중증의 급성신손상 환자에서 지속적 신대체요법 대체치료로서의 지속성 순화 혈액투석

신용봉 ( Yong Bong Shin ),조장희 ( Jang Hee Cho ),박자용 ( Ja Yong Park ),최지영 ( Ji Young Choi ),박선희 ( Sun Hee Park ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5

Purpose: Although continuous renal replacement therapy (CRRT) is commonly used as a renal replacement therapy in critically ill patients with acute kidney injury, it has some disadvantages such as inconvenience, intensive labor, expensiveness and high bleeding risk. Recent studies have shown that sustained-low efficiency dialysis (SLED) can overcome these shortages of CRRT and also has the advantages of CRRT. We prospectively compared the efficiency, safety, cost and convenience between SLED and CRRT, and evaluated whether SLED could be a complementary substitute to traditional CRRT. Methods: Forty-six critically ill patients with acute kidney injury (AKI) from 2003 to 2005 were treated with SLED (n=25) and CRRT (n=21). The modality was tended to be selected randomly and based largely on availability of equipments and not on the clinical status of patients. Mann-Whitney rank-sum test, Fisher`s exact test and chi-square test were used for statistics, and data were described as median value, range from 25th to 75th. Results: The Acute Physiology and Chronic Health Evaluation (APACHE) II score at the point of ICU admission was 27 for SLED (range 17-3 25-75th percentile) and 26 for CRRT group (range 19-31) (p= NS). There were no significant differences between the two groups in mean arterial blood pressure when measured pre-dialysis (83 for SLED vs. 85 for CRRT; p=NS), mid-dialysis (90 vs. 84; p=NS) and at the end of treatment (88 vs. 80; p=NS). Incidences of hypotension also did not differ between the two groups (p=NS). Ultrafiltration volume per treatment day was similar in two treatment modalities (000 mL for SLED vs. 400 mL for CRRT; p=NS). Heparin was used to thirty-one patients (SLED: 18 patients, CRRT: 13 patients). The dosage of heparin tended to be lower in SLED (900 unit per day for SLED vs. 6,000 unit per day for in CRRT, p=0.065). Total clotting number was 4 for SLED and 11 for CRRT (p=NS). There was also no significant difference in hospital mortality between the two groups (56% for SLED vs. 42.9% for CRRT; p=NS). SLED was superior to CRRT in the aspect of cost and convenience. Conclusion: Our data suggest that SLED can be used as a useful substitute to traditional CRRT in critically ill patients with AKI.

복막투석에서 야간저류 후 투석액 대 혈장 sodium 농도비의 유용성

신용봉 ( Yong Bong Shin ),이현철 ( Hyun Chul Lee ),최혁준 ( Hyok Joon Choi ),조지형 ( Ji Hyung Cho ),장민화 ( Min Hwa Jang ),조영준 ( Yung Jun Cho ),박선희 ( Sun Hee Park ),조동규 ( Dong Kyu Cho ),김용림 ( Yong Lim Kim ) 대한내과학회 2002 대한내과학회지 Vol.63 No.6

배경: 복막투석에서 표준 복막평형검사 (standar d PET)는 인력과 시간이 많이 드는 검사이며 단지 확산에 의한 용질이동을 측정하므로 수분이동을 정확히 반영할 수 없다. 복막을 통한 sodium의 제거는 한외여과와 밀접한 연관이 있으며 최근 연구에 의하면 투석액 sodium 농도는 복막의 수분이동과 복막특성을 반영해줄 수 있다고 제시되고 있다. 저자는 야간저류 후의 투석액 sodium 검사가 표준 PET과 동일한 정보를 줄 수 있는지와 한외여과부 Background: Standard PET (peritoneal equilibration test) is time consuming and it cannot reflect the water removal accurately because it measures solute transport by diffusion only. Thus, it is important to find parameters that can be used to predict both

철도공급산업 경쟁력 평가 항목 도출 및 중요도 산정

정성봉(Sung-Bong Chung),최지호(Ji-Ho Choi),신용선(Yong-Sun Shin),장기태(Ki-Tae Chang) 한국철도학회 2013 한국철도학회 학술발표대회논문집 Vol.2013 No.11

