연구논문 : 만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교

김선민 ( Sun Min Kim ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),노영욱 ( Young Wook Roh ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ),오영하 ( Young Ha Oh ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

목적: 만성 바이러스간질환에서 병의 경과와 예후를 평가하고 치료반응을 예측함에 있어 간섬유화의 진단은 중요하다. 최근 간섬유화 평가에 표준방법이지만 침습적 간생검을 대신하여 여러 가지 비침습적 진단법이 이용되고 있고, 또한 새로운 검사법들이 개발되고 있다. 저자들은 만성 B형 및 C형간염 환자를 대상으로 임상에서 광범위하게 흔히 시행하는 혈액검사와 임상 소견을 이용한 아래와 같은 진단법들만으로 간섬유화를 얼마나 정확하게 평가할 수 있는지 알아보고, 단일 검사로 간섬유화를 평가하는 데 유용하다고 알려져 있는 hyaluronic acid(HA)와 IV형 콜라겐 농도와 비교하여 그 임상적 유용성을 평가하였다. 대상과 방법: 2002년 3월부터 2007년 2월까지 만성 바이러스간 질환으로 간생검을 시행받은 225명의 환자(HBV 180명, HCV 43명, HBV+HCV 2명)를 대상으로 분석하였다. 간생검을 시행하는 날에 말초혈액검사, 혈액응고검사, 혈청생화학검사를 시행하고, 혈중 HA, IV형 콜라겐 농도를 측정하였다. 간섬유화의 정도는 F0(섬유화가 없음), F1(문맥역 섬유화), F2(문맥주변부 섬유화), F3(섬유성 격막) 및 F4(간경변증)의 4단계로 구분하였다. 대상 환자를 F0-1, F2-4 혹은 F0-2, F3-4의 두 집단으로 분류하여 두 집단을 구분하고자 할 때 AAR(AST/ALT ratio), API(age-platelet index), APRI(AST to platelet index), CDS(cirrhosis discriminant score), platelet count, HA, IV형 콜라겐의 예측능을 area under the receiver operating characteristic curve (AUROC)값을 이용하여 비교하였다. 결과: 대상환자의 섬유화의 단계는 F0 집단은 17명, F1 집단은 40명, F2 집단은 61명, F3 집단은 74명, F4 집단은 33명이었다. 의미 있는 간섬유화를 F2 이상으로 판단할 때, 의미 있는 섬유화의 예측에 대한 AUROC 값은 APRI=0.822, CDS=0.776, platelet count=0.773, API=0.756, HA=0.749, IV형 콜라겐=0.718, AAR=0.642 순이었고, F3 이상의 광범위한 섬유화 예측에 대한 AUROC값은 CDS=0.835, platelet count=0.795, API=0.794, HA=0.766, AAR=0.711, IV형 콜라겐=0.697, APRI=0.691 순으로 관찰되었다. 결론: 만성 바이러스간질환에서 간섬유화를 평가하는 데 임상 소견 및 혈액검사를 이용한 방법들이 비침습적 진단법 중 단독 검사로도 유용한 것으로 알려져 있는 혈중 HA와 IV형 콜라겐 농도와 비교하여 우월하거나 대등하였다. 특히 APRI는 다른 인자들에 비해 F2 이상의 의미 있는 섬유화를 예측하는 데 가장 유용하였고, CDS는 F3 이상의 광범위한 섬유화를 예측하는 데 가장 유용하였다. Background/Aims: The aim of this study was to determine the clinical performances of noninvasive serum markers for the prediction of liver fibrosis in chronic viral liver diseases. Methods: We analyzed a total of 225 patients with chronic viral liver diseases (180 with hepatitis B virus, 43 with hepatitis C virus, and 2 with hepatitis B+C virus) who underwent a liver biopsy procedure at the Hanyang University Guri Hospital between March 2002 and February 2007. Serum was also obtained at the time of liver biopsy. Liver fibrosis was staged according to the scoring system proposed by the Korean Study Group for the Pathology of Digestive Diseases. Various noninvasive serum markers were evaluated, including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP) index, AST/platelet ratio index (APRI), cirrhosis discriminant score (CDS), platelet count, hyaluronic acid (HA), and type IV collagen. Results: There were 17, 40, 61, 74, and 33 patients at stages F0, F1, F2, F3, and F4, respectively. The overall diagnostic accuracies of each marker, as determined by the area under receiver operating characteristics curves, were APRI=0.822, CDS=0.776, platelet count=0.773, AP index=0.756, HA=0.749, type IV collagen=0.718, and AAR=0.642 for predicting significant fibrosis (≥F2); and CDS=0.835, platelet count=0.795, AP index=0.794, HA=0.766, AAR=0.711, type IV collagen=0.697, and APRI=0.691 for predicting extensive fibrosis (≥F3). Conclusions: Conclusions: All noninvasive serum markers evaluated in this study were useful for predicting significant or extensive liver fibrosis in chronic viral liver diseases. In particular, APRI was most useful for the prediction of significant fibrosis, and CDS was most useful for the prediction of extensive fibrosis. (Korean J Hepatol 2009;15:454-463)

