Chronic Kidney Disease-mineral Bone Disorder and Active Vitamin D Analogs for Treating Severe Hyperparathyroidism in Children Receiving Chronic Peritoneal Dialysis

강은구,이주훈,박영서,Kang, Eun Gu,Lee, Joo Hoon,Park, Young Seo Korean Society of Pediatric Nephrology 2014 Childhood kidney diseases Vol.18 No.2

목적: 본 연구는 만성복막투석환자에서 만성 신부전 무기질 골 장애의 목표 달성 정도의 평가와 중증 부갑상선기능항진증에서 비타민 D 치료에 대해 검토하였다. 방법: 본 연구는 2003년 1월부터 2012년 12월까지 1년 이상 복막투석을 시행한 53명의 환자를 대상으로 한 후향적 연구이다. 결과: 인산염 결합제제와 비타민 D 치료에도 불구하고 투석기간 중 인, 칼슘, PTH가 KDOQI의 목표치 내에 있었던 비율의 평균${\pm}$표준편차 값은 각각 $25.06{\pm}17.47%$, $53.30{\pm}23.03%$, $11.52{\pm}9.51%$이었다. 10명(18.9%)의 환자에서 CKD-MBD의 임상적 증상 혹은 영상의학적 징후가 있었고, 이는 증상 혹은 징후가 없었던 군과 비교하여 PTH가 목표치보다 높았던 시간의 비율이 길고($63.79{\pm}27.86%$ vs. $37.09{\pm}27.76%$, P=0.022) PTH가 목표치보다 낮았던 시간의 비율이 짧은 것($11.74{\pm}7.37%$ vs $40.77{\pm}25.39%$, P<0.001)과 유의한 상관관계가 있었다. 중증 부갑상선기능항진증이 있었던 25명의 환자 중 고용량비타민 D 치료를 받은 환자는 13명이었고 이 중 7명의 환자가 특별한 합병증 없이 부갑상선기능항진증이 조절되었다. 결론: 만성복막투석에서 CKD-MBD를 조절하기 위한 노력에도 불구하고 칼슘, 인, 비타민 D, PTH가 목표치를 만족하는 기간의 비율은 낮은편이다. 중증 부갑상선기능항진증 환자의 반 정도에서 고용량 비타민 D 치료가 필요하였고 이 중 50% 정도에서 효과가 있었다. Purpose: The aims of this study were to assess the clinical and laboratory profiles of chronic kidney disease-mineral bone disorder (CKD-MBD) and to assess the effects of treatment of active vitamin D analogs on severe hyperparathyroidism (SHPT) in pediatric patients on chronic peritoneal dialysis. Methods: This is a retrospective study included 53 patients who had been undergoing dialysis for more than 1 year, between January 2003 and December 2012. Results: Even after treatment with phosphate binders and active vitamin D analogs, the $mean{\pm}standard$ deviation of the percentage of time during peritoneal dialysis that the patients' serum concentrations of phosphorus, corrected total calcium, and parathyroid hormone (PTH) fell within the Kidney Disease Outcomes Quality Initiative recommended ranges was $25.06{\pm}17.47%$, $53.30{\pm}23.03%$, and $11.52{\pm}9.51%$, respectively. Clinical symptoms or radiological signs of CKD-MBD were observed in 10 patients (18.9%). There were significant differences in percentage of time that the serum intact PTH concentration was outside of the recommended range between patients with and without symptoms or signs of CKD-MBD (below recommended range, $11.74{\pm}7.37%$ vs. $40.77{\pm}25.39%$, P <0.001; above the recommended range, $63.79{\pm}27.86%$ vs. $37.09{\pm}27.76%$, P =0.022). Of the 25 patients with SHPT, high-dose alfacalcidol treatment was required in 13 patients that controlled SHPT in 7 of these patients, without marked complications. Conclusion: Despite our efforts to manage CKD-MBD, patients' met the recommended ranges from relevant guidelines at a low frequency. The treatment of high-dose active vitamin D analogs was required in about half of the patients with SHPT and effective in about half of them.

8개월 여아에서 다발성 결석으로 진단된 시스틴뇨증 1례

강은구,이주훈,이범희,김구환,박영서,Kang, Eun Gu,Lee, Joo Hoon,Lee, Beom Hee,Kim, Gu-Hwan,Park, Young Seo 대한소아신장학회 2013 Childhood kidney diseases Vol.17 No.2

