뇌졸중 환자의 일상생활동작, 우울과 삶의 질의 관계

김원옥 ( Won Ock Kim ),강현숙 ( Hyun Sook Kang ),왕명자 ( Jmyung Ja Wang ),김정화 ( Jeong Hwa Kim ),최진이 ( Jin Yi Choi ) 경희대학교 동서의학연구소 2007 동서간호학연구지 Vol.13 No.2

본 연구는 뇌졸중 환자의 일상생활동작, 우울, 삶의 질의 관계를 파악하고자 하는 서술적 조사 연구로서 일상생활동작,’ 우울, 삶의 질 정효〉 관계가 있음을 확인하였다. 그러므로 본 안구의 주요한 결과를 중심으로 다음과 같이 고찰하였다. 뇌졸중 환자들의 일상활동 수행능력을 측정하는 도 구로 FIM, Modificd Barthel Index (MBI) 등이 많이 쓰 이고 있는데 FIM은 분야에 상관없이 표준화를 통한 높은 실용성,실행성, 이해도로· 인하여 널리 사. 하고 있는 도구로 이를 이용하여 측정한 본 연구에서는 872점으로 국내에서 만성 뇌졸중 환자와 퇴원 시 뇌졸중 환자를 대상으로 측정한 85. 9점 (Hw떼g, 2004) 과 85. 3점 (Kim, 2004) , 85. 8점 (Hong et al., 1998) 에 비하 여 약간 높아졌으나 비슷하였고, 일본 뇌졸중 환자를 대상으로 한 연구의 77. 1점보다는 높은 결과이었다 (Hama et al., 2007) . 특히 하부역역인 운동영역은 다 른 연구에 비해 높았으나 인지영역은 다른 연구에 비 해 낮은 편이었다 (Hwang, 2004二 Hama et al. , 2007, Hong 嫩 al. , 200긱 Kim, 2004) . 미국의 지역사회시설 에 있는 뇌졸중이 처음 발병한 환자들을 대상으로 재 활 후 5년간 환자를 추적한 연구에서 3년 후까지는 FIM점수가 상승하였으나 그 이후 감소되는 양상을 보였고 본 연구에서는 친단 후 경과 기간이 35.5개월 (87.2점)로 퇴원 후 3년 된 시점의 결과no도4점) 와 비교하였을 때 낮은 편이었다〈 Leonard, Mnler, Griffiths, Mcclatchie, & wherry, 1998) . 이러한 결과는 지역사 회와 집에서 간호를 받고 있는 뇌졸중 환자들에게 지속적인 재활 프로그램의 필요성이 높다는 것을 시사 한다고 볼 수 있다. 그러므로 입원을 한 직후부티 환 자에게 적절한 재활프로그램을 계획하여 시작하고 퇴원 후에는 연계되어 재활을 받을 수 있는 시설과 연결하여 환자가 지속적으로 재활을 할 수 있도록 돕는 병원과 지역사회가 공동으로 개발하고 시행하는 개활프로그램이 필요하다. 우울은 뇌졸중을 진단 받은 환자들의 급성기와 회 복기에 많이 동반되는 증상으로 본 연구에서도 CES- D를 이용하여 우울을 측정한 결과 23. 8점으로 Bak (2003) 의 연구와 비슷한 정도로 높게 측정되어 이 전의 연구결과와 같이 뇌졸중 환자의 가장 흔한 후유 증이 우울임을 다시 확인할 수 있었다 (Cho et al. 2003, `` Chon & Rhee, 1992, `` Kim, 2005, `` Kim, Seo, & Kang, 2000; singh et al. , 2000) . 그러므로 입원 시부터 신체적인 증상 뿐 아니라 우울도 같이 사정하고 우울이 진행되지 않도록 지속적인 관찰과 정서적인 간호가 뇌졸중 환자를 위한 재활프로그램에 포함이 되어야 한다. 삶의 질은 3 ``03점으로 뇌졸중 환자 l이명을 대상으로 한 chung (2000) 의 연구에서 의 3. 41점보다는 낮았으나 Kim과 Kim (2003) 의 연구의 3. 17점과는 비슷하였고 전체적으로 낮은 편이었다. 이런 결과는 최근 의학기술의 발전으로 뇌졸중으로 인한 사망률이 감소 되고 만성적인 뇌졸중 환자가 증가함에도 불구하고 재가뇌졸중 환자들에 대한 재활과 관리가 효과적으로 이루어지지 않고 있음으로 확인할 수 있었다. 따라서 뇌졸중과 삶의 질은 단기간에 향상되는 것이 아니므로 개활 프로그램이 단기적인 것보다는 체계적으로 계획되고 지속적으로 수행되어져 삶의 질을 관찰하는 연구가 필요할 것으로 생각된다. 또한 일상생활 동작을 잘 할수록 우울점수가 낮게 나타났고 삶의 질 정도가 높게 나타났다. 그리고 우 울 정도가 심할수록 삶의 질 정도가 낮은 것으로 나타났다. 뇌졸중 환자들에 대한 선행연구결과들을 살 펴보면 뇌졸중은 일상생활동작 수행과 같은 신체적인 문제, 우울, 대인관계 감소 등의 사회적 문제가 발생 되고 장기적인 치료와 간호를 요구하는 질병으로서 최종적으로. 삶의 질이 저하되는 것을 보고하고 있다 (Chung, 2000; Hama et al. , 2007, `` Ingrid, Kwakkel, Bruin, & Lindeman, 2007; Khan, 2004; Kim & Kim, 2003; singh et al. , 2007) . 