간세포암종에서 간절제술 후 이환율과 사망률에 영향을 미치는 위험 인자

김완욱,이광웅,최성호,허진석,김용일,김성주,이대성,이환효,백승운,고광철,이준혁,최문석,유병철,조재원 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: 간세포암종은 우리나라에서 간절제의 가장 흔한 적응증이다. 그러나 간경변을 동반한 경우가 많아 수술 후 이환율과 사망률이 높아 수술 전후 처치에 주의를 요한다. 최근에는 외과적 술기의 발전과 수술 전 및 수술 후 처치의 향상으로 이환율과 사망률이 감소하고 있으나 다른 수술에 비해 여전히 높다. 이에 본 연구에서는 간세포암종의 수술 중 위험 인자를 알아보고 수술 후 이환율과 사망률을 줄일 수 있는 방법을 찾아보고자 하였다. 대상과 방법: 1994년 11월부터 2001년 12월까지 간세포암종으로 진단받고, 간절제술을 시행받은 환자 510명을 대상으로 하였다. 대상 환자의 평균 연령은 51.6세였고, 남녀 비는 4.01 : 1이었다. 수술 전 HBsAg (+)는 76.0%, 수술 전, anti-HCV (+)는 8.2%였으며 종양의 크기는 평균 5.19 ㎝이었다. 환자 중 26.2%에서 수술 전 경도자 동맥색전술의 병력이 있었으며 8.7%에서 수술 전 경피적 간문맥색전술을 시행받았다. 시행받은 수술은 종양절제술 55예, 분절절제술 127예, 구역절제술 77예, 반간절제술 214예, 동반 혹은 확대 반간절제술 37예였다. 위험 인자로 나이, 성별과 각종 임상 지표(간기능 수치, 프로트롬빈시간, 혈청 알부민, 혈당, 알파태아단백, ICG 검사, 수술 전 경도자 동맥색전술, 경피적 간문맥색전술 시행 여부) 등의 수술 전 인자, 수술의 종류, 수술 시간, 수혈량 등의 수술 인자, 그리고 종양의 크기, 종양의 수, 간경변 여부 등의 병리조직학적 인자 등을 분석하였다. 분석자료는 대상 환자들의 의무기록을 통해 후향적 방법으로 조사하였다. 수술 사망은 수술 후 30일 이내에 사망한 경우로 정의하였고, 입원 사망은 수술 후 합병증으로 퇴원하지 못하고 사망한 경우로 정의하였다. 단변량 분석은 student t test와 x² test를 이용하였으며, 다변량 분석은 logistic regression을 이용하였다. 결과: 수술 후 합병증은 총 56예(10.5%)에서 나타났으며, 조절되지 않는 복수 19예, 호흡기 합병증 10예, 상처 합병증 8예, 간기능 이상으로 인한 고빌리루빈혈증 6예, 출혈 5예, 고질소혈증 4예 등이었다. 수술 사망은 5예(0.98%), 입원 사망은 수술 사망을 포함하여 6예(1.1%)였다. 이중 간부전과 연관된 사망이 5예였고, 간부전과 동반된 흡인성 폐렴으로 사망한 예가 1예 있었다. 이환율에 영향을 미치는 인자를 다변량 분석을 통해 알아본 결과, 수술 중 수혈량(P=0.002), 프로트롬빈시간(P=0.038), 혈당 수치(P=0.002)가 통계학적으로 의미가 있었고, 다변량 분석 상 수술 후 사망률과 관련된 인자로는 나이(P=0.028), 혈당 수치(P=0.011), 수술 전 경도자 동맥색전술 시행 여부(P=0.046) 등이 의미 있는 것으로 나타났다. 결론: 위의 위험 인자 분석을 통해 간세포암종에서 간절제시에 수술 후 이환율을 중이기 위해 가능한한 수술 중 출혈을 최소화하면서 불필요한 수혈을 피하고, 당뇨 환자에서는 수술 후 이환율과 사망률이 상대적으로 높고, 고령 환자에서는 사망률이 상대적으로 높으므로 수술 전후 처치에 세심한 주의가 필요함을 알 수 있었다. 수술전 경도자 동맥색전술 시행 여부가 수술 후 사망률과 유의한 상관성이 있었고 이에 대한 지속적인 연구가 필요하리라 생각된다. Background/Aims: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. Results: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

圓光醫大 附屬 第2病院 神經精神科 患者에 對한 統計的 考察(Ⅱ)

박민철,장광철,김상원,김한주,유미경,김훈,유용진,김현정,박남진,오상우,이귀행,노승호,백영석 圓光大學校 醫科大學 神經精神科學敎室 1992 圓光精神醫學 Vol.8 No.1

