백서 심근경색모델에서 시간경과와 경색의 크기에 따른 심자도의 변화

김미성(Mi Sung Kim),박영선(Young Sun Park),권순길(Sun Gil Kwon),지정훈(Jeong Hoon Ji),신종성(Jong Sung Shin),오광식(Kwang Sik Oh),양용모(Yong Mo Yang),연태진(Tae Jin Youn),김동운(Dong Woon Kim),조명찬(Myeong Chan Cho),이용호(Yong Ho 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Magnetocardiogram (MCG), which records the changes of magnetic fields generated by the heart`s electrical activity, theoritically can provide unique data for clinical application. To date, MCG has been investigated only at a single time point after myocardial infarction (MI) with severe left ventricular dysfunction in rats. The purpose of the present study was to investigate sequential changes of MCG after MI and to evaluate effects of infarct size on MCG. Methods: Acute MI were induced by the permanent ligation of left coronary artery in 22 rats. Magnetic fields were recorded just above a rat with Nb Superconducting Quantum Interference Device (SQUID) gradiometer inside a magnetically shielded room. MCG was measured before and immediately after surgery and it was subsequently recorded at the time points of 1, 4 and 6 hours post operatively. MCG was also measured at 1, 3, 7 and 21 days after surgery. Results: Elevation of ST segment and appearance of pathological Q wave on the MCG were evident immediately after the ligation of coronary artery and persisted to 6 hours after MI. On MCG, ST segment was depressed and T wave was inverted from 1 day after MI. In rats with small-and moderate- sized MI (infarct size〈30%), ST depression returned to near the isoelectric level and Q wave disappeared from 7 days after MI. However, ST depression and Q wave were still present in rats with larger infarct (infarct size≥30%). Conclusion: Evolutional changes of MCG were well-recognized up to 21 days after MI. Furthermore, the infarct size can be expressed by the extent of Q wave and ST segment depression on MCG. Taken together, these data indicate that MCG is a helpful modality for the diagnosis, evaluation of infarct size and follow up after MI.(Korean J Med 62:42-48, 2002)

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

서울지역 여대생들의 떡에 대한 인식 및 섭취 실태 조사

김영순,오순덕,김향미,신지홍,김현경,배유미,조규영,조성환 高麗大學校 倂設 保健大學 保健科學硏究所 2003 保健科學論集 Vol.29 No.1

This study conducted a survey of the improvement and popularization for Korea Rice Cakes, a Korean traditional food, on two hundred women students in five colleges in Seoul, Korea. It was investigated to get the information of the recognition, preference, and consumption patterns for the succession and improvement of Korean Rice Cakes. The results are as follows: 1. A portion of 41.5% among responders knows from three to six kinds of Korean Rice Cakes, and of 28% can make at least one among the kinds of Korean Rice Cakes. 2. A portion of 91% recognizes that Korean Rice Cakes are one of well-nourished food, but of 42% answers that Korean Rice Cakes cannot be replaced with the principle food. Also, there are no significant differences in the recognition of Korean Rice Cakes as the kinds of religions. 3. The frequency of purchase is about one or twice in a month (35.5%). Consumers (36.5%) intend to purchase Korean Rice Cakes for the commemoration of national holidays or anniversaries. 4. The reasons for the preference of other foods more than Korean Rice Cakes are the easiness of purchase (36.0%), the deliciousness (21.5%), the diverse kindness (17.5%), and the proper package (9.5%). It is important that constant and particular school / home education is need to improve and success Korean Rice Cakes.

단클론항체를 이용한 타액 내 Streptococcus mutans 수준의 측정

김추성,김재곤,양연미,백병주,이경열,김미아,임수민 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.2