8개월 여아가 지속적인 발열 및 다발성 요로 결석으로 입원하여 시행한 신장 초음파에서 오른쪽 신우 및 요관, 왼쪽 수질 부위의 다발성 요로 결석이 보였고, 자연 배출된 1 cm 크기의 결석이 100% 시스틴석으로 확인되었다. 소변 검사에서 시스틴을 비롯한 이염기 아미노산의 상승과 유전자 검사에서 SLC3A1의 c.1820del (p.L607fs)의 동형접합자로 확인되어 시스틴뇨증으로 진단되었다. 충분한 수분 섭취와 소변 알칼리화, 동물성 단백질 제한에도 불구하고 결석의 수와 크기가 증가하여 현재는 tiopronin으로 치료 중이다. Cystinuria is an autosomal recessive disease characterized by impaired transport of cystine and dibasic amino acids in the proximal renal tubule, resulting in the formation of cystine stones. It is believed to account for about 1% of all kidney stones and up to 10% of pediatric stones. Here we report a case of cystinuria with multiple renal stones confirmed by genetic mutational analysis. An 8-month-old girl was admitted to AMC with persistent fever and multiple renal stones. A renal sonogram showed multiple stones at the right renal pelvis, right distal ureter, and left renal medullary portion. An approximately 1 cm renal stone was extracted spontaneously, and stone analysis revealed it to be composed entirely of cystine. Cystinuria was confirmed by increased urine dibasic amino acid levels, including cysteine, and genetic mutational analysis showed the patient to be a homozygote for the pathogenic c. 1820del (p.L607fs) of SLC3A1. Despite treatment with oral hydration and urinary alkalinization, and restricted intake of animal protein, the stones increased in size and number. The patient has since been treated with tiopronin.

시공단계를 고려한 대단면 정거장 터널 안정성 해석

강은구(Kang Eun-Gu),김양운(Kim Yang-woon),안경철(Ahn kyeong-Cheol),한명식(Han Myeong-Sik) 한국철도학회 2009 한국철도학회 학술발표대회논문집 Vol.2009 No.5월

Urban construction has numerous difficulties due to ground weakness and various complaints from third party, so it is not economically efficient and constructability is not favorable. Therefore, underground, which has good ground conditions, was used for construction field and facilities such as stations, and they are scaled up to enhance accommodation of facility limitation and function of stations. Large section tunnel station construction has numerous risk factors such as work boundary of excavation equipment, a relaxation of stress concentration, a safety plan of tunnel stability, and so on. Therefore, by using large section tunnel station stability analysis considering construction step, we expect to analyze the latent problem during construction, and to stabilize a future project plan of a large section structure design by using an auxiliary method and a support design.

연구 못지않은 열정으로 가득찬 KAIST 건설 및 환경공학과

강은구(Eun-Gu Kang) 대한토목학회 2005 대한토목학회지 Vol.53 No.11

13세 남아에서 발견된 신동맥의 동맥류 증례 보고

예혜련,김민지,강은구,한지연,이주훈,박영서,Yeh, Hye Ryun,Kim, Min Jee,Kang, Eun Gu,Han, Jee Yeon,Lee, Joo Hoon,Park, Young Seo 대한소아신장학회 2014 Childhood kidney diseases Vol.18 No.1

Primary renal artery aneurysm has been estimated to account for an incidence of 0.015-1% with associated morbidities including renovascular hypertension and rupture. Renovascular hypertension associated renal artery aneurysms in children is not a common disease. In patients with complicated renal vascular disease, renal autotransplantation has been used as an alternative to percutaneous transluminal angioplasty, which may be hazardous in these situations. We report a case of a renal artery aneurysm in a 13-year-old Korean child presenting hypertension detected during school health examination. Preoperative workup demonstrated a $2.8{\times}2.1{\times}1.9$ cm saccular aneurysm in the right renal hilum that was not amendable to endovascular repair. A surgical strategy including extracorporeal renal artery reconstruction with autotransplantation was applied in order to restore renal artery anatomy and to treat renovascular hypertension. Immediately he complained of severe right flank pain and postoperative doppler sonography revealed lack of perfusion. On the 5th day after autotransplantation, the patient underwent a transplant nephrectomy. He was well postoperatively and was found to have a normal kidney function and stable blood pressure control without antihypertensive medication. This is the first pediatric case of renal artery aneurysm in Korea who underwent extracorporeal repair followed by autotransplantation failure. More pediatric cases with renal artery aneurysm should be reported to identify therapeutic outcome and long term prognosis. 소아에서 신장동맥의 동맥류는 신혈관성 고혈압 가운데 드문 질환으로 하나로 수술적인 치료법 가운데 복잡한 형태의 동맥류의 경우 신혈관 재건술과 신장 자가이식술이 현재 선호되고 있는 수술법이다. 본 저자들은 13세 소아환자에서 우연히 정기건강검진에서 발견된 고혈압에 대해 시행한 전산화 단층 혈관촬영술을 통해 발견된 일측성 신장동맥의 동맥류에 대해 보고한다. 환아는 $2.8{\times}2.1{\times}1.9$ cm의 크기의 우측 낭포성 동맥류가 발견되었으며, 분지혈관이 복잡하고 병변이 신문부에 위치하여 신혈관 재건술과 신장 자가이식을 시행하였다. 그러나 도플러 신장 초음파를 통해 신장 혈류가 매우 감소하였음을 확인 후 신장 자가이식 한지 5일째 신절제술을 시행하였다. 병리적 소견은 전반적인 신장 허혈성 변화를 보였고, 섬유근성 형성장애를 시사하는 소견은 없었다. 본 저자들은 국내에서 현재까지 보고된 바 없는 신혈관성 고혈압 및 일측성 신동맥의 동맥류로 진단된 소아를 대상으로 체외 신혈관 재건 및 신장 자가이식을 시도한 증례를 보고하였다. 추후에 신동맥의 동맥류와 관련된 신혈관성 고혈압의 치료에 대한 다양한 방법 및 장기적인 추적 관찰에 대한 보고가 추가되어야 할 것이다.

