뇌졸중 환자의 일상생활동작, 우울과 삶의 질의 관계

김원옥 ( Won Ock Kim ),강현숙 ( Hyun Sook Kang ),왕명자 ( Jmyung Ja Wang ),김정화 ( Jeong Hwa Kim ),최진이 ( Jin Yi Choi ) 경희대학교 동서의학연구소 2007 동서간호학연구지 Vol.13 No.2

본 연구는 뇌졸중 환자의 일상생활동작, 우울, 삶의 질의 관계를 파악하고자 하는 서술적 조사 연구로서 일상생활동작,’ 우울, 삶의 질 정효〉 관계가 있음을 확인하였다. 그러므로 본 안구의 주요한 결과를 중심으로 다음과 같이 고찰하였다. 뇌졸중 환자들의 일상활동 수행능력을 측정하는 도 구로 FIM, Modificd Barthel Index (MBI) 등이 많이 쓰 이고 있는데 FIM은 분야에 상관없이 표준화를 통한 높은 실용성,실행성, 이해도로· 인하여 널리 사. 하고 있는 도구로 이를 이용하여 측정한 본 연구에서는 872점으로 국내에서 만성 뇌졸중 환자와 퇴원 시 뇌졸중 환자를 대상으로 측정한 85. 9점 (Hw떼g, 2004) 과 85. 3점 (Kim, 2004) , 85. 8점 (Hong et al., 1998) 에 비하 여 약간 높아졌으나 비슷하였고, 일본 뇌졸중 환자를 대상으로 한 연구의 77. 1점보다는 높은 결과이었다 (Hama et al., 2007) . 특히 하부역역인 운동영역은 다 른 연구에 비해 높았으나 인지영역은 다른 연구에 비 해 낮은 편이었다 (Hwang, 2004二 Hama et al. , 2007, Hong 嫩 al. , 200긱 Kim, 2004) . 미국의 지역사회시설 에 있는 뇌졸중이 처음 발병한 환자들을 대상으로 재 활 후 5년간 환자를 추적한 연구에서 3년 후까지는 FIM점수가 상승하였으나 그 이후 감소되는 양상을 보였고 본 연구에서는 친단 후 경과 기간이 35.5개월 (87.2점)로 퇴원 후 3년 된 시점의 결과no도4점) 와 비교하였을 때 낮은 편이었다〈 Leonard, Mnler, Griffiths, Mcclatchie, & wherry, 1998) . 이러한 결과는 지역사 회와 집에서 간호를 받고 있는 뇌졸중 환자들에게 지속적인 재활 프로그램의 필요성이 높다는 것을 시사 한다고 볼 수 있다. 그러므로 입원을 한 직후부티 환 자에게 적절한 재활프로그램을 계획하여 시작하고 퇴원 후에는 연계되어 재활을 받을 수 있는 시설과 연결하여 환자가 지속적으로 재활을 할 수 있도록 돕는 병원과 지역사회가 공동으로 개발하고 시행하는 개활프로그램이 필요하다. 우울은 뇌졸중을 진단 받은 환자들의 급성기와 회 복기에 많이 동반되는 증상으로 본 연구에서도 CES- D를 이용하여 우울을 측정한 결과 23. 8점으로 Bak (2003) 의 연구와 비슷한 정도로 높게 측정되어 이 전의 연구결과와 같이 뇌졸중 환자의 가장 흔한 후유 증이 우울임을 다시 확인할 수 있었다 (Cho et al. 2003, `` Chon & Rhee, 1992, `` Kim, 2005, `` Kim, Seo, & Kang, 2000; singh et al. , 2000) . 그러므로 입원 시부터 신체적인 증상 뿐 아니라 우울도 같이 사정하고 우울이 진행되지 않도록 지속적인 관찰과 정서적인 간호가 뇌졸중 환자를 위한 재활프로그램에 포함이 되어야 한다. 삶의 질은 3 ``03점으로 뇌졸중 환자 l이명을 대상으로 한 chung (2000) 의 연구에서 의 3. 41점보다는 낮았으나 Kim과 Kim (2003) 의 연구의 3. 17점과는 비슷하였고 전체적으로 낮은 편이었다. 이런 결과는 최근 의학기술의 발전으로 뇌졸중으로 인한 사망률이 감소 되고 만성적인 뇌졸중 환자가 증가함에도 불구하고 재가뇌졸중 환자들에 대한 재활과 관리가 효과적으로 이루어지지 않고 있음으로 확인할 수 있었다. 따라서 뇌졸중과 삶의 질은 단기간에 향상되는 것이 아니므로 개활 프로그램이 단기적인 것보다는 체계적으로 계획되고 지속적으로 수행되어져 삶의 질을 관찰하는 연구가 필요할 것으로 생각된다. 또한 일상생활 동작을 잘 할수록 우울점수가 낮게 나타났고 삶의 질 정도가 높게 나타났다. 그리고 우 울 정도가 심할수록 삶의 질 정도가 낮은 것으로 나타났다. 뇌졸중 환자들에 대한 선행연구결과들을 살 펴보면 뇌졸중은 일상생활동작 수행과 같은 신체적인 문제, 우울, 대인관계 감소 등의 사회적 문제가 발생 되고 장기적인 치료와 간호를 요구하는 질병으로서 최종적으로. 삶의 질이 저하되는 것을 보고하고 있다 (Chung, 2000; Hama et al. , 2007, `` Ingrid, Kwakkel, Bruin, & Lindeman, 2007; Khan, 2004; Kim & Kim, 2003; singh et al. , 2007) . 