다혈관 관상동맥 중재술을 시술받은 급성 심근경색증 환자에서 내원 시 상승된 Troponin 1 수치의 의의

홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),이승현 ( Seung Hyun Lee ),박옥영 ( Ok Young Park ),박우석 ( Woo Seok Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),안영근 ( Young Keun Ahn ),조정관 ( Jeong Gwan Cho ),서순팔 ( 대한내과학회 2003 대한내과학회지 Vol.65 No.1

Background : Cardiac troponin I (cTnI) is a sensitive and specific biomarker for myocardial injury. The aim of this study was to determine the significance of clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI)

급성 심근경색증 환자에서 장기 임상경과에 대한 C - Reactive Protein 의 역할

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),박형욱(Hyung Wook Park),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),염주협(Ju Hyup Yum),김원(Weon Kim),김주한(Ju Han Kim),류제영(Jay Young Rhew),안영근(Young Keun A 대한내과학회 2001 대한내과학회지 Vol.61 No.6

Background: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. Methods: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9±9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43±0.14 mg/dL) on admission and Group II (n=122, 59.1±10.4 years, male 83.6%) with elevated CRP ( ≥1.0 mg/dL, mean value=3.50±0.93 mg/dL) on admission. Results: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4±10.5 to 52.0±9.0%, 1.52±1.13 to 2.77±0.55, p<0.001 vs Group II; 50.1±11.2 to 52.7±9.7, 1.55±1.11 to 2.76±0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). Conclusion: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.(Korean J Med 61:606-615, 2001)

급성 ST 분절 상승 심근경색증 환자에서 관상동맥 조영술 전 TIMI 혈류가 관상동맥 중재술 후 임상경과에 미치는 영향

홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),임지현 ( Ji Hyun Lim ),박형욱 ( Hyung Wook Park ),김한균 ( Han Gyun Kim ),박옥영 ( Ok Young Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),안영근 ( Young Keun Ahn ),조정관 ( Je 대한내과학회 2005 대한내과학회지 Vol.69 No.2

Background : Epicardial infarct-related artery patency is reliably assessed by the Thrombolysis In Myocardial Infarction flow grade (TFG), and this index is associated with clinical outcomes after fibrinolytics or primary angioplasty in patients with acute myocardial infarction (AMI). The aim of this study was to examine long-term clinical outcomes according to the pre-procedural TFG in AMI after percutaneous coronary intervention (PCI). Methods : A total of 132 patients with AMI who underwent PCI between July 2001 and December 2001 at Chonnam National University Hospital were divided into two groups according to the pre-procedural TFG: Group I (n=60, 62.7±9.2 years, male 66.7%) with TFG 0-1 and Group II (n=72, 61.6±11.1 years, male 68.1%) with TFG 2-3. Results : Hypertension was more prevalent in Group I than that in Group II (56.7% vs. 27.8%, p=0.001) and cardiogenic shock on admission was more frequently observed in Group I than that in Group II (20.0% vs. 5.6%, p=0.011). The left ventricular ejection fraction was lower in Group I than that in Group II (42.6±10.5% vs. 50.5±12.1%, p=0.022). The levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, white blood cell and monocyte counts were higher in Group I than in Group II. On diagnostic coronary angiogram, complex lesion was more frequently observed in Group I than that in Group II (53.4% vs. 36.2%, p<0.001). During 1-year clinical follow-up, the mortality was higher in Group I than that in Group II (10.0% vs. 1.4%, p=0.028), however, there were no significant differences in the incidences of restenosis and target lesion revascluarization between the two groups. The event-free survival rate was lower in Group I than that in Group II (60.0% vs. 79.2%, p=0.016). The independent predictors for major adverse cardiac events were cardiogenic shock, CRP ≥ 0.5 mg/dL, age ≥ 70 years, triple vessel disease, low pre-interventional TFG (0-1) and post-interventional TFG (0-2). Conclusion : Low pre-procedural TFG is associated with hypertension, cardiogenic shock, left ventricular dysfunction, and high mortality, and low event-free survival during one-year clinical follow-up after PCI in AMI.(Korean J Med 69:157-166, 2005)

