position Management, Varian) to audio-visually guide a human subject for 2s breath-hold at 90% exhalation position in each respiratory cycle. The improvement in the upper liver breath-hold motion reproducibility within the gating window using the QBH biofeedback system has been assessed for a group of volunteers. We assessed the residual respiratory motion management within the gating window and respiratory motion artifacts in 3D thoracic MRI both with/without QBH biofeedback. In addition, the RMSE (root mean square error) of abdominal displacement has been investigated. The QBH biofeedback reduced the residual upper liver motion within the gating window during MR acquisitions (~6 minutes) compared to that for free breathing, resulting in the reduction of respiratory motion artifacts in lung and liver of gated 3D thoracic MR images. The abdominal motion reduction in the gated window was consistent with the residual motion reduction of the diaphragm with QBH biofeedback. Consequently, average RMSE (root mean square error) of abdominal displacement obtained from the RPM has been also reduced from 2.0 mm of free breathing to 0.7 mm of QBH biofeedback breathing over the entire cycle (67% reduction, p-value=0.02) and from 1.7 mm of free breathing to 0.7 mm of QBH biofeedback breathing in the gated window (58% reduction, p-value=0.14). The average baseline drift obtained using a linear fit was reduced from 5.5 mm/min with free breathing to 0.6 mm/min (89% reduction, p-value=0.017) with QBH biofeedback. The study demonstrated that the QBH biofeedback improved the upper liver breath-hold motion reproducibility during the gated 3D thoracic MR imaging. This system can provide clinically applicable motion management of the internal anatomy for gated medical imaging as well as gated radiotherapy.

Excessive Daytime Sleepiness Case Confounding with Thyrotoxicosis (과도한 주간 졸림과 탈력발작을 주소로 내원한 환자에서 발견된 갑상선 중독증)

  • Chung, Jae-Kyung;Kim, Eui-Joong
    • Sleep Medicine and Psychophysiology
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    • v.18 no.1
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    • pp.40-44
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    • 2011
  • Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

Variations in Nutrients & CO2 Uptake Rates and Photosynthetic Characteristics of Saccharina japonica from the South Coast of Korea (다시마(Saccharina japonica)의 생장에 따른 영양염 및 CO2 흡수율과 광합성 특성 변화)

  • Hwang, Jae-Ran;Shim, Jeong-Hee;Kim, Jeong-Bae;Kim, Sook-Yang;Lee, Yong-Hwa
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.16 no.4
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    • pp.196-205
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    • 2011
  • To investigate the contribution of macroalgae to biogeochemical nutrients and carbon cycles, we measured the uptake rates of nutrients and $CO_2$ and characteristics of fluorescence of Saccharina japonica (Laminaria japonica Areschoug) using an incubation method in an acrylic chamber. From January to May 2011, S.japonica was sampled at Ilkwang, one of well-known macroalgae culture sites around Korea and ranged 46~288 cm long and 4.8~22.0 cm wide of whole thallus. The production rate of dissolved oxygen by S. japonica (n=25) was about $6.9{\pm}5.8{\mu}mol\;g^{-1}$ fresh weight(FW) $h^{-1}$. The uptake rate of total dissolved inorganic carbon ($TCO_2$), calculated by total alkalinity and pH, was $8.9{\pm}7.9{\mu}mol\;g^{-1}\;FW\;h^{-1}$. Mean nutrients uptake were $175.6{\pm}161.1\;nmol\;N\;g^{-1}\;FW\;h^{-1}$ and $12.7{\pm}10.1\;nmol\;P\;g^{-1}\;FW\;h^{-1}$. There were logarithmic relationships between thallus length and uptake rates of nutrients and $CO_2$, which suggested that younger specimens (<100-150 cm) were much more efficient at nutrients and $CO_2$ uptake than old specimens > 150 cm. There was a positive linear correlation ($r^2$=9.4) existed between the dissolved oxygen production rate and the $TCO_2$ uptake rate, suggesting that these two factors may serve as good indicators of S. japonica photosynthesis. There was also positive linear relationship between maximal quantum yield ($F_v/F_m$) and production/uptake rates of dissolved oxygen, $TCO_2$ and phosphate, suggested that $F_v/F_m$ could be used as a good indicator of photosynthetic ability and $TCO_2$ consumption of macroalgae. Maximum relative electron transport rate ($rETR_{max}$) of S. japonica increased as thallus grew and was high in distal part of thallus which may be resulted from the increase of photosynthetic cell density per area. The annual $TCO_2$ uptake by S. japonica in Gijang area was estimated about $1.0\sim1.7{\times}10^3C$ ton, which was about 0.02-0.03% of carbon dioxide emission in Busan City. Thus, more research should be focused on macroalgae-based biogeochemical cycles to evaluate the roles and contributions of macroalgae to the global carbon cycle.

