Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

김혜원,Kim Sejoong,Ohn Jung Hun,Kim Nak-Hyun,Lee Jong-chan,김은선,Lim Yejee,Cho Jae Ho,박희선,류지원,Kim Sun-wook 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.3

Background: Although bicarbonate has traditionally been used to treat patients with rhabdomyolysis at high risk of acute kidney injury (AKI), it is unclear whether this is beneficial. This study compared bicarbonate therapy to non-bicarbonate therapy for the prevention of AKI and mortality in rhabdomyolysis patients. Methods: In a propensity score-matched cohort study, patients with a creatine kinase (CK) level of >1,000 U/L during hospitalization were divided into bicarbonate and non-bicarbonate groups. Patients were subgrouped based on low-volume (<3 mL/kg/hr) or high-volume (≥3 mL/kg/hr) fluid resuscitation in the first 72 hours. Logistic regression analyses were used to identify the impacts of bicarbonate use and fluid resuscitation on AKI risk and need for dialysis. The Kaplan-Meier method was used to estimate survival. Volume overload and electrolyte imbalances were assessed. Results: Among 4,077 patients, we assembled a cohort of 887 pairs of patients treated with and without bicarbonate. Bicarbonate group had a higher incidence of AKI, higher rate of dialysis dependency, higher 30-day mortality, and longer hospital stay than the non-bicarbonate group. Further, patients who received high-volume fluid therapy had worse renal outcomes and a higher mortality than those who received low-volume fluids regardless of bicarbonate use. Bicarbonate use, volume overload, and AKI were associated with higher mortality. Volume overload was significantly higher in the bicarbonate group than in the non-bicarbonate group. Conclusion: Bicarbonate or high-volume fluid therapy for patients with rhabdomyolysis did not reduce AKI or improve mortality compared to non-bicarbonate or low-volume fluid therapy. Limited use of bicarbonate and adjustment of fluid volume may improve the short- and long-term outcomes of patients with rhabdomyolysis.

흰쥐에서 Iodine-131-Iododeoxyadenosine 의 생체분포 및 유방암 영상화에 관한 연구

김혜원,원종진,최시성,이현철,김창근,김선구,Yang, David J,이강무,민병철,이종덕,Kim, E Edmund 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.4

Purpose: I-131 labeled (2'-deoxy-2-iodo-β-D-arabinofuranosyl) adenine (IAD) may be involved in DNA synthesis during active proliferation of tumor cells. We conducted this study to find out the biodistribution of IAD and its feasibility for scintigraphic tumor imaging. Materisls and Methods: Tosyl acetyl-adenosine was dissolved in acetonitrile, and I-131-NaI was added and heated to synthesize IAD. Female Fisher 344 rats innoculated with breast tumor cells were injected witb 0.27 MBq of IAD. Rats were sacrificed at 0.5, 1, 2, 4, 24h and the % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy, rats bearing breast cancer were administered with 1.11 MBq of IAD and imaging was perforrned after 2 and 24h. Then, rat body was fixed and rnicrotomized slice was placed on radiographic film for autoradiography, Results: %ID/g of tumor wa.' 0.74 (0.5h), 0.73 (1h), 0.55 (2h), 0.38 (4h), and 0.05 (24h), respectively. At 1h after injection, %ID/g of tumor was higher than that of heart (0.34), liver (0.42), spleen (0.47), kidney (0,69), muscle (0.14), bone (0.33) and intestine (0.51). However, %1D/g of tumor was lower than blood (1.06), lung (0.77), and thyroid (177.71). At 4h, %ID/g of tumor in comparison with other tissue did not change. Tumor contrast expressed by tumor to blood ratio was 0.69 and tumor to muscle ratio was 5.11 at 1h. However, these ratios did not improve through 24h. On autoradiogram and scintigraphy at 2 and 24 hour, the tumor was well visualized. Conclusion: This results suggest that Ial) may have a potential for tumor scintigraphy. However, further work is needed to improve localization in tumor tissue. (Korean J Nucl Med 1998;32:374-81)

성인의 아토피 피부염과 식생활평가지수와의 관계: 국민건강영양조사 제7기 (2016-2018년) 자료 이용

김혜원,김지명,Kim, Hye Won,Kim, Ji-Myung 한국영양학회 2022 Journal of Nutrition and Health Vol.55 No.5

