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.

Identification of a sensitive urinary biomarker, selenium-binding protein 1, for early detection of acute kidney injury

Kim, Kyeong Seok,Yang, Hun Yong,Song, Hosup,Kang, Ye Rim,Kwon, JiHoon,An, JiHye,Son, Ji Yeon,Kwack, Seung Jun,Kim, Young-Mi,Bae, Ok-Nam,Ahn, Mee-Young,Lee, Jaewon,Yoon, Sungpil,Lee, Byung μ,Kim, Hyung TAYLOR & FRANCIS 2017 Journal of Toxicology and Environmental Health Vol.80 No.9

<P>Acute kidney injury (AKI) is associated with increased mortality rate in patients but clinically available biomarkers for disease detection are currently not available. Recently, a new biomarker, selenium-binding protein 1 (SBP1), was identified for detection of nephrotoxicity using proteomic analysis. The aim of this study was to assess the sensitivity of urinary SBP1 levels as an early detection of AKI using animal models such as cisplatin or ischemia/reperfusion (I/R). Sprague-Dawley rats were injected with cisplatin (6 mg/kg, once i.p.) and sacrificed at 1, 3, or 5 days after treatment. Ischemia was achieved by bilaterally occluding both kidneys with a microvascular clamp for 45 min and verified visually by a change in tissue color. After post-reperfusion, urine samples were collected at 9, 24, and 48 hr intervals. Urinary excretion of protein-based biomarkers was measured by Western blot analysis. In cisplatin-treated rats, mild histopathologic alterations were noted at day 1 which became severe at day 3. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were significantly increased at day 3. Levels of urinary excretion of SBP1, neutrophil gelatinase-associated lipocalin (NGAL), and a tissue inhibitor of metalloproteinase-1 (TIMP-1) were markedly elevated at day 3 and 5 following drug treatment. In the vehicle-treated I/R group, serum levels of BUN and SCr and AST activity were significantly increased compared to sham. Urinary excretion of SBP1 and NGAL rose markedly following I/R. The urinary levels of SBP1, NGAL, TIMP-1, and KIM-1 proteins excreted by AKI patients and normal subjects were compared. Among these proteins, a marked rise in SBP1 was observed in urine of patients with AKI compared to normal subjects. Based upon receiver-operator curves (ROC), SBP1 displayed a higher area under the curve (AUC) scores than levels of SCr, BUN, total protein, and glucose. In particular, SBP1 protein was readily detected in small amounts of urine without purification. Data thus indicate that urinary excretion of SBP1 may be useful as a reliable biomarker for early diagnosis of AKI in patients.</P>

피질하 혈관성 치매와 호모시스테인 및 MTHFR C677T 유전자 다형성의 상관관계

김희진,김지영,김숙희,김원기,김용성,최병옥 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.2

Background: Subcortical ischemic vascular dementia (SIVD) frequently causes dementia in elderly people, and elevated plasma homocysteine concentrations have been reported to be associated with vascular dementia. Although the homozygous C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene can induce hyperhomocysteinemia, the association between MTHFR C677T polymorphism and SIVD has not been studied. Therefore, we examined the association of SIVD with plasma homocysteine concentration and MTHFR C677T polymorphism. Methods: We enrolled 58 patients with vascular dementia (VaD), 43 patients with SIVD, 69 lacunar infarct patients without vascualr dementia (LOD), and 232 healthy individuals and checked their fasting plasma homocysteine levels and analyzed the C677T polymorphism in the MTHFR gene. Results: The mean plasma homocysteine level in VaD, SIVD, and LOD patients were significantly higher than that in healthy controls (p;0.01). The odds ratio adjusted with age, sex, hypertension, diabetes mellitus, and smoling were significantly higher in VaD (OR, 2.74; 95% CI, 1.04 to 7.23) and SIVD (OR, 3.12; 95% CI, 1.09 to 8.96) than that in controls. Compared with LOD, it was significantly higher in SIVD, but not in VaD (OR, 4.50; 95% CI, 1.05 to 19.26). In SIVD patients, the OR of plasma homocysteine level was higher in the TT genotype than those in the CC genotype (OR, 1.59; 95% CI, 1.01 to 2.49). Conclusions: Our findings suggest that elevated plasma homocysteine concentration and the MTHFR 6777 genotype are associated with SIVD.