Streptococcus mutans는 구강 내에 상존하는 치아우식증의 주요 원인균으로서 치면의 피막에 부착 후 glucan을 형성하여 세균의 군락을 이루며, 외부로부터 공급된 자당대사를 통하여 유기산을 생성함으로써 법랑질을 탈회시킨다. 치아우식 활성도의 평가를 위한 단클론항체를 이용한 방법은 진료실에서 빠른 시간 내에 간편하게 타액에 존재하는 Streptococcus mutans의 정량분석이 가능한 방법이다. 이 연구는 3세에서 6세 사이의 어린이 15명을 대상으로 자극성 타액을 채취하여 시판 중인 단클론항체를 이용한 Salivacheck Mutans, strip을 이용한 Dentocult-SM 그리고 MSB배지 배양법으로서 타액 내 Streptococcus mutans를 측정한 후 그 값을 우식경험치아수와 비교하여 상관관계를 알아보았다. Saliva-check Mutans를 이용한 방법은 Dentocult-SM과 MSB배지법과 통계학적으로 유의한 상관관계를 보였으나 (p<0.05), MSB배지법은 어린이의 우식경험치아수와 통계학적으로 유의한 결과를 나타내지 않았다 (p=0.34). Streptococcus mutans, one of the major causal agents of dental caries, is component of the dental plaque. It produces various organic acids such as lactic acid which is the end-product of glycolysis, and this leads to dental caries. A new system using species-specific monoclonal antibodies was developed to detect Streptococcus mutans in saliva. The system quickly detects salivary Streptococcus mutans in 30min and classifies the result into two levels. The purpose of this study was to investigate correlation between monoclonal antibody-based detecting system and selective medium-based detecting methods. Children's deft indices were also compared with Streptococcus mutans counts in MSB agar plate. Subjects consisted of 15 children in the age of 3 to 6 years. They were assigned to three groups: Group Ⅰ (deft index = 3), Group Ⅱ (deft index ≤ 3), Group Ⅲ (deft index ≥ 4). The results are as follows : 1. The rate of children with positive response was 13.3% and with negative response was 86.7% in the result of Saliva-check Mutans test kit. 2. There was a positive correlation between monoclonal antibody-based detecting system and selective medium-based detecting methods (p<0.05). 3. Streptococcus mutans counts in MSB agar plate were irrelevant to deft of children(p=0.34).

Effect of Developmental Lead Exposure on the Expression of Hippocampal NMDA Receptor Subunit mRNA

Kim, Tae-Wan,Chung, In-Sung,Bae, Jae-Hoon,Shin, Dong-Hoon,Lee, Mi-Young,Kim, Joon-Sik 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

목적: in vivo 및 vitro에서 해마 신경세포의 발생단계별 NMDA 수용체 아단위 mRNA 발현에 대한 연 폭로 영향을 알아보고자 하였다. 방법: 흰쥐 해마 신경세포의 발생단계별 NMDA 수용체 NR2A, NR2B 아단위 mRNA 발현에 대한 연의 영향은 정상군과 연 폭로군의 출생 후 7일, 14일, 22일 흰쥐의 해마에서 in situ hybridization으로 mRNA 발현 정도를 densitometer로 측정하여 비교하였고, 연과 NMDA 의 세포독성은 해마 신경세포 일차배양 후 도립현미경을 이용한 형태학적인 관찰과 LDH 활성도를 이용하여 측정하였다. 결과: 연 과 NMDA 에 의한 세포독성에 대한 in vitro 실험에서 형태학적 소견과 LDH 활성도에서 해마 미성숙 신경세포와 성숙 신경세포사이의 차이가 있었으므로, 연과 NMDA 독성효과는 해마 신경세포의 발달 단계에 따라 차이가 있다. 정상군의 해마에서의 NR2A mRNA 발현은 출생 후 연령이 증가함에 따라 점진적으로 증가하였으나, NR2B mRNA 발현은 출생 후 연령이 증가함에 따라 점진적으로 증가하였으나 NR2B mRNA 발현은 연령의 증가에 따른 변화가 없었다. 연 폭로에 희한 NR2A mRNA 발현은 유의하게 감소하였으나(p<0.05), NR2B mRNA 발현은 변화가 나타나지 않았다. 만성적 연 폭로는 NR2A를 포함하는 NMDA 수용체를 감소시킬 수 있음을 알 수 있다. 결론: 연은 해마신경세포의 발생단계에서 NMDA 수용체 아단위 특히 NR2A mRNA 발현의 변화를 야기하여 시냅스 신호 전달에 영향을 나타냄을 알 수 있었다. Hippocampus

