Elderly kidney transplant recipients have favorable outcomes but increased infection-related mortality

임정훈,Lee Ga Young,Jeon Yena,Jung Hee-Yeon,Choi Ji Young,CHO, JANG-HEE,Park Sun Hee,김용림,Kim Hyung-Kee,Huh Seung,유은상,Won Dong Il,Kim Chan-Duck 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.3

Background: The number of elderly patients with end-stage kidney disease has been increasing, but the outcomes of kidney transplants (KT) remain poorly understood in elderly patients. Therefore, we evaluated the clinical outcomes of elderly KT recipients and analyzed the impact of elderly donors. Methods: This retrospective cohort study included patients who underwent KT between 2000 and 2019. KT recipients were divided into four groups according to a combination of recipient and donor age (≥60 or <60 years); elderly recipients: old-to-old (n = 46) and young-to-old (n = 83); young recipients: old-to-young (n = 98) and young-to-young (n = 796). We compared the risks of mortality, graft failure, and acute rejection between groups using Cox regression analysis. Results: The incidence of delayed graft function, graft failure, and acute rejection was not different among groups. Annual mean tacrolimus trough level was not lower in elderly recipients than young recipients during 10-year follow-up. Mortality was significantly higher in elderly recipients (p = 0.001), particularly infection-related mortality (p < 0.001). In multivariable Cox regression analysis, old-toold and young-to-old groups had increased risk of mortality (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.14– 7.32; p = 0.03; aHR, 3.06; 95% CI, 1.51–6.20; p = 0.002). However, graft failure and acute rejection risks were not increased in elderly recipients. Conclusion: In elderly recipients, graft survival and acute rejection-free survival were not inferior to those of young recipients. However, mortality, especially risk of infection-related death, was increased in elderly recipients. Thus, low immunosuppression intensity might help decrease mortality in elderly recipients.

18–30세 사이에 발생하는 뇌경색의 특징, 다기관 레지스트리 연구

장윤경,송태진,김용재,허지회,이경열,김영은,장민욱,조수진,강석윤 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.3

Objectives: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. Methods: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. Results: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). Conclusion: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.

부산·울산·경남지역 직업병 감시체계

김정일,김병권,김정원,채창호,이철호,강동묵,김지홍,김진하,김영욱,이영하,이지호,김정호,윤형렬,유철인,정백근,장태원,김운규,윤동영,강진욱,김종은,안진홍,이동준,장준호,이광영,송혜란,최영희,이용환,조병만,최홍렬,고상백,김은아,이유진,홍영습,정갑열,김정만,김준연 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.1

Objective: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases Methods: l l hospital participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. Results: Between April 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. most of the HAVS cases came from shipbuilding, and 172 of them (92.7%) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9%). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6%) and 4 (12.1%) cases of occupational asthma, the agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10(58.8%) of the cases were diagnosed as squamous cell carcinoma and 5(29.4%) as adenoma. Conclusion: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.

Production and Characterization of Enzymes Involved in Chitin Catabolic Cascade from a Bacterial Strain Isolated from Soil

( Ji Hyun Lee ),( Jeong In Lee ),( So Yeon Park ),( Yoo Kyeong Jang ),( You Bin Lim ),( Hye Yoon Lee ),( Young Min Jung ),( Hae Chang Lee ),( Jong Hwa Lee ),( Shaheen Amna ),( Jae Kweon Park ) 한국키틴키토산학회 2019 한국키틴키토산학회지 Vol.24 No.1