이러한 연구 결과는 일상생활동작, 우울, 삶의 질이 단계적으로 순환되는 관계로 서 모두 뇌졸중환자를 위한 재활프로그램 내용에 포함되어야 함을 의미한다. 이런 연구결과들을 종합하여 볼 때 뇌졸중은 환자 의 뇌손상을 일으켜 장기적인 우울과 신체적인 기능 장애를 발생시킬 가능성이 높으므로 뇌졸중 환자의 재활프로그램은 입원을 하자마자 계획하여 치료와 동 시에 시작하고 특히 우울은 뇌졸중의 만성적인 건강 문제로 재활과정을 방해할 수 있으므로 신체적인 중 재와 더불어 정서적인 중재를 포함한 포괄적인 내용 의 프로그램이 바람직하고 장기적으로 삶의 질을 평 가함이 바랑직할 것이다. 또한 뇌졸중은 장기적인 재 활이 요구되는 질환이므로 단기간의 재활 프로그램을 병원에서만 시행하는 것이 아니라 퇴원 후 병원과 지 역 사회에서 연계하여 치료적인 연속성을 가지고 유지 할 수 있는 재활 프로그램의 개발이 반드시 필요할 것이 라고 본다. Introduction: The purpose of this study was to examine relationships among stroke patients`` activities of daily living(ADL), depression, and quality of life(QOL). Methods: Data were collected by questionnaires from 251 stroke patients at 5 hospitals and 2 public health centers in Seoul and Kyonggi-Do. The following Questionnaires were utilized for this study: Functional independence measure(FIM) from Grange, Hamilton, and Sherwin(1986), the Korean CES-D scale from Randloff(1977), and quality of life scale from Bang, Hwal-Lan(1991). Results: Data were analyzed using the pearson correlation, t-test, and ANOVA with SPSS/WIN 12.0. The results of this study were as follow; The subjects consisted of 110 females and 141 males. The mean score of activity of daily living was 87.2(range 18-126). Age, family history, comorbidity, paralysis site, and duration after diagnosis were significantly associated with activity of daily living. The mean score of depression was 23.8(range 11-44). Age, gender, education, and job were significantly associated with depression. The mean score of quality of life scale was 3.0(range 1-5). Gender, religion, education, job, economic status, and duration after diagnosis were significantly associated with quality of life. Relationships among activity daily living, depression, and quality of life scale: The activity of daily living had a negative relationship with depression score. The activity of daily living had a positive relationship with QOL score. The depression had a negative relationship with QOL score. Conclusion: Based on these results, it is necessary to run rehabilitation programs to improve stroke patients`` ADL, depression. Also, it research for of identifying stroke patients`` quality of life according to rehabilitation program.

