Elderly kidney transplant recipients have favorable outcomes but increased infection-related mortality

임정훈,Lee Ga Young,Jeon Yena,Jung Hee-Yeon,Choi Ji Young,CHO, JANG-HEE,Park Sun Hee,김용림,Kim Hyung-Kee,Huh Seung,유은상,Won Dong Il,Kim Chan-Duck 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.3

Background: The number of elderly patients with end-stage kidney disease has been increasing, but the outcomes of kidney transplants (KT) remain poorly understood in elderly patients. Therefore, we evaluated the clinical outcomes of elderly KT recipients and analyzed the impact of elderly donors. Methods: This retrospective cohort study included patients who underwent KT between 2000 and 2019. KT recipients were divided into four groups according to a combination of recipient and donor age (≥60 or <60 years); elderly recipients: old-to-old (n = 46) and young-to-old (n = 83); young recipients: old-to-young (n = 98) and young-to-young (n = 796). We compared the risks of mortality, graft failure, and acute rejection between groups using Cox regression analysis. Results: The incidence of delayed graft function, graft failure, and acute rejection was not different among groups. Annual mean tacrolimus trough level was not lower in elderly recipients than young recipients during 10-year follow-up. Mortality was significantly higher in elderly recipients (p = 0.001), particularly infection-related mortality (p < 0.001). In multivariable Cox regression analysis, old-toold and young-to-old groups had increased risk of mortality (adjusted hazard ratio [aHR], 2.89; 95% confidence interval [CI], 1.14– 7.32; p = 0.03; aHR, 3.06; 95% CI, 1.51–6.20; p = 0.002). However, graft failure and acute rejection risks were not increased in elderly recipients. Conclusion: In elderly recipients, graft survival and acute rejection-free survival were not inferior to those of young recipients. However, mortality, especially risk of infection-related death, was increased in elderly recipients. Thus, low immunosuppression intensity might help decrease mortality in elderly recipients.

18–30세 사이에 발생하는 뇌경색의 특징, 다기관 레지스트리 연구

장윤경,송태진,김용재,허지회,이경열,김영은,장민욱,조수진,강석윤 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.3

Objectives: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. Methods: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. Results: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). Conclusion: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.

부산·울산·경남지역 직업병 감시체계

김정일,김병권,김정원,채창호,이철호,강동묵,김지홍,김진하,김영욱,이영하,이지호,김정호,윤형렬,유철인,정백근,장태원,김운규,윤동영,강진욱,김종은,안진홍,이동준,장준호,이광영,송혜란,최영희,이용환,조병만,최홍렬,고상백,김은아,이유진,홍영습,정갑열,김정만,김준연 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.1

Objective: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases Methods: l l hospital participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. Results: Between April 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. most of the HAVS cases came from shipbuilding, and 172 of them (92.7%) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9%). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6%) and 4 (12.1%) cases of occupational asthma, the agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10(58.8%) of the cases were diagnosed as squamous cell carcinoma and 5(29.4%) as adenoma. Conclusion: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.

Production and Characterization of Enzymes Involved in Chitin Catabolic Cascade from a Bacterial Strain Isolated from Soil

( Ji Hyun Lee ),( Jeong In Lee ),( So Yeon Park ),( Yoo Kyeong Jang ),( You Bin Lim ),( Hye Yoon Lee ),( Young Min Jung ),( Hae Chang Lee ),( Jong Hwa Lee ),( Shaheen Amna ),( Jae Kweon Park ) 한국키틴키토산학회 2019 한국키틴키토산학회지 Vol.24 No.1

The present study was aimed to isolate the bacteria producing chitinolytic enzymes including chitin deacetylase (CDA) from soil origin. About 24 bacteria were screened for their chitinolytic enzymes producing ability on the basis of colloidal chitin. Amongst one of the most potent isolates designated to JI-02 was further selected as the most prominent chitinolytic and CDAlike enzyme (CDA-X) producer based on the ability of deacetylation of an artificial substrate pNP-acetamilide. The maximum production of CDA-X in crude enzyme from JI-02 was observed in the presence of 1% colloidal chitin at 37°C and pH 6.4 after 120 h of incubation. Potent enzyme activity of CDA-X was determined toward pNP-acetamilide, demonstrating that optimal pH, temperature and ionic strength of the CDA-X were assessed to be 7.0, 52°C and 125 mM, respectively. Unexpectedly, Nacetylglucosamine (GlcNAc) was not fully converted by the action of CDA-X to glucosamine (GlcN) under the established conditions. Further study on enzyme activity toward chitin-oligosaccharides consisting of multi-N-acetylglucosamine (GlcNAc)n, n=2-5 may be necessary to elucidate the mode of action which requires the minimum size of (GlcNAc)n. However, our data suggest that CDA-X can convert chitin to chitosan with the maximum yield of approximately 0.08g/L during the fermentation of the strain in the presence of chitin. Furthermore, we found that crude enzyme showed the significant chitosanolytic activity. Taken together, our data suggest that the strain JI-02 may be a potential candidate as a particular strain for better understating of chitin catabolic pathway.

