미숙아에서의 적정 산소요법

진현승 대한신생아학회 2014 Neonatal medicine Vol.21 No.2

In the past several decades, supplemental oxygen has been used more than anyother medical product in preterm infants. Early trials suggested that restrictingoxygen supplementation could reduce retinopathy of prematurity without any otherconsequences; however, when oxygen restriction was practiced widely, an increasein the neonatal mortality rate was observed. Subsequently, many studies have beenreported oxygen toxicity and stress in the eye, brain, lungs and other organs. Bothhypoxia and hyperoxia are harmful, requiring clinicians to maintain the oxygenlevel at an optimal middle range in premature infants to minimize the risks associatedwith either of the two extremes. Recently, the results of a multi-national,randomized, prospective, meta-analysis collaboration study shows low saturationtargets (85-89%) until 36 weeks postmenstrual age are associated with a higher incidenceof deaths and necrotizing enterocolitis, whereas higher saturation targets (91-95%) are associated with a higher incidence of retinopathy of prematurity in infantsof <28 weeks’ gestational age. The optimal oxygenation target level in preterminfants still remains unclear and randomized control trials are required for furtherinvestigation according to gestational age and conditions of preterm infants. 수십년 간 산소는 미숙아치료에서 가장 많이 사용되어온 중요한 치료수단 중 하나였다. 치료 초기의 무분별한 산소치료로 미숙아망막증의 증가와 이후 오히려 과도한 제한으로 인한 사망률의 증가를 보였다. 이후 많은 연구와 임상경험을 통해 눈, 귀, 폐 등을 포함한 각종 장기에 미치는 여러 산소독성 또한 보고 되고 있다. 저산소증과 고산소증 모두가 미숙아에 해가 되므로 이러한 위험을 최소화 할 수 있는 적정 산소치료 기준이 요구되어 왔다. 최근 대규모 다국적 전향적 메타분석 연구에서는 28주 미만의 미숙아에서 저산소포화도군(85-89%)에서 높은 사망률과 괴사성장염을 보였고, 고산소포화도군(91-95%)에서는 높은 미숙아망막증이 발생한 결과를 얻었다. 아직 미숙아에서 적정 산소치료 기준은 명확하지 않은 상태이며 앞으로도 세분화되고 명확한 기준제시를 위해서는 많은 연구들이 필요하다

Auriculotemporal and greater auricular nerve blocks have roles in patients with Ramsay Hunt syndrome with trigeminal nerve involvement -A report of two cases-

진현승,심우석,Hee-Jin Roe 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

Ramsay Hunt syndrome (RHS) refers to herpes zoster infection of the geniculate ganglion of the facial nerve. Cases complicated by multicranial nerve involvement in the process of reactivation of the virus, which are known to show virulent clinical course and worse prognosis, are not common in literature as in practice, and there has been only one reported case of suspected co-involvement of the trigeminal nerve in Korean literature. Therefore, in cases of RHS with severe rash over the face and neck, it is pertinent to give consideration to such multiple involvement in their early presentation. Facial nerve palsy and herpes related pain are the two worrisome complication, which could be alleviated by early treatment with neural blockade in addition to oral medication. Especially, nerve blocks are known to decrease the extent of nerve inflammation or damage, thereby facilitating recovery and probably preventing postherpetic neuralgia. We report two rare cases of Ramsay Hunt syndrome with trigeminal nerve involvement, where early implementation of blockade of somatic peripheral nerve branches, in addition to the conventional treatment, promoted early recovery.

A survey of user acceptance of electronic patient anesthesia records

진현승,김명희,이석영,정휘연,최수주,이혜원 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.4

Background: An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users’ attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods: A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. Results: A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. Conclusions: Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR. Background: An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users’ attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods: A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. Results: A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. Conclusions: Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR.

정장제(Probiotics)와 신생아 괴사성 장염

진현승 대한신생아학회 2012 Neonatal medicine Vol.19 No.1

Necrotizing enterocolitis (NEC) is the most common serious disease of the gastrointestinal tract in preterm infants. Although the pathogenesis of NEC is completely unknown, enteral bacterial growth plays in such disease. The immature development of the preterm gut and the exposure to the neonatal intensive care unit environment along with associated treatments promotes inappropriate intestinal colonization with a predominance of pathogenic organisms. Probiotics are the dietary supplements, containing potentially beneficial bacteria or yeast and may offer potential benefits for preterm infants by increasing mucosal barrier function,improving nutrition, up-regulation of the immune system, reducing mucosal colonization by potential pathogens, and altering the key components of intestinal inflammation. Large randomized controlled trials have shown its effectiveness in the probiotics of the prophylaxis for NEC and mortality. However, important questions remain in establishing the clinical applications for the probiotics,including the optimal duration of administration as well as preferred probiotics dose and species. Further, there is a need to understand the interaction of the probiotics and gut. More additional clinical studies are needed to determine the safety and efficacy of the probiotics in the prophylaxis of NEC.