본 연구는 1986년 7월 11일부터 1991년 7월 10일까지 원광의대 부속 제2병원 신경정신과에서 의래 및 입원치료를 받았던 6,072명의 환자를 대상으로 병원 역학조사를 실시하고 그 결과를 1차조사 (박민철 등1986)와 비교했다. 1.전체 환자 중 남자가 54.4%로 여자보다 많았고, 이리와 이리 인접지역이 84.0%로 대부분의 지역을 나타났다. 의료보장상태는 보험환자가 57.1%, 의료보호환자21.8%, 일반환자 21.1%였으며 연령별로는 20대 24.6%, 30대 22.8%로 20대 30대가 절반정도를 차지했다. 2.외래환자에서는 신경중성장애가 46.0%로 가장 많고 정동장애, 경련성장애 순이며, 입원환자에서는 정신분열증이 30.5%로 가장 많고 기질성정신장애, 정동장애의 순이었다. 3.남자는 신경증성쟝애(23.4%), 정신분열증, 기질성정신장애 순이고 여자는 신경증성장애(39.9%), 정동장애, 정신분열증의 순이었다. 남자가 여자보다 많은 진단은 알코올정신장애(94.6%), 기질성정신장애, 소아정신장애 순이고, 여자가 남자보다 많은 진단은 정동장애(64.5%), 신경증성장애였다. 4.진단별 연령분포에서 신경증성장에는 30대(25.3%), 20대, 40대 순이고, 정신분열증은 20대(40.5%), 30대, 40대 순이며, 정동장애는 20대, 30대, 50대 순이나 비교적 비슷한 융이었다. 5.진단별 발병연령에서 신경증성장에는 20대, 30대가 절반이고,정신분열증은 20대(51.3%), 10대, 30대 순이며 정동장애는 20대(30.7%), 30대, 50대 순이었다. 진단별 평균 발병연령은 신경증성장애 32.7세, 정동장애 36.1세, 정신분열증 23.6세였다. 6.진단별 이병기간은 2년이상이 신경증성장에 28.3%, 정신분열증 68.5% 정동장애 43.9%인데 전체적으로 41.0%였다. 진단별 평균 이병기간은 정신분열증 73.2개월, 정동장애 45.5개월, 신경증성장애 29.5개월이었다. We examined epidemiologic study of 6,072 patients who visited Wonkwang Neuropsychiatric hospital since July 11 of 1986 until July 10 of 1991 and compared this results with previous study(Park et al 1986). The study revealed as follows:1. Of total patients males visited this hosptial more than females as 57.1%, Most of them(84.0%) resided Iri and neighbouring Iri. In the point of insurance, insured patients, medicaid patients and uninsured patients were 57.1%, 21.8% and 21.1% respectively. On the distribution of age, the twenties, the thirties were 24.6%, 22.8% respectively and twenties and thirties were about half of total patients. 2. Of outpatients neurotic disorder was the most as 46.0%, secondly mood disorder and thirdly convulsive disorder, but of inpatients schizophrenia was the most as 30.5%, secondly organic mental disorder and thirdly mood disorder. 3. Of males neurotic disorder was the most as 23.4%, secondly schizophrenia, and thirdly organic mental disorder, but of females neurotic disorder was the most as 39.9%, secondly mood disorder and thirdly schizophrenia. alcoholic mental disorder(94.6%), organic mental disorder, child mental disorder were mostly found in males,but mood disorder(64.5%) and neurotic disorder were mostly found in females. 4. On the distribution of age neurotic disorder was found the most in the thirties(25.3%), next in the twenties and in the forties, and schizophrenia was found the most in the twenties(40.5%), next in the thirties and in the forties, but mood disorder was found the most in the twenties, next in the thirties and in the forties but revealed similar rates relatively. 5. On the distribution of age of onset neurotic disorder developed nearly half during the twrnties and the thirties, schizophrenia developed mostly during the twenties (51.3%), secondly the teens and thirdly the thirties, but mood disorder developed firstly the twenties(30.7%), secondly the thirties and thirdly the fifties. on the average age of onset of illness neurotic disorder, mood disorder and schizophrenia were 32.7 years, 36.1 years and 23.6 years respectively. 6. On the duration of illness more than two years was 28.3% in neurotic disorder, 68.5% in schizophrenia and 3.9% in mood disorder and on the average duration of illness schizophrenia, mood disorder and neurotic disorder were 73.2 months, 45.5 months and 29.5 months respectively.

