그린님 Riggs박사의 1996년 ALS에 관한 논문입니다.

[맷돌]

Copyright 1996 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.
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Volume 53(3) March 1996 pp 225-227
-------------------------------------------------------------------Amyotrophic Lateral Sclerosis, Heterogeneous Susceptibility, Trauma, and Epidemiology
[Special Article]
Riggs, Jack E. MD
From the Departments of Neurology, Medicine, and CommunityMedicine, West Virginia University School of Medicine, Morgantown.
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Outline
Abstract
METHOD
RESULTS
COMMENT
REFERENCES
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--------------------------------------------------------------------Abstract
Epidemiological studies relating antecedent trauma and amyotrophic lateral sclerosis (ALS) demonstrate a contradiction:positive (but poorly structured) retrospective case-control studies and negative (but uninterpretably small) prospective cohort studies. In this report, the equations for the case-control odds ratio and cohort relative risk in populations with heterogeneous susceptibility to ALS are analyzed. The case-control odds ratio and cohort relative risk converge as the proportion of ALS-nonsusceptible individuals in a population ! increases and the rate of ALS in nonsusceptible individuals decreases. Cohort studies of antecedent trauma and ALS have no significant advantage over case-control studies in populations in which most individuals are relatively nonsusceptible to ALS. Accordingly, the relationship between antecedent trauma and ALS can be addressed by carefully defined case-control studies.
(Arch Neurol. 1996;53:225-227)
추상적 관념에 따른 논술이라고 처음부터 정의를 하고있습니다.

ALS에 관한 선례적 외상성 증상에 관계시켜 논증을 시도했지만
아직은 빈약하게 구조된 논증이라는 글머리로 시작됩니다.
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For more than half a century, anecdotal case reports have suggested a relationship between antecedent trauma and amyotrophic lateral sclerosis (ALS) [1-4]. Epidemiological investigation into the issue of antecedent trauma and ALS, however, has produced contradictory results: positive (but poorly structured [5]) retrospective case-control studies [6,7] and negative (but uninterpretably small [5]) prospective cohort studies [8]. Kurland et al [5] stated that "only prospec! tive eval‎uation of a large cohort of trauma victims can provide an unbiased answer to this controversy," but "such an eval‎uation would be prohibitively expensive, and the results would not be available in our lifetime." These statements imply that properly constructed and carefully defined case-control studies may offer the only practical means of resolving the issue of antecedent trauma and ALS.

Case-control studies are characteristically efficient with respect to the investment of time and money, while cohort studies are time-consuming and expensive [9]. Consequently, recognizing those situations in which cohort studies provide little advantage over case-control studies would have significant practical importance. For example, cohort studies provide little advantage over case-control studies involving rare conditions [9]. The following analysis suggests that cohort studies of antecedent trauma and ALS should have no significant advantage over case-control studies if! the vast majority of the population is relatively nonsusceptible to ALS.
반세기 이전 일련의 선례된 외상성 증상이 ALS와 연계된 것이라는
일화적 사례문에 따른 논증이고
이러한 선례에 따른 지식 습득은
ALS환자들에게 조사와 치료에 투자되는 많은 시간과 돈을 절약하는데
특징적이면서 유용한 효과가 있다고 기술하고 있습니다.
예를 들자면 기존의 ALS환자가 가지고 있던 증상과 드믄 증상을 포함시켜서
환자들에게 약간의 이익을 증진시키는 결과에 관한 내용이랍니다.