초·중·고등학교 학생·학부모·일반교사의 보건교육 영역별 요구도와 보건교육

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2005 韓國學校保健學會誌 Vol.18 No.1

Purpose: The purpose of this study was to identify the needs of health education in students, their parents and teachers in the elementary, middle and high schools and the current situation of health education class. Method: The subjects of this study were a total of 9450 persons including students, their parents and teachers from 279 schools throughout the country. They were selected through convenient sampling. Data were analyzed through x^(2)­test and ANOVA. Result: Students, their parents and teachers replied that 18 dimensions of health education class (DHEC) are necessary. The four DHEC - healthier life style, sex education, mental health and safety education - showed high educational needs in students, their parents, and teacher. High school students had higher educational need of 'symptom management for daily living' than elementary and middle school students. Students, their parents and teachers in elementary school had higher educational needs of 17 DHEC that those in middle and high school. The percentages of schools with health education class taught by health teachers were 99.2%, 75.5% and 66.0% respectively in elementary, middle and high schools. Health education was given mainly using physical education classes at elementary schools, and creative class hours at middle and high schools. In general, health education took 1-3 hours per week at elementary schools, and less than an hour at middle and high schools. Conclusion: Therefore, based on the results, systematic health education class should begin from elementary school to meet the need of health education in students, their parents and teachers, and further study should be made on the number of hours required and the amount of contents of 18 DHEC.

초·중·고등학교 학생, 학부모, 일반교사의 보건교육 요구

윤순녕,김영임,최정명,조희순,김영희,박영남,오경순,이분옥,조선녀,조소영,한선희,하영미 韓國學校保健學會 2004 韓國學校保健學會誌 Vol.17 No.2

Purpose : The purpose of this study was to identify needs of health education of the students, parents, general teachers, and health teacher of the elementary, middle, and high schools. Method : 279 schools of elementary, middle, and high school were sampled nonproportionally during the period from June 28 to July 26, 2004 . The data were collected by the questionnaire from 1,888 students, 1,876 parents, 1,695 general teachers, 279 health teachers. A frequency, % and χ2-test were used to analysis by SAS program. Result : 1. It showed that 98.1% of elementary school students, 92.3% of middle school students, 89.6% of high school students answered that they need health education. The most of students, parents, and general teachers had high interests in health education. 2. In the case of students, main causes of needs of health education was 'to prevent diseases or accidents''. But parents answered that it was 'to build up a healthier behavior'. General teachers answered that it was 'more effective systematic and continuous health education'. 3. Over 80% of students, parents, and general teachers about the question of who qualified person is to teach health education as a regular class responded that health teacher is available. Especially 93% of elementary school students answered like that. 4. The most of students, parents, and general teachers answered that health education in the classroom is favorable 1 to 2 hours per week. Conclusion : As results of the study , the majority of students, parents, general teachers agreed needs of health education. Therefore, on the basis of this study, systematic and continuous health education is necessary. Additionally the establishment of independent health subject is required certainly.

간암 환자에 합병된 Citrobacter braakii 패혈증 1례 보고

이해미,배성하,이수남,이정우,신아영,류시영,이수연,윤문희,한선영,한남익,이영석,유진홍 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Citrobacter species is a gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. Citrobacter braakii refers to the genomospecies 6 of the Citrobacter freundii complex. There are no detailed studies on infections caused by this newly identified specific genetic species in Korea. We herein report a case of a patient with hepatocellular carcinoma who, after undergoing transcatheter arterial chemoembolization, developed biloma which later progressed to C.braakii sepsis and did not respond to treatment. To our knowledge, this is the first reported case in Korea on C. braakii infection resulting in septic shock in a patient with malignancy in Korea.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