이러한 연구 결과는 일상생활동작, 우울, 삶의 질이 단계적으로 순환되는 관계로 서 모두 뇌졸중환자를 위한 재활프로그램 내용에 포함되어야 함을 의미한다. 이런 연구결과들을 종합하여 볼 때 뇌졸중은 환자 의 뇌손상을 일으켜 장기적인 우울과 신체적인 기능 장애를 발생시킬 가능성이 높으므로 뇌졸중 환자의 재활프로그램은 입원을 하자마자 계획하여 치료와 동 시에 시작하고 특히 우울은 뇌졸중의 만성적인 건강 문제로 재활과정을 방해할 수 있으므로 신체적인 중 재와 더불어 정서적인 중재를 포함한 포괄적인 내용 의 프로그램이 바람직하고 장기적으로 삶의 질을 평 가함이 바랑직할 것이다. 또한 뇌졸중은 장기적인 재 활이 요구되는 질환이므로 단기간의 재활 프로그램을 병원에서만 시행하는 것이 아니라 퇴원 후 병원과 지 역 사회에서 연계하여 치료적인 연속성을 가지고 유지 할 수 있는 재활 프로그램의 개발이 반드시 필요할 것이 라고 본다. Introduction: The purpose of this study was to examine relationships among stroke patients`` activities of daily living(ADL), depression, and quality of life(QOL). Methods: Data were collected by questionnaires from 251 stroke patients at 5 hospitals and 2 public health centers in Seoul and Kyonggi-Do. The following Questionnaires were utilized for this study: Functional independence measure(FIM) from Grange, Hamilton, and Sherwin(1986), the Korean CES-D scale from Randloff(1977), and quality of life scale from Bang, Hwal-Lan(1991). Results: Data were analyzed using the pearson correlation, t-test, and ANOVA with SPSS/WIN 12.0. The results of this study were as follow; The subjects consisted of 110 females and 141 males. The mean score of activity of daily living was 87.2(range 18-126). Age, family history, comorbidity, paralysis site, and duration after diagnosis were significantly associated with activity of daily living. The mean score of depression was 23.8(range 11-44). Age, gender, education, and job were significantly associated with depression. The mean score of quality of life scale was 3.0(range 1-5). Gender, religion, education, job, economic status, and duration after diagnosis were significantly associated with quality of life. Relationships among activity daily living, depression, and quality of life scale: The activity of daily living had a negative relationship with depression score. The activity of daily living had a positive relationship with QOL score. The depression had a negative relationship with QOL score. Conclusion: Based on these results, it is necessary to run rehabilitation programs to improve stroke patients`` ADL, depression. Also, it research for of identifying stroke patients`` quality of life according to rehabilitation program.