수술환자에 있어 수술실내에서 수술대기 시간이 불안에 미치는 영향에 관한 연구

이혜원,이규정,김해옥,이해옥,김혜숙,이미경,송말순,Lee, Hea-Won,Lee, Kyu-Chung,Kim, Hae-Ock,Lee, Haik-Ock,Kim, Hea-Suk,Lee, Mi-Kyung,Song, Mal-Soon 대한간호협회 1990 대한간호 Vol.29 No.3

This study was attempted to provide us with basic information on how to improve understanding with patients for operation, and to offer then better nursing and treatment. This kind of study will help scientific application to nursing practice and operating room. The data was collected by interviewing 29 patients who underwent the elective surgery under the general anesthesia at Y hospital in Seoul. The interview ran from October 15 to December 15, 1989. The research instrument was a anxiety measurement device (SAAI) originally developed by Spielberger, et al and modified by Jung-Tack Kim. 1. Hypothesis Testing Hypothesis one was that there would be a difference in state anxiety level according to a time difference in watiting for operation. This hypothesis was rejected(state.anxiety level one hour before operation P>.05, r-.747, State anxiety level half an hour before operation P>.05, r-.1550, state anxiety level just before operation, P>.05, r=.1099). However, state anxiety, evel appeared to be associated with a longer watiting period, like one day before operation (P<.05, r-.4628). Hypothesis two was that there would be a difference according to state anxiety level of patients for operation. This was rejected. (Change of blood perssure in systolie P>.05 r=.1082, Change of blood pressure in diastolic P>.05, r=.088, Change of pulse rate, P>.05, r-1.909) 2. Examining trait anxiety and state anxiety levels, the average level of trait anxiety was 42.034, and the average level of state anxiety one day before operation was 43,000. The average level of state anxiety was averaged 42.356 in a waiting room for operation. 3. Examining the state anxiety level by time period, the one hour before was 42.379 the level half an hour before 42.276, and the level just before operation 42.414. The low level of state anxiety was due to the fact that premedication was not eliminated. 4. Age and time period like one day before operation was related to state anxiety level (F=5.271, P<.0.01) and blood pressure in waiting room for operation. That is, state anxiety level and blood pressure of patients one day before operation appeared high. Sex was relation to changes of blood pressure ; the blood pressure of male patients appeard higer than of female patients. A marital status was also related anxiety level one hour before operation the married patient for operation showed a higher state anxiety level than that of the unmarried patient for operation. Education was similarily related to trait anxiety level in which highly educated patients show lower levels of trait anxiety than poorly educated ones. Motive for hospitalization was related to state anxiety level for patient one hour before operation (F=6.464, P<.05) likewise, patients who are supposed to undergo operation hastily showed higher levels of anxiety than patients who expect elective surgeries.

Association between ABCB1 Polymorphisms and Ischemic Stroke in Korean Population

Kim, Young-Ock,Kim, Seung-Yu,Yun, Dong Hwan,Lee, Sang-Won The Korean Society for Brain and Neural Science 2012 Experimental Neurobiology Vol.21 No.4

<P>Neuronal expression of ATP-binding cassette, sub-family B (MDR/TAP), member 1 (ABCB1) has been demonstrated after brain ischemia. To investigate whether ABCB1 polymorphisms are associated with the development, risk factors (hypertension, dyslipidemia, and diabetes mellitus), severity (National Institutes of Health Stroke Scale, NIHSS), and sequelae (Modified Barthel Index, MBI) of ischemic stroke (IS), four single nucleotide polymorphisms (SNPs) of the ABCB1 gene [rs4148727, promoter, -154T>C; rs3213619, 5'-untranslation region (5'UTR), -129T>C); rs1128503, synonymous, Gly412 (C>T); rs3842, 3'UTR, A>G] were analyzed in 121 IS patients and 291 control subjects. SNPStats and SPSS 18.0 were used to obtain odds ratios (OR), 95% confidence intervals (CI), and p values. Multiple logistic regression models (codominant1, codominant2, dominant, recessive, and log-additive models) were applied to analyze the genetic data. The rs3842 SNP was weakly associated with the development of IS (p=0.020 in codominant1 model and p=0.028 in dominant model). In the analysis of clinical phenotypes, ABCB1 polymorphisms were nominally associated with hypertension (rs3213619 and rs3842, p<0.05), dyslipidemia (rs1128503, p<0.05), diabetes (rs3842, p<0.05), and NIHSS (rs4148727, p<0.05). Interestingly, rs3842 showed statistically strong association between IS with hypertension and IS without hypertension (Fisher's exact p=0.003, OR=0.11, 95% CI=0.03-0.51 in recessive model). These results suggest that the ABCB1 gene may be associated with the development and clinical phenotypes of IS in Korean population.</P>

