백서 심근경색모델에서 시간경과와 경색의 크기에 따른 심자도의 변화

김미성(Mi Sung Kim),박영선(Young Sun Park),권순길(Sun Gil Kwon),지정훈(Jeong Hoon Ji),신종성(Jong Sung Shin),오광식(Kwang Sik Oh),양용모(Yong Mo Yang),연태진(Tae Jin Youn),김동운(Dong Woon Kim),조명찬(Myeong Chan Cho),이용호(Yong Ho 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Magnetocardiogram (MCG), which records the changes of magnetic fields generated by the heart`s electrical activity, theoritically can provide unique data for clinical application. To date, MCG has been investigated only at a single time point after myocardial infarction (MI) with severe left ventricular dysfunction in rats. The purpose of the present study was to investigate sequential changes of MCG after MI and to evaluate effects of infarct size on MCG. Methods: Acute MI were induced by the permanent ligation of left coronary artery in 22 rats. Magnetic fields were recorded just above a rat with Nb Superconducting Quantum Interference Device (SQUID) gradiometer inside a magnetically shielded room. MCG was measured before and immediately after surgery and it was subsequently recorded at the time points of 1, 4 and 6 hours post operatively. MCG was also measured at 1, 3, 7 and 21 days after surgery. Results: Elevation of ST segment and appearance of pathological Q wave on the MCG were evident immediately after the ligation of coronary artery and persisted to 6 hours after MI. On MCG, ST segment was depressed and T wave was inverted from 1 day after MI. In rats with small-and moderate- sized MI (infarct size〈30%), ST depression returned to near the isoelectric level and Q wave disappeared from 7 days after MI. However, ST depression and Q wave were still present in rats with larger infarct (infarct size≥30%). Conclusion: Evolutional changes of MCG were well-recognized up to 21 days after MI. Furthermore, the infarct size can be expressed by the extent of Q wave and ST segment depression on MCG. Taken together, these data indicate that MCG is a helpful modality for the diagnosis, evaluation of infarct size and follow up after MI.(Korean J Med 62:42-48, 2002)

심근경색의 위험인자로서 Thrombomodulin유전자변이의 의의

박현영,김영미,권혁문,지선하,조승연,정남식,심원흠,장양수 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.6

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

심근경색 모델 흰쥐에서 스트레스가 B-type Natriuretic Peptide 발현 및 심박변이율 변화에 미치는 영향

이삼윤(Sam Youn Lee),이미경(Mi Kyoung Lee),김남호(Nam-ho Kim),주민철(Min Cheol Joo),조항정(Hyang Jeong Jo),강지숙(Ji Sook Kang),김병숙(Byung Sook Kim),윤선식(Sun Sik Yoon),최을식(Eul Sig Choi),이문영(Moon Young Lee) 대한스트레스학회 2010 스트레스硏究 Vol.18 No.3

