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.

Does Age Influence the Poor Prognosis after Aneurysmal SAH Surgery in Elderly Patients?

Sim, Jong-Eun,Kim, Hyung-Dong,Song, Young-Jin,Noh, Seung-Jin The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.40 No.5

Objective : The incidence of aneurysmal subarachnoid hemorrhage has been increasing. At the same time, surgical results for elderly patients are unsatisfactory and no guidelines of treatment are available. We carried out a study comparing variable factors and surgical results between young and old age groups to find ways to improve prognosis. Methods : A retrospective study was carried out on 754 patients who were operated on between 1990 and 2004 by the same surgeon in our hospital. The patients were divided into seven groups according to age : 93 patients below 40 years of age [Group I], 419 patients aged $40{\sim}59$ [Group II], 115 patients aged $60{\sim}64$ [Group III], 82 patients aged $65{\sim}69$ [Group IV], 28 patients aged $70{\sim}74$ [Group V], 12 patients aged $75{\sim}79$ [Group VI] and 5 patients over the age of 80 [Group VII]. We then checked their medical history, Fisher's grade, Hunt-Hess grade, postoperative complications, and Glasgow Outcome Scale. Results : Age was not a statistically significant factor among patients below 70 years of age [P $value{\ge}0.05$]. But for those aged 70 and older, the age factor had a statistical value [P $value{\le}0.001$]. In addition, there was a close correlation between Hunt-Hess grade IV and V patients, and those with vasospasm, and hydrocephalus after surgery, with poor prognosis in elderly patients as well as young patients [P $value{\le}0.001$]. Conclusion : Advanced age [under the age of 70] dose not precluded adequate surgical treatment in patient with AN SAH, and we should be also alert to preventable causes of delayed neurological deterioration for improving the outcome in all elderly groups.

말기 암환자의 임종 전 48시간 동안의 임상증상

심윤수,김도연,남은미,이순남,Sim, Yun-Su,Kim, Do-Yeun,Nam, Eun-Mi,Lee, Soon-Nam 한국호스피스완화의료학회 2007 한국호스피스.완화의료학회지 Vol.10 No.4

목적: 말기 암환자의 여명을 예측하는 것은 환자와 가족들에게 '평안한 임종'을 맞기 위한 준비를 할 수 있도록 하고, 의료진에게는 적극적 증상완화와 전인간적 돌봄을 가능하게 할 수 있다. 이에 본 연구는 말기 암환자에서 임종 전 48시간 동안의 임상증상을 파악하고 임종을 예측하는 임상증상을 확인하여 환자 가족 및 의료진에게 이 시기에 나타나는 변화들을 이해하여 준비된 평안한 임종을 맞는데 도움이 되고자 한다. 방법: 2003년 7월부터 2006년 3월까지 한 대학병원에 입원하여 사망한 말기 암환자 89명을 대상으로 하여 임종 전 48시간 동안의 임상증상을 조사하였고 입원 시, 임종 48시간-24시간전, 임종 24시간전$\sim$임종시까지 시간대별 증상의 빈도 변화를 분석하였다. 결과: 전체 대상 환자의 중앙 연령은 62세(범위, $16{\sim}97$세)였다. 임종 48시간전 임상증상의 빈도는 의식혼탁(57%)이 가장 흔하였으며 이외 통증(30%), 발열(22%), 호흡곤란(19%)의 순이었다. 원발암에 따른 임종 48시간전 임상증상도 유사한 빈도를 보였으나 담도계암환자에서 발열의 빈도가 다른 암종에 비해 유의하게 높았다(P=0.012). 임종이 임박할수록 입원 시에 호소하던 전신 쇠약감과 식욕부진은 감소한 반면 의식혼탁은 유의하게 증가하였다(P<0.001). 결론: 말기 암환자에서 의식혼탁은 임종이 임박했음을 나타내는 가장 중요한 임상 지표로 생각된다. Purpose: Individual cancer patients often experience many symptoms that impair their quality of life at the end of life. Identifying symptoms at the terminal stage of cancer patients and possible imminent death prediction by using that assessment can assist physicians and patients in preparing the 'peaceful death'. This study examines symptom experience during the last 48 hours of life of terminal cancer patients, and determines whether symptom experience change with proximal to death. Methods: The medical records of 89 patients who died with terminal cancer at a hospital between July 1, 2003 and March 31, 2006 were reviewed. Symptom prevalence at the last 48 hours was analyzed along with the change of symptom experience at the admission, $48{\sim}24$ hours, and $24{\sim}0$ hours before death. Results: Median age of all patients was 62 years old (range $16{\sim}97$). During the last 48 hours, symptom prevalence was described as follows; unclear consciousness (57%), pain (30%), fever (22%), and dyspnea (19%). According to the primary site, unclear consciousness was notified the most frequent symptom, but fever was relatively high prevalence in patients of biliary origin cancer rather than other site cancer (P=0.012). As death was Impending, the prevalence of poor appetite and general weakness were decreased, while that of unclear consciousness was increased, which were all statistically significant (P < 0.05). Conclusion: The presence of unclear consciousness could be regarded as the symptom indicator as imminent death of terminal canter patients.

