원형탈모증을 앓고 있는 만 4세 유아의 아동중심놀이치료 사례연구

장정순(Jeong Soon Chang),한유진(Youjin Han) 한국생애놀이치료학회 2023 한국생애놀이치료학회지 Vol.6 No.1

This study is a case study of child-centered play therapy for a four-year-old child suffering from circular alopecia. It aims to analyze the play theme, and verify changes in psychological evaluation. The child received one year of hospital treatment for circular alopecia, which was relieved but recurred. In order to resolve the child’s psychosocial difficulties due to the recurrence, this case was referred to play therapy. In this study has found first, the themes of play manifested in the early stages were relationship, dependence, parenting, and mastery. In the 1st middle stage, the themes were relationship, dependence, mastery, parenting and anxiety appeared. Also in the 2nd middle stage, the themes of relationship, power and control, dependence, revenge, safety and security, mastery, parenting, protection were found. In the later stage, the themes of relationship, safety and security, mastery, parenting, integration, self-sufficiency, and resilience appeared. Second, child-centered play therapy was confirmed to provide positive changes as a result of psychological evaluations conducted before and after. The significance of this study is that after child-centered play therapy was performed on a four-year-old child suffering from circular alopecia, the play themes were analyzed and changes in psychological evaluation were confirmed.

Update ARDS Clinical Practice Guideline: Non-pharmacological

( Youjin Chang ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

The 2021 revision of Clinical Practice Guideline (CPG) for Acute Respiratory Distress Syndrome (ARDS), which KATRD and KSCCM are working on jointly, was decided to proceed in the de novo method following the CPG in 2016. Methodology experts and experts from each society gathered and formed groups to derive key questions (KQs) about ARDS treatment which reflect the existing CPG, the latest journal reviews, and domestic realities. A total of 12 key questions were elicited based on PICO (Population, Intervention, Comparator, Outcome), and 7 of them were related to non-pharmacological treatment, which are as follows. KQ 1. In adult patients with ARDS, does applying lower tidal volumes, compared with higher, conventional volumes reduce mortality? KQ 2. In adult patients with ARDS, does a limitation of plateau pressure, compared with not limiting reduce mortality? KQ 3. In adult patients with ARDS, does a limitation of driving pressure, compared with not limiting reduce mortality? KQ 4. In adult patients with ARDS, does applying higher positive end-expiratory pressure (PEEP) compared with lower or conventional reduce mortality? KQ 5. In adult patients with ARDS, does receiving PEEP titration, compared with standard care reduce mortality? KQ 6. In adult patients with moderate to severe ARDS, does the use of ECMO, compared with standard care reduce mortality? KQ 7. In adult patients with moderate to severe ARDS, does applying prone position, compared with standard care lower mortality? A literature search was conducted on the above 7 non-pharmacological treatments. After selecting keywords for each key question, a search formula was established, and the following final literature was searched through PubMed, Embase, and Cochrane Library (KQ 1: 27,763, KQ 2: 1,008, KQ 3: 611, KQ 4-5: 10,786, KQ 6: 4,180, KQ 7: 1,839). In this regard, selection, exclusion, arrangement, and analysis of literatures within each group is currently in progress.

Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia

Youjin Chang,Sang Oh Lee,Tae Sun Shim,Sae Hoon Choi,,Hyung Ryul Kim,Yong-Hee Kim,Dong Kwan Kim,Seung-Il Park,Sang-Bum Hong 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.3

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

Neuroendocrine Differentiation in Acquired Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor

Chang, Youjin,Kim, Seon Ye,Choi, Yun Jung,So, Kwang Sup,Rho, Jin Kyung,Kim, Woo Sung,Lee, Jae Cheol,Chung, Jin-Haeng,Choi, Chang-Min The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.3

Background: Small cell lung cancer (SCLC) transformation during epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment in lung cancer has been suggested as one of possible resistance mechanisms. Methods: We evaluated whether SCLC transformation or neuroendocrine (NE) differentiation can be found in the cell line model. In addition, we also investigated its effect on responses to conventional chemotherapeutic drugs of the SCLC treatment. Results: Resistant cell lines to various kinds of EGFR-TKIs such as gefitinib, erlotinib, CL-387,785 and ZD6474 with A549, PC-9 and HCC827 lung adenocarcinoma cell lines were established. Among them, two resistant cell lines, A549/GR (resistant to gefitinib) and PC-9/ZDR (resistant to ZD6474) showed increased expressions of CD56 while increased synaptophysin, Rb, p16 and poly(ADP-ribose) polymerase were found only in A549/GR in western blotting, suggesting that NE differentiation occurred in A549/GR. A549/GR cells were more sensitive to etoposide and cisplatin, chemotherapeutic drugs for SCLC, compared to parental cells. Treatment with cAMP and IBMX induced synaptophysin and chromogranin A expression in A549 cells, which also made them more sensitive to etoposide and cisplatin than parental cells. Furthermore, we found a tissue sample from a patient which showed increased expressions of CD56 and synaptophysin after development of resistance to erlotinib. Conclusion: NE differentiation can occur during acquisition of resistance to EGFR-TKI, leading to increased chemosensitivity.

