Pharmacological Strategies beyond Statins: Ezetimibe and PCSK9 Inhibitors

최자연,나진오 한국지질동맥경화학회 2019 지질·동맥경화학회지 Vol.8 No.2

Dyslipidemia, highly elevated, low-density lipoprotein (LDL) cholesterol, is a major cardiovascular risk factor. Statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) and are recommended as a first-line therapy for the primary and secondary prevention of ASCVD. However, statins may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events (i.e., residual cholesterol risk) according to meta-analyses of statin trials. Current guidelines for cholesterol management to achieve additional LDL cholesterol reduction and reduce ASCVD risk recommend two hyperlipidemic agents besides statins. Use of ezetimibe, a cholesterol absorption inhibitor, leads to additional LCL cholesterol reduction and decreased ASCVD risk, when added to statin therapy, without raising significant safety concerns. Furthermore, in combination with a mild-to-moderate statin intensity, ezetimibe is used in situations of statin-associated adverse effects such as myalgia and the combination therapy is relatively safer. Monoclonal antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), alirocumab, and evolocumab, have been approved to lower LDL cholesterol level. While there are drawbacks to the use of PCSK9 inhibitors, including high cost and adverse events such as injection site reaction, they significantly decreased serum LDL cholesterol levels and thereby ASCVD risks when added to maximally tolerated statin therapy.

Transcatheter Aortic Valve Replacement with Minimal Contrast Dye in Patients with Renal Insufficiency

최자연,홍그루,홍성진,심지영,안철민,김중선,김병극,고영국,최동훈,장양수,홍명기 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.11

Purpose: Concerns have been consistently raised in regards to the considerable amount of contrast dye used during transcatheter aortic valve replacement (TAVR) in patients with renal insufficiency. In the present study, we introduced minimal contrast TAVR and compared its 30-day clinical outcomes with conventional TAVR. Materials and Methods: We retrospectively investigated 369 patients who underwent TAVR between July 2011 and April 2020 in our institute. Among them, 93 patients with severe aortic stenosis and renal insufficiency (estimated glomerular filtration rate ≤50 mL/min/1.73 m2) were included and divided into a conventional TAVR group (n=56) and a minimal contrast TAVR group (n=37). In the minimal contrast TAVR group, the total amount of contrast was <10 mL during the entire TAVR procedure. Thirty-day major adverse clinical events (MACE), including death, stroke, implantation of permanent pacemaker, and initiation of hemodialysis, were investigated. Results: The incidence of MACE was significantly lower in the minimal contrast TAVR group than the conventional TAVR group (16.2% vs. 42.9%, p=0.010). Death occurred in 9 patients (16.1%) in the conventional TAVR group and in 0 patients in the minimal contrast group (p=0.011). Hemodialysis was initiated in 2 patients (5.4%) in the minimal contrast TAVR group and in 7 patients (12.5%) in the conventional TAVR group (p=0.256). Multivariate regression analysis showed that the minimal contrast TAVR procedure was an independent predictor for reducing MACE (hazard ratio 0.208, 95% confidence interval: 0.080–0.541, p=0.001). Conclusion: Minimal contrast TAVR is feasible and shows more favorable short-term clinical outcomes than conventional TAVR in patients with renal insufficiency.

Surgical Removal of a Left Ventricular Thrombus Which Showed Morphologic Changes Over Time in a Patient with Stress-Induced Cardiomyopathy

최자연,박은진,박성훈,김희동,송지영,김지백,이선기,유양기,백만종,나진오 한국심초음파학회 2015 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.23 No.2

Although stress-induced cardiomyopathy (SCMP) is a reversible disease and the prognosis is usually excellent, severalcomplications can occur and can result in fatal adverse events. The formation of left ventricular (LV) thrombus is one of thesecritical complications of SCMP. This report describes a case of SCMP complicated by formation of a LV thrombus that becameincreasingly mobile as LV contractility recovered, and for which surgical removal was performed. Here, we report a case of SCMPcomplicated by LV thrombus and review the literature regarding this topic.