태아기 신생아 뇌실내 출혈

진현승 대한소아청소년과학회 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.1

Purpose:To determine incidence, characteristics and risk factors associated with intrauterine intraventricular hemorrhage(IU-IVH) among premature infants. Methods:The medical records of infants with intraventricular hemorrhage(IVH) admitted to the neonatal intensive care unit of Asan Medical Center from January 1999 to June 2003 were reviewed retrospectively. Infants whose IVH with cystic change were detected within five days of life were defined as the IU-IVH group. The control group included those without any IVH. Various maternal and neonatal factors were evaluated between the IU-IVH and control groups, and risk factors for IU-IVH were identified using multiple logistic regression analysis. Results:The incidence of IU-IVH was 49/1024(15.9%). Mothers who are younger, primiparous, use less antenatal steroid, and neonates with greater incidence of neonatal respiratory distress syndrome, had higher incidences of IU-IVH compared to neonates with normal neurosonography. Risk factors associated with IU-IVH included neonatal respiratory distress syndrome and placenta infarct by placenta biopsy. Most infants with IU-IVH were ≥1,501 g, ≥34 weeks gestational age and had low grade IVH. The size of the cysts associated with IU-IVH remained the same or disappeared in 96 %. IU-IVH does not seem to affect short-term neurodevelopmental outcome although a longer period of follow-up is needed. Conculusion:IU-IVH occurred mostly in ≥1,501 g, ≥34 weeks infants with grade I IVH without developmental delays. However, the high incidence of total IVH merits more attention in terms of awareness of its existence as an unusual IVH among premature infants 목 적 : 미숙아에서 흔히 발생되는 뇌실내 출혈의 낭성병변은 출혈이 흡수되는 과정에서 생기는 것으로 출혈 후 수일에서 수주내 나타나는 것으로 알려져 있다. 본 연구는 출생 후 5일 이내에 실시한 뇌초음파 소견상 이미 낭성병변을 동반한 뇌실내 출혈을 지닌 환아들을 태아기 뇌실내 출혈을 보인 환아로 가정하고 이들의 특징적인 임상소견과 신경학적 예후 및 산전 위험인자를 알아보고자 하였다.방 법 : 대상군으로는 1999년 1월부터 2003년 6월까지 3년 6개월간 본원 신생아 집중치료실에 입원한 환아 중 생후 5일 이내에 실시한 뇌초음파 검사상 낭성병변을 동반한 뇌실내 출혈을 지닌 환아와 대조군으로는 같은 기간 중 입원된 뇌실내 출혈이 없었던 환아를 대상으로 이들의 의무기록과 산모의 의무기록을 후향적 조사하였다.결 과 : 연구 기간동안 뇌초음파를 실시한 총 1,024명의 환아 중에 309명이 뇌실내 출혈을 보였고, 이중 첫 뇌초음파상 낭성병변을 동반한 뇌실내 출혈을 보여 태아기 뇌실내 출혈의 조건을 만족하는 환아는 49명이었다. 이들 환아들의 출생체중은 대부분 1,501 g 이상이었고, 재태연령 역시 34주 이상이었으며, III등급 뇌실내 출혈을 동반한 1명을 제외한 48명의 환아가 I등급의 뇌실내 출혈과 동반한 낭성병변을 보였다. 2명(4.4%)만이 이후 실시한 뇌초음파 검사상 낭성병변의 크기가 증가하였고, 11명(24.4%)은 평균 34일만에 사라졌다. 태아기 뇌실내 출혈과 연관된 산전 인자로는 산모의 나이가 적을수록, 초산일수록, 산전 스테로이드를 투여 받지 못하였을 때 의미있게 태아기 뇌실내 출혈이 증가하였고, 신생아 인자로는 신생아 호흡곤란 증후군과 동반한 경우 유의하게 증가하였다. 여러 인자들에 대한 다변수 로지스틱 회귀분석 결과 신생아 호흡곤란 증후군을 보인 경우와 태반 조직검사상 경색소견을 보인 경우가 의의가 있었으며 생후 18개월경까지의 신경발달학적 예후에 있어서는 두 군간 별다른 차이를 보이지 않았다.결 론:미숙아의 태아기 뇌실내 출혈의 빈도는 15.9%로서 전체 뇌실내 출혈 중 많은 부분을 차지하고 있었으나 대부분 I등급의 경미한 출혈로서 짧은 기간동안의 추적관찰상 신경발달학적 예후에 영향을 미치는 중요한 인자는 아니라고 사료된다.

