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과체중 및 비만 치료: 2013 미국 심장학회의 과체중과 비만 관리지침에 대한 검토
신미승 ( Mi Seung Shin ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
Obesity is a major contributor to many chronic diseases and a risk factor for cardiovascular disease. It is also associated with increased risk of all-cause and cardiovascular disease (CVD) mortality. Toward the goals of the American College of Cardiology (ACC) and American Heart Association (AHA) for preventing CVD and promoting cardiovascular health, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute and professional organizations to develop the 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. The 2013 guideline is the second edition of the ``Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report`` published in 1998. The new guideline maintains its focus on primary care practitioners (PCPs) and their patients in an effort to manage obesity more effectively and to reduce cardiovascular risk. The new guideline limits its scope by using five critical questions (CQs) and provides a summary of evidence-based recommendations and a treatment algorithm derived from the five CQs. The five CQs deal with the risks of overweight and obesity and the benefits of weight loss, and evaluate the following three treatment areas: diet, behavioral therapy, and surgical therapy. The recommendations and treatment algorithm serve as a guide for PCPs in the evaluation, prevention, and management of being overweight and obesity. (Korean J Med 2014;87:136-141)
신미승 ( Mi-seung Shin ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2
Right ventricular (RV) failure is a complex clinical syndrome characterized by impaired RV filling and ejection. RV function is altered in the setting of either pressure overload or volume overload. RV failure may result from a primary reduction of myocardial contractility caused by ischemia, cardiomyopathy, or arrhythmia, but left ventricular (LV) failure remains the leading cause. As RV dysfunction progresses to RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, leading to increasing venous congestion. Ventricular interdependence may result in impaired LV filling, a decrease in LV stroke volume, and low cardiac output. The important clinical manifestations of RV failure are fluid retention, decreased systolic reserve, low cardiac output, or arrhythmias. The initial diagnosis is based on clinical history and physical examination. A chest X-ray, electrocardiogram, and biochemical tests should be routinely obtained to evaluate the underlying causes and comorbidities. Bedside echocardiography provides valuable information on cardiac structure and function. RV ejection fraction is the most commonly used index of RV function although it is a highly load-dependent index. (Korean J Med 2016;91:131-138)
급성 관동맥증후군에서 예후평가를 위한 NT-proBNP, troponin 1, hs-CRP의 유용성
오병천 ( Pyung Chun Oh ),한승환 ( Seung Hwan Han ),정욱진 ( Wook Jin Chung ),강웅철 ( Woong Chol Kang ),서일혜 ( Yiel Hea Seo ),엄영실 ( Young Sil Eom ),문찬일 ( Chan Il Moon ),봉정민 ( Jeong Min Bong ),신미승 ( Mi Seung Shin ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2
Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a an of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation. (Korean J 77:200-210, 2009)
정혜경,신미승,강덕희,최규복,윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4
0bject The adult polycystic kidney disease(APCK) is inheritant disease in which cysts aredistributed throught the cortex and medulla of both kidneys. The disease process is usually notclinically apparent until the third or fourh decade of life. Mild persistent proteinuria(> 200mg/d) can be developed in 20% to 40% of cases, but nephrotic-range proteinuria is rare and whenfound, should prompt a search for the other concomitant renal disorder, such as IgA nephropathy, rapidly progressive glomerulonephropathy, focal glomerulosclerosis. Material aud Result : We report a case of APCK presented with nephrotic syndrome. A 76-year-old man was admitted due to generalized edema with weakness. The blood pressure was120/80mmHg. The BUN/creatinine were 15/1.2mg/dl, serum albumin 2.9g/dl, cholesterol / triglyceride 432/273mg/dl, total urinary protein excretion 8.41g/day.The serum level of IgG, IgAS, IgM, C_3, C_4 were within normal range and anti-nuclear antibody and anti-double strand DNA antibody were also negative. The abdominal ultrasonography and computerized tomography revealed multiple large cysts in both kidneys.The patient was treated with Enalapril®, an angiotensin converting enzyme inhibitors, 5mg forcontrol of proteinuria. Conclusion : The APCK presented with nephrotic syndrome is rare and to our knowledge,this is a first report in Korea.
조영주,신미승,장윤혜,장중현,박성숙,최혜영 대한알레르기학회 1998 천식 및 알레르기 Vol.18 No.4
Backgrount: Bronchial asthma is classically defined as a reversible obstruction and hypsrresponsiveness of the airway attributed to an inflammatory process. However, some individuals with asthma show an irreversible component of airflow obstruction. It may be associated with structural changes in the airway resulting from severe or long standing airway inflammation and remodelling. Objective: The study was undertaken to compare the clinical characteristics of patient and airway remodelling as shown in bronchial wall thickness in HRCT according to the duration of asthma. Material and methods: A retrospective clinical study was done on 119 patients with bronchial asthma, who had been admitted to Ewha Womans University Mokdong Hospital. Patients were divided to three groups according to disease duration and, clinical characteristics, pulmonary function test and HRCT were done. Results: Basal FEV, and FVC was significantly lower in patient with longer duration. (p $lt;0. 05) However pulmonary function was improved regardless of disease duration after 2 weeks steroid and bronchodilator therapy, and there was no significant difference in level changes according to the disease duration. The inner diameter of the bronchi and thickness of the bronchial wall at segmental and subsegmental bronchi increased significantly in patient with longer duration of asthma(p$lt;0.05). Conclusion: These findings showed that airway remodelling was more extensive in patients with longer duration of disease resulting in decreased pulmonary function. These facts suggested that early anti-inflammatory therapy would be helpful for prevention of airway remodelling.