형사보상법에서 명예회복제도의 의미와 개선방향

최자연,김정환 한국형사정책학회 2018 刑事政策 Vol.30 No.3

Act on Criminal Compensation and Restoration of Impaired Reputation(the following ‘Criminal Compensation Act’) provides that the defendant of a case finalized by a verdict of 'not guilty' may request to publish the final and conclusive written verdict of the case of a verdict of not guilty to restore the reputation. This regulation has it’s own meaning since it has concrete system only for restoration of impaired reputation. Normally, it is difficult to avoid injury to a one’s honor once people get criminal trial. Even though there is no final and conclusive judgment, people forejudge the verdict as an offender. It is obvious that Criminal Compensation Act is amended for restoration of impaired reputation for such persons and reforming other’s belief. Criminal Compensation Act has purpose for recovering the relationship with other people by publication of written verdict of not-guilty, nevertheless, it’s utilization rate is remarkably low. This is because there is no supplement and revise action for reality. The low utilization rate comes from lake of advertisement of written verdict of not-guilty, effectualness of method of public announcement, and one restoration way for all cases. But it is the core that Criminal Compensation Act has reliability and the intent of a full explanation for the case of not guilty. If Prosecutors’ Office keep publishing written verdict of not-guilty to maintain the reliability, it may be difficult to raise the utilization rate and complement and progress the system. Therefore, it is desirable that the various levels of courts is enforced to promote and that Restoration of Impaired Reputaion Deliberation Committee which is independent from prosecutors handles the system. Restoration of impaired reputation deliberation committee is able to search their own restoration of impaired reputation plan themselves considering a degree of spread of the case, a degree of social relationship disability and a desired way of restoration of impaired reputation for each defendant of a case finalized by a verdict of 'not guilty'. Restoration of impaired reputation deliberation committee fulfills whole responsibility that prosecutor has restored the defendant’s social value. 형사보상법 제30조는 형사사건에서 무죄가 확정된 사건의 피고인에게 명예회복을 할 수 있는 방법으로 무죄재판서 게재 청구를 규정하고 있다. 형사보상법상 명예회복은 명예회복만을 위한 구체적인 방법을 규정했다는 점에서 의의가 있다. 일반적으로 한 개인이 형사재판을 받게 되었을 때 범죄 혐의에 대해 알려질 경우 재판을 받는 무죄피고인의 명예훼손은 피하기 어렵다. 사람들은 범죄의 유무죄 여부가 확정되지 않았음에도 결론적으로 무죄선고를 받은 피고인이 마치 죄인인 것처럼 예단을 갖게 되기 때문이다. 형사보상법상 명예회복이 무죄선고를 받은 피고인에게 명예를 회복시켜 사람들에게 형성된 잘못된 인식을 바로잡고자하는 취지는 분명하다. 무죄재판서를 공개하여 명예훼손으로 인한 타인과의 관계에 대한 불편함 등을 해소하고자 하는 취지를 가지고 있음에도 불구하고 형사보상법상 명예회복제도의 이용률은 현저히 낮다. 이는 현실에 맞는 적극적인 수정·보완이 이루어지지 않았기 때문이다. 이용율 저조의 원인은 홍보의 부족과 공시방법의 효과성에 대한 고민, 그리고 일률적인 회복방안으로 파악된다. 그러나 형사보상법 제30조의 무죄재판서 게재 청구가 가지고 있는 신뢰성과 무죄의 사실을 충분히 설명하고자 하는 취지는 명예회복제도의 핵심이다. 무죄공시의 신뢰도를 보장하기 위해 형사보상법상 명예회복을 검찰청에 하도록 하면 과실이 알려지지 않길 바라는 검찰로 인해 명예회복제도의 이용촉진과 보완·발전이 어려울 수 있다. 따라서 법원에 홍보를 강제하고 검찰과 독립된 기관인 명예회복 심의위원회를 만들어 형사보상법상의 명예회복제도를 운영하는 것이 바람직하다. 명예회복 심의위원회는 사건의 확산정도, 개인의 사회활동 장애정도, 개인이 희망하는 명예회복 방안을 고려하여 명예회복방안을 주체적으로 찾도록 할 수 있다. 명예회복 심의위원회는 검찰이 무죄를 선고받은 피고인에게 다른 사람과의 관계에서 사회적 가치를 회복할 수 있도록 그 책임을 다하게 할 것이다.

