위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

Identification of a sensitive urinary biomarker, selenium-binding protein 1, for early detection of acute kidney injury

Kim, Kyeong Seok,Yang, Hun Yong,Song, Hosup,Kang, Ye Rim,Kwon, JiHoon,An, JiHye,Son, Ji Yeon,Kwack, Seung Jun,Kim, Young-Mi,Bae, Ok-Nam,Ahn, Mee-Young,Lee, Jaewon,Yoon, Sungpil,Lee, Byung μ,Kim, Hyung TAYLOR & FRANCIS 2017 Journal of Toxicology and Environmental Health Vol.80 No.9

<P>Acute kidney injury (AKI) is associated with increased mortality rate in patients but clinically available biomarkers for disease detection are currently not available. Recently, a new biomarker, selenium-binding protein 1 (SBP1), was identified for detection of nephrotoxicity using proteomic analysis. The aim of this study was to assess the sensitivity of urinary SBP1 levels as an early detection of AKI using animal models such as cisplatin or ischemia/reperfusion (I/R). Sprague-Dawley rats were injected with cisplatin (6 mg/kg, once i.p.) and sacrificed at 1, 3, or 5 days after treatment. Ischemia was achieved by bilaterally occluding both kidneys with a microvascular clamp for 45 min and verified visually by a change in tissue color. After post-reperfusion, urine samples were collected at 9, 24, and 48 hr intervals. Urinary excretion of protein-based biomarkers was measured by Western blot analysis. In cisplatin-treated rats, mild histopathologic alterations were noted at day 1 which became severe at day 3. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were significantly increased at day 3. Levels of urinary excretion of SBP1, neutrophil gelatinase-associated lipocalin (NGAL), and a tissue inhibitor of metalloproteinase-1 (TIMP-1) were markedly elevated at day 3 and 5 following drug treatment. In the vehicle-treated I/R group, serum levels of BUN and SCr and AST activity were significantly increased compared to sham. Urinary excretion of SBP1 and NGAL rose markedly following I/R. The urinary levels of SBP1, NGAL, TIMP-1, and KIM-1 proteins excreted by AKI patients and normal subjects were compared. Among these proteins, a marked rise in SBP1 was observed in urine of patients with AKI compared to normal subjects. Based upon receiver-operator curves (ROC), SBP1 displayed a higher area under the curve (AUC) scores than levels of SCr, BUN, total protein, and glucose. In particular, SBP1 protein was readily detected in small amounts of urine without purification. Data thus indicate that urinary excretion of SBP1 may be useful as a reliable biomarker for early diagnosis of AKI in patients.</P>

독성물질의 세포사 기전 및 세포사 유발물질의 검색법 개발에 관한 연구(Ⅰ) : 독성물질로 인한 파킨슨병 모델에서의 세포사 기전 연구 Study on the cell-death mechanisms of toxin-induced parkinsonism

강태석,김종민,서경원,김영옥,김준규,오재호,이윤동,김규봉,오정자,송연정,임종준,전범석,문전옥,최광식 식품의약품안전청 2000 식품의약품안전청 연보 Vol.4 No.-

