항파상풍 톡소이드 주사후 항파상풍 항체 역가

이한식,하영록,구홍두,장석준,심호식,김승환,이정운 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Objective : Tetanus decreased in prevalence since the systemic vaccination began in 1940s. Despite of the improvement in treatment like critical care with ventilatior or antibiotics, the mortality rate resides around 45%. Currently the tetanus prevention protocol recommends immunization in infancy and boosters every tenth years. Thereafter the immunization with toxoid only or toxoid plus immunoglobulin injections is recommended according to the type of injury. In most of ED in Korea, only tetanus immunoglobulin is given without any basis. Previously we proved the effect that passive immunization with the immunoglubulin 250 IU last long for only a month. At this time we measured the effect of the active immunization with toxoid and its effect was compared to the effect of the tetanus immunoglobulin to find out the logical tetanus prevention after an injury. Method: 20 healthy adult volunteers were injected with tetanus toxoid and their anti-tetanus antibody titers measured before the injection, 1 week and 4 weeks after the inection. No volunteers have taken any medication for chronic illness(e.g. hepatits, tuberculosis) or had an tetanus immunization or booster in the last 6 months. Antibody titers were measured by IMMUNOZYM??-TETANUS and t-test was performed on the results, Results: 1. Total 20 volunteers(12 males and 8 females) were participated. 2. Subjects` ages were 21 to 44 years old and there were no relevance to the antibody titer. 3. The antibody titers of before the anti-tetanus toxoid injection and 1 week, 4 weeks after the injection revealed significant difference and the antibody titers of the first and the forth week after the injection also showed a significant difference. Conclusion: Currently in Korea, the tetenus immunoglobulin 250 IU given alone as tetanus prevention was injected, but it did not elevate the anti-tetanus antibody titer for 4 weeks where as tetanus toxoid injected intramuscularly did significantly. Therefore, tetanus toxoid should be given on the dirty injuries with additional tetanus immunoglobulin injection to accomplish the correct method of tetanus, tetanus toxoid prevention.

흰쥐에서 출혈량에 따른 비장세포 증식력과 말초임파구 아형의 변화

이한식,정성필,김욱진,조영순,장석준 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. Methods: Male Sprague-Dawley rats(weight,350∼400 g) were anesthetized, subjected to hemorrhages of 7.5 ㎖/㎏, 15 ㎖/㎏, and 22.5 ㎖/㎏ by percutaneous cardiac puncture with ㎖/㎏ needles, After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+),7 cytotoxic cell(CD8+), and B cell(CD45RA+). Results: Hemorrhage of 7.5 ㎖/㎏ did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15 ㎖/㎏, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. Conclusion: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15 ㎖/㎏ without any change in the peripheral lymphocyte subpopulation.

상악 측절치의 치내치에 대한 증례보고 : REPORT OF 2 CASES

윤석희,이재천,김영재,장기택,한세현,김종철 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.3

치내치(dens invaginatus)는 치아 발생 과정 중 경조직이 석회화되기 전에 법랑질 상피가 함입되어 생기는 치아 기형이다. 치내치는 함입된 정도에 따라다양한 형태학적 변이를 보이는데 이러한 기형은 미생물이 침입할 수 있는 통로가 될 수 있어 치수조직의 괴사와 치근단 농양 또는 치은 농양의 원인이 된다. 이러한 경우 근고나의 복잡한 해부학적 형태 때문에 근관 치료가 매우 어렵다. 본 증례는 상악 좌측 측절치의 동통을 주소로 내원한 두 명의 환아들에 관한 것이다. 첫 번째 증례는 수산화 칼슘제재를 이용한 근관치료를 시행하여 양호한 결과를 얻었고 두 번째 증례는 치아를 발거하였다. 발거된 치아는 미세전산화 단층촬영을 이용하여 해부학적 형태를 살펴보았기에 보고하는 바이다. Dens invaginatus is a malformation of tooth resulting from an infolding of the enamel epithelium during tooth development. This malformation shows a broad spectrum of morphologic variations. This invagination frequently allows the entry of irritants and microorganism, which usually lead to necrosis of the adjacent pulp tissue and then to periapical or periodontal abscess. Root canal treatment of such tooth is often difficult because of the unusual form and complicated pulpal space. This article reports 2 cases of dens invaginatus in maxillary lateral incisors. The first case was successfully treated with Ca(OH)₂. In the second case, involved tooth was extracted and this extracted tooth was observed using the micro-computed tomography.