The present study was aimed to isolate the bacteria producing chitinolytic enzymes including chitin deacetylase (CDA) from soil origin. About 24 bacteria were screened for their chitinolytic enzymes producing ability on the basis of colloidal chitin. Amongst one of the most potent isolates designated to JI-02 was further selected as the most prominent chitinolytic and CDAlike enzyme (CDA-X) producer based on the ability of deacetylation of an artificial substrate pNP-acetamilide. The maximum production of CDA-X in crude enzyme from JI-02 was observed in the presence of 1% colloidal chitin at 37°C and pH 6.4 after 120 h of incubation. Potent enzyme activity of CDA-X was determined toward pNP-acetamilide, demonstrating that optimal pH, temperature and ionic strength of the CDA-X were assessed to be 7.0, 52°C and 125 mM, respectively. Unexpectedly, Nacetylglucosamine (GlcNAc) was not fully converted by the action of CDA-X to glucosamine (GlcN) under the established conditions. Further study on enzyme activity toward chitin-oligosaccharides consisting of multi-N-acetylglucosamine (GlcNAc)n, n=2-5 may be necessary to elucidate the mode of action which requires the minimum size of (GlcNAc)n. However, our data suggest that CDA-X can convert chitin to chitosan with the maximum yield of approximately 0.08g/L during the fermentation of the strain in the presence of chitin. Furthermore, we found that crude enzyme showed the significant chitosanolytic activity. Taken together, our data suggest that the strain JI-02 may be a potential candidate as a particular strain for better understating of chitin catabolic pathway.

유방암의 위와 대장전이

유현아,김은영,서민지,정은,조민정,오현진,장지혜,박지찬,이정의,박석영 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.

성장기 아동의 single tooth scissors bite의 교정 치료: 증례 보고

김지인,현홍근,김영재,김정욱,장기택,이상훈,한세현,김종철 大韓小兒齒科學會 2011 大韓小兒齒科學會誌 Vol.38 No.4

A scissors bite in the posterior teeth occurs when the upper teeth are positioned totally buccal to the lower teeth in centric occlusion, either unilaterally or bilaterally. This malocclusion can result from either excessive width of the maxilla or deficient width of the mandible, or sometimes combination of the both. Scissors bite, when left untreated without a proper dental intervention, interferes with the normal mandibular growth leading to a state where consequent disharmony in dental arch width evokes occlusal disturbances. Therefore, early preventive orthodontic treatment is necessary in patients with scissors bite. Scissors bite rarely involves anterior and posterior sites concuttently across the dental arch but usually affect single tooth. Even in the single tooth scissors bite cases, more likely to be met in the clinical fields, immediate dental intervention is indicated because continuous occlusal forces that exacerbate the already adverse axis of the posterior teeth. In this case study, patients with single tooth scissors bite, each 7, 14, 12, and 16 years old, were each treated with criss-cross elastic, fixed appliance, removable appliance, and miniscrews. With the proper selection of appliances appropriate to each specific cases, good treatment outcome can be achieved without resulting any side effects. 중심교합위의 상태에서 편측 혹은 양측으로 상악 구치부의 치아가 하악 구치부의 협측으로 위치한 경우를 scissors bite라 고 한다. 이는 상악의 폭경이 크거나 하악의 폭경이 좁은 경우 발생한다. Scissors bite의 경우 방치하게 되면 하악의 성장이 방해받게 되고 그 결과, 악궁 폭경의 부조화가 심해져 저작 장애를 일으킬 수 있으므로 조기 차단 교정이 반드시 필요하다. 실제 임상에서는 여러 치아의 scissors bite보다 최후방 구치 혹은 그 외 하나의 구치만의 single tooth scissors bite(STSB)을 보이는 경우가 많다. 이러한 STSB의 경우도 방치하게 되면 저작력으로 인하여 구치의 각도가 더욱 악화되므로 즉각적인 치료가 필요하다. 본 증례에서는 STSB를 보이는 7세, 14세, 12세, 16세의 환자에게 각각 criss-cross elastic, 고정성 장치, 가철성 장치, miniscrew를 사용하여 치료한 증례를 보고하였다. 각 환자의 증례에 적합한 장치를 잘 선택하여 사용한다면 치아를 정출시키는 등의 부작용을 야기하지 않고 양호한 결과를 얻을 수 있을 것이다