난소절제후 Estrogen을 투여한 흰쥐 대동맥에서 Protein Kinase C-α와 Fas 발현의 변화

이왕수,이상엽,안지현,송영빈,김학진,이광재,유재격,김상욱,김태호,김치정,류왕성 중앙대학교 의과대학 의과학연구소 2001 中央醫大誌 Vol.26 No.3

Estrogen is believed to decrease coronary artery disease. Protein kinase C-α(PKCα)appear to be important in signal conduction pathways. Estrogen treatment increases catalytic activity of PKCα,and activation of PKCαcan modulate estrogen receptor levels and responsiveness. And it was reported that activation of PKC can protect cells from apoptosis induced by Fas ligation. But the beneficial effect of estrogen on PKCαwas not clearly demonstrated. The objective of this study was to evaluate the role of PKCαafter ovariectomy and estrogen therapy in rat aorta. The results were summarized as below: 1. The significant pathological changes were not observed in the rat aorta irrelevant to ovariectomy and estrogen therapy. 2. The expression of Fas was decreased in the aorta of estrogen-treated rats than that of ovariectomized rats without estrogen therapy. 3. Increased expression of PKCαwas more marked in the aprta of estrogen-treated rats than that of ovariectomized rat without estrogen therapy. In conclusion,PKCαmay be important in signal conduation pathway on the effect of estrogen. Activation of PKCαby estrogen reduced Fas expression, suggesting that PKCαactivation may play a role in protection against atherasclerosis. Further studies are needed to elucidate the role of PKCαafter estrogen therapy.

링 레이저를 위한 새로운 광대역 파장 가변 필터에 대한 연구

김광유,이정렬,엄진섭 강원대학교 산업기술연구소 2006 産業技術硏究 Vol.26 No.A

In this paper, we proposed the new wavelength tunable filter for wide tunability of fiber ring laser. The proposed filter consists of the cascaded connection of Fiber Reflection Mach-Zehnder Interferometer and Sagnac filter or of hybrid filter and Fiber Reflection Mach-Zehnder Interferometer. The simulation shows that the continuous tunable range of 50nm can be obtained and that more stable single mode operation of ring laser can be expected due to narrow FWHM. of filter spectrum.

Homocysteine-thiolactone 이 유발시키는 소 혈관내피세포의 손상효과

유동찬,김보은,전가영,권오형,지광환 금오공과대학교 2007 論文集 Vol.28 No.-

The homocysteine-thiolactone, a reactive metabolic compound of homocysteine has been implicated in human cardiovascular diseases. The increasing of total plasma homocysteine concentration lead to homocystinuria, which may cause to elevate the concentration of homocysteine-thiolactone in the blood serum. It might be one of the risk factor which is responsible for the development of several vascular diseases. The present study is to demonstrate the harmful effect of homocysteine-thiolactone induced on calf pulmonary artery endothelial (CPAE) cells. CPAE were cultured in RPMI1640 medium supplemented with 10% FBS. CPAE were grown in humidified atmosphere of 5% C₂ in air at 3TC. Cells cultured with homocysteine-thiolactone at concentrations ranging from 0.1mM, lmM, 5mM and l0mM (dissolved in dH₂O). After incubation, cells were stained with MTT. Cell viability was evaluated under the UV-visible absorbance at 540nm. Cells viability was significantly decreased by increasing the concentration of homocysteine-thiolactone, Our data provide the evidence to understand the effect of homocysteine-thiolactone on the cardiovascular system.

로버스트 회귀모형화 및 최소자승법과 역전파 신경망과의 성능비교

柳志喆,金光洙 忠州大學校 1997 한국교통대학교 논문집 Vol.32 No.1

Recently, neural network models have been employed as an alternative to regression analysis for point estimation or function fitting in various fields projected in the operations research domain as an alternative to optimization techniques. Especially backpropagation neural network is currently the most widely applied network architecture. This popularity primarily reflects the ability of backpropagation networks to learn complicated multidimensional mapping. One way to look at this ability is that, in the words of Werbos backpropagation goes "Beyond Regression". In this study, through the computer simulation, the performance of the three major function fitting techniques is evaluated such as regression analysis(LSM), robust regression analysis(MSR) and backpropagation neural network model. For the simulation of robust regression analysis, the quantitative systems for business plus software was used. Backpropagation algorithm was developed using C++. The study conclusions show that at the point of performance MSR held the best result, because MSR performs best in the 3 cases among the tested 4 cases.