본 연구에서는 우리나라 성인 중 AD를 앓고 있는 사람들의 식이 섭취량을 분석하여 이들의 식습관이 AD발병 위험과 관련이 있는지 분석하고자 하였다. 활용한 자료는 제7기 국민건강영양조사 (2016-2018년) 자료로서, 참가자 중 19-64세 성인 10,571명을 AD군 (n = 366)과 non-AD군 (n = 10,205)으로 나누어 영양소 섭취 현황과 식생활평가지수 점수를 비교·분석하였다. 그 결과, AD군의 1일 총 에너지섭취량은 non-AD군보다 많았고, 단백질 에너지섭취비율, 섭취에너지 1,000 kcal 당 단백질, 인, 철, 칼륨 섭취량이 AD군이 non-AD군보다 유의미하게 낮았다. 식생활평가지수 총점을 비교했을 때에는, AD군의 총 채소류, 김치 및 장아찌류를 제외한 채소류, 고기·생선·달걀·콩류 섭취점수가 non-AD군보다 낮았다. 연구대상자의 식생활평가지수와 AD 위험도와의 관계를 분석했을 때, AD 위험도는 총 채소류, 김치 및 장아찌류를 제외한 채소류, 고기·생선·달걀·콩류 섭취 점수가 증가할수록 감소하였다. 결론적으로, 성인 AD환자들은 채소류와 단백질 식품 섭취가 낮았는데, 이들 식품군의 높은 섭취는 낮은 AD 위험과 관련이 있음을 확인한 바, 추후 성인 AD 관리 및 치료 시 채소류와 단백질 식품의 충분한 섭취에 대해 강조해야 할 것이다. Purpose: The purpose of this study was to analyze the dietary intake of Korean adults with atopic dermatitis (AD) to determine whether the risk of developing AD was related to their diet. Methods: Among the participants in the 7th National Health and Nutrition Survey (2016 to 2018), 10,571 adults aged 19-64 were divided into AD (AD group, n = 366) and control groups (non-AD group, n = 10,205) to compare and analyze their nutrient intake status and Korean Healthy Eating Index (KHEI) score. Depending on the prevalence of AD, the nutrient intake, nutrient intake per 1,000 kcal, acceptable macronutrient distribution range, and KHEI score were tested for significance by correcting for age, sex, body mass index, education, marriage, occupation, residence area, physical activity, and energy intake variables that were derived for confounding factors. Results: The acceptable macronutrient distribution range for protein was lower in the AD group than in the non-AD group. Comparing the nutrient intake per 1,000 kcal, the intakes of protein, phosphorus, iron, and potassium of the AD group were significantly lower than those of the non-AD group. In the KHEI, the scores of total vegetables, vegetables excluding kimchi and pickles, meat, fish, eggs, and legumes of the AD group were significantly lower than those of the non-AD group. In addition, as these food intake scores increased, the risk of AD significantly decreased. Conclusion: In conclusion, adult AD patients had low intakes of vegetables, meat, fish, eggs, and legumes, and it was confirmed that high intakes of these foods may be associated with low AD risk. Therefore, we suggest that an adequate intake of vegetables and foods containing protein would be necessary for the management and treatment of AD in adults.

의과대학생을 위한 죽음교육이 말기환자 돌봄 태도에 미치는 영향에 대한 예비연구

김혜원,박중철,Kim, Hae Won,Park, Joong Chul 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.3

End-of-life care competencies have been perceived as important and essential, so it has been suggested that end-of-life care be studied in undergraduate medical education. However, end-of-life care curriculum has mostly focused on acquisition of knowledge and skills rather than attitudes. Therefore, we aimed to explore whether education about death affects medical students' attitudes towards care for dying patients and perception of death anxiety, meaning in life, and self-esteem. A total of 15 first- or second-year medical students were surveyed with questionnaires before and after completing a 6-week death education course. Paired data analysis showed that participants' attitudes towards caring for terminally ill patients and their caregivers improved significantly (t=-2.84, p=0.013) with an effect size of 0.73. In contrast, no significant changes were found in death anxiety, meaning in life, or self-esteem. All participants agreed that formal teaching about death and dying must be encouraged in medical schools. Our results suggest that death education may positively influence attitudes towards end-of-life care. Although replication with larger samples is necessary, this preliminary finding may support the importance of developmentally appropriate end-of-life care education in medical schools.

PET Imaging of Click-engineered PSMA-targeting Immune Cells in Normal Mice

김혜원,Won Chang Lee,In Ho Song,Hyunsoo Park,Sang Eun Kim 대한방사성의약품학회 2022 Journal of radiopharmaceuticals and molecular prob Vol.8 No.2