미다졸람의 비강 내 추가투여가 소아의 경구 진정요법에 미치는 영향

장수영,김지연,박기태 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.1

Effect of supplementary intranasal midazolam on oral sedation of children The purpose of this study was to compare the cardiopulmonary parameters of two sedation regimens during dental treatment: (1) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen(N2O/O2) inhalation( CH-HZ group); (2) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen(N2O/O2) inhalation and supplementary intranasal(IN) midazolam administration(MIDA group). Among the patients of OO hospital who received dental treatment under sedation over the past 5 years, 44 patients were selected for each group of CH-HZ and MIDA according to their age, gender and weight. Following parameters that were recorded every 5 minutes were compared: 1) Heart rate(HR) 2) O2 saturation 3) End tidal carbon dioxide concentration(EtCO2) 4) Respiratory rate(RR) 33 patients of Group MIDA who have complete data of 15 minutes before and after supplementary IN midazolam administration were selected. And measurements 15 minutes before and after midazolam administration in same patient were evaluated. The results were as follows: 1. Heart rate was significantly higher in MIDA group than in CH-HZ group, but it was within normal range. 2. Comparing HR, O2 saturation, EtCO2, RR between before and after of supplementary IN midazolam administration in the same patient, the differences were not statistically significant. 이 연구는 소아환자의 경구 진정요법 시 미다졸람의 비강 내 추가 투여가 심폐기능에 미치는 영향을 알아보기 위한 것으로 5 년간 삼성서울병원 소아치과에서 chloral hydrate와 hydroxyzine을 경구투여하고 N2O/O2 inhalation을 추가로 사용한 진정요법으로 치료 받은 환자 중 미다졸람을 추가투여 받은 실험군(MIDA군)과, 미다졸람을 추가 투여하지 않은 대조군 (CH-HZ군)을 각각 44명씩 선정하여 서로 비교하였다. 진정요법 중 5분마다 측정된 1) Heart rate(HR) 2) O2 saturation 3) End tidal carbon dioxide concentration (EtCO2), 4) Respiratory rate(RR)의 평균값을 비교하였다. 또한 동일 환자에서의 미다졸람 투여 전 후의 심폐기능지표의 변화 양상을 평가하기 위해 MIDA군 중에서 미다졸람 투여 전 후 15분 이상의 기록이 존재하는 33명을 선정하여 미다졸람 투여 전 후 15분 시점의 측정값을 각각 비교하였다. 결과는 다음과 같다. 1. Heart rate는 미다졸람을 추가 투여한 군에서 유의하게 높았으며 나머지 심폐기능 지표의 측정값들은 차이가 없었다. 두 군의 측정값들은 모두 정상범위 안에 있었다. 2. 동일 환자에서 미다졸람 투여 전 후 15분의 측정값을 비교한 결과 두 시점간에 측정된 값들은 유의한 차이가 없었다.

2급 응급구조사의 성인외상환자에 대한 처치의 적절성 평가

장문수,어은경,김상현,김창섭,송근정,박한규,유지영,최동섭 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