정보 시스템을 이용한 항공기 착륙요율 결정 사례 연구 : 잔액 보상 방식에 의한 착륙요율 결정 방법 중심

유광의,김봉균 한국항공운항학회 1998 한국항공운항학회지 Vol.6 No.1

The purpose of this research is to look for the best description of calculating the reasonable Landing Fee. Landing Fee is consisted one of major revenues for maintaining an airport. Traditional Landing Fee Rate has been charged based on the weight factor; Maximum take-off weight, Maximum landing weight, or Maximum authorized weight. To achieve a better reliable value of Landing Fee Rate, The elements of Noise and Peak-Time have to be considered as well as the aircraft weight. This research designs the algorithms for calculating Landing Fee Rate and also Landing Fee, based on the aircraft weight. The Network is also applied to above. That is, CGI(Common Gate Interface) is constructed to interface the terminal of calculating Landing Fee Rate, and the terminal of collecting and transmitting the data such as the Weight. The computer language on the CGl was made by C++ and PERL. The main point of this research is to integrate the airport and Information System and to construct the database which is based on the different perspective of calculating Landing Fee Rate. However, the result of the most efficient and reliable will be computed based on above. This research will broaden the range of application up to the each case of airports.

國民學校 新·舊 特別活動 敎育課程 比較 硏究

金錡坤,柳光燦 전주교육대학교 1995 論文集 Vol.31 No.-

The curriclums of Extra-curricular activities should demonstrate that what activities are Extra-curricular activities in details and how the Extra-Curricular activities are different from other regular curriculums while equal educational values be given to both curriculums. It is noted that the above two main considerations are alive in the revision of curriculums of Extra-curricular activities for the 6th phase of curriculums. Basic direction of revision on to curriculums of Extra-curricular activities for the 5th phase of curriculums was designed to clarify what activities are Extra-curricular activities in a systematic way. When we look into the orientations announced by the Ministry of Education regarding basic directions of revision as to curriculums of Extra-curricular activities for the 5th curriculums of the elementary public schools, we can observe the following key points ; ① It is a partial revision in a principle. ② Lesson hours of 1st year and 2nd year for apecial activities are clearly delineated. ③ Fleixble administration is stressed. ④ Established is the activity of life application to be guided by teachers in charge of classes. It is noticeable that the 5th phase of curriculums in cussession of the 4th phase was directed in far more intensive way to listing activities falling into scope of Extra-curricular activities, related to. In the considerations of delineation of activities in details, the both of the 6th and the 5th was same in partial revision in a principle while including the entire revisions. A foremost feature of the 6th phase of curriculums is that it differs from curriculums of Extra-curricular activities but retains its educational importance equal to regular curriculums. It is pointed out that it was a first curriculum oriented to consider about what are categorical characteristics as Extra-curricular activities. In order that features of such Extra-curricular activities be administered in a normal way, it is needless to say that facilities and fund support should be increased up and departments of Extra-curricular activities should be organized in the consideration of talents, aptitude and interest of students and teacher.

버나드 맬라무드의 The Fixer : 고통을 위한 구원 Salvation Though Suffering

김광선,유동익 명지대학교 인문과학연구소 1999 인문과학연구논총 Vol.20 No.-

Bernard Malamud handles the Jaw as a symbol of the tragic experience of man existentially. He tries to see the Jew as universal man. Thus he sees the Jews as exemplars of the injustices that eventually affect all human beings. He also sees suffering as something that all humans must face. The Fixer concerns the fate of Yakov a poor Jew in Tsarist Russia who undergoes great suffering during two-and-a-half years in prison. Malamud focused on Bok's thoughts, his experiences in his cell and salvation through suffering as a moral human being. After imprisonment, Yakov learned the central condition of existence-that life could be better that it is, and that the only way to improve the quality of life is for all persons to strive for good will among men, to be reasonable. The implied lesson is quite simply, that people can change. Their circumstances may remain the but spiritually they transcend their surroundings. Out of the everyday defeats and indignities of ordinary people, Malamud creates beautiful parables that capture the joy as well as the pain of life; he expresses the dignity of the human spirit searching for through suffering and the existential anguish of life in our time.

누설전류 파형 측정에 의한 실리콘 고무의 표면 열화 평가

김정호,정규원,서광석,유영식,박용관 成均館大學校 科學技術硏究所 1999 論文集 Vol.50 No.1

In this study, we investigated the erosion resistance of the silicone rubber by measuring leakage current with Inclined-Plane Method. From the results of our study, it was observed that the typical leakage current waveform was the mixed figure of sinusoidal wave and rectifying wave. And, it is considered that the former is due to conductivity of the contaminant when the surface is wet, and the latter is due to the arc discharge of dry band. And, as the surface erosion is being accelerated, the proportion of the rectifying wave is increasing. And, the ratio of discharge duration to discharge-extinguish time changes and can be divided into three regions, which is similar to the changes of erosion depth and width. Therefore, it can be known that the erosion process has some correlation with the change of leakage current.