Doses of Coronary Study in 64 Channel Multi-Detector Computed Tomography : Reduced Radiation Dose According to Varity of Examnination Protocols (64 채널 Multi-Detector Computed Tomography를 이용한 관상동맥검사의 선량 : 검사 프로토콜 다변화에 따른 환자선량 감소)

  • Kim, Moon-Chan
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.299-306
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    • 2009
  • Purpose : To compare radiation dose for coronary CT angiography (CTA) obtained with 6 examination protocols such as a retrospectively ECG gated helical scan, a prospectively ECG gated sequential scan, low kVp technique, and cardiac dose modulation technique. Materials and Methods : Coronary CTA was performed by using 6 current clinical protocols to evaluate effective dose and organ dose in primary beam area with anthropomorphic female phantom and glass dosimetric system in 64 channel multi-detector CT. After acquiring topograms of frontal and lateral projection with 80 kVp and 10 mA, main coronary scan was done with 0.35 sec tube rotation time, 40 mm collimation ($0.625\;mm{\times}64\;ea$), small scan field of view (32 cm diameter), 105 mm scan length. Heart beat rate of phantom was maintained 60 bpm in ECG gating. In constant mAs technique 120 kVp, 600 mA was used, and 100 kVp for low kVp technique. In a retrospectively ECG gated helical CT technique 0.22 pitch was used, peak mA (600 mA) was adopted in range of $40{\sim}80%$ of R-R interval and 120mA(80% reduction) in others with cardiac dose modulation. And 210 mAs was used without cardiac dose modulation. In a prospectively ECG gated sequential CT technique data were acquired at 75% R-R interval (middle diastolic phase in cardiac cycle), and 120 msec additional padding of the tube-on time was used. For effective dose calculation region specific conversion factor of dose length product in thorax was used, which was recommended by EUR 16262. Results : The mean effective dose for conventional coronary CTA without cardiac dose modulation in a retrospectively ECG gated helical scan was 17.8 mSv, and mean organ dose of heart was 103.8 mGy. With low kVp and cardiac dose modulation the mean effective dose showed 54.5% reduction, and heart dose showed 52.3% reduction, compared with that of conventional coronary CTA. And at the sequential scan(SnapShot pulse mode) under prospective ECG gating the mean effective dose was 4.9 mSv, this represents an 72.5% reduction compared with that of conventional coronary CTA. And heart dose was 33.8 mGy, this represents 67.4% reduction. In the sequential scan technique under prospective ECG gating with low kVp the mean effective dose was 3.0 mSv, this represents an 83.2% reduction compared with that of conventional coronary CTA. And heart dose was 17.7 mGy, this represents an 82.9% reduction. Conclusion : In coronary CTA at retrospectively ECG gated helical scan, cardiac dose modulation technique using low kVp reduced dose to 50% above compared with the conventional helical scan. And the prospectively ECG gated sequential scan offers substantially reduced dose compared with the traditional retrospectively ECG gated helical scan.

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