만성 신장질환으로 혈액 투석을 시행하는 환자의 퇴행성 요추 질환에 대한 수술 결과

장해동,이재철,신병준,홍시전,안중현,최성우,강덕원,조형규 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.3

Study Design: Retrospective study. Objectives: To analyze the outcomes of degenerative lumbar spine surgery in patients undergoing hemodialysis due to chronic kidney disease (CKD). Summary of Literature Review: Patients who undergo hemodialysis due to chronic renal disease tend to exhibit accelerated changes in bone quality, deterioration of spinal stenosis, and accompanying neurological degeneration. The surgical treatment of chronic spinal diseases is also becoming more necessary with the increased lifespan of these patients. Materials and Methods: We reviewed the medical records and radiographs of patients with CKD undergoing hemodialysis who were followed-up for more than 1 year after posterior lumbar spinal surgery. We evaluated clinical, laboratory, and radiologic variables. For a comparative analysis, patients were classified into subgroups according to age (65 years old), duration of hemodialysis (10 years), and type of surgery (simple decompression or fusion). Results: We included 21 patients (5 men, 16 women) with a mean age of 66.2 years (range, 48-87 years). The mean duration of hemodialysis and follow-up was 18.9 years and 43 months, respectively. Decompressions with fusion were performed in 11 patients and simple decompressions in the other 10. The mean visual analog scale (VAS) of leg pain and the Oswestry Disability Index (ODI) significantly improved after surgery at time of the last follow-up; meanwhile, the mean VAS score for lower back pain did not show a statistically significant improvement. The postoperative ODI was correlated with age (correlation coefficient=0.71, p=0.006). In patients less than 65 years old, the ODI improvement was greater (p=0.035) than in those 65 years of age or older. There was no significant difference in the clinical outcomes according to the duration of hemodialysis. Complications were observed in 11 patients (52.4%, 7 in fusion and 4 in simple decompression), of which 2 cases were infections, and reoperations were performed in 5 patients. The union rate of the fusion cases at the 1-year follow-up was 81.8%. Conclusions: Appropriate spine surgery improved radicular pain and the ODI in patients with degenerative lumbar disease undergoing hemodialysis. However, postoperative complications were frequent and the improvement of clinical outcomes was minimal, especially in patients over 65 years of age and in those who underwent fusion. Therefore, the surgical treatment of patients with chronic renal disease undergoing hemodialysis requires adequate consideration of age and the duration of hemodialysis. 연구 계획: 후향적 연구목적: 투석을 시행 중인 만성 신장질환 환자의 퇴행성 요추 질환에 대한 수술적 치료 후 임상적, 영상의학적 결과를 분석하고자 하였다. 선행 연구문헌의 요약: 만성 신장질환으로 인한 혈액투석을 시행하는 환자는 골질의 변화, 척추관 협착증의 악화, 그리고 동반하는 신경학적인 퇴행이 가속화되는 경향이 있다. 해당 환자군의 수명 증가와 함께 만성 척추 질환에 대한 수술적 치료의 필요성 또한 증가하고 있다. 대상 및 방법: 만성 신장질환으로 혈액투석을 시행하는 환자 중 퇴행성 요추 질환으로 본원에서 후방 접근에 의한 척추 수술 시행 받고 1년 이상 추시된환자를 대상으로 하여, 의무 기록과 영상 검사를 검토하였다. 임상지표와 영상의학적 자료 등을 조사하였으며, 나이(65세 이상과 미만의 군), 혈액투석 기간(10년 이상과 미만의 군), 수술의 종류(단순 감압술, 유합술)에 따른 결과를 비교 분석하였다. 결과: 대상 환자는 총 21명(남자 5명, 여자 16명)이었고, 평균 나이는 66.2(48~87)세였다. 평균 투석기간은 18.9년이었고, 추시 기간은 43개월이었다. 유합술이 11예, 단순 감압술이 10예였다. 하지 방사통의 평균 VAS 점수와 평균 ODI 점수는 술전에 비해 최종 추시시 유의하게 호전되었으나 요통의 평균VAS 점수는 통계적으로 유의한 호전을 보이지 않았다. 술 후 최종 ODI는 환자의 나이증가와 유의한 상관관계를 보였고(상관계수=0.71, p=0.006), 65세미만의 환자 군에서 술 후 ODI의 호전 정도가 유의하게 컸다(p=0.035). 혈액투석 기간에 따른 임상결과는 유의한 차이가 없었다. 수술 후 합병증은 총 11 명(유합술 7예, 감압술 4예)에서 관찰되었고, 그 중 감염은 2예였으며, 재수술은 5명 환자에서 시행되었다. 유합술 환자의 술 후 1년째 유합율은 81.8%였다. 결론: 혈액투석을 시행중인 만성 신장질환 환자에서 적절한 척추 수술 시행 후 하지 방사통과 ODI점수는 유의하게 호전되었으나, 합병증이 발생하는 경우가 빈번하고, 특히 65세 이상과 유합술 환자군에서 임상 결과의 호전이 미미하였다. 따라서 혈액투석 중인 만성 신장질환 환자의 수술적 치료는 나이및 투석 기간 등에 대한 충분한 고려가 필요할 것으로 사료된다. 약칭 제목: 혈액투석환자 퇴행성요추 수술결과