효소 분석 및 유전자 분석으로 진단된 한국인 Tay-Sachs 병 1례

진현승,최진호,유한욱 대한소아청소년과학회 2004 Clinical and Experimental Pediatrics (CEP) Vol.47 No.12

저자들은 발달 지연을 주소로 내원한 18개월 남아에서 국내에서는 처음으로 hexosaminidase A 효소 분석과 유전자 분석에 의해 Tay-Sachs 병으로 진단 받은 1례를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Tay-Sachs disease is an autosomal recessive, neurodegenerative disorder that results from excessive storage of the cell membrane glycolipid, and GM2 ganglioside within the lysosomes of cells. This disease is caused by deficiency of the isoenzyme β-hexosaminidase A, produced in the endoplasmic reticulum. Patients with Tay-Sachs disease are characterized by normal motor development in the first few months of life, followed by progressive weakness and loss of motor skills beginning around 2 to 6 months of life. Neurodegeneration is relentless, with death occurring by the age of 4 or 5 years. Tay-Sachs disease could be diagnosed by hexosaminidase enzyme assay and DNA analysis of HEXA gene. However, specific treatment has not been developed. We report here on a case of Tay- Sachs disease in 18-month-old male who presented with delayed development and seizure. This patient showed hyperacusis and cherry red spot in macula on examination of the fundus. The hexosaminidase A activity was zero percent in the enzymatic assay and DNA analysis identified a mutation that glutamine is substituted by stop codon at position 390(Q390X). This patient is the first case of Tay-Sachs disease in Korea diagnosed by enzymatic assay and DNA analysis.

농촌어메니티자원정보를 활용한 마을회관 접근성 평가에 관한 연구

진현승 ( Hyun Seung Chin ),박미정 ( Mee Jeong Park ),윤도식 ( Do Sic Yun ) 한국농촌계획학회 2014 농촌계획 Vol.20 No.2

Village community centers are public locations where residential members of communities gather for various group meetings, social support, public information and recreational activities. Since the residents voluntarily operate the facilities, a convenient access to the center is a very important criterion for choosing where such facilities should be distributed throughout the districts. In particular, it is highly desirable to locate them within walking-distances from the residential populations. In this work, we have evaluated the accessibility to the community centers in several rural areas based on the surveys that were collected from year 2005 to 2012. We used the collected rural amenity resource distributions of the area for the evaluating the accessibilities to village center. More specifically, we considered some factors such as residential district and fraction of elderly population in the vicinity.

지니계수분해법을 이용한 농촌마을 시설물의 지역 격차 분석

박미정,윤도식,진현승,신민지 한국농촌계획학회 2014 농촌계획 Vol.20 No.3

This research aims to identify regional inequitable development through the analysis of facilities distribution pattern. This study describes the concepts underlying the application of the Gini's coefficient and decomposition method to measure the regional inequitable development in Sun-chang County, Jeonbuk Province, Korea. We used the facility data surveyed for three years, from 2010 to 2012 for facility distribution pattern that RDA surveyed. These data have been serviced on the web. The Lorenz Curve presents a graphical view of the inequitable facility distribution and the Gini's Coefficients quantifies the distribution pattern. And furthermore, Gini Decomposition represents intra regional inequalities. These applied techniques can describe how the local development affects other district and change regional inequalities.

Beliefs of and Attitudes toward Political Advertising

Jin, Hyun Seung(진현승),Ahn, Chasu(안차수) SBS 2007 미디어경제와 문화 Vol.5 No.3

농촌 마을정원 설계를 위한 정원요소 선호도 분석

박미정,최진아,강성진,전보배,진현승 한국농촌계획학회 2015 농촌계획 Vol.21 No.4

The study aims to examine preferences between community residents and visitors in designing a rural community garden. It analyzed diverse aspects of a garden design including garden’s function, location, management subject, components and so on. The survey was conducted on residents or visitors participants with a self-administered survey questionnaire. The results revealed that both residents and visitors highly preferred a rural community garden as a role of relaxation, appreciation, and healing. Meanwhile, there were differences of preference for location and garden components between residents and visitors. The results implicated that residents’ preference and characteristics of a community are essential in designing a rural community garden, which will lead to sustainable garden construction.