완화의료 전문인들의 일터영성(workplace spirituality)이 말기환자 돌봄수행에 미치는 영향

홍영준 ( Hong Young Joon ),임성희 ( Lim Seonghee ) 한국가족사회복지학회 2017 한국가족복지학 Vol.57 No.-

This study aims to examine the direct effects of two workplace spirituality dimensions, community at work and meaning in work, and burnout on three caring dimensions, emotional, social and spiritual care, for terminally ill people. It also seeks to examine the moderating effect of burnout in the relationship between two workplace spirituality dimensions and three caring dimensions. For these purposes, data were collected from 114 interdisciplinary team members, doctors, nurses, social workers and pastors, working in 68 palliative care in nationwide by questionnaires. The study results indicated that community at work has a positive effect on emotional care, and that meaning in work has a positive effect on social and spiritual care. The results also provided that burnout does not impact on three caring dimensions and has no moderating effect in the relationship between two workplace spirituality dimensions and three caring dimensions. In the findings, managers or leaders from palliative care should consider the potentially positive influence of workplace spirituality on caring for terminally ill people and can improve practitioners` performance with any interventions to increase workplace spirituality. The limitations of this study and recommendations for the future research were discussed.

은퇴베이비부머의 영적안녕감이 삶의 만족도에미치는 영향 -우울감의 매개효과 중심으로-

홍영준 ( Young Joon Hong ),이정훈 ( Jung Hoon Lee ) 한국가족사회복지학회 2014 한국가족복지학 Vol.45 No.-

The purpose of this study is to examine the effect of spiritual well-being on the lifesatisfaction, and the mediating effect of depression on the relationship between spiritualwell-being and life satisfaction among the baby-boomer retirees in Korea. The subject for thisstudy is 251 baby-boomer retirees people who participated in the work·fare program of jobacademy and Welfare Centers. The collected data were analyzed with SPSS WIN(ver.18.0)program, and frequency analysis, descriptive analysis, multiple regression, and Sobel test wereutilized. The result revealed that depression has a partial mediating effect between spiritualwell-being and life satisfaction. Based on these findings, the theoretical and practicalimplications were discussed.

복지환경변화에 따른 민관협력 갈등에 대한 고찰

홍영준(Young Joon Hong) 비판과 대안을 위한 사회복지학회 2017 비판사회정책 Vol.- No.56

본 연구의 목적은 최근 복지환경의 빠른 변화로 인해 일어나는 민관협력을 분석하고 민관협력의 개선방안을 논의하고자 함이다. 서울시의 경우 찾아가는 동주민센터 사업 시행 후 민관협력에 대한 논의 및 민과 관이 함께 하는 통합사례관리가 시행되어 왔다. 본 연구는 갈등을 5단계(회피, 수용, 경쟁, 타협, 협력)로 구분한 토머스 킬만의 갈등모델을 통해 현재의 민관협력을 분석해보고 향후 민관협력을 위한 제언을 하였다. 또한 토머스 킬만의 갈등 모델을 서울시 한 자치구의 복지전달체계 개편에 적용하여 이해를 더하였다. The purpose of the study is to analyze the conflict of current public-private cooperation due to the recent rapid change of social policies and to make suggestions for a better public-private cooperation. In case of Seoul, there has been ongoing discussion about the private-public cooperation and public-private integrated case management services after the welfare delivery system reform of community outreach service center. This study apply the Thomas-Killman Conflict Model which consists of five strategies(avoiding, accommodating, competing, compromising, & cooperating) to current private-public cooperation and give insight into the better private-public cooperation. Also, this study specifies the Thomas Killmans’s five strategies by applying the model to one district’s example in Seoul.

급성 심근경색증 환자에서 내원 시 단핵구 증가증과 예후

홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),이승현 ( Seung Hyun Lee ),박옥영 ( Ok Young Park ),박우석 ( Woo Seok Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),류제영 ( Jay Young Rhew ),양승호 ( Seung Ho Yang ),안영근 ( 대한내과학회 2002 대한내과학회지 Vol.63 No.5