Identification of Genes Modulated by High Extracellular Calcium in Coculture of Mouse Osteoblasts and Bone Marrow Cells by Oligo Chip Assay

Kim, Hyung-Keun,Song, Mina,Jun, ji-Hae,Woo, Kyung-Mi,Kim, Gwan-Shik,Baek, Jeong-Hwa The Korean Academy of Oral Biology 2006 International Journal of Oral Biology Vol.31 No.2

Calcium concentration in the bone resorption lacunae is high and is in the mM concentration range. Both osteoblast and osteoclast have calcium sensing receptor in the cell surface, suggesting the regulatory role of high extracellular calcium in bone merabolism. In vitro, high extracellular calcium stimulated osteoclastogenesis in coculture of mouse osteoblasts and bone marrow cells. Therefore we examined the genes that were commonly regulated by both high extracellular calcium and 1,25(OH)_(2)vitaminD_(3)(VD3) by using mouse oligo 11 K gene chip. In the presence of 10 mM[Ca^(2+)]e or 10 nM VD3, mouse calvarial osteoblasts and bone marrow cells were co-cultured for 4 days when tartrate resistant acid phosphatase-positive multinucleated cells start to appear. Of 11,000 genes examined, the genes commonly regulated both by high extracellular calcium and by VD3 were as follows; 1) the expressions of genes which were osteoclast differentiation markers or were associated with osteoclastogenesis were up-regulated both by high extracellular calcium and by VD3; trap, mmp9, car2, ctsk, ckb, atp6b2, tm7sf4, rab7, 2) several chemokine and chemokine receptor genes such as sdf1, scya2, scyb5, scya6, scya8, scya9, and ccr1 were up-regulated both by high ectracellular calcium and by VD3, 3) the genes such as mmp1b, mmp3 and c3 which possibly stimulate bone resorption by osteoclast, were commonly up-regulated, 4) the gene such as c1q and msr2 which were related with macrophage function, were commonly down-regulated, 5) the genes which possibly stimulate osteoblast differentiation and/or mineralization of extracellular matrix, were commonly down-regulated;slc8a1, admr, plod2, lox, fosb, 6) the genes which possibly suppress osteoblast differentiation and/or mineralization of extracellular matrix, were commonly up-regulated;s100a4, npr3, mme, 7) the genes such as calponin 1 and tgfbi which possibly suppress osteoblast differentiation and/or mineralization of extracellular matrix, were up-regulated by high extracelluar calcium but were down-regulated by VD3. These results suggest that in coculture condition, both high extracellular calcium and VD3 commonly induce osteoclastogenesis but suppress osteoblast differentiation/mineralization by regulating the expression of related genes.

대동맥 협착증과 동반된 출혈성 위장관 동정맥 기형에서 Estrogen-Progesterone 치료 1예

김도연,김화정,김효정,남준식,박수영,박영미,신정은,주미순,황민규,정혜경,손혜영,이선영,이한주 大韓消化器內視鏡學會 1999 Clinical Endoscopy Vol.19 No.부록2

CD34+ 조혈 모세포 이식 2례

김정아,정현식,김원석,윤성수,이홍기,박찬형,박성규,김동욱,이종욱,한치화,민우성,김춘추,김동집 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