조직의 서비스지향성이 이직의도 및 조직몰입에 미치는 영향에 관한 연구 - 감정노동의 매개효과를 중심으로

이선규,정영근,강은구,조용화,김은경,소병삼,윤광식,Lee, Sun-Kyu,Jung, Young-Keun,Kang, Eun-Gu,Cho, Yong-Hwa,Kim, Eun-Kyeong,So, Byung-Sam,Youn, Kwang-Sic 한국디지털정책학회 2014 디지털융복합연구 Vol.12 No.12

Organizational Service Orientation is an essential factor to survive competition. So, a number of studies have investigated the impact of service orientation on Job Performance, and many evidence testify with certainty variable. Accordingly, this study investigated the impacts of Service Orientation on Turnover Intention and Organizational Commitment. In addition, this study examined the mediating effects of Emotional Labor. The results of this study are as followings ; First, Service Orientation are negatively related to Turn over Intention. Second, Service Orientation are positively related to Organizational Commitment. Third, Emotional Labor have partially moderated effect on the relationship between Service Orientation and Turnover Intention, Organizational Commitment. These findings provide the theoretical and practical implications. 조직의 서비스 지향성이 경쟁에서 살아남기 위한 중요한 요인으로 강조되고 있으며, 많은 연구에서 조직의 서비스 지향성이 조직 성과에 영향을 미치는 주요 변수임을 밝히고 있다. 따라서 본 연구는 서비스 지향성이 조직구성원의 이직의도와 조직몰입에 어떠한 영향을 미치며, 이들의 관계에서 감정노동이 조절역할을 하는지 실증 검증을 통해 살펴보고자 하였다. 실증 분석결과, 기업의 서비스 지향성은 이직의도 및 조직몰입에 긍정적인 영향을 미치며, 두 변수간의 관계에서 감정노동은 유의미한 조절효과를 가지는 것으로 나타났다. 이러한 결과는 조직의 서비스 지향성이 조직 문화로서 정착될 때, 조직의 성과는 향상될 수 있는 것을 시사하는 것으로, 학술적 실무적인 가치가 크다 하겠다.

롤투롤 그라비아 옵셋 인쇄전자장비의 특성

윤성식(Seong Shik Yoon),강은구(Eun Gu Kang),유세민(Se Min Yu),허성준(Seong Joon Heo),조정대(Jeong Dai Jo) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.11

Recently, printed electronics have been actively research for apply to electronic device manufacturing process to replace traditional manufacturing process. Roll to Roll printing technology can make it possible to produce electronic device such as display, RFID, solar cell, e-paper, etc. Gravure offset printing is typical method for Roll to Roll printing. In this study, Gravure offset printing is applied to the vertical structure of the printing module equipped with printing system, we found that ink and blanket, film's characteristics are very important element by printing test of the 20㎛, 30㎛, 40㎛, 50㎛ horizontal, vertical, bending, radial fine pattern.

철도시스템 신기술개발 동향분석

김도연(Do Yeun Kim),정윤상(Yun Sang Jeung),강은구(Eun Gu Kang),안현근(Eun Gu Kang),김유진(Hyun Geun An),최지훈(Ji Hun Choi),차재원(Jae Won Cha),박순(Soon Park),박정수(Jeong Soo Park) 한국철도학회 2017 한국철도학회 학술발표대회논문집 Vol.2017 No.10

전하 제어법을 이용한 압전 액추에이터의 이력저감

정순종,이대수,송재성,홍원표,강은구,최원종 한국공작기계학회 2005 한국공작기계학회 춘계학술대회논문집 Vol.2005 No.-

This paper presents a method to reduce hysteresis in multilayer ceramic actuator by connecting the actuator with a capacitor in a series circuit. The change in hysteresis with respect to the capacitor was examined. 0.2Pb(Mg_(1/3)Nb_(2/3))O₃-0.8Pb(Zr_(0.475)Ti_(0.525)) O₃ ceramic material was used as a piezoelectric material for the actuator. Displacement of the actuator was measured in a capacitive gap sensor measuring system. In case of inserting a capacitor in a total circuit, hysteresis became dramatically decreased, and then finally the hysteresis value can be reduced below 0.2%. It was found in this present study that reducing the hysteresis in the actuator is dependent upon the characteristics of the capacitor in total circuit and also operating frequency