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

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.

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.

비장애 아동과 전반적 발달장애 아동에서 회전 후 안구진탕 기간의 비교

김진미,송지원,홍은경,김성희,김경미 대한감각통합치료학회 2005 대한감각통합치료학회지 Vol.3 No.1

Objective : The purpose of this study was to get the mean of duration of post-rotatory nystagmus test in normal children and to differentiate the duration of post-rotatory nystagmus test between normal children and children with pervasive developmental disorder. Method : 84 subjects were between 3 and 5 years of age and consisted of 64 normal children and 20 children with the pervasive developmental disorder. Analysis of the data was done by using t-test and ANOVA. Results : The results were as follows: 1. Range of duration of post-rotatory nyatagmus test in normal children was 5-22second on left and 7-21 second on right and the mean was 12.63 second on left and 12.59 second on right. 2. Range of duration of post-rotatory nystagmus test in children with the pervasive developmental disorder was 3-11 second on both and the mean was 5.65 second on left and 5.60 second on right. 3. There was no significant difference between males and females with normal children in duration of post-rotatory nystagmus test. However, there was a significant difference of the mean duration between 3 and 5 years old normal group. 4. Children with pervasive developmental disorder significantly have relatively lower duration than the duration of post-rotatory nystagmus test of normal children. Conclusions : The results of the study showed significant difference between normal children and children with pervasive developmental disorder in duration of post-rotatory nystagmus test and suggest that they could be applied to the baseline of clinical therapy.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

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.

Quantitative comparison of mRNA expression of glucosyltransferase(GTF) between xylitol-resistant(X^(R)) and xylitol-sensitive(X^(s)) mutans streptococci

Kim, Chong-Chul,Lee, Mi-Na,Kim, Young-Jae,Lee, Sung-Hoon 大韓小兒齒科學會 2006 大韓小兒齒科學會誌 Vol.33 No.1

Since the long-term exposure of mutans streptococci to xylitol is known to select for xylitol-resistant(X^(R)) natural mutants, the occurrence and survival of such X^(R) strains were performed in batch culture methods. The aim of the study was to compare the differentiation and quantification of mRNA expression of the gtf genes of X^(R) and X^(S) mutans streptococci. Using a real-time reverse-transcription polymerase chain reaction, the expression of each gtf was determined. In X^(R) strains, the relative levels of transcription of gtfB and gtfC were decreased while that of gtfD was increased, suggesting the presence of independent promoters. It also suggested that mutation related to production of glucosyltransferase occurred under the exposure of xylitol could explain the caries-preventive mechanisms of xylitol. 자일리톨에 장기간 노출된 mutans streptococci는 자일리톨에 내성이 발현되어 자일리톨 내성균주가 생성된다고 알려져 있다. 본 연구의 목적은 mutans streptococci에서 자일리톨 내성균주와 감성균주의 gtf 유전자 발현량을 각각의 유전자별로 정량적으로 분석하고 비교하는 것이다. 실시간 역전사 중합효소연쇄반응법을 이용하여 각각의 gtf 발현을 조사한 결과 gtfD는 증가한 반면. gtfB와 gtfC는 감소하였는데 이는 각 유전자의 독립된 조절기전이 존재함을 보여주는 것이다. 또한 자일리톨에 노출된 mutans streptococci에서의 glucosyltransferase와 연관된 유전자변형이 자일리톨의 치아우식증 예방효과의 작용기전 중 하나임을 알 수 있었다.

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 추계학술발표논문집 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.

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