Background: In most solid tumors, the CD34 antigen has not been detected, so positive selection of CD34+ cells may reduce tumor cell contamination and the CD34+ cells are capable of reconstituting hematopoiesis. We tried CD34+ cell transplantation in two patients. Method: CD34+ cells from chemotherapy + G-CSF mobilized PBPCs or bone marrow were positively selected with an avidin-biotin immunoadsorption column (CEPRATE SC system). Case 1. One course of chemotherapy using cyclophosphamide(200㎎/㎡) and etoposide (4.2g/㎡), combined with G-CSF(5㎍/㎏) S.C. was used in a relapsed lymphoma patient. This patient responded to the induction chemotherapy. CD34+ cells from harvested bone marrow were selected by the CellPro immunoadsorption column. The total number of mononuclear cells loaded onto the CellPro was 2.4×10^(8)/㎏, with 1.1% CD34+ cells. After column separation, the total number of positively selected cells was 5.16×10^(6)/㎏. The number of CFU-GM was 76.8×10⁴/㎏. This patient was treated with melphalan (140㎎/㎡) and TBI (1200cGy) and the positively selected CD34+ cells were infused. The time to neutrophil recovery greater than 0.5×10^(9)/L was 19 days and the time to platelet recovery greater than 50×10^(9)/L was 21 days. Case 2. Two courses of mobilizing chemotherapy were given 4 weeks apart using taxol(210㎎/m2) and adriamycin(60㎎/m2), combined with G-CSF(5㎍/㎏) S.C. in a breast cancer patients with 7 axillary node metastasis. CD34+ cells from each single leukapheresis product were selected by the CellPro immunoadsorption column. In the first collection, the total number of nucleated cells was 4.4×10^(8)/kg, with 0.42% CD34+ cells. In the second collection, the total number of nucleated cell was 2.8× 10^(8)/㎏ with 0.43% CD34+ cells. After colum separation, the total numbers of collected cells were 4.0×106/kg and 4.8×10^(6)/kg, the total number of CD34+ cells were 1.2×10^(6)/㎏ and 0.82×10^(6)/㎏. Colonogenic assays of positively selected CD34+ cells gave rise to myeloid erythroid, and multilineage colonies, with a median of 190 CFU-GM, 190 BFU-E, and 164 CFU-GEMM per 1×10³ adsorbed cells, respectively. High-dose chemotherapy with cumulative doses of 40mg/㎡ mitoxantrone, 750mg/㎡ thioptepa, and 1000mg/㎡ carboplatin was administered. Positively selected CD34+ cells were rapidly infused 24 hours after the end of high-dose chemotherapy. The time to neutrophil recovery greater than 0.5×10^(9)/L was 16 days and the time to platelet recovery greater than 50×10^(9)/L was 20 days.

Lidocaine, Thrombin, Epinephrine 의 항균효과

김진우,이동건,전혜선,김승준,김석찬,안중현,김치홍,권순석,김영균,김관형,문화식,신완식,송정섭,박성학 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

목적 : 기관지내시경 검사에서 흔히 사용되는 국소마취제인 lidocaine과 내시경시 지혈목적으로 사용되는 thrombin과 epinephrine이 각종 균주에 미치는 항균효과에 대해 알아보고자 하였다. 재료 및 방법 : 균주는 가톨릭대학교 성모병원에서 2004년 3월부터 2004년 9월까지 임상검체 에서 동정된 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 각각 42, 42, 42, 43주를 대상으로 하였다. Lidocaine, thrombin, epinephrine 감수성 검사는 National Committee for Clinical Laboratory Standards (NCCLS, 2002)의 기준에 따랐다. 결과 : Lidocaine은 S. aureus, S. pneumoniae, P. aeruginosa에서 MIC_(50), MIC_(90) 모두 20,000 ㎍/mL 이었다. K. pneumoniae는 각각 10,000 ㎍/mL이었다. Thrombin은 S. aureus와 P. aeruginosa에서 MIC50 500 lU/mL 과 MIC_(90) 500 IU/mL 이상이었고, K. pneumoniae에서는 MIC_(50)과 MIC_(90)이 모두 500 lU/mL이상이었으나 S. pneumoniae에서는 MIC_(50)과 MIC_(90)은 125 IU/mL이었다. Epinephrine은 K. pneumoniae, S. pneumoniae에 대한 MIC_(50), MIC_(90)가 모두 >500 ㎍/mL이었고, S. aureus와 P. aeruginosa에 대한 MIC_(50), MIC_(90)가 모두 500 ㎍/mL이었다. 결론 : 기관지 내시경 검사에서 흔히 쓰이는 lidocaine, thrombin, epinephrine 등의 약제들이 호흡기 질환의 흔한 병원균인 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 균주들에 대해 항균 효과가 있을 수 있어 세균배양검사에 영향을 미칠 수 있겠다. Background : We performed this stody to find out about antimicrobial effect of lidocaine which is commonly used local anesthetic, and thrombin and epinephrine used for hemostasis during bronchoscopic procedures. Materials and Methods : The microorganisms that were cultured from specimens obtained during bronchoscopy were Staphylococcus aureus (n=42), Streptococcus pneumoniae (n=42), Klebsiella pneumoniae (n=42), and Pseudomonas aeruginosa (n=43) collected from St. Mary's Hospital, from March to Sep 2004 were used for susceptibity testing. Susceptibility to lidocaine, thrombin, and epinephrine were tested according to the National Committee for Clinical Laboratory Standards. Result : MIC_(50) and MIC_(90) of lidocaine for S. aureus, S. pneumoniae, P. aeruginosa were all 20,000 ㎍/mL and that for K. pneumoniae were 10,000 ㎍/mL. MIC_(50) and MIC_(90) of thrombin for both S. aureus and P. aeruginosa was 500 IU/mL and above 500 IU/mL, respectively; that for K. pneumoniae were all above 500 IU/mL and for S. pneumoniae they were 125 IU/mL, MIC_(50) and MIC_(90) of epinephrine for K. pneumoniae and S. pneumoniae were above 500 ㎍/mL; that for S. aureus and P. aeruginosa were 500 ㎍/mL. Conclusion : We observed possible antimicrobial effect of lidocaine, thrombin, and epinephrine in vitro against pathogens such as S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa, which are common respiratory microorganisms. The use of these agants could affect the result of bacterial culture.