최근 철도투자에 대한 인식이 개선됨에 따라 철도산업에 대한 관심은 날로 증가하고 있는 상황이다. 하지만, 국내 철도시장 규모는 한계가 있어 국내 철도산업의 발전을 위해서는 해외시장진출이 필수적이다. 효과적인 철도산업의 해외진출을 위해서는 국내 철도산업의 시장구조 및 기술수준을 객관적으로 파악할 필요가 있으나 아직까지 이러한 분석은 부재한 상황이다. 이에 본 연구에서는 국내 철도공급산업의 기술수준 경쟁력을 분석하기 위해 M. Porter의 다이아몬드 모델을 기반으로, 기존 산업경쟁력 사례분석 및 경제학적 지표추정 방법을 활용하여, 철도공급산업 특성에 맞는 철도공급산업 경쟁력 평가항목 을 선정하고, AHP 분석을 통해 항목간 중요도 산정을 하였다. 본 연구를 통해 국내 철도공급산업의 현 위치를 정확하게 진단할 수 있을 것으로 판단되며, 이를 통해 해외 철도시장진출 전략을 수립하는데 큰 기여를 할 것으로 기대된다. Improved awareness of recent railway investment , depending on the growing interest in the railway industry , and is the situation . However , the domestic rail market is limited to the development of the domestic rail industry into overseas markets is essential. Effective overseas expansion of the railway industry in the domestic railway industry market structure and technology level , but still have to understand the objective of this analysis is the absence . In this study, the technological level of domestic rail supply industry to analyze the competitive M. Porter"s diamond model , based on analysis of existing industry practices and economic competitiveness index estimation , utilizing railway supply industry railway supply industry, according to the characteristics and the competitive selection of assessment items , AHP analysis was to estimate the importance between items . In this study, the current position of the domestic railway supply industry can be expected to accurately diagnose , and thereby to establish the international rail market strategy is expected to be a major contribution.

호텔연회서비스의 직무만족과 업무의 효율화 방안

조춘봉(Chun Bong Cho),신용모(Yong Mo Shin) 한국외식경영학회 2000 외식경영연구 Vol.3 No.1

This study is concerning the service quality improvement of hotels banquet business operations. The purpose of the study was to examine the influence of job performance and banquet business importance on the service employees' job satisfaction and efficiency and the banquet service facilities as well as the effect of the service-offering ability and banquet service system upon job satisfaction and efficiency. It was closely related to guest satisfaction and the service quality improvement of hotel banquet business. The study results were summarized as follows: First, there were significant factors that influenced the successful accomplishment of banquet business, and its high efficiency required a professional knowledge of employees job at the banquet department of the five-star deluxe hotels in Korea. Second, the more conscious employees were of the significance of banquet business, the more efficient job satisfaction they have. Third, the facilities of banquet department and the ability of service offerings also were the valuable factors for the successful accomplishment and efficiency of banquet business. Fourth, it was found that the physical factors such as office layout and the systemized flow diagram had a significant relationship to the successful accomplishment and efficiency of banquet business. Finally, it was noteworthy that there was an indispensable relationship between the highly effective banquet business and the support for the department related to banquet business, especially sales personnel, reservation processing, banquet service team(designers, artists, engineers, cooks etc) and so on.

5년이상 장기 지속적 외래 복막투석 환자의 영양상태와 투석 적절도

김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김성호(Sung Ho Kim),조영준(Young Jun Cho),신용봉(Yong Bong Shin) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A CAPD may have many negative impacts on nutritional status. Protein and caloric malnutrition are highly prevalent in chronic CAPD patients. In order to evaluate the relationship between nutritional and dialysis adequacy of long-term CAPD patients, twenty patients treated for aver 5 years on CAPD, with a mean age of 50.5±12.2 years and dialysis duration of 82.6±19.5 months(range 60-116) were studied. Four-teen of the twenty patients(70%) had no residual renal function(RRF). In these twenty patients the mean weekly Kt/Vurea and Ccr were 1.85±0.24 and 58.110.8L/week/1.73m²with the median body surface area(BSA) of 1.61m². Female(n=7) patients had lower BSA(1A7 vs 1.69m²), TBW(27.7 vs 35.6L), and higher serum albu-min(4.01 vs 3.41g/dL), weekly Kt/Vurea(2.02 vs 1.76) than male(n=13) patients. Six patients had nPCR0.9 and nPCR was negatively correlated with age(r= -0.53, p<0.05), BSA(r=-0.54, p<0.05) and positively correlated with serum albumin(r=0.53, p<0.05). Serum albumin was not changed during 5 years of CAPD. Fourteen patients were well nourished and six patients were mild to moderately malnourished on SGA score. Fourteen of the twenty patients had nor- mal serum albumin(≥3.5g/dL) and 6 had hypoalbu- minemia(<3.5g/dL). Serum albumin was positively correlated with nPCR(r=0.53, p<0.05) and negatively with BSA(r=-0.6S, p<0.001) and total body water (TBW)(r=-0.69, p<0.001). Hypoalbuminemia patients had high peritoneal membrane transport characteristics(24h D/Pcr 0.84 vs 0.74, p<0.05). Four patients had weekly Kt/Vurea>2.0 and Kt/Vurea was nega-tively correlated with BSA(r=-0.61, p<0.001). In conclusion, for Korean patients on long-term CAPD, small body size is the key for adequate dialysis and nutrition. Low serum albumin levels may be related with high peritoneal transport.