요로결석 환자에서 Pethidine, Nalbuphine, Ketorolac의 진통효과 비교

장석준,박인철,정성필,최성욱,이한식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Ureter stone cause severe flank and abdominal pain. In emergency room, these patients require rapid pain relief and diagnosis. Therefore, authors have conducted a study on the efficacy of three types of commonly used analgesics including non opioid analgesics; intramuscular ketorolac 30mg and nalbuphine 10mg was compared with pethidine 50mg in 74 patients who visited SEVERANCE hospital emergency care center with complaint of flank colicky pain from Jan1. 1996 to Mar 31. 1996. Pain was assessed before the drug administration, and then at 10min, 20min, 30min time interval after the first dose. Visual analogue scale was used to assess the pain intensity and scale was self drawn by each patient during the time of pain assessment. Additional need of rescue analgesia and adverse effecfs of first-line analgesia was also recorded. Statistical significant was confirmed using ANOVA and Chi square test. The difference in the decrease of pain intensity was not significant among the three analgesics(P=0.65). Rescue anagesia was required in 37.1% of pethidine, 42.8% of nalbuphine, 16.6% of ketorolac and totally 33.8%. The incidence of all types of adverse event of pethidine, nalbuphine and ketorolac were 14.2%, 14.2% and 5.5% in respectively. The results of this study have shown that non opioid analgesics are as effective as opioid analgesia. Therefore, non opioid analgesics can be tried first line of pain relief drug of renal coliky pain with minimal adverse effects.

단순 외상 환자에서 퇴원시 설명문이 환자의 이해도에 미치는 영향

장석준,정상원,최성욱,황태식,이한식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

The many previous publications have shown the advantages of written discharge instruction over verbal discharge instruction on the basis of comparing the functional illiteracy among emergency department patients. Therefore, authors have conducted a study on the efficacy of written discharge instruction over the verbal discharge instruction of two groups: minor laceration and sprain patients. For the purpose of this study, minor laceration is defined as less than 3 ㎝ laceration on the face or head, or less than 5 ㎝ laceration on extremities. And simple sprains were limited to the extremities. A total of 416 patients who visited Yong Dong Severance Hospital Emergency Care Center were the subject of this study during the period of 2 months from Feb. 1. to Mar. 31. 1996. The study was done prospectively, and patients who entered this study were randomly selected. Simple discharge instruction were made prior to the study and patients were given or verbally told the one of two instruction sets by the emergency medicine resident. After reading or hearing the instructions, each patient was asked to answer four specific questions about them. Statistical significance was examined by t-test and p value of 0.05 or less was considered statistically significant. Mean age for verbal and written instructed group were 26.2 and 25.6 years old. There were 262 and 154 patients in verbal and written instructed group, and the mean score was 2.24±1.20 and 3.42±0.52, respectively. The type of injury was divided into laceration and sprain. Laceration group showed mean score of 2.15±1.23, 3.32±0.51, and sprain group of 2.34±1.16, 3.59±0.50 in verbal and written instruction group, respectively. For the patient younger than 13 years old, discharge instruction was given or described to a guardian. Age less than 13 years old group showed mean score of 2.75±1.11, 3.31±0.48 and more than 13 years old group of 2.10±0.19, 3.34±0.53 in verbal and written instruction group, respectively. The result showed statistical significance between verbal and written instruction group of type of injury and age difference. For the future, simplified written discharge instruction may help and improve the patient`s understanding of the proper management of injury.