지황(地黃)의 품질평가

정은아,김희정,심상범,김종우,김남재,Jung, Eun-Ah,Kim, Hee-Jung,Sim, Sang-Bum,Kim, Jong-Woo,Kim, Nam-Jae 한국생약학회 2000 생약학회지 Vol.31 No.2

The dried roots of Rehmannia glutinosa (RG) have been used in the traditional medicine for treatment of diabetes, fever and dysuria, etc. In order to investigate the quality evaluation of the dried roots of RG, we conducted the physico-chemical and biological evaluation method. The amount of catalpol from commercial samples is very diverse about $0.00{\sim}3.89%$ by using HPLC method, because it is easily decomposed by processing of RG. So, we should try to identify the correlation with the contents of catalpol and biological activities of RG. We chose 3 samples which were a wide difference of catalpol contents between each sample (Sample-I; 3.4%, Sample-II; 2.8%, Sample-III; 0.05%). Sample-I and Sample-II were found to be more effective than Sample-III on the DPPH free radical scavenging effect and inhibitory effect on $H_2O_2-catalyzed$ lipid peroxidation in rat liver in vitro. And, Sample-I and Sample-II exhibited more significant effects than Sample-III on accelerating actions of the small and large intestinal transport, and diuretic action in mice. So, it is suggested that the quantitative determination of catalpol should be required for the tandardization of the dried roots of RG.

국산 밀 품종 및 제분율에 따른 막걸리의 품질 특성

심은영,이석기,우관식,김현주,강천식,김시주,오세관,박혜영,Sim, Eun-Yeong,Lee, Seuk Ki,Woo, Koan Sik,Kim, Hyun-Joo,Kang, Chon-Sik,Kim, Si Ju,Oh, Sea-Kwan,Park, Hye-Young 한국식품영양학회 2016 韓國食品營養學會誌 Vol.29 No.5

본 연구는 국내산 밀 품종에 따른 제분율 별로 밀 막걸리의 품질특성을 평가하고자 수행하였다. 원료곡의 탄수화물은 70% 제분율의 금강밀, 백중밀이 78.37, 78.16%로 가장 높았다. 밀의 품종 및 제분율에 따른 막걸리의 품질특성을 검정한 결과, 가용성 고형분 함량, 환원당, 알코올은 각각 $10.94{\sim}12.33^{\circ}Brix$, 2.89~4.71%, 14~15.97% 범위를 나타냈으며 백중밀 70% 제분율에서 알코올 15.97%, 환원당 4.71%로 가장 높은 함량을 나타냈다. 밀 막걸리의 glucose 함량은 159.4~560.7 mg%의 범위를 보이며 원료 밀 대비 상당량 증가하였고 그 외 mannitol과 arabinose도 존재하였다. 밀 막걸리의 유기산 분석에서, 유산균에 의한 대사산물인 lactic acid는 85.3~650.3 mg%의 분포를 나타내며 가장 높은 수준을 나타냈고 제분율 증가에 따라 그 함량도 증가하였고 제분율별 품종 비교에서는 조경밀이 가장 높았다. 밀 막걸리의 품질 관련인자의 상관성 분석에서는 원료곡의 단백질 함량은 밀 막걸리의 총산, 환원당과 부의 상관을 보였고(p<0.001), 원료곡의 탄수화물 함량은 밀 막걸리의 총산, 환원당(p<0.001) 및 알코올 함량(p<0.05)과 정의 상관을 나타내었다. 가용성 고형물의 함량은 알코올, 환원당 함량과 정의상관을, pH와는 부의 상관관계를 나타내었다(p<0.001). 밀 막걸리의 알코올 함량 비교 시 70, 85% 제분율에서 품종과 제분율에 따른 차이가 존재하지 않았으므로 85% 밀가루도 막걸리용으로 이용 가능할 것이라 생각된다. 하지만 품종과 제분율에 따라 함유하는 유리당과 유기산 등 여러 가지 품질특성이 상이하기 때문에 이를 고려한 원료의 선택이 필요할 것이다. This study aimed to evaluate the quality characteristics of wheat-Makgeolli (WM), a traditional Korean cereal alcoholic drink, using three varieties of wheat, namely Jokyoung (JK), Baegjoong (BJ) and Keumkang (KK). Samples of WM brewed from 100%, 85% and 70% milling rates of the three Korean wheat cultivars were analyzed for alcohol, pH, coloring degree, total acids, soluble solid, free sugars, and organic acids. As the milling rates in wheat decreased, total sugar content in WM increased while the pH of all samples decreased. The WM exhibited 0.95~1.27% in acidity, $10.2{\sim}12.5^{\circ}Brix$ in total sugar, and 14~16% in alcohol content. The most organic acids in WM was lactic acid, ranging in all the samples from 85.3~650.3 mg%. The results showed that BJ under a 70% milling rate had the highest reducing sugar contents and 15.97% in alcohol content. The carbohydrate content increased with the milling rate of wheat. Resulting in a positive correlation between carbohydrate content of wheat and total acids, reducing sugars (p<0.001), and alcohol content (p<0.05) in WM. Total sugar content is positively correlated with alcohol and reducing sugar content (p<0.001). Considering the yield, the milling rates will be adjusted to raw material prices.