심박변이율의 감소는 심근 경색 환자에서 예후의 악화와 관련되어 있다. 심박변이율 중 very low frequency가 심부전환자의 예후를 판단할 수 있는 독립적 인자로서 사용이 가능하다고 보고된 바 있으며, 심실의 압력 증가에 반응해서 생성되는 B-type natriuretic peptide가 심근 경색의 예후 인자로서 사용할 수 있음 역시 보고된 바 있다. 본 연구에서는 심근경색 모델을 제작하여 일정의 회복 기간을 거친 다음 다시 일정 기간의 스트레스를 겪게 한 후 심박변이율의 변화 및 심실 조직에서의 BNP 발현 정도를 비교하여 스트레스에 의한 영향을 관찰하고자 하였다. Sprague-Dawley계 수컷 흰쥐 15마리를 대상으로 하였다. 실험동물은 인위적 스트레스 및 수술을 받지 않은 대조군(CON, n=5), 심근경색 수술을 받은 후 restraint stress를 받지 않은 군(MI+No Stress, n=5), 심근경색 수술을 받은 후 1주일 동안 restraint stress를 받은 군(MI+Stress, n=5)으로 분류하였다. 심근경색 모델 제작 직후 15분 이상 심전도의 변화를 기록하였으며, 2개월 정도 후 심근경색 수술을 받은 동물을 두 군으로 나누어 그 중 한 군에는 1주일 동안 restraint stress를 가한 후 restraint stress를 가하지 않은 동물과 심박변이율을 비교 분석하였다. 심실 조직은 좌심실 전벽 부위의 위축을 관찰할 수 있었고, 대식세포에 의하여 응고, 괴사된 심근세포의 탐식과 혈관이 풍부한 육아조직 및 섬유 변화를 볼 수 있었다. 심박변이율은 심근경색 수술을 받은 직후 심박수는 유의한 증가를 보였고, standard deviation of the normal to normal intervals (SDNN), very low frequency (VLF) 및 low frequency (LF)의 유의한 감소를 보였다. 심근경색 수술을 받았던 동물에서 두 달 정도의 회복 기간을 거친 후 스트레스를 받지 않은 군은 심박수 및 기타 심박변이율 분석에서 SDNN 값을 제외하고는 정상군과 유의한 차이를 관찰할 수 없었던 반면 1주일 동안 스트레스를 받은 군에서는 심박수가 다시 유의하게 증가했을 뿐만 아니라 SDNN, VLF 및 LF 역시 정상군과 유의한 차이를 보였다. 이상의 결과를 종합하면 심근경색 동물에 대해 1주일 동안 스트레스를 가한 결과 심박변이율이 감소하고 심실에서의 BNP 발현은 더욱 증가하여 악화함을 보여주고 있다. Diminished heart rate variability (HRV) is associated with less favorable prognosis after myocardial infarction (MI). It has been reported that very low frequency (VLF) power in HRV analysis is an independent risk predictor in patients with congestive heart failure and B-type natriuretic peptide (BNP) can be used as a prognostic factor of MI. The purpose of this study was to investigate whether stress has an effect to the changes of BNP expression and/or heart rate variability in MI model in rats. Male Sprague-Dawley rats were divided into 3 groups: control group (CON), MI group (MI+No Stress), and MI followed by stress group (MI+Stress). MI+Stress group rats were raised for a two month recovery period after the operation, followed by being exposed to restraint stress for 2 hours per day for 1 week. Electrocardiogram was recorded after the operation and the last day after 1 week of stress. The frequency components of HRV were calculated in the frequency domain such as VLF, low frequency (LF), high frequency (HF) and so on. In HRV analysis, standard deviation of the normal to normal intervals (SDNN) was significantly reduced in both groups compared to the control group. VLF and LF also were significantly reduced in MI+Stress group compared to the control groups. In addition, BNP expression in western blotting was shown the strongest bands in MI+ Stress group among experimental groups. These results suggest that BNP and HRV were aggravated by stress in MI rat model. (Korean J Str Res 2010;18:275∼285)

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.

유도 '되치기 본'의 개선 방안에 관한 연구

김의환,김도준,김규수,김관현,김종달,최종삼,조용철,박순진,윤익선,안병근,정 훈,김미정,한성철 龍仁大學校 武道硏究所 1999 武道硏究所誌 Vol.10 No.1