MPTP 독성물질이 도파민성 신경세포에 선택적으로 작용하여 산화성 손상에 의한 신경세포사를 일으키는 것을 이용하여 파킨슨병의 동물모델을 만들고, 이를 통해서 아폼토시스를 비롯한 포사의 기전에 대한 연구 및 너코틴의 신경세포 보호효과 여부를 판정하는 실험을 병행하고자 하였다. 파킨슨꾐의 동물모델을 MPTf 독성 물질을 이용하여 확립하였으며, MPTP(30mgag, i.p.)를 투여한 후 1, 2,3, 4, 5일째 흑질 조직을 채춰하여 tarm로 박걸하여 tyrosine hydroxylase 면역조직화학염색을 수행하여 cell countif우한 결과, control은 57.635ce11s, 1일째 친.OfDells,2일째 57.9±6cells,3일릴 없.3±죠ells, 4일째 49.0츠3cells, 5일째 39.4±Scells료 4, 3일째 뚜렷한 신경세포 수의 감소를 보였다. 신경세포사 기전 규명을 위한 아폼토시스 분걱에서는 벼PTP 투여 후 1, 2, 3, 4, 5일째 조직을 채취하여 Hoechst staining, TUNEL staining을 수곡하였는데 양성 반응을 보인 신경세포는 관찰되지 않아. 아폼토시스로 인한 세포사가 관찰되지 않았다. bIPTP 파킨슨병 동물모델에서 nicotine 보호효과 탐색에 관한 실험은 nicat푸e 0.2mgAg을 5일 퐁안 투여 후 리『fP(30mgag)를 CS7Bt/6 마은스에 복강 내주사로 nicotine과 병용 투여한 후 1, 2, 3, 4, 5일째 뇌를 적출하땄다. 신경세포사가 뚜렷이 관찰되기 시작하는 4, 5일째의 신경세포 수의 감소 정도를 20. 30% 정도 약화시키는 경향을 보였으나, nicotine 보호효과에 대한 추가 실헝이 현재 수행 중에 있다. The cause of Parkinson's disease (PD) is largely unknown. However, free radical toxicit? may plaf a role ip. the degeneration of substantia nigra, which is the Hajorfocus of pathological damages in PD. Recently, a neuroprotective effect of nicotine in PD has been suggested. Therefore, the mechanism of neurodegenerafion and protective potential o( nicotine in PD were investigated in the experimental modeB of Pll using a neurotoxin, C57BL/6mice were administered with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 30 mg/kg,j.p.). The degree of neurodegenerafion was determined by immunohistochemical stainiHB oftyrosine hydroxylase (TH). TH-positive cells on nigral sections were found 56.0 ±4, 57.9 ±6,52.315ce11s, 49.0±3cells, and 39,4±Scells at days 1, 2, 3, 4, 5, respectively (controls : 57.6±Scells). Hoechst and TUNEL staining showed no evidence of apoptosis. The exandnation on themice co-adrunistered with nicotine(0.2mgAg) and MPTP(30mgag) revealed a tendency ofnicotine protective effects. At days 4 and 5, the degree of TH-positive cells was decreased by20-30%, In corclusiffn, the role of apoptosis was not evidenced in this MPTP modeB of PB.The possible proteccon by nicotine should be elucidated with further studies.

유료노인주거시설 규모계획에 관한 연구 : 일본의 사례분석을 중심으로 With Rate of Rentable Area and Area of Private and Public

김태일,박철민,고경옥 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

Population of our country has been changing to aging society's population. Aging of population structure is will cause social changes in market. because of increasing needs of housing for The elderly and welfare service and so on. Aim of this study is to get basic data of fee charging home for The elderly. This study is based on researching of fee charging home for The elderly. Plan of 32 facilities were collected and analyzed Results of analysis is as follows : Rate of rentable area is 0.45∼0.69 and it mean that rate of public space to total scale of facility is 30∼55percent. It seem that Rentable rate is depended on location of fee charging home, its function. It is necessary to analyze relation of between Rentable rate and location of fee charging home and its function. In case of fee charging home established by administration and social welfare foundation, scale of facility is large and all so medical space is installed within facilities. But in case of fee charging home established by private, scale of facility in not large and medical service os provided from near medical facilities in community.