확장 범주 뇌사자의 신장이식 성적

박자용 ( Ja Yong Park ),조장희 ( Jang Hee Cho ),윤영득 ( Young Deuk Yoon ),송은주 ( Eun Joo Song ),진미경 ( Mi Kyung Jin ),류정훈 ( Chung Hoon Yu ),정희연 ( Hee Yeon Jung ),임정훈 ( Jeong Hoon Lim ),신용봉 ( Yong Bong Shin ),최지 대한내과학회 2011 대한내과학회지 Vol.80 No.4

목적: 신장이식 대기자에 비해 장기 공여자의 수는 매우 부족하다. 확장 범주 뇌사자 신장이식이 그 대안으로 제시되고 있다. 본 연구에서는 단일기관에서 시행한 확장 범주 뇌사자 신장이식을 대상으로 이식신 기능 및 생존율을 후향적으로 분석하였다. 방법: 2003년 1월부터 2009년 12월까지 본원에서 시행한 77예의 뇌사자 신장이식을 대상으로 하였다. 뇌사자의 나이, 장기 적출 전 크레아티닌 청소율, 고혈압 병력, HLA 불일치 개수 및 뇌사자의 사망 원인에 따른 이식 수술 후 신장 기능의 차이를 알아보았다. KONOS의 확장 범주 공여자 정의에 따라 두 군(확장 범주, 표준 범주 공여자)으로 나누어 이식 수술 후 36개월까지의 신장 기능과 이식신 및 환자 생존율을 비교분석 하였다. 결과: 뇌사자의 나이가 많거나 크레아티닌 청소율이 낮은 경우 및 고혈압 병력이 있거나 뇌혈관 질환이 사망 원인이었던 경우 이식 수술 후 신장 기능이 낮았다. 수술 후 36개월까지의 신장 기능을 비교하였으며, 확장 범주 공여자군에서 크레아티닌 청소율이 의미있게 낮았다(49.8 ± 22.7 vs. 75.0 ± 28.6, p < 0.05). 그러나 이식신 기능 부전과 이식신 생 존율 및 환자 생존율에서는 두 군 간의 차이가 없었다. 결론: KONOS 기준의 확장 범주 뇌사자 신장이식에서 이식신 기능은 표준 범주 공여자에 비하여 낮게 유지되었다. 그러나 이식 후 3년까지의 이식신 및 환자 생존율은 표준 범주 공여자와 차이가 없었다. 공여자가 부족한 현실에서 확장 범주 뇌사자는 공여자군을 늘일 수 있는 받아들인 만한 대안으로 생각된다. Background/Aims: The Korean Network for Organ Sharing (KONOS) was established in 2000, and the KONOS criteria for expanded- criteria donors (ECD) have since been applied to kidney allocation from deceased donors. The outcome of cadaveric kidney transplantation from ECD according to KONOS criteria has not been investigated. Methods: Seventy-seven cadaveric kidney transplants from January 2003 to December 2009 were recruited retrospectively. Factors that influence the glomerular filtration rate (GFR) of graft kidneys up to 36 months after transplantation were evaluated. Postoperative renal function and allograft and patient survival in the ECD group (n = 28) were compared with those in the standard- criteria donor (SCD) group (n = 49). Results: The GFR of graft kidneys was different according to donor GFR, age, hypertension history, and cause of brain death. In the ECD group, GFR was lower than that in the SCD group by KONOS criteria. No differences in allograft or patient survival were observed until 3 years after kidney transplantation. Conclusions: Cadaveric kidney transplantation using the ECD by KONOS criteria is acceptable in term of graft and 3-year patient survival, although the GFR was lower in the ECD than in the SCD group. (Korean J Med 2011;80:408-418)

전해액 첨가제를 이용한 고전계 양극산화의 자기정렬에 관한 연구

김민우,박성수,심성주,강태호,신용봉,하윤철,Kim, Min-Woo,Park, Seong-Soo,Sim, Seong-Ju,Kang, Tae-Ho,Shin, Yong-Bong,Ha, Yoon-Cheol 한국전기화학회 2011 한국전기화학회지 Vol.14 No.4