CNN과 Kibana를 활용한 호스트 기반 침입 탐지 연구

박대경 ( Daekyeong Park ),신동규 ( Dongkyoo Shin ),신동일 ( Dongil Shin ) 한국정보처리학회 2020 한국정보처리학회 학술대회논문집 Vol.27 No.2

사이버 공격이 더욱 지능화됨에 따라 기존의 침입 탐지 시스템(Intrusion Detection System)은 기존의 저장된 패턴에서 벗어난 지능형 공격을 탐지하기에 적절하지 않다. 딥러닝(Deep Learning) 기반 침입 탐지는 새로운 탐지 규칙을 생성하는데 적절하다. 그 이유는 딥러닝은 데이터 학습을 통해 새로운 침입 규칙을 자체적으로 생성하기 때문이다. 침입 탐지 시스템 데이터 세트는 가장 널리 사용되는 KDD99 데이터와 LID-DS(Leipzig Intrusion Detection-Data Set)를 사용했다. 본 논문에서는 1차원 벡터를 이미지로 변환하고 CNN(Convolutional Neural Network)을 적용하여 두 데이터 세트에 대한 성능을 실험했다. 평가를 위해 Accuracy, Precision, Recall 및 F1-Score 지표를 측정했다. 그 결과 LID-DS 데이터 세트의 Accuracy가 KDD99 데이터 세트의 Accuracy 보다 약 8% 높은 것을 확인했다. 또한, 1차원 벡터에 대한 데이터를 Kibana를 사용하여 데이터를 시각화하여 대용량 데이터를 한눈에 보기 어려운 단점을 해결하는 방법을 제안한다.

The Function of Dimeric Structure of Soluble Intercellular Adhesion Molecule-1 (sICAM-1): Inhibition of Leukocyte Function Associated Antigen-1 (LFA-1) Binding to ICAM-3

Choi, Suck-Chei,Han, Weon-Cheol,Park, Do-Sim,Kim, Eun-Cheol,Oh, Hyun-Mee,Oh, Jung-Mi,Jun, Chang-Duk The Korean Society for Microbiology 2002 Journal of Bacteriology and Virology Vol.32 No.1