Introduction to Industrial Applications of Low Power Design Methodologies

Kim, Hyung-Ock,Lee, Bong-Hyun,Choi, Jung-Yon,Won, Hyo-Sig,Choi, Kyu-Myung,Kim, Hyun-Woo,Lee, Seung-Chul,Hwang, Seung-Ho The Institute of Electronics and Information Engin 2009 Journal of semiconductor technology and science Vol.9 No.4

Moore's law has driven silicon technology scale down aggressively, and it results in significant increase of leakage current on nano-meter scale CMOS. Especially, in mobile devices, leakage current has been one of designers' main concerns, and thus many studies have introduced low power methodologies. However, there are few studies to minimize implementation cost in the mixed use of the methodologies to the best of our knowledge. In this paper, we introduce industrial applications of low power design methodologies for the decrease of leakage current. We focus on the design cost reduction of power gating and reverse body bias when used together. Also, we present voltage scale as an alternative to reverse body bias. To sustain gate leakage current, we discuss the adoption of high-$\kappa$ metal gate, which cuts gate leakage current by a factor of 10 in 32 nm CMOS technology. A 45 nm mobile SoC is shown as the case study of the mixed use of low power methodologies.

Induction of microglial apoptosis by corticotropin-releasing hormone

Ock, Jiyeon,Lee, Heasuk,Kim, Sangseop,Lee, Won-Ha,Choi, Dong-Kug,Park, Eun Jung,Kim, Sang-Hyun,Kim, In Kyeom,Suk, Kyoungho Raven Press [etc.] 2006 Journal of neurochemistry Vol.98 No.3

<P>Abstract</P><P>Neuropeptides are short-chain peptides found in brain tissue, some of which function as neurotransmitters and others as hormones. Neuropeptides may directly or indirectly modulate glial functions in the CNS. In the present study, effects of various neuropeptides on the viability and inflammatory activation of cultured microglia were investigated. Vasoactive intestinal peptide, substance P, cholecystokinin and neuropeptide Y did not affect microglial cell viability, whereas corticotropin-releasing hormone (CRH) induced a classical apoptosis of mouse microglia in culture as shown by nuclear condensation and fragmentation, terminal deoxynucleotidyl transferase dUTP nick-end labeling, and cleavage of caspase 3 and poly(ADP-ribose) polymerase protein. CRH, however, did not influence nitric oxide production or expression of inflammatory genes including those encoding cytokines and chemokines, indicating that CRH did not affect the inflammatory activation of microglia. The CRH-induced microglial apoptosis appeared to involve a mitochondrial pathway and reactive oxygen species, based on the mitochondrial membrane potential change, caspase 9 activation and sensitivity to antioxidants. Taken together, our results indicate that the stress neuropeptide CRH may regulate neuroinflammation by inducing the apoptosis of microglia, the major cellular source of inflammatory mediators in the CNS.</P>

Influencing Factors on Quality of Life of Patients with Hemophilia

Won Ock Kim,Hyun Sook Kang,Young A Song 한국간호과학회 2005 한국간호과학회 학술대회 Vol.2005 No.10

Diatoms in the Holocene Sediments of the Maxwell Bay, King George Island, Antarctica

Won Hyung Kim(김원형),Mi-Ock Kim(김미옥),Byong-Kwon Park(박병권) 한국해양과학기술원 1991 KOREAN JOURNAL of Polar Research Vol.2 No.1

Neurotoxicity of microglial cathepsin D revealed by secretome analysis

Kim, Sangseop,Ock, Jiyeon,Kim, Ae Kyung,Lee, Ho Won,Cho, Je-Yoel,Kim, Deok Ryong,Park, Jae-Yong,Suk, Kyoungho Raven Press [etc.] 2007 Journal of neurochemistry Vol.103 No.6

<P>Abstract</P><P>Microglia-driven inflammatory responses have both neuroprotective and neurotoxic effects in the CNS. The excessive and chronic activation of microglia, however, may shift the balance towards neurotoxic effects. In this regard, proteins secreted from activated microglia likely play a key role in the neurotoxic effects. To characterize secreted proteins of activated microglia, conditioned media obtained from BV-2 mouse microglia cells were analyzed by two-dimensional gel electrophoresis or liquid chromatography coupled with tandem mass spectrometry. Among many proteins identified in the secretome of activated microglia, an aspartic endoprotease cathepsin D has been found to mediate microglial neurotoxicity based on the following results: (i) the expression of cathepsin D protein was markedly increased in lipopolysaccharide/interferon-&ggr;-stimulated microglia compared with resting microglia as determined by western blot analysis of conditioned media; (ii) knockdown of cathepsin D expression in microglia using short hairpin RNA diminished the neurotoxicity in the coculture of microglia and neuroblastoma cells and (iii) recombinant procathepsin D protein exerted cytotoxic effects toward cultured neurons. In conclusion, cathepsin D appears to play a central role in the microglial neurotoxicity, and could be a potential biomarker or drug target for the diagnosis and treatment of neurodegenerative diseases that are associated with excessive microglial activation and subsequent neurotoxic inflammation.</P>