유방암의 위와 대장전이

유현아,김은영,서민지,정은,조민정,오현진,장지혜,박지찬,이정의,박석영 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.

비흑색종 피부암에서 고에너지 X-선 방사선치료

장지영,오윤경,천지선 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.33 No.S

Purpose: To evaluated the efficacy of radiotherapy in the nonmelanoma skin cancer. Materials and Methods: Eleven patients were diagnosed as non-melanoma skin cancer of the head and trunk. There were 9 women and 2 men. The mean age was 70 years with a range of 35 years to 93 years. Seven patients had squamous cell carcinoma and 4 patients had basal cell carcinoma. The mean tumor size was 3.1 cm (range 1 to 8 cm). All patients were treated with 6-megavoltage X-ray radiotherapy. Mean biological effective dose (BED₂) was 50.9 Gy/43 days (range: 37.5 to 59.4 Gy). Median follow-up period was 49 months (range: 18 to 107 months). Results: The local tumor control was 100% and median disease free survival time was 30 months. Local recurrence was noted in 3 patients and distant metastasis in 1 patient. Affecting factor in local recurrence was only radiation dose. By BED₂, median survival time was 30 months for ≥45 Gy and 12 months for <45 Gy (p=0.027). Radiotherapy related chronic complication was observed in 1 patient. Conclusions: High energy X-ray radiotherapy is an effective and safe treatment for nonmelanoma skin cancer, although the number of patients is small.

대학생의 전공에 따른 유행 동조성, 혁신성, 의복가치 차이에 관한 연구

장정임;윤지원;김수영;이규혜 한양대학교 2005 韓國 生活 科學 硏究 Vol.25 No.1

A change in economic and social environment has brought lots of changes in lifestyles and values of onsumers. This paper presents fashion conformity, innovativeness and clothing values of college students according to their academic majors. Respondents were 181 undergraduate students with diverse majors. The survey was conducted using a questionnaire designed to measure fashion conformity, innvativeness and utilitarian/hedonic clothing values. Seventeen items measuring fashion conformity and innovativeness and thirty six items measuring clothing values were adopted from existing studies. Chi-square, ANOVA, and multiple comparisons of means were conducted. Students were clustered into three groups of majors: Engineering/NaturalScience/Information majors (ENI), Business/Social/Humanity (BSH) majors and HumanEcology/Art/PhysicalEducation (HAP) majors. HAP majors were more innovative than ENI majors. Significant differences were found in hedonic and utilitarian aspects of clothing values. HAP majors had higher level of novelty/fun/attraction, fashion consciousness and social appraisal sensitivity dimensions. ENI majors showed higher level of comfort seeking among clothing values. No significance was found in clothing confidence, mix and match, economy, utility and handling dimensions of clothing values across different groups of majors. Results of this study imply that the consumer group according to a major has relation to fashion conformity, innovativeness and clothing values.

상악 제2유구치와 상악 제1대구치의 치관 형태: 치아계측학적 연구

김지인,현홍근,김영재,김정욱,장기택,이상훈,한세현,김종철 大韓小兒齒科學會 2011 大韓小兒齒科學會誌 Vol.38 No.4

The basic structure of the primary crowns usually resemble their succeeding permanent teeth. However, maxillary second primary molars resemble ipsilateral first permanent molars. Accordingly in this study, odontometric data of the two teeth was obtained, then analyzed to verify the morphological relationship and sex difference between the two teeth. Dental study casts were examined for their mesiodistal and buccolingual width of the crowns, diameter of each cusps, and intercuspal distances. Photographs of the crowns were taken to measure the angles between each cusp tip. The results are as follows : 1. In boys, PrI, PaI, DBC angle, and MBC angle did not show any statistically significant difference between the two teeth(p>0.05), and moderate level of correlations were observed. 2. In girls, crown index, DBC angle, and MBC angle of the two teeth did not show any statistically significant difference(p>0.05), and moderate level of correlations were recognized. 3. Measurements that did not show statistically significant difference between the two teeth in both boys and girls were DBC angle and MBC angle(p>0.05). In DLC angle, however, statistically significant difference was observed(p<0.01). 4. Most of the measurements showed sex differences, except DBC angle, which did not show any sex difference in both teeth(p>0.05). 유치 치관의 기본적인 구조는 대개 계승 영구치를 닮는다. 그러나 제2유구치는 계승 영구치인 제2소구치보다 오히려 제1대 구치와 더 유사한 경향이 있다. 이에 본 연구는 한국인에서 상악 제2유구치와 제1대구치의 치아계측학적 자료(odontometric data)를 얻어 두 치아의 형태와 크기 사이의 연관성을 살펴보고, 나아가 남녀간의 차이점 유무를 고찰해 보고자 하였다. 남아 150명, 여아 150명 총 300명의 모형을 이용하여 상악 제2유구치와 상악 제1대구치의 근원심 치관 폭경, 협설측 치관 폭경, 각 교두의 직경, 교두정간 거리를 계측하였고, 치관의 교합면 사진을 촬영하여 각 교두정 사이의 각도를 측정하여 다음과 같은 결과를 얻었다. 1. 남아에서 Protocone index, Paraconeindex, Distobuccal cusp(DBC)각, Mesiobuccal cusp(MBC)각은 상악 제1대 구치와 제2유구치 사이에 통계적 유의차가 관찰되지 않았고(p>0.05), 중등도의 상관관계가 확인되었다. 2. 여아에서 crown index, Distobuccal cusp(DBC)각, Mesiobuccal cusp(MBC)각은 상악 제1대구치와 제2유구치 사 이에 통계적 유의차가 관찰되지 않았고(p>0.05), 중등도의 상관관계가 확인되었다. 3. 남, 여 모두에서 Distobuccal cusp(DBC)각, Mesiobuccal cusp(MBC)각은 두 치아 사이에 유의할만한 차이를 보이 지 않았고(p>0.05), Distolingual cusp(DLC)각에서는 통계적 유의차가 관찰되었다(p<0.01). 4. 대부분의 계측치에서 남녀 차이를 나타냈지만, Distobuccal cusp (DBC)각은 상악 제1대구치와 제2유구치 모두에서 남녀 차이를 보이지 않았다(p>0.05).