Intercellular adhesion molecule-1 (ICAM-1) is a membrane protein, exists as a dimer on the cell surface, and interacts with leukocyte function associated antigen-1 (LFA-1), a member of ${\beta}_2$-integrin family. A soluble circulating form of ICAM-1 (sICAM-1) is also detected in human serum, and has been implicated as a regulator for LFA-1-dependent cell-cell interaction in vivo. However, previous reports demonstrated that sICAM-1 shows little inhibitory effect on LFA-1 binding to ICAM-1, indicating that sICAM-1 is unlikely to antagonize LFA-1/ICAM-1-mediated cellular events in vivo. Here, we investigated the property of the dimeric sICAM-1 as an inhibitor of LFA-1 interaction with ICAM-3, since the lower avidity of LFA-1 for ICAM-3 compared with ICAM-1 or ICAM-2 had been speculated. Using recently constructed heterodimeric sICAM-1 joined at the C terminus via an ${\alpha}$-helical coiled coil (ACID-BASE) (Jun, CD. et al., 2001, Proc Natl Acad Sci 98, 6830-6835), we also tested whether the structural integrity in dimer could affect the inhibitory action of sICAM-1. Engineered sICAM-1 dimer that contained intact ectodomain (E34/E34) significantly blocked SKW3 cell (LFA-$1^+$) binding to ICAM-3, but not to ICAM-1 and ICAM-2, indicating the lower avidity of LFA-1 to ICAM-3 than that of both ICAM-1 and ICAM-2. A one binding site knock out mutant (E34/K34) showed ${\sim}2$-fold reduction in efficiency compared with E34/E34 to inhibit cell binding. Interestingly, a one binding domain deletion mutant (E34/${\Delta}D1$-D2) showed significant reduction (${\sim}5$-fold) compare with E34/K34, suggesting that structural integrity, which is precluded in E34/${\Delta}D1$-D2, is necessary for optimal binding of dimeric sICAM-1 to LFA-1, thereby inhibiting LFA-1/ICAM-3-dependent adhesion. Furthermore, BIAcore affinity measurements revealed that E34/${\Delta}D1$-D2 bound to immobilized soluble open LFA-1 I domain with an ${\sim}3$-fold reduced affinity compared with E34/K34. Overall, our results demonstrate that maintaining the structural integrity in dimer is necessary for optimal binding of sICAM-1 to LFA-1, and further suggest the therapeutic potential of dimeric sICAM-1 to antagonize LFA-1/ICAM-3-mediated cellular events in vivo.

60 Hz 자기장이 예쁜꼬마선충의 생식에 미치는 영향 연구

박병재,장혜진,김희성,강희은,심례림,최유미,김윤명,김남,김윤원,Park, Byeong-Jae,Jang, Hye-Jin,Kim, Hui-Seong,Gang, Hui-Eun,Sim, Rye-Rim,Choe, Yu-Mi,Kim, Yun-Myeong,Kim, Nam,Kim, Yun-Won 한국전자파학회 2010 전자파기술 Vol.21 No.5

60 Hz 자기장에서 예쁜꼬마선충(C. elegans)의 발생 및 생식에 미치는 영향을 조사하였다. 자기장 노출 조건은 $0{\sim}500\;{\mu}T$이며, 실험 온도는 선충의 일반적 배양 온도 범위($2 1.2{\pm}0.6^{\circ}C$)에서 일정하게 유지하였으며, 노출은 선충의 배양 기간 동안 지속되었다. C. elegas 야생형 N2 및 스트레스에 민감한 hsf-1와 crt-1 등의 돌연변이체들에서 실험에 사용한 노출 조건에 따른 생식력의 차이는 없었다. 여러 세대에 걸쳐 자기장에 노출한 경우에도 자기장에 의한 생식력의 변화는 없었다. 결론적으로, C. elegans는 크기가 매우 작으므로(길이 약 1 mm) 유도전류가 적게 발생하여, 자기장($-500\;{\mu}T$)에 의한 영향이 없는 것으로 사려된다.

음료 개발을 위한 가공용 쌀의 수화, 호화 및 당화특성 비교

신동선,최예지,심은영,오세관,김시주,이석기,우관식,김현주,박혜영,Shin, Dong-Sun,Choi, Ye-Ji,Sim, Eun-Yeong,Oh, Sea-Kwan,Kim, Si-Ju,Lee, Seuk Ki,Woo, Koan Sik,Kim, Hyun-Joo,Park, Hye-Young 한국식품영양학회 2016 韓國食品營養學會誌 Vol.29 No.5