중소도시 하수관거의 침입수량 및 수질오염 원단위 산정

김옥형,박승기,정재훈,임경호 公州大學校 工學硏究院 生産技術硏究所 2004 論文集 Vol.12 No.-

The volume of wastewater in combined sewers in study areas usually exceeds capacities of the sewer system or the treatment plant during storms. For this reason, combined sewer systems are designed to overflow occasionally and discharge excess waste water. The 6 monitoring sites were selected from two small cities near the Hongsung prefecture during over a rainy season. Monitoring was performed by collecting grab samples and by measuring the rainfall and flow rates during dry and wet seasons. Generally the flow rate of wastewater in combined sewers was rapidly decreased after 23:00 PM and gradually increased from 06:30 AM in all sites during the dry season. Due to monitoring and statistical analysis, the groundwater contributes on sewage volume increase (average 3.4-25.4% more) during experimental periods. Therefore, this research is focus on the investigation of the effects of stormwater and groundwater to combined sewer systems.

분광 앨립소미트리를 이용한 유리기판 위의 박막 분석

성덕경,방경윤,오영륙,최은호,안일신,김옥경 한양대학교 이학기술연구소 2003 이학기술연구지 Vol.6 No.-

Spectroscopic ellipsometry 은 다양한 물질의 광학적 특징을 연구할 수 있는 강력한 기술이다. 현재 실리콘 웨이퍼 위의 박막 분석에는 그 효율성이 확실히 입증되어 있다. 그러나 현재 산업은 유리 기판위의 박막을 분석하기를 원하고 있다. Ellipsometry로 투명기판을 분석하기 위해서는 후면 반사에의한 비간섭성 효과를 고려해야 한다. 기존의 반사공식을 투명기판의 비간섭성을 고려하여 수정하였다. 투명기판 위의 샘플과 scratch를 낸 같은 샘플을 측정 분석하여 정확성을 확인하였다. 수정된 반사공식을 이용하면 디스플레이와 같은 투명재료를 이용하는 곳에 유용하게 사용될 것으로 기대되고 있다. A Spectroscpic ellipsometry is very strong technology to study optical properties of many materials. It has already substantiated a analytic efficiency about thin films above wafers to be made of silicon. However, the current industry needs thin films analyzed on a glass. When we analyze a glass using a ellipsometry, we have to consider a efficiency of incoherence due to reflect at the back side. So then, we slightly altered the original formula. We compared a scratched sample with a sample on the glass, because off getting a exactitude. Our technical development, using the changed formula, is expected the useful utilization in a part of using gIasses such as display.

염소를 포함한 액체에서의 금박막 패터닝과 표면 분석

성덕경,최정옥,안일신,김옥경 한양대학교 이학기술연구소 2004 이학기술연구지 Vol.7 No.

금박막은 높은 전도성의 화학적인 안정성을 가지고 있으므로 GaAs를 기판으로 한 bevice에서 널리 쓰이고 있으며 SAM(Self-Assembled Monolayer), Nanolithography 등에서도 아주 주요하게 사용되고 있다. 본 연구에서는 염소가 포함된 액체에 금박막이 접해있고 UV를 조사하여 식각이 되는 것을 발견하고 연구하였다. 노광량을 조절하여 금박막의 기각률을 조절할수 있으며, 또한 가모강제 공정을 거치지 않고 금박막에 직접 조사하게 되므로 간단하게 패터닝을 할수 있다. AFM(atomic force microscope), optical microscope, ellipsometry 를 이용하여 식각률 측정 및 표면 변화를 보았다. Various metals or their alloys are used in the semiconductor metallization process or in micro-or nano-structure devices. We report a novel etching technique of gold film based on new phenomenon that gold is soluble in chlorine containing solutions or solvents under UV irradiation. Mask patterns can be transferred to gold surface directly without resorting to complicate photoresist process. And, etch rate could be controlled from sub nanometer to few tens of nanometers per minute by adjusting exposure parameters. Moreover, non-toxic liquid such as NaCl solution can be used for the process. AFM(atomic force microscope), optical microscope, ellipsometry were used to characterize the etch rate and the surface morphology.