2010 해남, 평창, 원주지역 갈대 등 야초류의 이용실태와 사료가치 평가

서성(Sung Seo),한대덕(Dae Duk Han),장선식(Sun Sik Jang),김원호(Won Ho Kim),정민웅(Min Woong Jung),최진혁(Jin Hyuck Choi),김진숙(Jin Sook Kim),김하영(Ha Young Kim),이종경(Joung Kyong Lee) 한국초지조사료학회 2012 한국초지조사료학회지 Vol.32 No.1

본 연구는 부존 조사료자원 이용으로 수입사료를 줄이고 사료비를 절감하고자 2010년도에 전남 해남(간척지), 강원 평창(강변), 원주(섬강변), 전남 영광(와탄강변) 등 4개 지역에서 갈대와 억새 등 야초 자생지를 탐색하고, 수확·이용실태 조사와 함께 사료가치를 분석하였다. 전남 해남 해남목장 내 갈대(Phragmites communis) 위주의 야초 자생지는 300 ha로 예년에는 2회 곤포작업하여 연간 사일리지로 2,300~2,500톤(ha당 8톤)을 생산하였으나 2010년도는 1회 곤포조제로 사일리지 2,000톤(ha당 7톤)을 생산하였다. 유통가격은 롤 당 53천원으로 ㎏당 110원이었다. 곤포는 전량 자가소비하며, 외부 작업단에 롤 당 26천원의 작업비를 지불하였다. 연간 조수입은 2억 2,260만원이며, 소득은 1억원 수준(345천원/ha)이었다. 초장 150 ㎝의 갈대는 조단백질 8.4%, 상대사료가치 71.9 (건초 5등급), 건물 소화율 60.1%로 사료가치는 볏짚에 비해 약간 나은 것으로 평가되었다. 갈대 사일리지의 사료가치와 유기산 함량은 동일 지역에서 동일한 재료로 사일리지를 조제하더라도 수확시기에 따라 차이가 컸으며(CP 4.7~6.4%, RFV 62.2~78.9, 건물 소화율 41.9~53.9%), 갈대 사일리지의 품질은 수단그라스에 비해 불량하였다. 강원 평창 강변 자생갈대의 사료가치는 초장이 79, 117, 121, 142㎝로 생육이 진행됨에 따라 낮아져, 조단백질은 각각 13.9%에서 7.6%로, 상대사료가치는 90.7 (건초 3등급)에서 76.1 (건초 4등급)로, 건물 소화율은 72.9%에서 54.7%로 감소하였다. 원주 섬강 주변 야초류는 곤포수확 작업에 어려움이 있었으며, 초장 130 cm의 갈대는 조단백질 8.5%, 상대사료가치 82.3 (건초 4등급), 건물 소화율 70.2%로 사료가치는 높았으며, 220㎝의 성숙한 갈대는 조단백질 10.2%, 상대사료가치 65.1 (건초 5등급), 건물 소화율 48.9%로 볏짚 대비 조금 나은 것으로 평가되었다. 전남영광지역에서는 와탄천 주변에 자생하는 갈대를 수거 이용하고자 시도하였으나 경제성이 없어 중단하였다. 이상의 결과를 종합하여볼 때, 갈대, 억새 등 야초류는 현 상태에서 최대한 수거·이용하되, 사료가치를 유지하고 가축 기호성이 양호한 시기에 수확하는 것이 중요하며, 최소한 볏짚과 비슷하거나 그 이상의 사료가치를 기대하기 위해서는 7월 중순 이전(늦어도 7월까지)에 수확·이용하는 것이 권장된다. This study was carried out in 2010 to investigate the utilization and forage quality of native grasses, such as Phragmites communis which might reduce the cost of feeding domestic cattle. The regions surveyed were the Haenam ranch in Haenam, Pyeongchang, Wonju, and Yeonggwang. In Haenam, yearly silage production harvested from 300 ha was 2,000 MT (7 MT/ha). All of those round bale silages were self-consumed in that region, and marketing price was 50,000 55,000 won per roll (110 won/㎏). Phragmites communis of 150 ㎝ in length contained 8.4% crude protein (CP) with relative feed value (RFV) 71.9 and 60.1% in vitro dry matter digestibility (IVDMD), which was somewhat more favorable than forage quality of rice straw. The silage quality of Phragmites communis varied greatly by the time of harvest (CP 4.7 6.4%, RFV 62.2 78.9, and IVDMD 41.9 53.9%), even with the same district and of the same original forage materials. Generally, the quality of Phragmites communis silage of was poorer than that of sorghum * sudangrass hybrid. In Pyeongchang, forage quality of Phragmites communis was decreased from 13.9% to 7.6% in CP, 90.7 to 76.1 in RFV, and 72.9% to 54.7% in IVDMD, as plant was getting mature, from 79 ㎝ to 117 ㎝, 121 ㎝ or to 142 ㎝ in length. In Wonju, the quality values of Phragmites communis of 130 ㎝ in length were 8.5% CP, 82.3 RFV and 70.2% IVDMD, while those of matured grasses of 220 ㎝ in length were lower (10.2% CP, 65.1 RFV and 48.9% IVDMD), but this was a little more favorable than quality of rice straw. In Yeonggwang, feeding Phragmites communis was tried in a Hanwoo feed, but stopped due to low profitability. In conclusion, the overall quality of most native grasses including Phragmites communis in this survey was poor. Therefore, we recommend that Phragmites communis and native grasses should be harvested on June or July to obtain richer forage quality in forage values than rice straw.