Effects of 1,25-dihydroxyvitamin D₃ on the differentiation of MC3T3-E1 osteoblast-like cells

Kim, Hyun-Soo,Zheng, Mingzhen,Kim, Do-Kyung,Lee, Won-Pyo,Yu, Sang-Joun,Kim, Byung-Ock Korean Academy of Periodontology 2018 Journal of Periodontal & Implant Science Vol.48 No.1

Purpose: The purpose of this study was to evaluate the effects of 1,25-dihydroxyvitamin $D_3$ on the proliferation, differentiation, and matrix mineralization of MC3T3-E1 osteoblast-like cells in vitro. Methods: MC3T3-E1 osteoblastic cells and 1,25-dihydroxyvitamin $D_3$ were prepared. Cytotoxic effects and osteogenic differentiation were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase (ALP) activity assay, ALP staining, alizarin red S staining, and reverse transcription-polymerase chain reaction (RT-PCR) for osteogenic differentiation markers such as ALP, collagen type I (Col-I), osteocalcin (OCN), vitamin D receptor (VDR), and glyceraldehyde 3-phosphate dehydrogenase. Results: The MTT assay showed that 1,25-dihydroxyvitamin $D_3$ did not inhibit cell growth and that the rate of cell proliferation was higher than in the positive control group at all concentrations. ALP activity was also higher than in the positive control group at low concentrations of 1,25-dihydroxyvitamin $D_3$ ($10^{-10}$, $10^{-12}$, and $10^{-14}M$). RT-PCR showed that the gene expression levels of ALP, Col-I, OCN, and vitamin D receptor (VDR) were higher at a low concentration of 1,25-dihydroxyvitamin $D_3$ ($10^{-12}M$). Alizarin red S staining after treatment with 1,25-dihydroxyvitamin $D_3$ ($10^{-12}M$) showed no significant differences in the overall degree of calcification. In contrast to the positive control group, formation of bone nodules was induced in the early stages of cell differentiation. Conclusions: We suggest that 1,25-dihydroxyvitamin $D_3$ positively affects cell differentiation and matrix mineralization. Therefore, it may function as a stimulating factor in osteoblastic bone formation and can be used as an additive in bone regeneration treatment.

Immunological Compatibility of Bone Tissues from Alpha-1,3-galactosyltransferase Knockout Pig for Xenotransplantation

Kim, Se Eun,Kang, Kyung Won,Gu, Suna,Hwang, Seongsoo,Ock, Sun A,Shim, Kyung Mi,Jang, Kwangsik,Choi, Seok Hwa,Lee, Sang-Myeong,Kang, Seong Soo Hindawi 2018 BioMed research international Vol.2018 No.-

<P>We investigated whether the lack of galactosyltransferase (<I>α</I>-Gal) expression in bone tissue is associated with reduced immune response of human peripheral blood mononuclear cells (PBMCs) against pig bone tissue. When human PBMC obtained from heparinized blood of healthy volunteers was stimulated with bone extracts of pigs with <I>α</I>-1,3-galactosyltransferase knock out (<I>α</I>-Gal KO), the proliferation of human PBMCs and production of proinflammatory cytokines such as TNF-<I>α</I> and IL-1<I>β</I> were significantly reduced compared to those stimulated with bone extracts of wild type (WT) pigs. In addition, activation of CD4<SUP>+</SUP> helper T cells and production of IL-2, IFN-<I>γ</I>, and IL-17 were reduced upon stimulation with bone tissue extracts from <I>α</I>-Gal KO pigs. This is possibly due to the lowered activities of the NF-<I>κ</I>B, p38, ERK, and JNK signaling pathways. Our findings can be used to evaluate the compatibility of bone tissues from <I>α</I>-Gal KO pigs with human bone grafting as novel natural biomaterials, thereby increasing the feasibility of future clinical applications.</P>