산란계에 Microbial Phytase 첨가시 산란율, 계란 품질, 인 이용율 및 영양소 대사율에 미치는 영향

장해동,김인호,유종상,조진호,현영,김희성,황일환,김효진,신승오,황염,주천상,진영걸 한국가금학회 2008 韓國家禽學會誌 Vol.35 No.2

The study was conducted to evaluate the effects of dietary microbial phytase on egg productivity, egg quality,phosphorus utilization and nutrient digestibility in laying hens. The animals used in the experiment were a total of 120 Hy-Line Brown laying hens (32 weeks old). Dietary treatments included 1) CON (basal diet), 2) LP (low phosphorus diet) 3) NP (low phosphorus diet + 0.03% normal microbial phytase) and 4) CP (low phosphorus diet + 0.03% coated microbial phytase). Six laying tly increased in CON and CP treatments compared to LP treatment (P<0.05). CON, CP and NP treatments significantly increased their egg shell breaking strength and egg shell thickness compared to LP treatment (P<0.05). CON, CP and NP treatments resulted higher yolk color and Haugh unit than LP treatment (P<0.05). Calcium and inorganic phosphorus contents in blood were higher in CP treatment compared to LP treatment (P<0.05). Dry mater digestibility and nitrogen digestibility were greater in CP treatment than CON, LP and NP treatments (P P<0.05). Calcium digestibility and phosphorus digestibility were significantly improved in CP and NP treatments than CON and LP treat-ments (P<0.05). Calcium retention of CON, CP and NP treatments were higher than LP treatment (P<0.05). Phosphorus retention was increased in CP and NP treatments compared to CON and LP treatments (P<0.05). LP treatment significantly increased their nitrogen, calcium excretion compared to CON, CP and NP treatments (P<0.05). Phosphorus excretion was decreased in LP, CP and P<0.05). In conclusion, CP treatment improved egg production, egg quality, inorganic calcium and phosphorus in blood, calcium and phosphorus retention and nutrient digestibility and decreased nitrogen and calcium excretion in laying hens.

기독교적 과학관

장해동 한남대학교 기독교문화연구원 2005 기독교문화연구 Vol.10 No.-

Bacillus subtilis 급여가 비육돈의 육질 특성, 생산성 및 분내 유해가스 발생에 미치는 영향

장해동,유종상,이제현,김효진,신승오,황염,주천상,진영걸,강대경,Jang, Hae-Dong,Yoo, Jong-Sang,Lee, Je-Hyun,Kim, Hyo-Jin,Shin, Seung-Oh,Hwang, Yan,Zhou, Tain-Xiang,Chen, Ying-Jie,Kang, Dae-Kyung 한국축산식품학회 2008 한국축산식품학회지 Vol.28 No.3