사회적으로 부과된 완벽주의가 분노억제에 미치는 영향: 외부 통제소재의 매개효과를 중심으로

최자연,오경자 한국건강심리학회 2015 한국심리학회지 건강 Vol.20 No.1

본 연구는 사회적으로 부과된 완벽주의가 분노억제에 미치는 영향을 외부 통제소재가 매개하는지에 대해 확인하려는 목적으로 진행되었다. 이를 위해 대학생 380명을 대상으로 다차원적 완벽주의 척도, IPC 통제소재 척도, 상태-특성 분노표현 양식 척도를 통해 설문을 실시하였다. 구조방정식을 통해 수집된 자료를 분석하여 외부 통제소재의 매개효과를 검정한 결과, 사회적으로 부과된 완벽주의와 분노억제 간의 직접경로가 유의하지 않은 것으로 나타나 외부 통제소재의 완전매개 모형이 더욱 적합함을 확인하였다. 추가적으로 외부 통제소재의 하위유형에 해당하는 강력한 타인 통제소재와 우연 통제소재를 직접 투입한 모형의 경로계수를 비교한 결과, 강력한 타인 통제소재는 사회적으로 부과된 완벽주의와 분노억제의 관계에서 모든 경로가 유의하였으나 우연 통제소재는 분노억제와의 경로가 유의하지 않은 것으로 나타나 외부 통제소재가 매개변인으로 기능하는데 있어 강력한 타인 통제소재의 영향력이 더욱 분명한 것을 확인하였다. 이러한 결과를 중심으로 연구가 지니고 있는 함의와 연구에서 나타난 제한점 및 추후 연구 방향에 대해 논의하였다. The purpose of this study was 1) to explore the mediating effects of external locus of control on the relationship between socially prescribed perfectionism and anger-in expression and 2) to compare mediating effects of other and chance factor are sub-factors of external locus of control. Three hundred eighty undergraduate students participated in study. They were asked to complete questionnaires about perfectionism, locus of control, and anger expression. The data were analyzed using Structural Equation Modeling. The results were as follows: (1) socially prescribed perfectionism was positively related to external locus of control and anger-in expression. (2) the relationship between socially-prescribed perfectionism and anger-in expression was completely mediated by external locus of control. (3) the results further that the other factor showed significant mediating effect. Based on these results, the implication and limitation of the study were discussed.

A case of dilated cardiomyopathy associated with ephedrine use

오지윤,최자연 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

A Typical Case of L-Transposition of the Great Arteries Initially Presented as Complete Atrioventricular Block in Middle-Aged Man

박성훈,최자연,박은진,김희동,최민주,최수인,김지백,이선기,나진오 한국심초음파학회 2015 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.23 No.1

L-transposition of the great arteries (L-TGA) is a rare congenital anomaly and could cause complete atrioventricular (AV) block atrelatively younger age. We present a case of 43-year-old male who complained of dizziness due to complete AV block. Weconfirmed L-TGA using transthoracic echocardiography and cardiac computed tomography. Permanent pacemaker was insertedwithout complications. No invasive treatment including corrective surgery was performed because patient’s cardiac function wasalmost normal and the symptom was completely resolved after pacemaker insertion.