Background : The inflammation is an important feature of atherosclerotic lesions, and peripheral monocytosis is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). The aim of this study was to determine the significance in clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI) and major adverse cardiac events and event-free survival rate after PCI according to the value of peripheral monocyte on admission. Methods : A total of 127 patients with AMI who underwent PCI between June 2000 and June 2001 at Chonnam National University Hospital were divided into two groups: Group I (n=63, 61.7±10.9 years, male 71.4%) with normal monocyte count (<900/mm3, mean value=536±202/mm3) on admission and Group II (n=64, 61.7±13.4 years, male 78.1%) with elevated monocyte count (≥900/mm3, mean value=1,140±260/mm3) on admission. Results : Baseline ejection fraction was lower in Group II than in Group I (Group I; 53.3±13.0% vs Group II; 45.0±11.7%, p=0.014). The value of C-reactive protein, troponin-T and troponin-I was higher in Group II than in Group I (Group I; 2.8±1.9 mg/dL, 1.98±1.53 ng/mL, 18.3±17.7 ng/mL vs Group II; 5.3±5.0 mg/dL, 3.34±2.54 ng/mL, 43.1±24.0 ng/mL, p=0.034, 0.020, 0.006, respectively). The incidence of target lesion revascularization was higher in Group II than in Group I during hospitalization and during 6-month clinical follow-up after PCI (1.6% vs 12.5%, 19.0% vs 31.3%, p=0.012, 0.015, respectively). The event-free survival rates were lower in Group II than in Group I during hospitalization and during 6-month follow-up after PCI (96.8% vs 84.4%, 71.4% vs 53.1%, p=0.006, 0.008, respectively). Conclusion : Peripheral monocytosis is associated with LV dysfunction and higher incidence of target lesion revascularization and worse mid-term event-free survival during hospitalization and at 6 months after PCI in patients with AMI.(Korean J Med 63:521-531, 2002) Key Words : Coronary Diseases, Myocardial Infarction, Angioplasty, Inflammation

시뮬레이티드 어닐링과 조합한 PID 유전 제어기 설계

홍영준(Young-Joon Hong),김낙교(Lark-Kyo Kim),남문현(Moon-Hyun Nam) 대한전기학회 2000 대한전기학회 학술대회 논문집 Vol.2000 No.7

관상동맥 중재술을 시술받은 불안정형 협심증 환자에서 저분자량 헤파린의 장기 효과

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),서순팔(Soon Pa 대한내과학회 2002 대한내과학회지 Vol.63 No.2

Background: Antithrombotic therapy with heparin reduces the rate of ischemic events in patients with acute coronary syndrome. Low-molecular-weight heparin (LMWH), given subcutaneously twice daily, has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer and does not require monitoring. Methods: We prospectively analyzed 180 patients with unstable angina who underwent percutaneous coronary intervention (PCI) between 1999 and 2001 at Chonnam National University Hospital to receive either 120 U/kg of Dalteparin (Fragmin), administered subcutaneously twice daily (group I; n=90, 61.8±8.9 years, male 67.8%), or continuous intravenous unfractionated heparin (group II; n=90, 62.6±9.7 years, male 70.0%). During hospitalization and at 6 month after PCI, major adverse cardiac events such as acute myocardial infarction, target vessel revascularization, death, or restenosis were examined. Results: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death were not different between two groups. At follow-up coronary angiography at 6 month after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 26/90, 28.8% vs. Group II; 32/90, 35.6%, p=0.041) and the incidence of target vessel revascularization was lower in group I than in group II (Group I; 21/90, 23.3% vs Group II; 27/90, 30.0%, p=0.039). There was no difference in the rate of major and minor hemorrhage, ischemic stroke and thrombocytopenia between two groups. In the multivariate analysis, factors relating to restenosis were lesion length, postprocedural minimal luminal diameter, CRP on admission, diabetes mellitus, type of hepairn, stent use. Conclusion: Dalteparin, a LMWH, is superior to standard unfractionated heparin for reducing restenosis rate and target vessel revascularization without increasing bleeding complications. (Korean J Med 63:158-168, 2002)

장기적인 우심실 첨부 조율 시 좌심실 기능부전의 발생에 관여하는 인자

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Ch 대한내과학회 2002 대한내과학회지 Vol.63 No.2

Background It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. Methods We studied sixty-four patients (male:female=27:37, mean age=57.6±15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2±44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. Results Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3±11.5% vs. 64.9±10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd ≥180 ms than in patients without (44.4±12.0% vs. 61.7±9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). Conclusion LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd ≥180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing. (Korean J Med 63:169-176, 2002)