METHOD
Case-control studies compare the proportional history of an exposure in subjects with (cases) or without (controls) a particular disease [9]. For example, epidemiological data in a retrospective case-control study of trauma and ALS can be presented by the following classic 2x2 table: (Table 2)In this table, a represents the number of individuals with both trauma and ALS; b, the number of individuals with trauma but without ALS; c, the number of individuals without trauma but with ALS; and d, the number of individuals without trauma and without ALS. The odds ratio (OR) of trauma among ALS cases compared with controls is given by the (Equation 1)
이 논증은 이미 우리가 알고있는 특수한 증상과
노출되어 있는 증상들에 균형이 잡힌 병력을 비교하실 수가 있을 것이랍니다
예를 들자면 일반적인 증상들을 소급시킨 유행성 자료랍니다.
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Table 2.
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Equation 1
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The Feinstein-Horowitz equations can be used to express the OR in a population consisting of individuals who are either susceptible (s) or nonsusceptible (ns) to a particular disease [10]. The proportions of ALS-susceptible and -nonsusceptible individuals in the population would be Ps and Pns, respectively. The rates of trauma and no trauma would be t and nt, respectively. When trauma is truly antecedent to the onset of ALS, rates of trauma and no trauma should be the same for both ALS-susceptible and -nonsusceptible individuals. Since everyone in a population either experiences trauma or does not, t plus nt must equal 1 (or nt=1-t). Rates of ALS in susceptible individuals with trauma and no trauma are designated Rst and Rsnt, respectively. Since the rate! s of ALS and non-ALS in susceptible individuals must also equal 1, the rates of non-ALS in susceptible individuals with trauma and no trauma are designated 1-Rst and 1-Rsnt, respectively. Finally, rates of ALS in nonsusceptible individuals with trauma and no trauma are designated Rnst and R (nsnt), respectively. Rates of non-ALS in nonsusceptible individuals with trauma and no trauma are designated 1-Rnst and 1-Rnsnt, respectively. The case-control 2x2 Table fortrauma and ALS can be presented using these Feinstein-Horowitz algebraic expressions (Table 1) [10]. For example, the number of cases of ALS and antecedent trauma would be the number of individuals in the study (X) times the sum of two products: (1) the proportion of ALS-susceptible individuals times the rate of trauma times the rate of ALS in traumatized ALS-susceptible individuals and (2) the proportion of ALS-nonsusceptible individuals times the rate of trauma times the rate of ALS in traumatized ALS-nonsusceptible! individuals. Thus, a in the classic 2x2 OR Table becomesX(Ps tRst +Pns tRnst). Substituting the corresponding values for a, b, c, and d into (Equation 1), the Equation forOR becomes: (Equation 2)

Feinstein Horowitz박사의 방정식은 개인에 따라 특수한 경우에는
민감하게 반응할 수도 있고 그렇지 않을 수도 있답니다.
ALS환자들에게도 마찬가지로 적용이 된다는군요.
각기 외부적으로 나타나는 증상과 그렇지 않은 증상에 관한 비율이
적용된다는 논술입니다.
결론적으로 외형적으로 나타나는 ALS환자의 비율과
그렇지 않은 환자의 비율은 이제까지의 경우로 봐서 같다고 보여진답니다.

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Table 1. Case-Control 2x2 Table forTrauma and Amyotrophic Lateral Sclerosis


This analysis has broader implications than just for trauma and ALS. Although cohort studies provide little advantage over case-control studies involving rare conditions [9], there may be many reasons why a condition is rare. Some disorders may be rare because few in the population are inherently susceptible. Whenever molecular genetic studies identify genes that are associated with enhanced diseas! e susceptibility and genetic epidemiological studies determine that these genes are relatively rare, then cohort studies of these diseases should offer no significant advantage over case-control studies. This theoretical deduction has significant practical importance for the planning of epidemiological studies at times of fiscal constraint.

Accepted for publication November 27, 1995.

Reprint requests to Department of Neurology, West Virginia University Health Sciences Center, Morgantown, WV 26506 (Dr Riggs).

참고 자료로 16명의 환자의 증상에 관한 링크번호가 나열되어 있습니다.

REFERENCES
1. Woods AH. Trauma as a cause of amyotrophic lateral sclerosis. JAMA. 1911;56:1876-1877. [Context Link]
ALS의 외형적 증상을 나타내는 환자

2. Harris W. The traumatic factor in organic nervous disease. BMJ. 1933;2:955-960. [Context Link]
유기적 신경 발작 증세를 보이는 환자.

3. Jelliffe SE. The amyotrophic lateral sclerosis syndrome and trauma. J Nerv Ment Dis. 1935;82:415-435. [Context Link]
외형적 증후군 환자

4. Turner JWA. Trauma and progressive muscular atrophy. Lancet. 1939;2:549-551. [Context Link]
근육이 쇠약되고 위축되어 가는 외형적 환자
5. Kurland LT, Radhakrishnan K, Smith GE, Armon C, Nemetz PN. Mechanical trauma as a risk factor in classic amyotrophic lateral sclerosis: lack of epidemiologic evidence. J Neurol Sci. 1992;113:133-143. [Medline Link] [BIOSIS Previews Link] [Context Link]
유형적으로 눈에 보여지는 결핍증거로 일반적이 아닌 요인의 위험분자로
인한 환자의 외형적 모습