Analysis of high predicted pulmonary function: possibility of overestimation in small elderly examinees

( Youjin Chang ),( Ho Cheol Kim ),( Kyung-wook Jo ),( Jae Seung Lee ),( Yeon-mok Oh ),( Sang Do Lee ),( Sei Won Lee ) 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.1

Background/Aims: Few studies have attempted to interpret unusually high predicted pulmonary function test results. This study aimed to investigate the demographic features of patients with an unusually high predicted pulmonary function. Methods: The demographic data of subjects who underwent pulmonary function testing at a tertiary referral hospital during between January 2011 and December 2011 were retrospectively reviewed. Results: Of the 68,693 included patients, 55 (0.08%) had a percent predicted forced expiratory volume in 1 second or forced vital capacity ≥ 140%. These patients had a relatively older median age (72 years vs. 54 years, p < 0.001), female predominance (65.5% vs. 42.5%, p = 0.001), lower body weight (52.5 kg vs. 64.5 kg, p < 0.001) and shorter height (148.4 cm vs. 164.2 cm, p < 0.001). Furthermore, 6.1% of women older than 80 years with weight < 50 kg and height < 150 cm had a high predicted pulmonary function. Conclusions: A high predicted pulmonary function is not rare among elderly subjects with a small body size. Physicians should consider the demographics of the examinees, especially those of minority populations, particularly as the test results might be determined using an incorrect reference equation.

Steroid therapy in severe respiratory infection

( Youjin Chang ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Mechanical Ventilation in Rt. Heart Failure

( Youjin Chang ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

2023 Korean Guideline for the Management of Adult Patients with HAP/VAP

( Youjin Chang ),( Kyung Hoon Min ),( Young Seok Lee ),( Jee Youn Oh ),( Jong Min Lee ),( Ae-rin Baek ),( Bo Young Lee ),( Ha Young Choi ),( Kyeongman Jeon ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Culture-negative Nosocomial Pneumonia is Associated with Favorable Clinical Outcomes Compared with Culture-positive Pneumonia: A Nationwide Multicenter Retrospective Observational Cohort Study

( Youjin Chang ),( Sangbong Choi ),( Hyuk Pyo Lee ),( Kyung Hoon Min ),( Sang-bum Hong ),( Ae-rin Baek ),( Hyun-Kyung Lee ),( Woo Hyun Cho ),( Changhwan Kim ),( Sung-soon Lee ),( Jee Youn Oh ),( Heung 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Culture-negative and culture-positive nosocomial pneumonia have not been sufficiently studied whether they should be regarded as the same group or different in their clinical characteristics and outcomes. Methods A nationwide multicenter retrospective observational cohort study was conducted among patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) admitted to the 13 tertiary or university-affiliated hospitals in Korea from June 1 to Dec 31, 2019 by the Korean HAP/VAP Study Group. Results Among 526 patients with HAP/VAP enrolled out of 206,372 adult hospitalized patients screened, 468 patients with respiratory cultures were eligible. Among them, 257 (54.9%) patients were culture-negative (CN) and 211 (45.1%) were culture-positive CP). Their median age was 71 [62-79] and 69% were males. CN patients had a higher percentage of females (35% vs 26%, P=0.022) and less chronic neurologic disease with lower risk of aspiration compared with CP. Initial SOFA score on diagnosis of pneumonia was lower in CN patients than in CP (CN: 4.4±3.8 vs CP: 6.4±4.2, P < 0.001). As empirical antibiotic use, extendedspectrum penicillin/β-lactamase inhibitors-based antibiotics were used significantly more in the CN group (CN: 62% vs CP: 52%, P=0.021), while carbapenem-based antibiotics were used significantly more in the CP group (CN: 16% vs CP: 26%, P=0.007). CN patients had a lower clinical failure for HAP/VAP (CN: 24% vs CP: 45%, P < 0.001) and a lower hospital mortality rate (CN: 24% vs CP: 35%, P=0.013) than CP patients. In multivariate analysis, culture-negativity was a significant prognostic factor of clinical failure for HAP/VAP (OR: 0.590, 95% CI: 0.367-0.947, P=0.029). Conclusion Patients with CN HAP/VAP had less organ failure, lower rate of treatment failure and favorable hospital mortality than CP patients. This study suggests that CN and CP HAP/VAP patients are clinically different patient groups.

The Distribution of Multidrug-resistant Microorganisms and Treatment Status of Hospital-acquired Pneumonia/Ventilator-associated Pneumonia in Adult Intensive Care Units: a Prospective Cohort Observational Study

Chang Youjin,Jeon Kyeongman,Lee Sang-Min,Cho Young-Jae,Kim Young Sam,Chong Yong Pil,Hong Sang-Bum 대한의학회 2021 Journal of Korean medical science Vol.36 No.41

Background: It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospitalacquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea. Methods: A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected. Results: A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59–76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae (n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/ β-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P = 0.032; 60- day mortality: 41% vs. 55%, P = 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092–0.859; P = 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545–13.192; P = 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988–1.779; P = 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens. Conclusion: In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.