2급 응급구조사의 성인외상환자에 대한 처치의 적절성 평가

장문수,어은경,김상현,김창섭,송근정,박한규,유지영,최동섭 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

In Korea, EMT have two classified subgroup of first and second degree : EMT-P, and EMT. For the beginning, authorization of the first EMT was made in this year through the EMT educational program. There are 8 items which EMT can perform the treatment without the supervision by a physician. But there was no previous report of pertinent assesment of treatment performed by the EMT. There upon authors have conducted review of assessment done by the EMT in EC setting, and proposed the following treatment application can be used by EMT at the field of accident. The study materials include adult trauma patient older than 15 years, and sustained trauma within 48 hours before visiting Ewha University DongDaeMoon Hospital Emergency Deparment. The duration of study was from Apr. 1 1995 to Aug. 31 1995. the study was conducted by 5 certified EMT. The EMT's performance was evaluated by the attending Emergency Medicine physician. The result were as followings ; 1. Among the total 5532 ED visiting patients during the study period, 1267 were adult trauma patients who recieved treatment within 48 hours of injury. 2. Among 1222 out of 1267 patients have completed performed survey. 3. Male to female ratio was 2.6 : 1, age distribution was from 15 to 87 years old and mean age was 34.6 years old. 4. The MOI showed : MVA (33.1%), blunt trauma (29.9%), slip down (16.8%), penetrating injury(15.4%), and miscellaneous (5.7 %), burn (3.1%), falling down injury(2.9 %), bite injury(1.1%) in order. 5. There were 437 cases of survey completed by the EMT. For assessment of mental status of 3 different method : AVPU, 5 scale mental status and GCS, were correlated with EM physician with 99.1%, 98.6%, 97.7 %, respectively. 6. For 320 out of 437 cases of survey completed, 319 patients recieved treatment by the EMT within 30 minute and 1 patient between 30 to 60 minute of an ED arrival. 7. For those 437 cases of survey completed, 266 patient (60.9%) had adequate treatment and 54 patients (12.4%) had inadequate treatment. 67 patient (15.3%) did not received treatment but it was adequate inway, and 50 patients (11.9%) did not received treatment even though patient required treatment. In cases of adult trauma patients, EMT's mental status assessment was correlated with EM physician's assessment. But treatment done by EMT without the supervision of EM physician was adequate only in 76.2 %. Therefore, continuous education and assessment of treatment performed by EMT in needed to improve field treatment by EMT future.

국소 진행된 식도암에서 방사선치료와 광역동치료의 병행 3예

장지영,박찬국 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Surgical resection has been the mainstay of therapy with curative intent in esophageal cancer. However, a large proportion of the esophageal cancer patients is detected with unresectable disease at the time of initial diagnosis. The survival outcome of radiotherapy alone was very poor although radiotherapy has been the major treatment modality in advanced esophageal cancer. We report the outcome of radiotherapy and photodynamic therapy in a multimodality approach for the treatment of patients with advanced esophageal cancer. Three patients with advanced esophageal cancer were treated with two-times photodynamic therapy 7-22 days before external beam radiotherapy. All patients had the middle thoracic lesion and squamous cell carcinoma. Total tumor dose of external beam radiotherapy delivered with curative intent was 55.8 Gy for 40-46 days. Significant toxicity during radiotherapy was not seen in all patients. The survival periods of 3 patients were 29, 12, and 27 months, respectively. Two out of three were alive at final follow-up. Radiotherapy and photodynamic therapy are the current modalities of palliating dysphagia and obstruction in esophageal cancer. This paper shows that the combination of radiotherapy and photodynamic therapy offers promising results for patients with advanced esophageal cancer.