This study was conducted to evaluate the effects of dietary Bacillus subtilis on meat quality, growth performance and fecal malodor gas emission in finishing pigs. Thirty-six pigs (Landrace ${\times}$ Yorkshire ${\times}$ Duroc, $83.53{\pm}1.01\;kg$ average initial body weight) were used in a 35 d growth assay. Dietary treatments were 1) CON (basal diet), 2) B1 (basal diet + B. subtilis 0.1%) and 3) B2 (basal diet + B. subtilis 0.2%). The pigs were distributed into four pigs per pen with three replicate pens per treatments by completely randomized design. For the entire period, the final weight, ADO, ADFI and gain/feed were not significantly different among the treatments. There were no significant differences in meat quality (sensory evalution, meat color, TBARS, water holding capacity, drip loss, cooking loss and M. longissimus dorsi area) among the treatments. $H_2S$ was significantly decreased in B2 treatment compared to CON and B1 treatments (p<0.05). However, ammonia, mercaptans and acetic acid were not significantly different among the treatments. In conclusion, B. subtilis 0.2% treatments decreased fecal $H_2S$ gas emission in finishing pigs.

Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

장해동,Kim Eung-Ha,Lee Jae Chul,Choi Sung-Woo,Kim Kyungbum,Shin Byung-Joon 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6

Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%–35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.

미국산과 중국산 DDGS의 급여가 비육돈의 육질 및 아미노산 함량에 미치는 영향

장해동,홍종욱,이종하,이운선,이철영,유종상,이제현,김종규,강대경,김인호,Jang, Hae-Dong,Hong, Jong-Wook,Lee, Jong-Ha,Lee, Un-Sun,Lee, Chul-Young,Yoo, Jong-Sang,Lee, Je-Hyun,Kim, Jong-Gyu,Kang, Dae-Kyung,Kim, In-Ho 한국축산식품학회 2008 한국축산식품학회지 Vol.28 No.5

This study was conducted to evaluate the effects of com distillers dried grain with soluble (DDGS) in American and Chinese on quality and amino acid of meat in finishing pigs. 120 pigs (Landrace$\times$Yorkshire$\times$Duroc, 64.50 kg average initial body weight) were used in 56 day growth assay. Dietary treatments were included CON (basal diet), ADS (basal diet + DDGS from American) and CDS (basal diet + DDGS from Chinese). The pigs were allotted into four pigs per pen with ten replicates per treatments by completely randomized design. Backfat thickness and lean percentage were not affected by treatment (p>0.05). For the meat color, redness was significantly increased in DDGS treatments compared to CON treatment (p<0.05). CDS treatment was higher than in ADS treatment (p<0.001). Water holding capacity was higher in CON and CDS treatments compared to ADS treatment (p<0.05). pH was greater in DDGS treatments than CON treatment (p<0.05), and ADS treatment was higher than in CON treatment (p<0.05). For the amino acid of meat, CDS treatment significantly increased their arginine, isoleucine, leucine and lysine compared to other treatments (p<0.05). DDGS treatment was higher than in CON treatment (p<0.001). Methinonine, phenylalanine, threonine and valine were significantly increased DDGS treatments than CON treatment (p<0.05). Cysteine was greater in CDS treatment than CON and ADS treatments (p<0.001). DDGS treatments was higher cysteine than in CON treatment (p<0.001). Proline significantly improved in CON treatment compared to CDS treatment (p<0.05). Tyrosine was greater in DDGS treatments than CON treatment (p<0.01). In conclusion, redness and amino acids of meat were affected by DDGS treatments.