This study aimed to increase the targeting ability against PSMA in cell therapy using metabolic glycoengineering and biorthogonal chemistry and to visualize cell trafficking using PET imaging. Cellular membranes of THP-1 cells were decorated with azide(-N3) using Ac4ManNAz by metabolic glycoengineering. Engineered THP-1 cells were conjugated with DBCO-bearing fluorophore (ADIBO-Cy5.5) for 1 h at different concentrations and analyzed by confocal fluorescence microscopy and flow cytometry. For PSAM ligand conjugation to THP-1 cells, Ac4ManNAz treated THP-1 cells were incubated with DBCO-PSMA ligand (ADIBO-GUL) at a final concentration with 100 μM for 1 h. To evaluate the effect on cell recognition, PSMA ligand conjugated THP-1 cells(as effectors) were co-cultured with PSMA positive 22RV1 (as target cells) at 3 : 1 a effector-to-target cell (E/T) ratio. The interaction between THP-1 and 22RV1 was monitored by confocal fluorescence microscopy. For preparing the radiolabeled THP-1, the cells were treated at the activity of ~ 740 kBq of [89Zr]Zr(oxinate)4/5 × 106 cells. Radiolabeled cells were analyzed for determination of cell-associated radioactivity by gamma counting and viability using MTS assay. In the cytotoxicity assay, THP-1 cells did not have any cytotoxicity even when the Ac4ManNAz concentration was 100 μM. In confocal microscopy and flow cytometry, THP-1 cells were efficiently labeled ADIBO-Cy5.5 in a dose-dependent manner, and the dose of 100 μM was the optimal concentration for the following experiments. The clusters of PSMA ligand-conjugated THP-1 cells and 22RV1 cells were identified, indicating cell-cell recognition over the cell surface between two types of cells. Cell radiolabeling efficiency was 54.5 ± 17.8%. THP-1 labeled with 0.09 ± 0.03 Bq/cell showed no significant cytotoxicity compared to unlabeled THP-1 up to 7 days. We successfully demonstrated that Ac4ManNAz treated cells were efficiently conjugated with ADIBO-GUL for preparing the PSMA-targeting cells, and [89Zr]Zr(oxinate)4 could be used to label cells without toxicity. It suggested that PSMA-ligand conjugated cell therapy could be improved cell targeting and be monitored by PET imaging.

표준의 패러다임 전환은 기술표준원의 소명

김혜원,Kim, Hye-Won 기술표준원 2005 기술표준 Vol.40 No.-

격려사

김혜원,Kim, Hye-Won 한국제품안전협회 2006 제품안전 Vol.1 No.-

DITI를 통한 불임여성의 체열에 대한 연구

김혜원,김용석,이경섭,Kim, Hye-Won,Kim, Yong-Suk,Lee, Kyung-Sub 대한한방체열의학회 2002 대한한방체열의학회지 Vol.1 No.1

Causes of infertility include a wide range of physical, as well as emotional factors. In Oriental medicine, women's infertility is believed to be caused by the deficiency of the Chung and Ren vessel. Then the Kidney Qi is collapsed and cold. Many infertility women complain the cold hypersensitivity and/or body coldness, especially on the lower abdomen, back and knee. The aim of this study is to examine the interrelationship between infertility and body surface temperature. The 25 infertility women were allocated as infertility group and 25 fertility women (experienced delivery or pregnancy), as control group at the Kangnam Korean Hospital, KyungHee University, Seoul, Korea, from April to December 2000. Thermographic observations for this study were made using the Dorex DITI on 3 different areas's cold hypersensitivity: lower abdomen, back and knee. All data were coded for computer analysis and significances were tested by Mann-Whitney Test. The mean ${\Delta}T$ for abdomen cold hypersensitivity was $0.25{\pm}1.77^{\circ}C$ On control group and $1.00{\pm}0.39^{\circ}C$, infertility group. The mean ${\Delta}T$ for back cold hypersensitivity was $1.75{\pm}0.40^{\circ}C$ on control group and $1.21{\pm}0.58^{\circ}C$, infertility group. The mean ${\Delta}T$ for knee cold hypersensitivity was $0.65{\pm}0.70^{\circ}C$ on control group and $1.32{\pm}0.58^{\circ}C$, infertility group. It was revealed that the cold hypersensitivity on the lower abdomen, back and knee are significantly inter-related to the women infertility. These results do not conflict with the view of Oriental medicine. According to the above results, it is concluded that the body surface temperature, cold hypersensitivity and/or body coldness, have a great effect on women infertility.

Functional Defect and Its Possible Mechanism of Diabetic Cardiomyopathy

김혜원,이희란,장연진,박형섭,박소영,Kim, Hae-Won,Lee, Hee-Ran,Jang-Yang, Yeon-Jin,Park, Hyoung-Sup,Park, So-Young The Korean Society of Pharmacology 1993 대한약리학잡지 Vol.29 No.2

