중학교 수학에서 유리수와 소수의 지도에 대한 연구

정루비,김인수 全南大學校 師範大學 科學敎育硏究所 2012 科學敎育硏究誌 Vol.36 No.1

In this paper, we studied the instruction of finite and infinite decimals covered in the unit 'Rationals and Circulating Decimals' in the 2nd grade Mathematics of the middle school. We analyzed the process of introducing the concepts and content of the unit 'Rationals and Circulating Decimals' in the textbooks. And we conducted a survey to find out how students understand the finite and infinite decimals. Based on this, we tried to find the efficient ways to instruct students in decimals. As a result, we suggest that it would be efficient to instruct students to distinguish between finite and infinite decimals by the expressions of presented decimals in class and to understand that fractions and decimals are the different ways of expression for the same number.

Methemoglobinemia Caused by an Inert Ingredient after Intentional Ingestion of Pesticide

정루비,손창환,서동우,김원영,유승목,오범진,임경수 대한중환자의학회 2014 Acute and Critical Care Vol.29 No.4

We report two cases of toxic methemoglobinemia caused by an inert ingredient in pesticide product after intentional ingestion of pesticide. First, 51-year-old male visited to the emergency department (ED) after the ingestion of pesticide in a suicide attempt. Initial methemoglobin (MetHb) level was 25.6%. We did not know the cause of methemoglobinemia at that time. Second, 56-year-old female visited to the ED after the ingestion of the same pesticide in a suicide attempt. MetHb level after 30 minutes was 16.1%. The patients were treated with methylene blue. We contacted to the Korean Rural Development Administration and estimated that magnesium nitrate was more likely to cause methemoglobinemia. This report highlights the importance of considering the possibility of methemoglobinemia caused by inert ingredient in pesticide and early antidotal therapy.

응급센터를 통하여 중환자실에 입원하는 환자들의 시기별 예후 예측 인자 분석: 초기(응급센터)와 후기(중환자실) 예후 예측 인자

정루비,안정환,전현민,정성민,신태용,김영식,하영록 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.4

Background: Many critically ill patients in the ED are hospitalized to the ICU, but most prognosis predicting systems have been developed based on the physiochemical variables of the critically ill in the ICU. The objective of this study is to identify prognostic predictors early in the ED when compared with well-known predictors in the ICU and estimate their predictive abilities. Methods: An observational prospective study was performed in an urban ED. Information of all the critically ill patients admitted to the ICU via the ED including vital signs, laboratory results, and physiochemical scoring systems were checked during 6 months and divided into the early stage for the ED and the late stage in the ICU. Poor outcome was defined as 28-days mortality. After checking for significant predictors among them through univariate analysis, we identified the most discriminating predictors in each stage using logistic regression and a decision tree analysis. Results: A total of 246 patients were enrolled. In univariate analysis, the significant predictors including central venous pressure, fraction of inspired oxygen (FiO2), pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2), albumin, mortality in emergency department sepsis, acute physiology and chronic health evaluation II, simplified acute physiology score II, and sequential organ failure assessment scores were identified in the early stage, while PaO2/FiO2, base excess, unmeasured anion, albumin, anion gap, albumin-corrected anion gap, APACHEII, SAPSII, SOFA, and rapid emergency medicine score were identified in the late stage. Through a decision tree analysis, PaO2/FiO2 and SAPSII were revealed as the most discriminating predictors in the ED and ICU, respectively. Conclusions: The prognosis discriminating predictor in critical patients was different between the ED and ICU. Emergency physicians should pay more attention to the critical patients having low PaO2/FiO2.

기면 상태의 의식 저하로 응급의료센터에 내원한 비외상 환자들에서 뇌졸중이 아닌 원인 질환 감별을 위한 혈중 C-reactive protein, delta neutrophil index, lactic acid 및 ammonia 측정의 유용성

강현구,정루비,김영식,이규현,유우성,윤영탁,김학중 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4