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

신규간호사 배치후 교육시 프리셉터쉽 적용 사례연구

김창희,김혜숙,조혜성,이순옥,함형미,박미미 성인간호학회 2000 성인간호학회지 Vol.12 No.4

The purpose of this study was to examine the effect of preceptorship on On the Job Training of new nurses. The research design was a retrospective survey and one group pre-rost test design. The subjects were 49 entry nurses and 49 preceptors The data were collected from Feburary 1, 1998 to December 1, 1998. One questionnair applied in this study consisted of general characteristics, the responses of new entry nurses and their preceptors and their qualities. The other questionnair consisted of job satisfaction of new entry nurses and Preceptors and their competencies. The data were analyzed for frequencies, mean score, standard deviation, t-test, and ANOVA. The results of the study were as follows : 1) Preceptees's responses were that the nurses' affiliation of unit. cooperation of other nurses, and competencies of nursing skills improved after OJT applied preceptorship. 2) Preceptors's answers were that preceptorship had a positive effect on their continuing education. 3) While preceptees's job satisfaction scores were high in interaction, administration, and organization, they were low in autonomy and pay. 4) Pre-competency scores were the same as post-competency scores. 5) After preceptorship, preceptors responded that their nursing skill & communication competency increased, but their nursing administration competency decreased. 6) Finally, preceptorship's other effects were as follows: ① Checklists for preceptee education at the nursing unit were developed separately. ② It was proved that 'preceptor interview note' was effective on manage preceptorship. ③ We obtained duty orierlap periods, medical-surgical units-1 month. 5 ICU-2 months. operaction room-3 months ④ We prepared a preceptor program based on the study results.

성악골 절제술후 발생한 중앙부및 구개 결손부의 재건

김훈,임재석,최성원,김호겸,권종진,최미숙,김성문 大韓顎顔面成形再建外科學會 1996 Maxillofacial Plastic Reconstructive Surgery Vol.18 No.1

There are various defects caused by trauma or resection of maignant tumor in the orofacial region, which can be reconstructed with various regional and pararegional flaps. Among these defects, it is very difficult to reconstruct palatal and midfacial defects after maxillectomy and patients have problems in speaking and swallowing of food. Therefore it is very important for surgeons to reconstruct these defects functionally and esthetically and to return the patients to the normal social activity. These defects are usually obturated with prosthodontic appliances to assist the phonation and swallowing. But nowadays surgical reconstruction by various flaps was considered and performed for better rehabilitation. For this purpose the forehead flap, the nasolabial flap, the tongue flap, the sternocleidomastoideous flap, the temporal flap, the latissimus dorsi flap, the scapular flap etc. are used. We reconstructed small-sized plalatal defects with tongue flap, medium-sized palatal and maxillary defects after maxillectomy with temporal myofascial flap and large midfacial defects including eyeball exenteration with latissimus dorsi myocutaneous flaps. Here we are to report 5 cases of these flaps used for the reconstruction of palatal and midfacial defects and consider the versatility, reliability and limitation in use of these flaps.

Could cluster of risk factors predict clinical outcome in patients with acute myocardial infarction?