유아교사의 소진에 관한 연구

유경숙,김수옥 한국아동교육학회 2004 아동교육 Vol.13 No.2

본 연구에서는 광주광역시 유아교사의 소진경험에 대해 체계적으로 분석하고 검토해 봄으로서 유아교사의 전문성을 신장하고 유아교육의 질적 향상에 기여하고자 한다. 근무시간에 따른 소진에서는 12시간 이상 근무하는 집단이 가장 소진한 것으로 나타났다. 즉 평균 이상의 시간을 근무하는 경우 소진하는 것으로 볼 수 있는데, 이것은 근무시간이 긴 교사들은 정서적 고갈의 소진 증상을 자주 느끼고 일에서 성취감도 적게 느끼는 것으로 보아 개인적인 특성 요인들보다 근무여건이 소진에 더 절정적인 영향을 미치는 것으로 여겨진다. 본 연구의 대상인 광주지역 유아교사들의 평균 근무시간은11시간으로 나타났으며, 근무시간이 길어질수록 일에 대한 집중력이 털어지므로 교사의 스트레스로 작용하여 소진이 높게 나타나는 것으로 해석된다. The purpose of this study was to find the difference among child teachers' exhaustion A questionnaire was distributed to 278 child teachers who worked in Nurseries and Kindergartens at Kwangju. The questionnaire consisted of 13 questions regarding teachers' background and exhaustion. To find exhaustion by the background variables of child teachers, t-test, One-way Anova, and Scheffe-test were used The result was as follows; Child teachers' exhaustion found a significant difference by formal schooling and average hours of duty. The higher exhaustion was found in a group of child teachers who completed not more than a college, a group of those who finished a graduate school, and a group of those who worked for more than 12 hours in average.

빠딴잘리 요가경에 나타난 인간의 본성과 삶의 목적

조옥경,김명권 한국동서정신과학회 1999 동서정신과학 Vol.2 No.1

본 연구의 목적은 빠딴잘리 요가경에서 가정하고 있는 인간관과 인생관을 알아보는 것이었다. 다양한 요가의 기법들과 목표는 단순한 철학적 이해를 넘어 인간 심성의 개발이라는 측면에서 심리학의 관심사와 일치한다. 그러므로 빠딴잘리 요가경을 심리학적인 시각에서 살펴보는 것이 필요하다고 보았다. 빠딴잘리는 인간은 순수의식인 뿌루샤와 물질적 요소인 쁘라끄르띠로 되어 있고 이 두 요소는 서로 관련 없이 독립적으로 존재한다고 보았다. 현상적으로 경험하는 심리적 실체인 '나'는 뿌루샤와 쁘라끄르띠의 혼동으로 파생된 것이므로 궁극적으로는 허구임을 강조하였다. 이 혼동을 아위디아(Avidya￣)라고 하며 이로 인해 피할 수 없는 인간의 온갖 고통이 파생된다. 고통을 피하려는 욕구는 모든 인간에게 공통된 것으로 이를 위해서는 고통의 근본원인인 아위디아를 완전히 뿌리뽑아야한다. 여러 가지 명상법과 고행 법은 결국 아위디아를 제거하여 인간 본연의 실체, 즉 뿌루샤와 쁘라끄르띠의 완전한 분리를 체험하는 것이다. 이를 위해 사는 삶만이 진정으로 가치가 있는 삶임을 빠딴잘리는 거듭 강조하고 있다. 뿌루샤의 절대적 존재를 깨닫고 직접 체험함으로써 쁘라끄르띠의 무상한 세계를 초월하여 절대 자유와 행복에로 도달하는 것이 인생의 진정한 목적이라는 것이다. 이러한 빠딴잘리 요가경의 인간과 인생에 대한 태도는 언뜻 보기에는 지나치게 비현실적이고 때로는 무모한 것처럼 보인다. 그러나 빠딴잘리는 자신의 시각을 뒷받침하는 이론적, 경험적 근거를 제시하면서 자유와 행복을 위한 구체적인 방법을 과학적이고 체계적으로 설명하였다. 오랜 세월을 거쳐 경험적으로 입증되어온 요가의 실천적 방법들이 최근 심리치료에 적극적으로 도입되고 있는 실정임을 고려할 때 그 방법들의 이론적 근거를 제공하는 철학적 가정들을 심리학적인 측면에서 재조명해보고 그 가치를 새롭게 찾는 것이 시급한 일이라고 본다. This theoretical study aims to examine the several basic assumptions that Patan~jali's Yoga Su￣tra has adopted about the nature of man and the goal of life. The Yoga Su￣tras are considered the foundation of all Yoga practice and Yoga psychology. People have been practicing Yoga for centuries in order to obtain the physical and psychological benefits that arise out of this discipline. Despite the increasing interest of contemporary Western psychology in the practice of Yoga, comparatively little has been written about its philosophical aspect. It is the purpose of this paper to make explicit theoretical points of Yoga's view about man and his life. Patan~jali assumed that man consists of two separate elements; Purus??a and Prakr??ti. The Purus??a is the pure and essential consciousness. Prakr??ti is the term used to designate everything else in the universe aside from the Purus??a, mainly the natural or material world. According to Patan~jali, the cause of all mental pain and anguish is avidya, lack of understanding the distinction between Purus??a and Prakr??ti. This wrong identification with man's material nature as opposed to one's Purus??a, that is Avidya￣, should be removed by the right knowledge to obtain the absolute happiness and freedom free from all the pain and suffering. Hence the true goal of life is to escape from pain which are yet to come by means of destroying Avidya￣. As the Avidya￣ is the fundamental cause of other sufferings, one's whole life should be devoted to the effective and practical ways to root it out. The philosophical presuppositions of Patan~jali about man and man's life seems to be metaphysical and mystical, not deserving of serious scientific comment. But he deals with human sufferings and the practical means to overcome them in a systematic way. His theoretical assumptions helps us to gain an understanding of Yoga psychology's principles of mental health, psychological disturbance, and therapeutic change.