쌀음료베이스 개발을 위한 품종별 가공용 쌀의 기초자료 확보를 위해 국내산 쌀 7종(삼광, 일품, 설갱, 안다, 다산1호, 고아미4호, 단미)과 수입쌀 3종(미국쌀, 중국쌀, 태국쌀)을 대상으로 수화, 호화 및 당화 관련 특성을 살펴보았다. 품종별쌀의 수분함량은 11.88~15.26% 범위로 나타났으며, 수분흡수율은 안다, 미국쌀이 가장 높게 나타났다. 수분결합력은 태국쌀이 가장 높았으며, 단미, 고아미4호 및 설갱은 낮은 수분결합력을 나타내었다. 용해도는 10종의 시료 중 단미가 월등히 높은 26.6%를 나타내었으며, 팽윤력은 설갱, 안다, 미국쌀이 유의적으로 높은 수준을 나타냈다(p<0.05). 품종별 쌀가루의 아밀로오스 함량은 고아미4호와 태국쌀이 가장 높은 반면, 단미가 가장 낮았다. RVA를 측정한 결과, 호화온도는 단미와 고아미4호가 각각 $91.6^{\circ}C$와 $78.5^{\circ}C$로 가장 높았고, 그 외 품종은 $68.0{\sim}71.1^{\circ}C$로 나타났다. 최고점도와 최종점도는 다산1호가 가장 높았고, 단미가 가장 낮게 나타났다. 치반점도는 일품과 미국쌀이 낮게 나타나, 노화가 더디게 진행될 것으로 예상되었다. 한편, 쌀, 수침처리 쌀, 건식쌀가루, 습식쌀가루로 가공용 쌀 전처리를 달리하고, 수침시 흡수되는 수분량을 고려하여 물을 첨가하고, 고온용 ${\alpha}$-amylase 처리 후 당화특성을 비교하였다. 당화액의 pH는 일품을 제외한 모든 품종에서 습식쌀가루가 유의적으로 높게 나타났다(p<0.05). 가용성 고형분 함량은 대부분 수침처리한 것보다 수침처리하지 않는 것, 쌀보다는 쌀가루의 효소처리가 더 효과적으로 높게 나타났다. 환원당 함량은 전처리 방법에 따라 수침처리하지 않는 것보다 수침처리한 것, 쌀보다는 쌀가루가 유의적으로 더 높게 나타났다(p<0.05). 색도는 L값의 경우 고아미4호를 제외한 대부분 품종에서 쌀보다 수침처리한 쌀이 낮은 값을 보였다. a값은 수침처리하지 않는 쌀과 습식쌀가루에서 낮은 값을 보였으며, b값은 쌀보다 수침처리한 쌀, 건식쌀가루보다 습식쌀가루가 품종에 따라 다소 차이가 있는 것으로 나타났다(p<0.05). 이러한 연구결과를 종합해 보면, 쌀을 원료로 한 음료베이스 개발을 위해서는 원료곡의 호화, 액화 및 당화에 영향을 주는 여러 가지 인자와 품종별 특성을 고려한 접근이 이루어져야 할 것이다. This study evaluated the hydration, gelatinization, and saccharification properties of rice processing for beverage development. The properties of rice were studied on 10 rice cultivars (Samkwang, Ilpum, Seolgaeng, Anda, Dasan-1, Goami-4, Danmi, American rice, Chinese rice, and Thai rice) and employing four kinds of pre-treatment methods (dry grain, wet grain, dry flour, and wet flour). The results showed that moisture content of rice was between 11.88~15.26%. Increase in soaking time along with highest water absorption was noted in American rice cultivar (46.81%). The water binding capacity of Thai rice was higher when compared to that of other rice flours. In addition, solubility and swelling power of rice were 4.52~26.65% and 0.19~2.05%, respectively. The amylose content of Goami-4 was higher in rice processing. Using a rapid visco analyzer (RVA), the initial pasting temperature of Danmi cultivar was found to be the highest; the peak viscosities of Anda cultivar and Dasan-1 cultivar, and Chinese rice were higher than of those of other rice flours. After saccharification, the pH, soluble solids content, and reducing sugar content of rice processed through different pre-treatment methods were in the range of 6.22~7.08, $4.67{\sim}16.07^{\circ}Brix$, and 0.35~11.67% (w/w), respectively. In terms of color values, the L-value of dry grain, a-value of wet (grain, flour), and b-value of dry sample (grain, flour) were found to be the highest. Assessment of various factors and cultivars characteristics of the raw grains are of importance in the development of rice beverage.

역동적 심상치료가 유방암환자의 억압된 분노와 면역기능에 미치는 효과

김은심 성인간호학회 2003 성인간호학회지 Vol.15 No.4

Purpose: The purpose of this study was t o identify the effect of dynamic imagery therapy on "anger-in" and immune function in patients with breast cancer. Method: Dynamic imagery therapy was given for 10 sessions with 2 times informative education. Data collection was from June, 24th t o August, 12th 2002. The participants were experimental group 15, control group 15. This study was designed using a quasi-experimental approach with non-equivalent Pre test-Post test Design. The instruments used in this study include the anger scale developed by Spielberger(l972) and modified by Chon, Kyum Koo (1996). The data was analysed with x^2-test, t-test, ANOVA and ANCOVA. Result: 1) That the level of "Anger-in" in patients will be significantly lower than that o f the control group was supported (p<.001). 2) That the level of T3 lymphocyte and NK Cells, IgG. Cortisol in patients will be significantly lower than that of the control group was supported (T3. IgG: p<.05, Cortisol (p<.001). Conclusion: The dynamic imagery therapy is suggested as an effective nursing intervention to reduce anger level and increase immune function for patients with breast cancer.