Oxidative modification of cellular proteins and lipids may play a role in the development of diabetic complications. Diabetic cardiomyopathy has been suggested to be caused by the intracellular $Ca^{2+}$ overload in the myocardium, which is partly due to the defect of calcium transport of the cardiac sarcoplasmic reticulum (SR). In the present study, the possible mechanism of the functional defect of cardiac SR in diabetic rats was studied. Both of the maximal $Ca^{2+}$ uptake and the affinity for $Ca^{2+}$ were decreased in the diabetic rat SR in comparison with the control. To investigate whether the functional defect of the cardiac SR in streptozotocin-induced diabetic rat is associated with the oxidative changes of cardiac SR proteins, the carbonyl group content and glycohemoglobin levels were determined. The increase in carbonyl group content of cardiac SR (2.30 nmols/mg protein, DM; 1.78, control) and in glycohemoglobin level $(13{\sim}17%,\;DM;\;3{\sim}5%,\;control)$ were observed in the diabetics. The extent of increase in calcium transport by phospholamban phosphorylation was greater in the diabetic cardiac SR membranes than that in the control. The phosphorylation levels of phospholamban, as determined by SDS-PAGE and autoradiography with $[{\gamma}^{32}P]ATP$, were increased in diabetic cardiac SR. These results suggest that the impaired cardiac SR function in diabetic rat could be a consequence of the less-phosphorylation of phospholamban in the basal state, which is partly due to the depleted norepinephrine stores in the heart. Furthermore, the oxidative damages in cardiac SR membranes might be one of the additional factors leading to the diabetic cardiomyopathy. 스트렙토조토신으로 당뇨를 유발시킨 쥐의 심근 근장그물에서 칼슘이동이 저하됨을 볼 수 있었다. 칼슘이동의 저하는 최대칼슘 uptake의 감소와 칼슘에 대한 affinity의 감소로 나타났다. 이러한 심근 근장그물의 기능저하가 나타나는 작용기전이 심근 근장그물 단백의 산화성 손상과 관계가 있는지를 살펴보았다. 당뇨쥐에서는 glycohemoglobin과 carbonyl group의 양이 현저히 증가됨을 볼 수 있었다. 한편으로 cyclic AMP 의존성 protein kinase의 catalytic subunit에 의한 phospholamban 인산화에 의해 심근 근장고물 칼슘이동의 증가를 보였고, 이 증가는 대조군에 비하여 당뇨군에서 훨씬 현저하게 나타났다. SDS-polyacrylamide를 이용한 전기영동후 autoradiogram을 통하여 확인한 phospholamban 인산화는 당뇨군에서 진한 band로 나타남이 확인되었다. 이상의 결과로 미루어 당뇨군의 심근 근장그물 기능저하는, 기초상태에서 아마도 심근내 저하된 norephinephrine 양으로 인하여 phospholamban 인산화 정도가 적으므로 근장그물 $Ca^{2+}-ATPase$ 억제가 나타남을 제시해 주며, 근장그물 단백의 산화성 손상도 당뇨성 심근질한을 일으킬 수 있는 또 다른 요인 중의 하나로 생각된다.

산욕초기 초산모의 모성 정체성과 영아돌보기 활동 자신감에 관한 연구

김혜원,황문숙,홍경자,Kim, Hae-Won,Hwang, Moon-Sook,Hong, Kyung-Ja 한국여성건강간호학회 1998 여성건강간호학회지 Vol.4 No.1

In this study the levels and influencing characteristics of maternal identity and self confidence for caring the baby were identified during the immediate postpartum period. 114 primiparous women who delivered vaginally normal baby participated in the survey from August 1 to October 31, 1996. SD scale was to measure maternal identity which consisted of 11 items for mother and 6 items for baby. Likert scale was to measure self confidence for caring the baby (38 items). Cronbach's alphas for evaluating internal consistency as follows : .86 for maternal identity and .96 for self confidence scale for caring the baby. The study showed these results : 1. Mean score of maternal identity(82.03 : 52.65 for mother, 29.38 for baby) was considered relatively low. 2. Mean score of self confidence for caring the baby(113.91) was considered relatively low. 3. There were significant influencing characteristics of primiparous to maternal identity : age(total ; F=3.53, p=.0329, for mother ; F=2.60, p=.0719, for baby ; F=3.12, p=.0481), prenatal infant care preparation(total ; t=2.31, p=.0306, for mother ; F=2.62, p=.0160), knowledge about infant care during the hospitalization(for baby ; F=3.94, p=.02222), colostrum feeding(total ; t=1.95, p=.0541, for baby ; t=2.71, p=.0080), frequency of breast feeding during the hospitalization(for baby ; F=3.91, p=.0228)and feeding type after discharge(for baby ; F=3.18, p=.0456). 4. There were significant influencing characteristics of primiparous to self confidence for caring the baby : routine husband support(F=6.09, p=.0031), prenatal infant care preparation(t=2.04, p=.0574), knowledge about infant care during the hospitalization(F=3.15, p=.0467), education of breast feeding during the hospitalization(t=-1.79, p=.0850). 5. Correlation between maternal identity and self confidence for caring the baby was r=.37608(p=.0001). This study implies that special education programs for primipara are needed. For the future, this study suggest that maternal role variables need to be monitored through the home visiting follow up. Also intervention programs related to prenatal care, discharge education, home visiting follow up need to be developed and then evaluated their effectiveness.