혈액투석요법 환자의 우울, 불안 및 수면장애에 대한 연구

윤석준,양창국,한홍무 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 혈액투석요법을 받는 말기 신부전증 환자들은 불안이나 우울 등의 심인증상 외에도 여러 가지 수면장애를 호소할 수 있다. 말기 신부전증 환자에서 심인증상과 수면장애가 많을수록 삶의 질에 장애를 초래하며 혈액투석요법 도중 탈락이 높다. 저자는 본 연구에서 혈액투석요법 중인 환자의 우울, 불안 및 수면장애 등을 조사하여 향후 환자가료에 활용하고자 하였다. 방 법 : 부산시내 4곳의 혈액투석요법기관에서 혈액투석요법을 받는 말기 신부전증 환자 153명(남 87, 여 66)과 정신적, 신체적으로 건강한 동아대학교병원 행정직원 및 의과대학 학부모 113명(남 58, 여 55)을 대상으로 구조화된 면담과 자기평가척도를 실시하였다. 연구도구는 저자 등이 본 연구에 알맞게 개발한 인구통계학적 자료를 포함한 수면관련 설문지, 우울증 자가평가 척도인 Beck Depression Inventory(BDI), 불안 자가평가 척도인 State-Trait Anxiety Inventory(STAI)를 이용하였다. 결 과 : 환자군이 대조군에 비하여 신체증상 및 심인증상을 더 많이 호소하였고(p<0.05), 수면관련 불편을 더 많이 나타내었다(p<0.001). 환자군의 BDI 평균은 22.9로 대조군의 11.2보다 유의하게 높았다(p<0.001). BDI 점수를 기준으로 볼 때 남자환자 64명(74.7%), 여자환자 47명(71.2%)은 우울증군에 속하였다. STAI 평균 점수는 두 군간에 유의한 차이가 없었다. 환자군은 대조군에 비하여 입면잠복기와 수면 중 깨어 있는 시간이 더 길었고, 낮 동안의 졸리움 등 수면관련 불편을 더 많이 호소하고 있었다. 또한 환자군은 불면증(65.4%), 하지불편증후군(46.4%), 악몽(27.3%), 주기성사지운동장애(23.5%), 수면 식사장애(18.3%), 야경증(14.4%) 등을 유의하게 더 많이 호소하고 있었다(p<0.05). 결 론 : 혈액투석요법을 받고 있는 말기 신부전증 환자들은 대조군에 비해서 신체적, 심인적 증상을 유의하게 더 호소하고 불면증을 포함한 다양한 수면장애를 동반하고 있다. 또한 이들 사이에 높은 상호관계가 있는 바, 이는 혈액투석요법 증인 환자들에서 신체적 증상 및 심인적 증상뿐만 아니라 수면장애에 대한 치료적 접근이 필요함을 시사한다. Objectives : Psychological distresses and complaints in sleep, in addition to physical distresses such as pruritus and bone pain, are common in patients with hemodialysis. The purposes of this study were to investigate 1) the severity of physical distresses, 2) the severity of depression and anxiety, 3) the sleep disturbances, and 4) the correlation of the above variables in patients with hemodialysis. Methods : The patients with hemodialysis(male 87, female 66) and controls(male 58, female 55) completed a self-administered questionnaire package, which included Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and questions characterizing the reported sleep problems and quantitating the severity of the self-perceived physical and psychological conditions with linear visual analogue scales. Results : The results indicated that patients with hemodialysis complained of more physical distresses, more depressed mood, and more sleep disturbances suggesting insomnia, restless legs syndrome, periodic limb movement disorder, nightmare and obstructive sleep apnea syndrome, etc. There were significant positive correlations of physical distresses, depressed mood and sleep disturbances. However, there were no significant differences in state and trait anxiety between both groups. Conclusions : The authors suggest that the quality of life in patients with hemodialysis

응급실 난동환자에 대한 연구

김성중,장석준,이한식 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Authors have reviewed emergency room violentee for 6 months and obtained following results; 1) Of violentees in the emergency room, male was 4 times much as female and a high incidence in third and fourth decade. 2) Traumatic patients were more violent than non-traumatic patients. Among traumatic: patients, assault was highest. The departmental distribution was Orthopedic Surgery, Internal Medicine and Plastic Surgery in order. 56 patients (21.2%) was drunken status. 3) The emergency room violence occured mostly in the night shift. 4) Patient caused more violence than a guardient. It happened mostly in front of the nursing station and in the emergency care unit. 5) The most of violence happened within 30 minutes in arrival. 6) The leading cause of violence was the delay of laboratory study and treatment. 7) The violence was mostly verbal abuse to the ED nurse. 8) Sixteen cases were reported to the police and they react in average 23 minutes. It is important to know the nature of the violent in emergency room. It helps in dealing with them and makes us realize about the education and training to the emergency personnels. It is necessary to solve the problems faced in the emergency deparment not only administrative and financial aids but also further study and endeaver of the emergency personnel.

Learning a Personalized Subspace for Federated Learning

Seok-Ju Hahn,Minwoo Jeong,Junghyee Lee 대한산업공학회 2021 대한산업공학회 추계학술대회논문집 Vol.2021 No.11

Privacy-preserving Federated Bayesian Learning of a Generative Model for Imbalanced Classification of Clinical Data

Seok-Ju Hahn,Junghye Lee 대한산업공학회 2019 대한산업공학회 추계학술대회논문집 Vol.2019 No.11

In clinical research, the lack of events of interest often necessitates imbalanced learning. One approach to resolve this obstacle is data integration or sharing, but due to privacy concerns neither is practical. Therefore, there is an increasing demand for a platform on which an analysis can be performed in a federated environment while maintaining privacy. However, it is quite challenging to develop a federated learning algorithm that can address both privacypreserving and class imbalanced issues. In this study, we introduce a federated generative model learning platform for generating samples in a data-distributed environment while preserving privacy. We specifically propose approximate Bayesian computation-based Gaussian Mixture Model called ‘Federated ABCGMM’, which can oversample data in a minor class by estimating the posterior distribution of model parameters across institutions in a privacy-preserving manner. PhysioNet2012, a dataset for prediction of mortality of patients in an Intensive Care Unit (ICU), was used to verify the performance of the proposed method. Experimental results show that our method boosts classification performance in terms of F1 score up to nearly an ideal situation. It is believed that the proposed method can be a novel alternative to solving class imbalance problems.

Fairness-aware Adaptive Decision Making for Fair Federated Learning

Seok-Ju Hahn,Gi-Soo Kim,Junghye Lee 대한산업공학회 2023 대한산업공학회 추계학술대회논문집 Vol.2023 No.11