옥살산 수용액에서의 전기화학적 양극산화에 의한 자기정렬된 알루미나 나노템플레이트의 제조에 있어서 전해액 첨가제를 이용하여 기존 양극산화 법으로는 보고된 바 없는 160~200 V 범위의 자기 정렬 구간을 관찰하였다. 고전계 양극산화와 펄스분리법 및 화학적 기공확장을 거쳐 생성된 자기 정렬구조를 FE-SEM 으로 관찰한 결과 이 전압구간에서의 기공간격과 전압과의 관계는 2.2 nm/V 으로 기존 고전계 양극산화의 결과와 유사하게 나타남을 알 수 있었다. 또한 양극산화막의 성장속도는 약 60 ${\mu}m$/hr로 유사한 기공구조를 얻을 수 있는 인산 수용액에서의 연질 양극산화에 비해 약 30배로 높은 것을 알 수 있었다. 이러한 고찰을 통하여 기공간격 300 nm 이상의 나노템플레이트를 고속으로 제조할 수 있는 조건을 확립하였다. Using an electrolyte additive, we examined, for the first time, a novel self-ordering regime of 160~200 V in high-field anodization which had been used for a fast fabrication of self-ordered anodic alumina nanotemplate. FE-SEM analyses conducted after the high-field anodization, pulse detachment and chemical widening of pores showed the relationship of 2.2 nm/V in this voltage range, which was identical to the previously reported one in the literature. The growth rate of the alumina film was about 60 um/hr, which was 30 times faster than that of phosphoric acid mild anodization. This study provides a new process for the fast fabrication of nanotemplates with interpore distances larger than 300 nm.

철도공급산업의 경쟁력 분석 방안 연구

최지호(Choi, Ji Ho),정성봉(Chung, Sung Bong),신용선(Shin, Yong Sun),남궁백규(Namkung, Baek Kyu),오재경(Oh, Jae Kyung) 대한토목학회 2013 대한토목학회 학술대회 Vol.2013 No.10

p-ANCA 연관 신염의 임상적 고찰: 단일 임상기관 연구

강혁주 ( Hyeock Joo Kang ),박선희 ( Sun Hee Park ),박자용 ( Ja Yong Park ),신용봉 ( Yong Bong Shin ),김찬덕 ( Chan Duck Kim ),탁우택 ( Woo Taek Tak ),이정호 ( Jeong Ho Lee ),김용림 ( Yong Lim Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