6. Kurtzke JF, Beebe GW. Epidemiology of amyotrophic lateral sclerosis, I: a case-control comparison based on ALS deaths. Neurology. 1980;30:453-462. [Medline Link] [BIOSIS Previews Link] [Context Link]
ALS로 인한 죽음을 근거로 비교조절한 환자의 유형


7. Kondo K, Tsubaki T. Case-control studies of motor neuron disease: association with mechanical injuries. Arch Neurol. 1981;38:220-226. [Medline Link] [BIOSIS Previews Link] [Context Link]
물리적 사고에 의한 운동근육신경 파괴로 전이된 환자의 케이스
(이부분을 주의깊게 살피셔야 겠네요
척추 즉 spine근육의 손상으로 진행되는 케이스에 관한 것도 포함되리라고
봅니다)

8. Williams DB, Annegers JF, Kokmen E, O'Brien PC, Kurland LT. Brain injury and neurologic sequelae: a cohort study of dementia, parkinsonism, and amyotrophic lateral sclerosis. Neurology. 1991;41:1554-1557. [Medline Link] [BIOSIS Previews Link] [Context Link]
뇌손상으로 인한 신경퇴화,치매,진전마비로 진행된 환자

9. Hennekens CH, Buring JE. Epidemiology in M! edicine. Boston, Mass: Little Brown & Co Inc; 1987. [Context Link]

10. Feinstein AR, Horowitz RI. An algebraic analysis of biases due to exclusion, susceptibility, and protopathic prescription in case-control research. J Chronic Dis. 1981;34:393-403. [Medline Link] [BIOSIS Previews Link] [Context Link]
응혈 인자적 규정과 감수성,
사물을 배척시키는 경향을 보이는 환자의 대수학적 분석에 따른 유형

11. Cornfield J. A method of estimating comparative rates from clinical data: applications to cancer of the lung, breast, and cervix. J Natl Cancer Inst. 1951;11:1269-1275. [Context Link]
폐암,유방암,경부암의 임상적 자료에 의한 비율조사에 따른 평가

12. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976;103:226-235. [Medline Link] [BIOSIS Previews Link] [Context Link]
제약회사의 설문자료에 근거한 대상습득에 경우에 따른 평가(원인적)

13. Miettinen OS. Theoretical Epidemiology: Principles of Occurrence Research in Medicine. Albany, NY: Delmar Publishers Inc; 1985. [Context Link] 유행성 질병학설

14. Kato T, Hirano A, Manaka H, et al. Calcitonin gene-related peptide immunoreactivity in familial amyotrophic lateral sclerosis. Neurosci Lett. 1991;133:16! 3-167. [Medline Link] [BIOSIS Previews Link] [Context Link]
면역학적 펩타이드(두개이상의 아미노산을 결합시킨 물질)로
환자의 직계가족 안에 유전자와 관계시킨 사례와 조사
즉 유전이냐 아니냐...뭐 이런 사례에 관한 조사입니다.

15. Rosen DR, Siddique T, Patterson D, et al. Mutations in Cu/Zn superoxide dismutase gene are associated with familial amyotrophic lateral sclerosis. Nature. 1993;362:59-62. [Medline Link] [BIOSIS Previews Link] [Context Link]
Cu/Zn과 같은 물질(약품)의 강력산화로 인한 변종사실에 관한 조사

16. Neilson S, Robinson I, Hunter M. Longitudinal Gompertzian analysis of ALS mortality in England and Wales, 1963-1989: estimates of susceptibility in the general population. Mech Ageing Dev. 1992;64:201-216. [Medline Link] [BIOSIS Previews Link] [Context Link]
일반적으로 대중안에서 민감하게 평가된
1963년 부터 1989년까지 영국과 웨일스에서 조사된
ALS는 죽음을 면할 수가 없다는 학설

Amyotrophic Lateral Sclerosis; Case-Control Studies; Disease Susceptibility; Epidemiology; Wounds and

이상 시간되는 대로 정확하지는 않을지 몰라도 훌터보았답니다.
일반적으로 쓰지않는 말들이 많아서 어려움이 많았답니다.
새삼 번역이라는 작업이 무쟈게 어렵다는 것을 느끼게 되는군요.
뜻은 알아도 능력이 짧아서
한국말로 번역을 할수없는 경우가 많았던 것 같았습니다
상기 내용을 가지고 계신 원본 논문의 사진을 보시면서 비교 검토해 보세요.