가족성 정신분열병 환자에서 임상 특성의 가족내 연관성

최경숙,이유상,장용이,조은영,전현옥,김창현,김상욱,홍경수 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.5

Objectives : This study aims at examining familial associations of symptoms and clinical characteristics in affected sibling or relative pairs of schizophrenia as an effort to identify genetically homogeneous phenotypes. Methods : Forty-seven relative pairs with DSM-IV diagnosis of schizophrenia from thirty-five Korean families multiply affected with schizophrenia were ascertained. Direct interviews were done using the Korean version of Diagnostic Interview for Genetic Studies (DIGS). The Krawieka Rating Scale and the Schedule for the Deficit Syndrome were also applied for further evaluation of psychopathologies. Intra-familial concordances and correlations of clinical characteristics and symptoms were tested using χ² -test and Spearman's correlation. Results : Significantly high concordance rate within relative pairs was found for the diagnosis of paranoid vs. non-paranoidsubtype (χ²=7.623, P=0.006, df=1). Deficit vs. non-deficit syndrome also showed significant concordance (χ² =3.850, p=0.0497, df=1). Among single symptom items in DIGS, only 'auditory hallucination' showed significant concordance rate ( χ² =5.503, P=0.019, df=1). Factor analysis for symptoms items in the Rrawiecka Rating Scale indicated three symptom dimensions ; negative, psychotic and affective, Psychotic (P =0.442, P=0.003) and affective dimension scores (p =0.427, P=0.004) showed significant intra-familial correlations. Age at onset of recognized psychotic symptoms showed significant correlation only within the male sibling pairs. Conclusion : Familial factors, Possibly genetic factor contribute to the phenotypic characteristics of paranoid vs. non-para-noid subtype, deficit vs. non-deficit syndrome, auditory hallucination, and affective syndrome, It supports their use in the delineation of homogeneous subgroups for future genetic studies.