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윤혜은,한미아,강명근,박종,김기순,류소연,Yun, Hye-Eun,Han, Mi-Ah,Kim, Ki-Soon,Park, Jong,Kang, Myeng-Guen,Ryu, So-Yeon 대한예방의학회 2010 Journal of Preventive Medicine and Public Health Vol.43 No.4
Objective: This study was performed to investigate the prevalence of impaired fasting glucose (IFG) and its related characteristics among healthy adults in some Korean rural areas. Methods: We conducted a cross-sectional study using the data from 1352 adults who were over the age 40 and under the age 70 and who were free of diabetes mellitus (DM), cardiovascular diseases and other diseases and who participated in a survey conducted as part of the Korean Rural Genomic Cohort Study. IFG was defined as a serum fasting glucose level between 100 and 125 mg/dL. Results: The prevalence of IFG was 20.4% in men, 15.5% in women and 12.7% overall. Multivariate logistic regression analysis demonstrated that the independent risk factors for IFG were male gender, having a family history of DM, the quartiles of gamma glutamyltransferase and high sensitive C-reactive protein and the waist circumference. The homeostatis model assessment for insulin resistance was very strongly associated with IFG. The prevalence of metabolic syndrome (MS) and MS components was higher in the subjects with IFG then in those with normal fasting glucose (NFG). Conclusions: The result of study could supply evidence to find the high risk population and to determine a strategy for treating IFG. Further research is needed to explain the causal relationship and mechanisms of IFG.
Hypermagnesemia Accompanied with Colonic Perforation in a Hemodialysis Patient
윤혜은,김영욱,하경선,심은휘,고승우,신석준 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.3
We report a case of a chronic hemodialysis patient who developed hypermagnesemia due to an overdose of magnesium-containing laxative and paralytic ileus resulting in colonic perforation. Despite intravenous calcium infusion and daily hemodialysis,the patient developed ischemic colitis and intestinal perforation. Colonic perforation accompanied with hypermagnesemia in hemodialysis patients has rarely been reported. This case suggests that hypermagnesemia should be considered in renal failure patients as this can result in life-threatening events despite prompt treatment.
윤혜은,정성진,Hyun Chul Whang,Yu Ri Shin,황현석,정현화,박철휘,양철우,김용수,신석준 대한의학회 2012 Journal of Korean medical science Vol.27 No.8
This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV)events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E´ ratio), a marker of LV diastolic function. The E/E´ ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.
윤혜은,김수정,김성준,정성진,신석준 대한의학회 2014 Journal of Korean medical science Vol.29 No.2
This study investigated whether tempol, an anti-oxidant, protects against renal injury by modulating phosphatidylinositol 3-kinase (PI3K)-Akt-Forkhead homeobox O (FoxO) signaling. Mice received unilateral ureteral obstruction (UUO) surgery with or without administration of tempol. We evaluated renal damage, oxidative stress and the expression of PI3K, Akt, FoxO3a and their target molecules including manganese superoxide dismutase (MnSOD), catalase, Bax, and Bcl-2 on day 3 and day 7 after UUO. Tubulointerstitial fibrosis, collagen deposition, α-smooth muscle actin-positive area, and F4/80-positive macrophage infiltration were significantly lower in tempol-treated mice compared with control mice. The expression of PI3K, phosphorylated Akt, and phosphorylated FoxO3a markedly decreased in tempol-treated mice compared with control mice. Tempol prominently increased the expressions of MnSOD and catalase, and decreased the production of hydrogen peroxide and lipid peroxidation in the obstructed kidneys. Significantly less apoptosis, a lower ratio of Bax to Bcl-2 expression and fewer apoptotic cells in TUNEL staining, and decreased expression of transforming growth factor-β1 were observed in the obstructed kidneys from tempol-treated mice compared with those from control mice. Tempol attenuates oxidative stress, inflammation, and fibrosis in the obstructed kidneys of UUO mice, and the modulation of PI3K–Akt–FoxO3a signaling may be involved in this pathogenesis.