Ethanol Infusion in the Vein of Marshall in a Patient with Persistent Atrial Fibrillation

김영훈,최자연,박은진,김희동,박성훈,송지영,이대인,심재민 대한심장학회 2015 Korean Circulation Journal Vol.45 No.5

We report the case of a 64-year-old male with persistent atrial fibrillation (AF) terminated by ethanol infusion into vein of Marshall as add-on therapy. Three-dimensional automated complex fractionated atrial electrogram (CFAE) during AF revealed clustering of CFAE at perimitral isthmus (PMI) and its unipolar mapping showed rotor-like activation, which was suggested to be critical in the perpetuation of AF. AF was organized to atrial tachycardia (AT) by 100% ethanol infusion in the vein of Marshall. Adjunctive radiofrequency ablation at PMI successfully terminated AT and led to bidirectional block of PMI

Prevalence of Gastrointestinal Diseases and Treatment Status in Noncardiac Chest Pain Patients

박창규,박성훈,최자연,박은진,이재중,이선기,나진오,최철웅,임홍의,김진원,김응주,나승운,서홍석,오동주 대한심장학회 2015 Korean Circulation Journal Vol.45 No.6

Background and Objectives: We evaluated the prevalence of gastroesophageal reflux diseases (GERD) in noncardiac chest pain (NCCP)patients, risk factors for GERD, and status of prescriptions for GERD in Korean population. Subjects and Methods: This was a retrospective non-interventional observational nation-wide 45-center study. Patients with a normalcoronary angiogram (CAG) and upper gastroendoscopy within 2 years after CAG were enrolled. The prevalence of GERD was examined. Other gastrointestinal diseases including peptic ulcer diseases or gastritis were also examined. Risk factors for GERD were comparedbetween the GERD group and non-GERD group. The ratio of patients medicated for gastrointestinal diseases (antacids or proton-pumpinhibitor) was also examined. Results: Nine hundred four patients were enrolled. Among the NCCP patients, GERD was present in 436 (48.2%), peptic ulcer disease in154 patients (17.0%), and gastritis in 659 (72.9%). There was no difference in risk factors for GERD between the GERD and non-GERDpatients. Medications for GERD and other gastrointestinal diseases were prescribed in 742 (82.1%) patients. Conclusion: GERD was common (42.8%) in Korean NCCP patients and most (82.1%) received the prescription of gastrointestinalmedications. No differences were evident in risk factors between GERD and non-GERD patients.

스마트폰 기반 장·노년용 기억력 훈련 프로그램의 인지기능 향상 효과: 예비 연구

신민섭,이미소,최자연,서성민,노은정,조지훈,오서진,권준수 한국건강심리학회 2015 한국심리학회지 건강 Vol.20 No.4

본 연구에서는 스마트폰 기반 기억력 훈련 프로그램이 장·노년층의 인지기능 향상에 유의미한 영향을 주는지를 알아보았다. 이를 위해 주의력, 기억력, 작업기억력을 훈련할 수 있는 프로그램을개발하였고, 만 50세에서 69세의 일반 성인 54명이 스마트폰을 이용하여 총 8주 간 훈련을 개별적으로 수행하였다. 인지기능의 변화를 확인하기 위해 훈련 시작 전과 후 전산화된 기억력 평가 시스템을 통해 인지기능을 평가하였다. 연구 결과, 훈련에 참여한 집단은 기억력과 작업기억력, 실행기능에서 유의미한 향상을 보였다. 이러한 결과는 스마트폰 기반 기억력 훈련 프로그램이 일반장·노년층의 기억력을 포함한 인지기능을 향상시키는데 도움을 줄 수 있음을 시사한다. 향후에는이러한 프로그램의 효과를 명확하게 확인하기 위해 통제집단을 포함한 연구가 필요할 것으로 사료된다. The purpose of this study was to investigate the effect of a smartphone-based memory training program on the cognitive functioning of old-aged adults. The authors developed a smartphone-based program for attention, memory, and working memory training. A total of 54 participants (ages 50-69) were observed individually for 8 weeks. Cognitive functioning was measured with the Memory Diagnostic System before and after the training. Results indicated that the training group showed a significant improvement in memory, working memory, and executive functioning. The results suggest that a smartphone-based memory training program can enhance cognitive functioning, including memory in old-aged adults. Additional controlled study is needed to confirm the present results.