( Sang Mi Park ),( Hong Nyun Kim ),( Se Yong Jang ),( Myung Hwan Bae ),( Dong Heon Yang ),( Hun Sik Park ),( Yongkeun Cho ),( Shung Chull Chae ),( Jang Hoon Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Purpose: Conventional risk factors are differently contributed to short-term prognosis of acute myocardial infarction (AMI); hypertension and diabetes increase adverse outcome, whereas hyperlipidemia, smoking, and obesity paradoxically decrease adverse outcome of post-MI patients. The aim of this study is to assess whether cluster of conventional risk factors, PARADOCS (Pressure of ARtery Abnormality, Diabetes, Obesity, Cholesterol, Smoking) score, would improve the ability to predict major adverse cardiac events (MACEs) in patients with AMI. Methods: Between November 2005 and July 2011, 24,020 patients (17,232 men; mean age=63.0±12.8) with AMI were analyzed from Korean AMI registry. PARADOCS score was calculated as follows; [number of non-paradoxical risk factors (NRF) -number of paradoxical risk factors (PRF)]+3 in which non-paradoxical risk factors are hypertension and diabetes, and paradoxical risk factors are the rest. The 1-year MACEs were defined as death and non-fatal MI. Results: NRF including hypertension and diabetes were present in 49.6% and 27.0%, whereas PRF including hyperlipidemia, smoking, and obesity were present in 12.3%, 43.0%, and 34.6%, respectively. During the follow-up, 1,409 (5.9%) MACEs occurred. PARADOCS score was significantly higher in patients with 1-year MACEs (3.38±1.03 versus 2.81±1.08, p<0.001). In Cox proportional hazards model, PARADOCS score was an independent predictor of 1-year MACEs (hazards ratio 1.26, 95% confidence interval 1.18-1.34; p<0.001) after adjusting for confounding variables. Patients were categorized into 3 groups according to the PARADOCS score; PARADOCSLOW (0-1, n=2,446), PARADOCSMID (2-3, n=14,594), and PARADOCSHIGH (4-5, n= 6,980). Kaplan-Meier survival curve showed that there were significant differences in the 1-year MACEs among three groups including 3.5% in PARADOCSLOW, 8.5% in PARADOCSMID, and 16.4% in PARADOCSHIGH, respectively (long-rank p<0.001). Conclusions: In post-MI patients, conventional risk factors are differently associated with short-term prognosis, and score of these risk factors, PARADOCS score, can provide useful prognostic information to clinicians.

MCR에 의한 혐기성 소화에 대한 암모니아의 영향

김양지,김춘미,김성일,김종수 선문대학교 ·중소기업기술지원연구소 2002 선문공대 연구/기술 논문집 Vol.7 No.1

혐기성 소화에서 미생물에 저해/독성 물질로 알려진 암모니아의 농도와 식종원에 따른 영향을 MCR(Master Culture Reactor)을 이용하여 회분식으로 분석하였다. 식종원은 축간농가 축산폐수 집수조의 침전슬러지 그리고 하수종말처리장 혐기성 소화조 잉여슬러지를 사용하였다. 식종원에 상관없이 암모니아는 1,500㎎NH_4-N/L에서 COD 제거율과 가스생성율로 측정된 혐기성 미생물의 활성에 저해영향을 주기 시작하여 2,500㎎NH_4-N/L에서 더욱 심하였다. 암모니아 저해 농도 범위에서 휘발성 유기산의 농도는 50㎎/L 범위로 유지되므로 메탄생성균 뿐만아니라 산생성균도 저해영향을 받는 것으로 나타났다. 축산폐수 집수조 침전슬러지로 식종된 경우 암모니아 2,500㎎NH_4-N/L 농도 범위 이상으로 운전하여도 COD 제거율과 가스생성율은 일정하게 나타났지만 하수종말처리장 혐기성 소화조 잉여슬러지로 식종된 경우 암모니아 농도가 증가할수록 COD 제거율과 가스생성율은 감소하였다. 결과적으로 암모니아에 장기간 순응된 축산폐수 집수조의 침전슬러지로 식종한 경우 암모니아의 저해 농도에 대하여 적응도 빨랐으며 저해영향도 적음을 알 수 있었다. The influence of ammonia and the sources of seeding on anaerobic digestion were investigated by batch operation of MCR(master culture reactor). The sources of seeding on anaerobic digestion were from swine wastewater collection pit and anaerobic digestion sludge of a municipal sewage treatment plant. The inhibition effects of ammonia on anaerobic microorganisms were initiated at ammonia concentration of 1,500 ㎎NH_4-N/L and the effects were increased by increasing ammonia concentration upto 2,500 ㎎NH_4-N/L regardless the sources of seeding as evidenced by decreases in COD removal efficiencies and biogas yields. The inhibition occurred to not only methanogens but also acidogens since the concentration of volatile fatty acids was maintained at 50 ㎎/L during the batch operations of MCR. The COD removal efficiency and biogas yield were maintained constantly while increasing ammonia concentration upto 2,500 ㎎NH_4-N/L when swine wastewater collection pit was used as seeding; however, those were decreased while increasing ammonia concentration when anaerobic digestion sludge was used as seeding. The results indicate that the seeding acclimated to high concentrations of ammonia for long time was easy in adaptation to high ammonia concentration and less subjective to ammonia inhibitory effects.