제2형 당뇨병 환자의 치료에서 복약순응도가 혈당 조절에 미치는 영향

김경선,김민정,박소현,박영주,허정순,이은경,김선영,이수형,김상수,강양호,손석만,김인주,김용기 한국병원약사회 2009 병원약사회지 Vol.26 No.2

Abstract: As known in clinical trial like DCCT, UKPDS, tight glycemic control is essential to prevent complications from diabetes mellitus(DM). In type 2 diabetes taking multiple medication, nonadherence to medications is common problem. The aim of our study is to investigate adher-ence rate of patients with type 2 DM and to evaluate association between many factors including adherence rate and HbA_(1C). 441 patients with type 2 DM who visited Busan National University Hospital endocrine internal department from Aug 13 to Sep 2, 2008(3weeks) were enrolled. We conducted a man-to-man questionnaire survey about general knowledge about diabetes mellitus, medicine and adherence, and measured HbA_(1C). Among them, 305 patients taking oral hypo-glycemic agent(OHA) were analyzed to investigate correlation between adherence rate and glycemic control. We studied 305 patients(male 126, female 179, average age 61.2±9.8 years, DM duration 8.6±6.4 years, average adherence 88.8±16.2%, average HbA_(1C) 7.03± 1.18%). HbA_(1C) showed significant relation with DM duration(r=0.137, p=0.017), number of aHA in regimen (r=0.135, p=0.018), dosage frequency(r=0.132, p=0.026), Medication Refill Adherence(MRA)(r=-0.124, p=0.030) and adherence(r=-0.168, p=0.003). Adherence had significant relation with MRA(r=0.148, p=0.010) but didn't have statical corelationship with DM duration, number of aHA and dosage frequency. Patients that their adherence rate exceed 90% took fewer OHA(p=0.011) and went on a better dietary treatment(p=0.007). In patients controlling diabetes mellitus with aHA, when adherence rate and MRA was higher, HbA_(1C) was lower. As a result, to improve adher-ence rate, it is necessary to enhance patient education, do careful consideration about prescrip-tion medicine number and dosage frequency

‘미녀와 야수’의 현대적 변용 양상

김만수 ( Kim Man-su ) 인하대학교 한국학연구소 2014 한국학연구 Vol.0 No.35

‘미녀와 야수(Beauty and Beast)’는 ‘뱀 신랑’ 혹은 ‘잃어버린 신랑 찾기’의 모티브를 가지고 있으면서 그리스 신화의 <프쉬케와 큐피드>, 그림 형제의 <개구리 왕자> 등의 다양한 형태로 출현하고 있다. 또한 <미녀와 야수>, <킹콩> 등의 애니메이션과 영화로 자주 각색되면서 이야기로서의 지속적인 생명력을 보이고 있다. ‘미녀와 야수’는 인간과 동물, 여성과 남성의 범주를 대립쌍으로 지니고 있으면서도 아름다움과 추함, 선과 악 등의 미적 윤리적 가치와 결합되기 때문에 매우 다양한 해석의 가능성을 제시하는 셈이다. 대체적으로 보아 ‘미녀’를 중심축으로 전개되는 이야기는 동물적 속성을 가진 남성을 받아들이면서 여성으로서의 성숙을 보여주는 반면, ‘야수’를 중심축으로 전개되는 이야기는 아름다움과 선함을 갖춘 여성과의 만남을 통해 자신의 야수성을 극복해가는 성장담의 형태를 보여준다. 또한 여러 형태의 현대적 변용들은 남성과 여성, 문명과 야만, 미와 추 등의 전통적인 이분법을 벗어난 새로운 해석을 시도하고 있다. 본고에서는 ‘미녀’에 해당하는 여주인공의 성장을 주로 다룬 텍스트를 대상으로 삼아 남성과의 만남을 통한 개인적 성장, 사회현실과의 만남을 통한 사회적 성장으로 나누어 분석하였다. 남성과의 만남을 통한 여주인공의 성장과 성숙은 미국 에니메이션의 단골 주제인데, <백설공주>에서 <슈렉>에 이르기까지의 에니메이션들은 인내, 순응 등의 보수적 가치 속에서 남성의 야수성을 받아들이면서 성인 여성으로 성장해가는 모습을 담고 있는 반면, <겨울왕국>에 이르러서는 여성의 주체적인 결단에 의해 자신의 미숙함을 극복해가는 모습을 담고 있다. 한편 여주인공이 사회현실과의 만남을 통해 성장해가는 모습은 최근 한국영화의 중요한 주제로 부상되고 있는데, 본고에서는 <늑대소년>, <파이란>, <내 깡패 같은 애인>을 중심으로 이들의 사회적 성장의 과정을 다루었다. 이들 작품에서도 ‘미녀와 야수’라는 도식은 어김없이 적용되고 있지만, 미녀의 자질을 가진 여주인공이 사회현실이라는 야수성과 맞서는 장면, 혹은 여주인공과의 만남을 통해 남주인공이 스스로의 야수성을 극복해가는 모습을 그리고 있다는 점에서 좀더 사회성이 강한 형태로 변용되고 있음을 볼 수 있다. ‘Beauty and the Beast’ has the same motif which can be found at the folk tales of ‘snake-bridegroom’ or ‘in searching for the lost bridegroom’. It has been changed into the various stories, for example, ‘Psyche and Cupid’ in Greek mythology, ‘The Prince Frog’ rewritten by Grimm brothers. It has been continued insistently in the modern popular film adaptations of ‘Beauty and Beast’ and ‘King Kong’. It is constituted by the binary oppositions: human/animal and male/female. It is combined with another aesthetic and ethical values: beauty/ugly and good/evil. In the consequences of these complexities, it can be interpreted into the various adaptation. The story focused on ‘beauty’ deals with the girl’s growth and maturity, which contains the process of accepting men’s brutality. The story focused on ‘beast’ deals with the men’s growth and maturity, which contains the process of overcoming the brutality of himself through the act of meeting girls. Most various modern adaptation of ‘Beauty and the Beast’ deals with new interpretation by denying the traditional binary opposition. In this paper, we classified these texts into two categories: the maturity through meeting the other men and the maturity through confronting with the social circumstance. The story focused on the girl’s growth and maturity against man’s brutality is the mainstream of American animations. It deals with conservative theme which is related to the heroin’s endurance and accommodation, as we can find it in the < Snow White > and < Shrek >. Sometimes it deals with more progressive attitude, as we can find it in the < Frozen >. The story focused on the girl’s growth and maturity in the process of confronting various social circumstances is the mainstream of contemporary Korean films. It deals with social realism which is related to the heroin’s awakening and acknowledgement, as we can find it in the < A Werewolf Boy >, < Failan > and < My Dear Desperado >. In these Korean movies, the heroin must confront the brutality of Korean society or meet the brutal men only to awaken herself and to grow an adults. So these movies in Korea had a focus on the reflections of the ‘beast’ of Korean society.