In Korea, EMT have two classified subgroup of first and second degree : EMT-P, and EMT. For the beginning, authorization of the first EMT was made in this year through the EMT educational program. There are 8 items which EMT can perform the treatment without the supervision by a physician. But there was no previous report of pertinent assesment of treatment performed by the EMT. There upon authors have conducted review of assessment done by the EMT in EC setting, and proposed the following treatment application can be used by EMT at the field of accident. The study materials include adult trauma patient older than 15 years, and sustained trauma within 48 hours before visiting Ewha University DongDaeMoon Hospital Emergency Deparment. The duration of study was from Apr. 1 1995 to Aug. 31 1995. the study was conducted by 5 certified EMT. The EMT's performance was evaluated by the attending Emergency Medicine physician. The result were as followings ; 1. Among the total 5532 ED visiting patients during the study period, 1267 were adult trauma patients who recieved treatment within 48 hours of injury. 2. Among 1222 out of 1267 patients have completed performed survey. 3. Male to female ratio was 2.6 : 1, age distribution was from 15 to 87 years old and mean age was 34.6 years old. 4. The MOI showed : MVA (33.1%), blunt trauma (29.9%), slip down (16.8%), penetrating injury(15.4%), and miscellaneous (5.7 %), burn (3.1%), falling down injury(2.9 %), bite injury(1.1%) in order. 5. There were 437 cases of survey completed by the EMT. For assessment of mental status of 3 different method : AVPU, 5 scale mental status and GCS, were correlated with EM physician with 99.1%, 98.6%, 97.7 %, respectively. 6. For 320 out of 437 cases of survey completed, 319 patients recieved treatment by the EMT within 30 minute and 1 patient between 30 to 60 minute of an ED arrival. 7. For those 437 cases of survey completed, 266 patient (60.9%) had adequate treatment and 54 patients (12.4%) had inadequate treatment. 67 patient (15.3%) did not received treatment but it was adequate inway, and 50 patients (11.9%) did not received treatment even though patient required treatment. In cases of adult trauma patients, EMT's mental status assessment was correlated with EM physician's assessment. But treatment done by EMT without the supervision of EM physician was adequate only in 76.2 %. Therefore, continuous education and assessment of treatment performed by EMT in needed to improve field treatment by EMT future.

국소 진행된 식도암에서 방사선치료와 광역동치료의 병행 3예

장지영,박찬국 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Surgical resection has been the mainstay of therapy with curative intent in esophageal cancer. However, a large proportion of the esophageal cancer patients is detected with unresectable disease at the time of initial diagnosis. The survival outcome of radiotherapy alone was very poor although radiotherapy has been the major treatment modality in advanced esophageal cancer. We report the outcome of radiotherapy and photodynamic therapy in a multimodality approach for the treatment of patients with advanced esophageal cancer. Three patients with advanced esophageal cancer were treated with two-times photodynamic therapy 7-22 days before external beam radiotherapy. All patients had the middle thoracic lesion and squamous cell carcinoma. Total tumor dose of external beam radiotherapy delivered with curative intent was 55.8 Gy for 40-46 days. Significant toxicity during radiotherapy was not seen in all patients. The survival periods of 3 patients were 29, 12, and 27 months, respectively. Two out of three were alive at final follow-up. Radiotherapy and photodynamic therapy are the current modalities of palliating dysphagia and obstruction in esophageal cancer. This paper shows that the combination of radiotherapy and photodynamic therapy offers promising results for patients with advanced esophageal cancer.

비흑색종 피부암에서 고에너지 X-선 방사선치료

장지영,오윤경,천지선 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.33 No.S

Purpose: To evaluated the efficacy of radiotherapy in the nonmelanoma skin cancer. Materials and Methods: Eleven patients were diagnosed as non-melanoma skin cancer of the head and trunk. There were 9 women and 2 men. The mean age was 70 years with a range of 35 years to 93 years. Seven patients had squamous cell carcinoma and 4 patients had basal cell carcinoma. The mean tumor size was 3.1 cm (range 1 to 8 cm). All patients were treated with 6-megavoltage X-ray radiotherapy. Mean biological effective dose (BED₂) was 50.9 Gy/43 days (range: 37.5 to 59.4 Gy). Median follow-up period was 49 months (range: 18 to 107 months). Results: The local tumor control was 100% and median disease free survival time was 30 months. Local recurrence was noted in 3 patients and distant metastasis in 1 patient. Affecting factor in local recurrence was only radiation dose. By BED₂, median survival time was 30 months for ≥45 Gy and 12 months for <45 Gy (p=0.027). Radiotherapy related chronic complication was observed in 1 patient. Conclusions: High energy X-ray radiotherapy is an effective and safe treatment for nonmelanoma skin cancer, although the number of patients is small.