Objective: A drowsy mentality is a common chief complaint at emergency departments (EDs), but it is difficult to evaluate the reason for drowsy mentality. Serum biomarkers are an alternative way to discover the reason for drowsy mentalities. This study examined the values of four biomarkers for a differential diagnosis of ED patients with drowsy mentality: Creactive protein (CRP), delta neutrophil index (DNI), lactic acid and ammonia. Methods: Adult patients who presented to the ED from April 2018 to March 2019 were reviewed retrospectively. Among the 369 patients with a drowsy mentality, 122 patients with acute trauma, dementia, epilepsy, seizure, alcohol abuse, syncope, psychological problems, and anaphylaxis were excluded. The four biomarkers of each patient were then measured. The clinical records were reviewed to analyze the usefulness of the four biomarkers as a differential diagnosis tool for ED patients. Results: Of the 247 included patients, 64 were diagnosed with a stroke, and 183 were not. CRP, DNI, lactic acid and ammonia were analyzed statistically, and the elevation of each biomarker level was related to a diagnosis of non-stroke disease. Conclusion: Elevations of CRP, DNI, lactic acid and ammonia suggest non-stroke disease in patients with drowsy mentality in ED. There might be metabolic causes other than stroke in ED patients with a drowsy mentality when the CRP, DNI, lactic acid and ammonia levels are highly elevated. A future study will be needed to confirm this.

Does the use of bedside ultrasonography reduce emergency department length of stay for patients with renal colic?: a pilot study

박용훈,정루비,이영근,홍종근,안정환,신태용,김영식,하영록 대한응급의학회 2016 Clinical and Experimental Emergency Medicine Vol.3 No.4

Objective The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. Methods A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. Results A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). Conclusion The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.

응급의료센터에서 진단된 급성 단순 방광염 환자의 항생제 내성률 및 적절한 항생제에 대한 고찰

정수용,김영식,정루비,이규현,유우성,윤영탁,최승주 대한응급의학회 2022 대한응급의학회지 Vol.33 No.5

Objective: This study analyzed the urine cultures of emergency department patients diagnosed with acute uncomplicated cystitis and determined the antimicrobial resistance and appropriate treatment for our region. Methods: Results of urine analysis and urine culture of acute uncomplicated cystitis patients diagnosed in our emergency department between January 2019 and December 2020 were examined and analyzed. Results: In our study, 256 out of 340 urine culture samples (75.3%) were positive for cystitis. The most common microorganism was reported to be Escherichia coli (93.0%). The resistance rates of E. coli to the following antimicrobial agents were as follows: amikacin (0.0%), ampicillin (63.5%), amoxicillin/clavulanate (15.6%), aztreonam (7.1%), ceftazidime (3.4%), cefotaxime (16.4%), cefoxitin (5.5%), cefazolin (19.9%), ciprofloxacin (29.4%), cefepime (1.7%), ertapenem (0.0%), gentamicin (18.1%), piperacillin/tazobactam (2.1%), trimethoprim/sulfamethoxazole (36.1%), and tigecycline (0.4%). The prevalence of extended-spectrum beta-lactamase producing E. coli strains was 17.8%. Conclusion: To determine the proper empirical antimicrobial treatment for acute uncomplicated cystitis, it is essential to examine the antimicrobial resistance. For our region, fosfomycin, nitrofurantoin, and 2nd and 3rd generation cephalosporin should be considered the first-line empirical treatment for acute uncomplicated cystitis.

중증 패혈증 및 패혈쇼크 환자들의 28일째 사망 예측 인자로서 미성숙 과립구의 평가

고영상,하상욱,정루비,최병호 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.2

Purpose: Recently, several studies for immature granulocyteproportion (IG%) in patients with sepsis have revealedits association with diagnosis and prognosis of patients withsepsis. In this study, we enrolled patients with severe sepsisand septic shock and compared IG% with other biologicmarkers as a predictor of 28-day mortality. Methods: This was a retrospective study for patients withsevere sepsis and septic shock who were admitted to theemergency department of a tertiary care hospital for fourmonths. The IG% measured using Sysmex XE-2100 andother inflammatory markers, including C-reactive protein,lactate, and procalcitonin were evaluated and compared for28-day mortality. Results: A total of 85 patients with septic shock and 45patients with severe sepsis were enrolled. In the non-survivorsgroup (n=32, 24.6%), APACHE II score (p=0.017),use of continuous renal replacement therapy (CRRT)(p=0.002), and septic shock (p=0.009) were statisticallyhigher compared with thesurvivors group. APACHE IIscore (Odd ratio [OR] 1.099, p=0.008) and IG% (≥0.5%)(OR 3.568, p=0.036) predicted the 28-day mortality independentlyafter adjusting SOFA score, septic shock,disseminatedintravascular coagulopathy, use of CRRT, andgender. However, IG (≥0.5%) had low specificity of 33.7%and positive predictive value (PPV) of 30.1% for 28-daymortality. Conclusion: IG% could be a useful biologic marker for predictionof 28-day mortality in patients with severe sepsis orseptic shock. However, the limitation of low specificity andPPV must be considered in clinical use.