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.

부산의 한 대학병원에서 분리된 Acinetobacter baumannii의 PER-1 Extended-Spectrum β-Lactamase 생성 현황

김정만,강현경,정석훈,배일권,권수봉,조병규,김둘만,김현주,김아성 대한임상미샐물학회 2004 Annals of clinical microbiology Vol.7 No.1

Lithographically-featured photonic microparticles of colloidal assemblies

Lee, Su Yeon,Kim, Shin-Hyun,Heo, Chul-Joon,Hwang, Hyerim,Yang, Seung-Man Royal Society of Chemistry 2010 Physical Chemistry Chemical Physics Vol.12 No.38

<P>We have described a new and promising strategy for the fabrication of composite and porous photonic crystal microparticles that combines the self-assembly of colloidal particles with photolithography techniques. We fabricated silica/SU-8 composite microparticles with photonic bandgaps <I>via</I> four steps: (1) deposition of the silica colloidal crystals on the photoresist, (2) embedding of the colloidal crystals in the photoresist, (3) UV exposure through a photomask and subsequent development, and (4) release of the microparticles from the substrate. Embedding was performed above the glass transition temperature (<I>T</I><SUB>g</SUB>) of uncrosslinked SU-8. At such temperatures, capillary forces on the silica particles facilitate the migration of colloidal crystals in the SU-8 matrix. Particle migration ceased when the top colloidal crystal layer was trapped at the interface between air and SU-8. In addition, we also prepared porous microparticles with an inverse opaline structure by dissolving the embedded silica particles from the composite structures. The porous microparticles showed enhanced reflectivity at the bandgap position due to the large refractive index contrast. The bandgap position of the microparticles was controlled by the size of the silica particles, which determined the lattice constant. Bilayered composite and porous microparticles with two distinct photonic bandgaps were also prepared by sequential deposition of colloidal crystals composed of two differently sized silica particles.</P> <P>Graphic Abstract</P><P>A new and promising fabrication strategy of photonic crystal microparticles was demonstrated by combining colloidal self-assembly with photolithography. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c0cp00134a'> </P>