목적: 급속진행성 사구체신염은 전체 사구체신염의 약 2~10%를 차지하며, 그 중에서 무면역침착 질환(pauci-immune disease)은 항호중구 세포질 항체(ANCA)와 연관있는 염증 질환으로, 본원에서 ANCA 연관 신염(ANCA associated nephritis)으로 진단된 예를 대상으로 한 임상경험과 예후과 관련이 있으리라 생각되는 인자들을 분석 보고하고자 한다. 방법: 2000년 1월부터 2006년 7월까지 경북대학교 병원내과에 입원하여 후향적 조사에서 RPGN, crescentic GN으로 진단된 39예 중 혈청ANCA 양성인 17예를 대상으로 하였다. 결과: 환자의 평균연령은 60.5±18.0세(15~79세)였으며 성별분포는 남자가 9예, 여자가 8예로 남녀 성별비는 1.13:1였으며, 61세 이상의 환자가 전체의 64.7%를 차지하였다. 중요 임상증상은 혈뇨, 단백뇨가 모든 환자(17예, 100%)에서 관찰되었으며 고혈압, 요독 증상, 부종, 상기도 감염 증상, 핍뇨, 객혈의 순이었으며, 이 중 신생존과 연관을 보이는 인자는 없었다. 면역혈청학적 소견은 17예 모두에서 p-ANCA 양성이었으며, 중요 검사실 소견에서 신생존과 관련하여 호전된 환자군과 악화된 환자군에서 의미있는 차이점을 보인 인자는 진단 당시의 혈중요소질소(p=0.032)와 사구체여과율(estimated GFR) (p=0.023)이었다. 진단시의 신생검 소견은 환자 모두에서 사구체내에 면역글로불린과 보체의 침착이 경미하거나 관찰할 수 없었고 반월상의 동반율은 48.81±30.9%, 사구체경화의 동반율은 32.6±31.8%였으며, 간질성침윤과 섬유화 정도는 경증에서 중등증의 소견을 보였으며 이 중 신생존과 관련하여 두 군 사이에 의미있는 차이점을 보인 인자는 없었다. 치료는 14예(82.4%)에서 내원 당시 투석치료가 필요하였으며, 스테로이드 충격요법이 8예(47.1%), 스테로이드 충격요법과 싸이클로포스파마이드(cyclophosphamide) 병합요법을 시행한 예가 4예(23.5%), 스테로이드 충격요법과 싸이클로포스파마이드 및 혈장교환술을 시행한 예가 2예(11.8%), 스테로이드 충격요법과 혈장교환술을 시행한 예가 2예(11.8%)였다. 평균 15개월의 추적기간 동안 13예(76.5%)에서 말기신부전으로 진행하여 유지 신대치요법이 필요하였고, 4예(23.5%)에서 신기능이 회복되었으며 경과 중 사망한 경우는 3예(17.6%)였다. 환자생존율은 1년 및 3년에서 80.2%였고, 신생존율은 1년 및 3년에서 33.3%였다. 결론: 진단 당시 신기능이 예후와 가장 관계가 있었으며 환자의 나이, 성별, 임상양상이나 병리학적 소견은 신생존과 관계가 없었다. 따라서 조기 진단과 치료가 신생존율 향상에 도움을 줄 수 있을 것으로 판단된다. Background/Aims: We evaluated the clinical characteristics and prognostic value of the clinical, laboratory, pathologic features, at time of diagnosis, and the renal survival of patients with ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis. Method: We retrospectively analyzed 17 patients who were diagnosed with ANCA-related nephritis at a single center. The risks of progression to ESRD or death according to the clinical parameters, the ANCA pattern and the renal pathologic findings were evaluated. Results: The major symptoms were hematuria (100%), proteinuria (100%), uremic symptoms (41.2%), edema (35.5%), upper respiratory symptoms (29.4%) and oliguria (23.5%), which were not correlated with renal survival. All the patients showed a p-ANCA pattern. The BUN level (p=0.032) and GFR (p=0.023) at the time of diagnosis were different between the improved and the progressed patients in terms of renal function. The pathology indices were not predictive factors of both renal and patient survival. Eight patients (47.1%) were treated with steroid IV pulse, 4 (23.5%) with steroid IV pulse and cyclophosphamide IV pulse, 2 (11.8%) with steroid IV pulse, cyclophosphamide IV pulse and plasma exchange, and 2 (11.8%) with steroid IV pulse and plasma exchange. Fourteen patients (82.4%) needed hemodialysis. There were 3 (17.6%) disease-related deaths, 13 patients (76.5%) reached ESRD and 4 (23.5%) showed recovery of renal function. The mean percent of patients who survived was 80.2% and the mean percent of renal survival was 33.3% at the 1st and 3rd year, respectively. Conclusions: Poor renal function at presentation was associated with a high risk for disease progression, but age, gender, the clinical patterns of presentation and the pathologic findings were not associated with the prognosis. Early diagnosis and treatment seems to be essential to improve the renal outcomes.(Korean J Med 74:523-530, 2008)

자발성 신동맥 박리에 의한 신경색 1 예

박선희(Sun Hee Park),최혁준(Hyuk Joon Choi),장민화(Min Hwa Jang),조지형(Ji Hyung Cho),신용봉(Yong Bong Shin),이덕현(Duk Hyun Lee),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),허승(Seung Huh),김영욱(Young Wook Kim),김용주(Yong Joo Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3

It is usually known that arterial dissection is associated with malignant hypertension, severe atherosclerosis or trauma. Marfan syndrome or Ehlers-Danlos syndrome may also be rare causes. However, as in this case, spontaneous arterial dissection without aortic dissection in normotensive men is rarely reported. A 39-year-old man presented with acute onset right flank pain with microscopic hematuria. Physical examination was unremarkable and his blood pressure was normal. Clinical impression was urolithiasis because he experienced two episodes of urolithiasis previously. IVP was not completed due to adverse reaction during study. Right renal infarction was diagnosed by contrast-enhanced computed tomography. To search for possible cardiac embolic disease, the patient underwent surface echocardiography, which was normal and a detailed evaluation for a thrombotic tendency was unremarkable. A renal arteriogram showed dissection of the main right renal artery with extension to renal artery branches and a wedge-shape perfusion defect in the distal part of the occluded artery. He received aorto-renal bypass surgery using his great saphenous vein. The patient developed hypertension 3 months later. To summary, we report a case of spontaneous renal artery dissection with renal infarction in a healthy man without hypertension.