윤혜은,장윤경,신석준,최범순,김병수,박철휘,송호철,윤선애,진동찬,김용수 대한의학회 2014 Journal of Korean medical science Vol.29 No.9
In a prospective randomized controlled study, the efficacy and safety of a continuousambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrincontainingand two glucose-containing dialysates a day. Eighty incident CAPD patientswere randomized to two groups; GLU group continuously using four glucose-containingdialysates (n = 39) and ICO group using one icodextrin-containing and two glucosecontainingdialysates (n = 41). Variables related to residual renal function (RRF), metabolicand fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125)and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decreasein mean renal urea and creatinine clearance (-Δ1.2 ± 2.9 mL/min/1.73 m2, P = 0.027) andurine volume (-Δ363.6 ± 543.0 mL/day, P = 0.001) during 12 months, but the ICO groupdid not (-Δ0.5 ± 2.7 mL/min/1.73 m2, P = 0.266; -Δ108.6 ± 543.3 mL/day, P = 0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICOgroup than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher inthe ICO group than the GLU group. Dialysis adequacy, β2-microglobulin clearance andblood pressure did not differ between the two groups. The CAPD technique using oneicodextrin-containing and two glucose-containing dialysates tends to better preserve RRFand is more biocompatible, with similar dialysis adequacy compared to that using fourglucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry,ISRCTN23727549]
윤혜은,형복진,황현석,이소영,전연주,송준창,오은지,박순철,최범순,문인성,김용수,양철우 대한의학회 2009 Journal of Korean medical science Vol.24 No.-
Intravenous immunoglobulin (IVIG) and/or plasmapheresis (PP) are effective in preventing antibody-mediated rejection (AMR) of kidney allografts, but AMR is still a problem. This study reports our experience in living donor renal transplantation in highly sensitized patients. Ten patients with positive crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Eight patients were desensitized with pretransplant PP and low dose IVIG, and two were additionally treated with rituximab. Allograft function, number of acute rejection (AR) episodes, protocol biopsy findings, and the presence of donor-specific antibody (DSA) were evaluated. With PP/IVIG, six out of eight patients showed good graft function without AR episodes. Protocol biopsies revealed no evidence of tissue injury or C4d deposits. Of two patients with AR, one was successfully treated with PP/IVIG, but the other lost graft function due to de novo production of DSA. Thereafter, rituximab was added to PP/IVIG in two cases. Rituximab gradually decreased PRA levels and the percentage of peripheral CD20+ cells. DSA was undetectable and protocol biopsy showed no C4d deposits. The graft function was stable and there were no AR episodes. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful living donor renal transplantation in sensitized recipients.
Status of Initiating Pattern of Hemodialysis: A Multi-center Study
윤혜은,김석영,최의진,장윤식,김영옥,정성진,정현화,신미정,이상주,김영수,김형욱,송호철,양철우,진동찬,김용수 대한의학회 2009 Journal of Korean medical science Vol.24 No.-
This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.
윤혜은,류소연,강명근,박종,김기순 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1
Objective: To investigate the relationship between body mass index (BMI) and liver function abnormalities in the general population in Korea. Methods: The study subjects were 5765 persons who were received questionnaire survey and health examination of national health and nutrition survey in 1998, 20-59 years in age and had no history of viral hepatitis. BMI was categorized by quartile and abnormal liver functions were defined aspartate aminotransferase (AST) >30 U/L or alanine aminotransferase (ALT) >35 U/L in serum level. In order to identify the association of BMI and abnormal liver function, chi-square test and multivariate logistic regression analysis were used. Results: The abnormality rates of AST were 35.0% in male and 13.4% in female. The abnormality rates of ALT were 35.8% in male and 11.1% in female. After controlling for the other covariates, the multivairate logistic regression analysis showed that BMI was the significant related factor of abnormal AST (male; odds ratio=1.25; 95% confidence interval=1.15-1.36, female; odds ratio=1.14; 95% confidence interval=1.02-1.26) and abnormal ALT (male; odds ratio=1.87; 95% confidence interval=1.71-2.04, female; odds ratio=1.56; 95% confidence interval=1.38-175). Conclusions: We identify that BMI was the significant risk factor of non-viral liver disease with abnormal liver functions. A large-scale investigation will be suggested in the future to demonstrate the causal-effect issue between abnormal liver function and obesity.