Caffeine이 지구성 운동 수행능력에 미치는 영향과 억제성 아미노산에 의하여 활성화되는 이온통로의 조절작용

김은경,김영표,천병옥,이계영,김연정,임백빈,조영욱,김창주,김성수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

To investigate the effect and mechanism of caffeine on endurance exercise, two experiments were performed. First, to test caffeine effect on aerobic exercise, 200-300g Sprague-Dawley rats were used and three groups, control group, low caffeine injection group and high caffeine injection group, were divided. Blood smpling by heart puncture were done at rest, after 30 min treadmill exercise, and after maximal exercise. Blood glucose, free fatty acid concentration were detected and following results were obtained. Glucose concentration showed significant difference between groups(p=0.0305) and also significant changes were exhibited between time(p=0.0004). Free fatty acid concentration had no difference between groups. but had significance between times(p=0.00065). Exercise endurance performance time showed significant difference(p=0.02350 in high caffeine injection group compared to control group. In this experiments, endurance exercise capacity was increased by caffeine injection. Therefore, second experiment was performed to investigate the effect of caffeine on ion current induced inhibitory amino acid neurotransmitter. GABA and glycine. Single periaqueductal gray neuron was acutely dissociated and nystatin perforated patch clamp was performed under voltage clamping condition. Caffeine evoked outward current in PAG neuron dose dependent manner. 1mM of caffeine application had no response. but 3mM caffeine evoked about 32.5±8.539pA outward ion current and 10mM caffeine evoked about 215.46±19.4pA outward current. 10^-2mM GABA activated Cl￣current and recorded by inward current. Caffeine inhibited GABA activated Cl￣ current concentration dependent manner. 10^-2mM of caffeine had no effect on 1-^-2mM of GABA response. but 10^-1mM caffeine inhibited GABA activated Cl￣ current about 5.74±2.13%, 1mM caffeine inhibited about 17.25±2.70%, 10mM caffeine inhibited GABA response about 45.31±7.71%. 10^-1mM of glycine activated Cl￣ current and also recorded by inward current. Caffeine inhibited glycine activated Cl￣ current concentration dependent manner. 10^-2mM caffeine decreased glycine activated Cl￣ current about 4.61±1.650%, 10^-1mM caffeine decreased about 6.49±2.24%, 1mM caffeine decreased about 26.82±4.27%, and 10mM caffeine decreased glycine response about 94.47±1.39%. These results suggest that caffeine inhibite inhibitory amino acid, GABA and glycine, this response causes excitation of CNS and this seems to be the basic mechanism of increasing effect to aerobic exercise performance by caffeine.

패류중 중금속함량에 관한 연구

신현수,허옥순,이진하,김세은,주인선,신동우,강석종,박만종,김지연,김근희,강숙경,정래석,허숙진,소유섭,최장덕,문병우,김진수 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

본 연구는 패류중 중금속함량 측정을 위한 분석효율이 높고 간편한 분해법을 찾아내어 그 방법에 의끓 유종중인 패류중 중금속함량을 파악하고자 수행하였다. 시료를 분해시키는 Microwave와 습식, 건식회법을 비교한 결과 변형습식회화르가 가장 적합하였다. 변형습식회차딘는 려린0,3+C104+H2SOf의 혼찰산을 쪼 · j 1 (v/v)의 비율로 혼합하여 사용하였 을 때 회수을 Pb린틴. Cd 97.8, Cu 94.2, Zn 92.8%를 나타내었근 분해시간은 2~2.5시간 소요되었다. 유통중인 패류중 중금속함량 」최소~최대(평균), mgAgl 은 Pb 0.028~o.528(0.153), Cd 0.OO7~1,832(0.587), Cu 0.360~37.375(4.6691, Zn 6.317~233.2iO(38.881), Hg 0.001 ~O.151(0.012)mg/ltg으로 나타났다. 또한 유통중인 5종의 패류중 중금속평균항량이 생산지 하재지역에서 구입한 패류에 비해 모든 중금속언써 약간 높은 함량을 보였으나 오염된 수준이 아닌 자연함유량수준이었다. This study was conducted to improve the digestion method for the determination of heavy metals in shellfishes and to estimate the contents of heavy metal in commercial shellfishes by their digestion method. This digestion method was compared microwave with wet and dry ash digestion for shellfish samples, obtained results showed that the modified wet ash Ⅱ digestion was convenient and easy to use. For the modified wet ash Ⅱ digestion, The mixed acid of HNO₃+HClO₄+H₂SO₄(25:5:1, v/v) was used. Under this condition, Recoveries were Pb 94.3, Cd 97.8, Cu 94.2 and Zn 92.8% and digestion time was ∼2.5 hours. The contents of heavy metal [minimum∼maximum (mean), mg/kg in commercial shellfishes were as follows ; Pb:0.028∼0.528(0.153), Cd:0.007∼1.832(0.587), Cu:0.360∼37.375(4.669), Zn:6.317∼233.250(38.881), Hg:0.001∼0.151(0.013). The contents of heavy metal in commercial shellfishes of five species were slightly greater than those of shellfishes purchased at Hajae. There was no great difference between the contents of heavy metal of Hajae and those of shellfishes purchased at Whole market.

