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윤창환,명선정,박완범 대한의학회 2019 Journal of Korean medical science Vol.34 No.29
Background: Graduate medical education is shifting from the traditional apprenticeship model to a competency-driven model. Here we describe the design and implementation of competency-based medical education (CBME) in an internal medicine residency program, and report satisfaction survey results. Methods: We redesigned the residency curriculum as CBME to be resident-centred, systematic, focused on general internal medicine, to provide experience in various care setting, and work-based assessment. In the second year of this CBME transition, we surveyed residents' overall satisfaction using 5-point Likert scale. Feedback on their training program was also analysed. Results: The overall satisfaction score was 3.24 and thirteen residents (61.9%) answered that the preceptor's practical training in an educational atmosphere and improvement through training were the merits of the training program. However, residents complained about the working condition such as work overload. Conclusion: With the CBME implementation, most residents expressed satisfaction with the hospital's educational environment but they suffered from overwork. Further efforts to improve the educational program and environment are warranted.
윤창환,조주희,김용진,김형관,신동호,김경환,김기봉,안혁,신대원,오병희,박영배 한국심초음파학회 2010 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.18 No.4
Background: The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery. Methods:We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure. Results: Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ≥ 200 pg/dL (p = 0.001). Conclusion: An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.
두가지 형태의 혈관내피전구세포(Endothelial Progenitor Cell, EPC)의 특성분석
윤창환,서재빈,허진,최진호,김지현,박승정,조상호,이준희,황경국,김상현,조주희,김명아,김효수 대한심장학회 2004 Korean Circulation Journal Vol.34 No.3
Background and Objectives:Endothelial progenitor cells (EPC) in one study group are not the same as those in other investigators, suggesting that EPC is not a single type of cell population. In this study, we tried to demonstrate the heterogeneity of EPC. 배경 및 목적: 이전의 연구를 통하여 혈관내피전구세포(EPC)가 하나의 세포군이 아니라는 것을 추정하였다. 본 연구는 이러한 서로 다른, 혈관내피전구세포를 규명하기 위하여 수행되었다. 방 법: 동일 혈액제공자로부터, 두 가지 종류의 혈관내피 전구세포를 순차적으로 얻기 위하여, 인간 말초혈액으로부터 전체 단핵구를 혈관신생조건하에서 배양하였다. 각 세포들의 발생시간에 따라 초기와 후기 혈관내피전구세포라 명하였다. 결 과: 초기 EPC는 spindle 모양으로 2~3주까지 증식 후 약 4주 이후부터 사라져 가는 반면, 후기 EPC는 cobblestone 모양으로, 2~3주에 처음 나타나서 4~8주까지 폭발적으로 증가하여 약 12주까지 증식한 후, 사라져 간다. 후기 EPC는 VE-cadherin, Flt-1, KDR을 초기 EPC보다 높은 수준으로 발현하였고, CD45는 초기 EPC와 달리 발현하지 않았다. 후기 EPC는 초기 EPC에 비해 뛰어난 Nitric oxide 생산능력과 HUVEC 단층배양으로의 편입, 시험관 내 모세혈관형성능력을 가진다. 결 론: 이전의 EPC에 관한 연구들은 두 가지 세포 중 한 가지씩만을 보고하였으나, 본 연구는 성인 말초혈액으로부터 두 가지 형태의 EPC를 동시에 배양하고, 각 세포의 특성을 분석한 첫 번째 연구이다. 저자들은 서로 다른 형태의 두 가지 혈관내피전구세포를 성인으로부터 분리하였으며, 그것들은 서로 다른 유전적, 기능적 차이로 인하여 성인의 혈관신생에 각각 다른 역할을 할 것으로 추정된다.
보문 : 분리기술·열역학·멤브레인기술·초임계기술·이은용액 ; 반응 표면 분석법을 사용한 새우껍질에서 astaxanthin 추출 조건의 최적화
윤창환 ( Chang Hwan Yoon ),복희성 ( Hee Sung Bok ),최대기 ( Dae Ki Choi ),노경호 ( Kyung Ho Row ) 한국화학공학회 2012 Korean Chemical Engineering Research(HWAHAK KONGHA Vol.50 No.3
최적의 추출조건을 찾는데 매우 유용한 방법인 반응 표면 분석법(RSM, response surface methodology)을 사용하여 새우껍질로부터 astaxanthin 추출조건을 최적화하였다. 추출조건은 용매 에탄올과 추출물질의 비율, 추출온도(˚C), 추출 시간(min)의 세가지 독립변수를 설정하여 BBD (Box-Behnken design) 방법을 이용하였다. 이 BBD 모델링은 0.9218의 R2 adj값과 0.0003의 확률 값 p 값으로 회귀 모델에 대한 신뢰도를 입증하였다. RSM 분석을 통해 찾아낸 새우껍질로부 터 astaxanthin의 최적 추출조건은 에탄올 용매비 1:29.7, 추출온도 49.5˚C, 추출시간 59.9 분이고, 이 때 astaxanthin 추출량은 17.80ug/g으로 예측하였다. 최적 수율로 예측된 결과는 각각의 조건에 따른 실험을 통해 그 예측의 정확도를 확인하였으며 17.77ug/g으로 예측조건과 비슷한 결과를 보였다. A 17-run Box-Behnken design (BBD) was used to optimize the extraction conditions of astaxanthin from shrimp waste. Three factors such as ratio of ethanol to raw material, extraction temperature (˚C) and extraction time (min) were investigated. The adjusted coefficient of determination (R2 adj) for the model was 0.9218, and the probability value (p=0.0003) demonstrated a high significance for the regression model. The optimum extraction conditions were found to be: optimized ratio of ethanol to raw material 29.7, extraction temperature 49.5˚C and extraction time 59.9 min. Under these conditions, the mean extraction yield of astaxanthin was 17.80ug/g, which was in good agreement with the predicted model value. Under these conditions, validation experiments were done and the mean extraction yield of astaxanthin was 17.77ug/g, which is in good agreement with the predicted model value.
채인호,윤창환,박진주,오일영,서정원,조영석,연태진,최동주 대한의학회 2017 Journal of Korean medical science Vol.32 No.6
The combined use of a drug-eluting balloon (DEB) and a bare metal stent (BMS) for the treatment of de novo non-small vessel coronary artery diseases (CAD) remains to be evaluated. We investigated the efficacy of a sequential treatment using a DEB together with a BMS implantation in comparison to a zotarolimus-eluting stent (ZES). This study was a prospective, randomized, open-label study. We designed it to demonstrate the non-inferiority of a sequential treatment using a DEB first followed by a BMS (DEB + BMS) compared with the use of a ZES. The primary endpoint was in-segment late loss (LL) at 9 months measured by quantitative coronary angiography (QCA). A total of 180 patients were enrolled in the study. The 9-month follow-up angiography was performed in 72 patients with DEB + BMS and 74 patients with ZES. When comparing the DEB + BMS results with the ZES ones, LL was 0.50 ± 0.46 mm in DEB + BMS patients vs. 0.21 ± 0.44 mm in ZES patients (P < 0.001). The mean difference of the LL was 0.31 mm, which was larger than the prespecified non-inferiority margin of 0.19 mm, and the 2-sided 95% confidence interval was 0.15–0.48. The clinical outcomes were not significantly different. In conclusion, the DEB + BMS strategy is inferior to the ZES one in terms of the LL result at 9 months. The DEB strategy for de novo coronary artery lesions needs to be improved for it to become an alternative treatment option. This was a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT01539603; http://www.clinicaltrials.gov/ct2/show/NCT01539603).