〈교녀가〉연구

김정화(Kim, Jeong-Hwa) 한국어문학회 2014 語文學 Vol.0 No.125

〈Gyonyoga〉 is a kind of genyoga, which was written by father for daughters who lost their mother early. The author is conjectured to be Lee Jungen who also wrote 〈Bukgeongga〉. This is the first study on 〈Gyonyoga〉. There are 4 editions of 〈Gyonyoga〉 among which 〈Gyonyoga〉 possessed by Yangju Song is the complete work. 〈Gyonyoga〉 contained various contents focusing alert about wrong doing and discipline about well doing as two pillars. It warns wrong doing, and behavior focusing on Genyoga item. In well doing, it is based on theory of Taeguk, the basic of Confucianism explaining the origin of all things in the universe. And, as for behavior of women, it focused on sewing and spinning and the proprieties of food. While 〈Gyonyoga〉is a full-length work, it has outstanding structural unification overall. 〈Gyonyoga〉 not only deals with the warning against evil and admonition for good behavior as the broad structure, but also have structural density shown in ‘sewing and spinning songs’, which demonstrated the characteristics of male writer pursuing organized writing from the first. And ‘sewing and spinning songs’ in 〈Gyonyoga〉 connected to the recommendation on the mind of women. Father as the author of 〈Gyonyoga〉 regarded the mind ruling important based on the Confucian view of the world precedent to the importance of behavior. While it is positive to explain difficult issues easily for the understanding of daughters, it stresses the didactic purpose too much, which could be a limit of literature for women. Meanwhile, ‘Bettle song as a folk song is a work song composed by women. Accordingly, it contains emotion and suffering of women’s life. But, ‘Bettle song’ in 〈Gyonyoga〉 was composed by a man. Accordingly, emotion and suffering of women’s life was not the subject of consideration to the author of 〈Gyonyoga〉. Narrativity of ‘Bettle song’ is also closely related to the fact that it is song of women. Narrative story itself stirs curiosity of women, and women can be comforted regardless of its reality. To the contrary, ‘Bettle song’ in 〈Gyonyoga〉 completely excluded narrative story and did not include any emotional expression on the life of women. That is because ‘Bettle song’ was used for the didactic purpose from the perspective of male as a part of 〈Gyonyoga〉 regardless of the authorship of the song.