Wellbeing식품과 건강

장해동 한국자동차공학회 2009 한국자동차공학회 지부 학술대회 논문집 Vol.2009 No.10

카세인을 이용한 치즈곤죽의 발효특성

장해동,이형주,Jang, Hae-Dong,Lee, Hyong-Joo 한국식품과학회 1985 한국식품과학회지 Vol.17 No.5

치즈곤죽의 제조공정과 기간을 단축시키기 위해서 생치즈 커드를 제조하지 않고 Na-caseinates, cream, 여러가지 미량성분, 유산종균, 효소를 혼합하여 치즈곤죽을 제조하고 $30^{\circ}C$에서 매일 30초간 교반하면서 7일 동안 발효시킨 다음 치즈곤죽의 물리 화학적 특성을 조사하기 위해 수소이온 농도, 적정산도, 수용성 질소, 생균수, 활성 SH기, 총 휘발성산, 유리 지방산. 전기영동에 의한 단백질분해를 분석하였다. 유산균에 의한 산생성은 단백질분해효소를 첨가하지 않은 치즈곤죽보다 첨가한 치즈곤죽에서 더 잘발히 일어나 3일 후에는 PH를 4.90이하로 떨어뜨려 5N NaOH로 PH를 5.40으로 조정해 주었으며 이후에 pH는 약간 증가하였고, 적정산도의 변화는 pH변화와 비슷한 경향을 보여주었다. 단백짙분해효소를 첨가하지 많은 치즈곤죽은 발효가 끝났을 때 총 질소의 약 40%가 수용성 질소로 되었으나 효소를 첨가한 치즈곤죽은 70%정도의 단백질이 수용성 질소로 분해되었다. 사용한 유산종균. 즉 Streptococcus lactis와 treptococcus cremoris에 의한 단백질 분해는 Cheddar치즈에서와 같이 as-casein이 $\beta$-casein보다 먼저 분해되며, 첨가한 단백질분해호소는 $\alpha$-casein과$\beta$-casein을 모두 활발히 분해 시켜 3일이 지나면 모든 단백질이 펩타이드와 아미노산으로 되었다. 단백질 분해효소를 첨가한 치즈곤죽에서는 쓴맛 펩타이드가 형성되었다가 사라짐을 관찰할수 있었다. 한편 지질분해효소를 침가할 경우 총 휘발성산이 4일 이후에 급격히 증가함을 통해 사용한 효소는 유지방을 잘 분해함을 알 수 있었으며 GLC에 의한 유리 지방산의 분석 결과는 Cheddar치즈곤죽은 시판Cheddar 치즈와 비슷하고 Italian형 치즈곤죽은 시판 Italian치즈보다 약간 떨어졌다. Cheddar치즈의 중요한 품미성분인 활성 SH기는 glutathione을 첨가한 치즈곤죽에서 발효 4일부터 증가하였으며 단백질분해효소를 함께 첨가할 경우 그 증가현상이 현저하였다. 단백질분해요소의 첨가유무에 따라 점도 변화는 다른 두 가지 양상으로 나타나 효소를 첨가할 경우 단백질이 분해됨에 따라 점도가 급격히 감소하였다. To shorten the processing of cheese slurry, four different slurries, ie, Control, Cheddar 1 and 2, and Italian-type that were made of Na-caseinates, cream, trace elements, lactic culture, and enzymes were fermented at $30^{\circ}C$ for 7days with daily stirring. PH, titratable acidity, soluble nitrogen, viable cell count, active SH groups, total volatile fatty acid, free fatty acid, electrophoretic patterns of degraded caseins, and viscosity were analyzed to investigate physicochemical properties of fermented slurries. Acid production was accelerated in the cheese slurries with protease than that without the enzyme and PH of the former was decreased after three days of fermentation to 4.90. The Change of titratable acidity agreed to PH patterns. Soluble nitrogen of the Control slurry was increased slowly for four days and then rapidly to 40% of total nitrogen while those containing protease to 70%. The protease of lactic cultures used (Streptococcus lactis and Streptococcus cremoris) broke down as-casein more rapidly than $\beta$-casein and most proteins were degraded to peptides and amino acids after three days of fermentation. Total volatile fatty acids were increased by added lipase and free fatty acids composition analyzed by GLC in cheddar slurry with 0.00001% lipase was similar to that of commercial cheddar cheese, while that in Italian-type slurry was a half of that in commercial Italian cheese. Active SH groups were increased in the cheese slurries with glutathione from fourth day of fermentation. The viscosity of slurries decreased very rapidly by addition of protease.

Management of Osteoporotic Vertebral Fracture: Review Update 2022

장해동,Kim Eung-Ha,이재철,최성우,Kim Hak Soo,Cha Joong-Suk,Shin Byung-Joon 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6

A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few “gold standard treatments” outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%–35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate’s effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.

연구논문 : 육성-비육돈에 있어 MSM(Methyl Sulfonyl Methane)급여가 성장 및 육질특성에 미치는 영향

장해동 ( Hae Dong Jang ),유종상 ( Jong Sang Yoo ),채수진 ( Su Jin Chae ),박송이 ( Song Lee Park ),김인철 ( In Cheol Kim ),박준철 ( Jun Cheol Park ),정현정 ( Hyen Jung Jung ),김영화 ( Young Hwa Kim ),김인호 ( In Ho Kim ),석호봉 ( H 한국국제농업개발학회 2006 韓國國際農業開發學會誌 Vol.18 No.2