냉전과 한국

하영선 서울大學校 附設 國際問題硏究所 1986 論文集 Vol.- No.10

In this paper, the author discusses three inter-related topics, namely the most recent trend in the study of the Cold War, the origin of the Cold War on the Korean Peninsula, and the various responses to the imposition of the Cold War "logic" upon the Korean Peninsula. The purpose of the discussion is to understand the nature of the impact of the postwar Cold War system upon the Korea's political life. As the result of the discussion, the author arrives at some tentative conclusions as below: (1) The trend in the study of the Cold War in 1970s is represented by the "postrevisionsm," which has attempted to synthesize the traditionalist arguments in 1950s and the revisionist perspectives in 1960s. In 1980s there has emerged a new critique of the "postrevisionsm" in the 1970s. This new perspective could be applied to the study in the Cold War in Korea. (2) The arguments put forward by Bruce Cumings on the origins of Korean War, which would represent the revisionist perspectives on the issue, is not persuasive in terms of the interpretation of empirical data. In other words, it seems more appropriate to view that the Cold War in Korea has developed on a full scale as an aftermath of the Korean War rather than to argue that the Korean War is the product of the Cold War on the Korean Peninsula. (3) The international political orientations of the major political forces in Korea, including both the rightists and leftists, have been more or less same in that all of them had been pro-American and pro-Soviet immediately after the liberation from Japan. However, a division had evolved thereafter along the widening schism between the United States and the Soviet Union. Whatever their exact international alignments may have been, they all failed in resisting the systemic pressures of the international power structure upon the domestic politics.

폭력외교연구 : 현대 외교에 있어서 군사력의 역할 The Role of Military Forces in the Contemporary Diplomacy

하영선 서울大學校 附設 國際問題硏究所 1984 論文集 Vol.- No.8

The main purpose of this paper is to examine the role of violence in the contemporary diplomacy. The "pure" diplomacy between two actors can be defined as a nonviolent act of negotiation to maximize their interests. However, the "real" diplomacy in the contemporary world order has to use violent and nonviolent means for its ends. The diplomacy of violence is thus an essential part of the contemporary diplomacy. The united States has used military forces short of war as An instrument of diplomacy on 215 occasions between 1946 and 1975. In Parallel, the Soviet Union Las employed its military forces in 190 incidents for political purposes during the years of 1944∼1979. Although the importance of military forces in the contemporary diplomacy has been partially declined in parallel with the changing nature of the world order,'the role of violence in the contemporary diplomacy. which is directly related with the structural weakness of the world order, cannot be easily declined in the near future.

사과의 品質 等級化에 關한 硏究

하영선,김수일 대구대학교 과학기술연구소 1996 科學技術硏究 Vol.3 No.2

This study reveals the following problems and improvements of the Shipment Standards for Agricultural Products and the paternal grading methods. In order to compete in the global markets by the quality standardization of apples, we recommended to avoid paternal grading methods and to increase the numbers of packing houses, which will lead the resonable price-setting process depending on the different quality of each apples. We suggest that the existing shipment standards and grading methods for apples should be reviewed to satisfy both grower and consumer needs

중공의 핵무기와 세계질서

하영선 서울대학교 사회과학연구소 1981 社會科學과政策硏究 Vol.3 No.2