영상검사에서 진단이 되지 않는 소아 충수돌기염의 수술적 치료를 고려할 수 있는 예측인자 연구

최승주,김영식,정루비,이규현,유우성,윤영탁,곽경훈,정수용 대한응급의학회 2023 대한응급의학회지 Vol.34 No.6

Objective: This study examined the predictive factors to decide the surgical treatment for clinically suspected pediatric acute appendicitis with equivocal imaging findings. Methods: This study was conducted retrospectively on children who visited local emergency medical centers and outpatients from January 2018 to February 2021. The electronic medical records were reviewed from 811 pediatric patients younger than 16 years of age with the chief complaint of abdominal pain and who underwent an imaging test for the clinical suspicion of appendicitis. Ninety-two patients who showed ambiguous findings on imaging tests but were still suspected of having appendicitis were analyzed. Recursive partitioning analysis and multivariable logistic regression were used to identify the variables associated with appendicitis. Results: Of the 92 enrolled patients, 23 patients were confirmed to have appendicitis, and 69 did not. Patients with the clinical suspicion who had an elevated white blood cell (WBC) count, polymorphonuclear leukocyte differential count (PMN), absolute neutrophil count (ANC), and leukocytosis were more likely to have appendicitis. The PMN (odds ratio=1.175; 95% confidence interval, 1.092-1.265) and ANC (odds ratio=1.00050; 95% confidence interval, 1.00025- 1.00075) remained significant after multivariable logistic analysis. Conclusion: Elevated PMN and ANC are clinical predictors of pediatric appendicitis when the imaging findings are nondiagnostic, and the clinical suspicion is continuous.

응급실에서 과호흡 증후군(hyperventilation syndrome) 환자 진단을 위한 호기말 이산화탄소 농도(end tidal carbon dioxide) 측정의 임상적 유용성

변인우,김영식,하영록,신태용,정루비,이규현,유우성 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6

Objective: Arterial blood gas analysis (ABGA) is routinely performed in hyperventilation syndrome (HVS) patients in the emergency department (ED). We tried to substitute end-tidal carbon dioxide (ETCO2) for arterial partial pressure of carbon dioxide (PaCO2) in HVS patients in ED. Methods: It was a prospective observational cohort study of HVS patients from May 2019 to March 2020. Data of age, sex, vital sign, ETCO2 and ABGA were collected. We compared the Pearson correlation between ETCO2 and PaCO2. Results: A total of 135 HVS patients were included in the study. The average value for ETCO2 was 24.9±7.2. It showed a significant linear between ETCO2 and PaCO2. The Pearson correlation coefficient was 0.893 (P<0.001). The linear correlation coefficients of ETCO2 <20 mmHg and ETCO2 20-35 mmHg groups were 0.513 and 0.827, respectively (P<0.001). Conclusion: We suggest that ABGA can be replaced by ETCO2 in HVS patients in ED.

임신과 관련된 흔적자궁각파열 1 례

이기영(KY Lee),정광채(KC Chung),김병화(BH Kim),서재식(JS Suh),윤루비(RB Yoon),김동진(DJ Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

Since the first report of pregnancy in a rudimentary uterine horn in 1669 by Mauriceau and Vessal, there have been probably well 350~400 others. Unfortunately a rudimentary uterine horn is mostly discovered as a complication of pregnancy, but if symptomless and uncomplicated, it may not discovered forever. About its incidence, it is reported that it occurs at a rate of 1 per 100,000 or 150,000. When a rudimentary horn is discovered as a complication of pregnancy, it mostly accompanies so severe hemorrhage caused by uterine horn rupture that it is considered very dangerous for its high mortality rate. Though a rudimentary uterine horn is discovered accidentally by various other causes, it is desirable to do a surgical removal of a rudimentary horn as a principle of medical cure. And it is also reported that a rudimentary horn frequently accompanies an anomaly of urogenital system. We have once treated a patient with a rudimentary uterine rupture caused by pregnancy in department of Obstetrics & Gynecology, Kangnam General Hospital Public Corporation. Here we present a report on the case of pregnancy in a rudimentary uterine horn with the reference to other reports on it.