The purpose of this study was to reform practically a Korean Judo's Doechigi-Bon(Forms of Counterattack, judo's Gaeshi no Kata, Judo's Uradori no Kata, Judo's Gonosen no Kata) that was established in 1955 Korea, according to changing of techniques by Judo's modernization, in order to have Judo's carefulness and systematic diffusion. Reform procedure of Judo's Doechigi-Bon was 1st stage, Questionnaire survey 303 judokas, 2nd stage, Technical seminar by judo experts(12 judo professor) 4 times, 3rd stage, wording report for reform, 4rd stage, Discussion and judgement of Teaching and Judgement commission of Korean judo Association(KJA), 5th stage, Public hearing for reform in KJA, 6th stage, Report and decision of board of directors in KJA, 7th stage, public publication of Judo News(No.53) in KJA. Basic principle of reform of Judo's Doechigi-Bon were as table 1. Table 1. Basic principle of reform of Judo's Doechigi-Bon ------------------------------------------------------------------------------- Items Reformed Key Points of Judo's Doechigi-Bon ------------------------------------------------------------------------------- 1. Structure 1) Grand classification : Classified by 3 parts(1,2,3Gyo) 2)Medium classification : Te waza, Goshi waza, Ashi waza devided per each part(Gyo) 3)Sub-classification : Classified five techniques per each part(Gyo) 2. Contents 1) Selected established techniques as possible 2) Considered rationalty and overlapping of counterattack techniques 3. Decision of Conterattack techniques 1) Refered to results of Basic Questionnaire survey 2) Priority to decisions of Judo expert technical seminar -------------------------------------------------------------------------------- Reformed Korean Judo's Doechigi-Bon(Forms of Counterattack techniques-KJA, 1999) are as follows: 1. Gyo; ① Uki otoshi -> Uchi mata ② Harai goshi -> Harai goshi gaeshi ③ O soto gari -> O soto gake ④ Ko uchi gari -> Sasae tsurikomi ashi ⑤ O uchi gari -> Ko soto gari 2. Gyo; ① Ippon seoi nage -> Okuri eri jime ② Tsuri domi goshi -> Uki waza ③ Okuri ashi harai -> Okuri ashi harai ④ Ko soto gari -> Tai otoshi ⑤ Hiza guruma -> Hiza guruma 3. Gyo; ① Kata guruma -> Sumi gaeshi ② Tai otoshi -> Ko soto gari ③ Hane goshi -> Harai tsurikomi ashi ④ Uchi mata -> Tai otoshi ⑤ Tomoe nage -> O uchi gari

신규간호사와 프리셉터가 인지하는 프리셉터의 교수효율성 비교

김지양,김영선,김춘실,박현숙,신미영,윤연숙,조유숙,박미미,유문숙 한국간호과학회 간호행정학회 2009 간호행정학회지 Vol.15 No.2

Objective: The purpose of this study was to compare preceptors and new graduate nurses on their perception of preceptor teaching effectiveness. Methods: The participants were 90 new nurses and 90 preceptors who worked in A medical center. The data were collected from July 1 to September 30, 2008. A cross-sectional descriptive survey was done using a structured questionnaire. Results: New nurses' perception (4.07±.44) of the preceptor teaching effectiveness was significantly higher than perception of the preceptors (3.57±.37). Fifty five percent of new graduate nurses reported a lack of coherence in the preceptor's practice guidelines. For 5 causal factors classified on the teaching effectiveness, the factor of 'Professional knowledge and ability' showed the highest score, but 'Interpersonal and communication skill' got lowest score for both group. Preceptors responded that they did not have enough time to teach well because of their heavy workloads. Conclusions: These results suggest that the preceptors need appropriate compensation and education opportunities, and new graduate nurses need consistent education by the teaching professionals. Therefore, it is important to give preceptors full charge of the preceptorship. Also, it will be necessary to develop education programs to enhance interpersonal and communication skill for preceptors and new nurses.

ATHB12, an ABA-lnducible Homeodomain-Leucine Zipper (HD-Zip) Protein of Arabidopsis, Negatively Regulates the Growth of the Inflorescence Stem by Decreasing the Expression of a Gibberellin 20-Oxidase Gene

Ora Son,허윤선,김윤경,이현정,김성한,김미란,남경희,이명석,김부용,박종범,박정안,이석찬,Atsushi Hanada,Shinjiro Yamaguchi,이인정,김승기,윤대진,Eva So¨derman,천충일 Sookmyung Women's University Research Institute of 2010 여성과 건강 Vol.6 No.1

자료포락분석(DEA)를 이용한 보건의료의 효율성 측정

김남송,박홍섭,김은진,김설화,김정숙,김현아,김경숙,신지혜,최은정,양은진,유선미,유수진 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

대동맥 협착증과 동반된 출혈성 위장관 동정맥 기형에서 Estrogen-Progesterone 치료 1예

김도연,김화정,김효정,남준식,박수영,박영미,신정은,주미순,황민규,정혜경,손혜영,이선영,이한주 大韓消化器內視鏡學會 1999 Clinical Endoscopy Vol.19 No.부록2