흰쥐중심편도체핵에서 Neurotensin 면역양성세포의 다리옆핵으로의 투사

박인식,최정화,박봉수,백선용,김봉선,김재봉,김진정 대한해부학회 1996 Anatomy & Cell Biology Vol.29 No.2

연쇄중합효소반응을 이용한 태아성별진단

이희섭,김용신,김화선,김정중,김원신 원광대학교 생명공학연구소 1996 생명공학연구소보 Vol.4 No.1

For sex determination by the PCR method, oligoprimers to Y-chromosome gene, DYZ1, SRY, and AMGL were synthesized and genomic DNA was extracted from male and female placenta for the control use. DYZ1 represented 154 bp single band to 0.001pg/ml male genomic DNA but did not represent 154 bp band in female genomic DNA, SRY represented 341 bp band to 1 pg/ml male genomic DNA but did not represent 341 bp band in female genomic DNA, and AMGL represented 977 and 788 bp double band to 1 pg/ml male genomic DNA and 977 bp single band to 1 pg/ml female genomic DNA in 2% agarose gel electrophoresis stained with ethidium bromide. DYZ1 was 1,000-fold sensitive than SRY and AMGL. DYZ1 and SRY could not identify the PCR failure from female but AMGL identified. To increase the sensitivity, the dual amplification of AMGL was performed and the sensitivity increased to 1,000-fold. During the dual amplification of female genomic DNA mixed with male genomic DNA, 0.00125pg/l, 1:400 part male genomic DNA contamination represented double bands as male. In 2 cases of 46, XY female, DYZ1 and AMGL amplification represented male band but SRY amplification did not represent male band. It was suggested that SRY gene was deleted in two 46, XY female cases. for fetal sex determination, PCR with DYZ1, SRY, and AMGL was performed in 10 cases of chorionic villi and 15 cases of amnionic cells. By the comparison with karyotyping result, fetal sex determination was achieved successfully in all 23 samples using PCR of SRY and AMGL but false result was detected in 3 cases(13%) using DYZ1. According to our results, it was concluded that DYZ1 was 1,000-fold sensitive than SRY and AMGL but could not be used because of its false results, and AMGL and SRY must be used concomitantly for precise sex determination.

민들레 잎과 뿌리 분말을 첨가한 설기떡의 품질 특성

유경미,김세희,장정화,황인경,김경임,김성수,김영찬 한국조리과학회 2005 한국식품조리과학회지 Vol.21 No.1

In order to develop a dandelion (Taraxacum officinale) with natural food applications, the effects of dandelion leaves and roots powder content on the physical, textural and sensory properties of sulggidduk were examined. Dandelion powders of leaves and roots at 0, 1, 2 and 3% were added to the dandelion sulgidduk. In the dandelion roots powder in sulgidduk, the color intensity of L values and the values and moisture content decreased however, the sensory color intensity, dandelion flavor and overall acceptability increased with increasing the dandelion powder content. The sensory overall acceptability indicated the dandelion roots powder content at 3% had the highest overall and flavor scores. As the dandelion leaves content was increased, the moisture contents, lightness, adhesiveness and cohesiveness of sulggidduk decreased, while the sensory color intensity, sensory hardness, hardness of texture properties and dandelion flavor increased. The addition at 1% of the dandelion leaves powder content with the dandelion sulggidduk and the addition at 3% of the dandelion roots powder content with the dandelion sulggidduk showed the highest overall acceptability.

화병(火病)을 동반한 갱년기 환자 치험 5례

송유림 ( Yu-rim Song ),박경미 ( Kyung-mi Park ),양승정 ( Seung-jeong Yang ),이은규 ( Eun-kyu Lee ),김혜화 ( Hye-hwa Kim ),조성희 ( Seong-hee Cho ) 대한한방부인과학회 2016 大韓韓方婦人科學會誌 Vol.29 No.4

Objectives: The purpose of this study is to evaluate the effects of Korean traditional treatments for Climacteric Syndrome Patients with Hwa-Byung. Methods: From February 2015 to May 2015, We treated 5 Cases Patients with Korean traditional treatments for a month. We measured treatment effects by Menopause Rating Scale (MRS), Beck`s Depression Inventory (BDI), Visual Analogue Scale (VAS) and Digital Infrared Thermal Imaging (DITI). Results: After treatment, First, the scores of MRS, BDI were decreased. Second, the symptoms such as hot flush, pantalgia, palpitation, insomnia, fatigue were significantly improved. Also, the difference of ?中 (CV17, Danjung) and 關元 (CV4, Guanyuan) temperatures were significantly decreased after treatment. Conclusions: This study suggests that Korean traditional treatments such as Gamicheonglijagam-hwan, acupuncture, moxibustion are effective on Climacteric Syndrome Patients with Hwa-Byung.