인공 석회화 기질의 개발 및 파골세포에 의한 기질흡수에 관한 연구

김현만,박주철,임도선,박수진,김윤지,고재승 대한구강해부학회 1997 대한구강해부학회지 Vol.21 No.1

To develop artificial matrix resorbable by osteoclasts can be used as a model system that biological function of osteoclasts would be assayed in vitro in a standardized condition instead of using heterogenous bone or dentin slices. The present study developed artificial substrates consisted of apatite crystals. collagen gen. agar, apatite crystals under collagen film, mixture of apatite crystals and collagen, and mixture of agar and apatite crystals. And osteoclastic attachement and resorption activity on the each substrate was assayed in vitro. Osteoclasts attached to apatite crystals, collagen, mixture of apatite crystals and collagen, and mixture of apatite crystals and agar, however, not to agar. This suggested that apatite crystals and collagen should be exposed on the surface of artificial substrate where osteoclasts can attach. Osteoclasts attached to the substrate resorbed the substrate consisted of apatite crystals, mixture of apatite crysals and collagen, and apatite crystals under thin film of collagen, however, not of collagen, mixture of apatite crystals and agar. This suggested that the first phase of osteoclasts in resorbing matrix is to secrete acid and the end result of this phase, whatever it may be, may activate secretion of hydrolytic enzymes specific to organic components.

강합성거더교의 장기거동추정

金守萬 水原大學校 2007 論文集 Vol.25 No.-

When a concrete structure is subjected to load, its response is both immediate and time dependent. Under sustained load, the stress variation occurs due to creep and shrinkage of concrete on the sections of concrete-steel composite girders. Especially the stress variations at interface of concrete deck and steel girder are important problem. However the creep and shrinkage characteristics of concrete are highly variable and are never exactly estimated. Also it may be difficult to estimate the amount of the deformation of concrete deck restrained by the steel girder. But It is necessary to establish upper and lower limits of stresses and strains under long term behaviour. To estimate these limits, in Standard Specification for Highway Bridge, it is based on the concept of Yassumi's method. In this study, comparing the analysis results of long term behaviour using the AEMM and Yassumi's method, the rationality of the Yassumi's method will be evaluated. From the result of this study, it is verified that the stress variation calculated by AEMM is larger than that by Yassumi's method.

철근콘크리트 구조물의 시간에 따른 구조거동

金守萬 水原大學校 2000 論文集 Vol.18 No.-

When a concrete structure is subjected to load, its response is both immediate and time dependent. Under sustained load, the deformation of a structure gradually increase with time and eventually may be many times greater than its instantaneous value. This inelastic and time-dependent deformation causes increase in deflection and curvature, redistribution of stress and internal action. And also shrinkage may cause the similar response. These prediction results of shrinkage and creep at any time are obtained to use model specified in design code. The analysis results of model in KCI concrete structural design code can be obtained higher estimates of creep than that of other model but lower estimates of shrinkage.

진행성 폐 종양 환자에서 종양 내 OK-432 주입술의 효과

정수현,김성빈,박진희,탁희상,옥철호,장태원,정만홍,천봉권 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background: Intratumoral injection of OK-432 produced significant antitumor effects. There are reports that OK-432 was injected directly into tumor tissue on gastrointestinal tracts and HCC tissue, producing decrease in serum alpha-fetoprotein level. We adopted this technique for treating locally advanced lung cancer. The object of this study is to evaluate the local therapeutic efficacy, side effects of injection for treating symptomatic mass. Methods: Twenty lung cancer patients (13 males and 7 females) underwent sonography guided OK-432 injection. We analyzed relationships between response of OK-432 and response of skin test, histology and age. Pain that patients feel was evaluated by VAS (Visual Analog scale). Results: A significant decrease of tumor size was observed. The mean pre-injection diameter of the lesions was 54.7±11.3mm, PR rate were 15.0% (3/20) and minimal change (50%<tumor size decreased.) patients were 35.0% (7/20). The VAS score before injecting OK-432 into the lesion was 5±3, this was decreased to 2.5±1.5 (p=0.04). Object response was significantly correlated with skin response, adenocarcinoma, and age. Conclusion: A significant decrease of tumor size and pain was observed. So OK-432 is a valuable treatment option for patients with symptomatic lesion from advanced lung cancer who are not amenable to further therapy.

忠南地方의 農業機械 訓練實態에 關한 調査

金聲來,李相祐,金滿秀 충남대학교 농업과학연구소 1977 農業技術硏究報告 Vol.4 No.1

This survey was conducted to secure a basic data for the effective training programs that might be an essential part of any successful mechanization of agriculture in Korea. Chung Nam provincial training center and 17 guidance offices with farm machinery training centers which were thought to be a medium level on their scale in whole country were selected in the survey on its training accomplishments, stafts, facilities, schedule and number of trainees at one time or in a class. The results and recommendations from this survey were as follows; To enhance the effect of farm machinery training, it was absolutely necessary for city or county training center to complement its facilities and equipments. It might be desirable that instructors of each training center should be the one educated or highly trained in the institution of farm machinery, and that the number of technical assistants should be increased and their present part time working condition should be changed to full-time status. It was recommended that training for farmers should be scheduled during off-season so that farmers could participate in the training couses, and that the number of trainees in a class should be reduced to about 10 trainees, which was approximately a fourth of the present situation.