한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

공자의 체육 교육 사상에 대한 고찰

金炳玉 조선대학교 교육연구소 1986 교과교육연구 Vol.9 No.-

Confucius, one of the four famous saints of the world, who had arranged and editted six Chinese classics, achieved to compile the culture before the confucianism. His thought involved all kinds of politics, ethics and education in the related fields. Originally, gymnastics became a part or field of the education and so the books of Confucius contain such contents but its name. This study is an attempt to seek for things, for which we are to take on the merits of the ancient important educational gymnastics by the favour of Confucius educational ideas for gymnastics in terms of modern physical education. At that time, Confucius accomplished and took into pratice the athletic thoughts due to the contemporary political and social influences. The essence he took into practice on the thought of physical education is a sort of athletics for citizens and soldiers. In peace time, it accomplished a function of rituals and health, which in war-time cultivated its military tactics. The aim of Confucius physical education lies in the promotion of physical health, in the learning of decorum, fighting capacity, and the making good use of leisure time. It will be pointed out that the crucial content of physical education consists in the shooting, ruling, and dancing, and also the method of physical education emphasizes the continued exercises, the spirit of volunteer, taste, and individual differences.

곰쓸개 복용 후 발생한 육안적 혈뇨와 신유두부 괴사증 1예

김우진,한민석,김수항,박인형,박진석,선제형,홍세인,박옥영,신정현,이숭,신병철 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Renal papillary necrosis occurs most commonly in association with urinary tract infection, diabetes mellitus, sickle cell disease, vascular disease, and analgesic nephropathy. Clinical presentation may be related to symptoms of pyelonephritis such as flank pain, renal colic, hematuria, Proteinuria, recurrent fever. The necrotic tissue may be sloughed off, and the diagnosis can sometimes be made by finding piece of renal medullary tissue in the urine. Pyelography may demonstrate cavities and sinuses in the resion of papillae. Anuria & oliguria can lead to the acute renal failure, and especially prognosis and progress may be affect influenced by urinary infection. We report a case of renal papillary necrosis with ingestion of bear gallbladder. On pyelography, Persistent contrast is diagnostic clue of renal papillary necrosis. This case is not be related to urinary tract infection, but occurred acute renal failure. Expectant treatment was gone.

김천산 자두의 성분과 그 특성

김순희,강병태,박동철,윤옥현,이재우,한만덕,최종동 동아시아식생활학회 2000 동아시아식생활학회지 Vol.10 No.1

Physicochemical properties and chemical compositions of two plums (Oishiwase, Formosa) produced in Kimcheon area were investigated. Chemical compositions of two plum cultivars were similar except nitrogen free extract(NFE). NFE value of Formosa was higher than Oishiwase. Alcohol insoluble substance content, total soluble pectin, total sugar content and total organic acid content of Oishiwase were 2.08%. 14,16%, 5.07% and 949.16mg%, respectively. In case of Formosa cultivar, those were 50%, 15.42%, 5.91% and 985.91mg%, respectively. Fructose content among free sugars of two plum cultivars range from 3.97~3.45% and the other were glucose, sucrose and inositol, 1.83~1.53%, 0.08~0.05% and 0,04~0.039%, respectively. Malic acid content was 35~373mg% and others were levulinic acid, lactic acid, citric acid, succinic acid and fumaric acid in the decreasing order.

全國主要 地方의 日射量 分析

김병철,김진흥,하옥남 조선대학교 동력자원연구소 1987 動力資源硏究所誌 Vol.9 No.2

The insolation and meteorological data which were measured in the meteorological observatory in several locations were examined and analysed. Also mean air temperature, wind speed and amount of cloud were examined. Monthly average insolation, clear sky solar radiation, diffuse, direct, global solar radiation and the ratio of the horizontal solar radiation and extraterrestrial solar radiation were observed and analysed to be a useful data in using the solar energy.