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만성 신장질환으로 혈액 투석을 시행하는 환자의 퇴행성 요추 질환에 대한 수술 결과
장해동,이재철,신병준,홍시전,안중현,최성우,강덕원,조형규 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.3
Study Design: Retrospective study. Objectives: To analyze the outcomes of degenerative lumbar spine surgery in patients undergoing hemodialysis due to chronic kidney disease (CKD). Summary of Literature Review: Patients who undergo hemodialysis due to chronic renal disease tend to exhibit accelerated changes in bone quality, deterioration of spinal stenosis, and accompanying neurological degeneration. The surgical treatment of chronic spinal diseases is also becoming more necessary with the increased lifespan of these patients. Materials and Methods: We reviewed the medical records and radiographs of patients with CKD undergoing hemodialysis who were followed-up for more than 1 year after posterior lumbar spinal surgery. We evaluated clinical, laboratory, and radiologic variables. For a comparative analysis, patients were classified into subgroups according to age (65 years old), duration of hemodialysis (10 years), and type of surgery (simple decompression or fusion). Results: We included 21 patients (5 men, 16 women) with a mean age of 66.2 years (range, 48-87 years). The mean duration of hemodialysis and follow-up was 18.9 years and 43 months, respectively. Decompressions with fusion were performed in 11 patients and simple decompressions in the other 10. The mean visual analog scale (VAS) of leg pain and the Oswestry Disability Index (ODI) significantly improved after surgery at time of the last follow-up; meanwhile, the mean VAS score for lower back pain did not show a statistically significant improvement. The postoperative ODI was correlated with age (correlation coefficient=0.71, p=0.006). In patients less than 65 years old, the ODI improvement was greater (p=0.035) than in those 65 years of age or older. There was no significant difference in the clinical outcomes according to the duration of hemodialysis. Complications were observed in 11 patients (52.4%, 7 in fusion and 4 in simple decompression), of which 2 cases were infections, and reoperations were performed in 5 patients. The union rate of the fusion cases at the 1-year follow-up was 81.8%. Conclusions: Appropriate spine surgery improved radicular pain and the ODI in patients with degenerative lumbar disease undergoing hemodialysis. However, postoperative complications were frequent and the improvement of clinical outcomes was minimal, especially in patients over 65 years of age and in those who underwent fusion. Therefore, the surgical treatment of patients with chronic renal disease undergoing hemodialysis requires adequate consideration of age and the duration of hemodialysis. 연구 계획: 후향적 연구목적: 투석을 시행 중인 만성 신장질환 환자의 퇴행성 요추 질환에 대한 수술적 치료 후 임상적, 영상의학적 결과를 분석하고자 하였다. 선행 연구문헌의 요약: 만성 신장질환으로 인한 혈액투석을 시행하는 환자는 골질의 변화, 척추관 협착증의 악화, 그리고 동반하는 신경학적인 퇴행이 가속화되는 경향이 있다. 해당 환자군의 수명 증가와 함께 만성 척추 질환에 대한 수술적 치료의 필요성 또한 증가하고 있다. 대상 및 방법: 만성 신장질환으로 혈액투석을 시행하는 환자 중 퇴행성 요추 질환으로 본원에서 후방 접근에 의한 척추 수술 시행 받고 1년 이상 추시된환자를 대상으로 하여, 의무 기록과 영상 검사를 검토하였다. 임상지표와 영상의학적 자료 등을 조사하였으며, 나이(65세 이상과 미만의 군), 혈액투석 기간(10년 이상과 미만의 군), 수술의 종류(단순 감압술, 유합술)에 따른 결과를 비교 분석하였다. 결과: 대상 환자는 총 21명(남자 5명, 여자 16명)이었고, 평균 나이는 66.2(48~87)세였다. 평균 투석기간은 18.9년이었고, 추시 기간은 43개월이었다. 유합술이 11예, 단순 감압술이 10예였다. 하지 방사통의 평균 VAS 점수와 평균 ODI 점수는 술전에 비해 최종 추시시 유의하게 호전되었으나 요통의 평균VAS 점수는 통계적으로 유의한 호전을 보이지 않았다. 술 후 최종 ODI는 환자의 나이증가와 유의한 상관관계를 보였고(상관계수=0.71, p=0.006), 65세미만의 환자 군에서 술 후 ODI의 호전 정도가 유의하게 컸다(p=0.035). 혈액투석 기간에 따른 임상결과는 유의한 차이가 없었다. 수술 후 합병증은 총 11 명(유합술 7예, 감압술 4예)에서 관찰되었고, 그 중 감염은 2예였으며, 재수술은 5명 환자에서 시행되었다. 유합술 환자의 술 후 1년째 유합율은 81.8%였다. 결론: 혈액투석을 시행중인 만성 신장질환 환자에서 적절한 척추 수술 시행 후 하지 방사통과 ODI점수는 유의하게 호전되었으나, 합병증이 발생하는 경우가 빈번하고, 특히 65세 이상과 유합술 환자군에서 임상 결과의 호전이 미미하였다. 따라서 혈액투석 중인 만성 신장질환 환자의 수술적 치료는 나이및 투석 기간 등에 대한 충분한 고려가 필요할 것으로 사료된다. 약칭 제목: 혈액투석환자 퇴행성요추 수술결과
사료내 흑운모 분말 첨가가 육성돈의 생산성, 혈액내 면역 및 스트레스 관련지표의 변화, 분중 악취방출 가스 생성에 미치는 영향
장해동 ( Hae Dong Jang ),김진동 ( Jin Dong Kim ),홍종욱 ( Jong Wk Hong ),유종상 ( Jong Sang Yoo ),김효진 ( Hyo Jin Kim ),신승오 ( Seung Oh Shin ),황염 ( Yan Hwang ),주천상 ( Tian Xiang Zhou ),진영걸 ( Ying Jie Chen ),조진호 ( Jin 한국동물자원과학회 2008 한국축산학회지 Vol.50 No.3
Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review
장해동,Kim Eung-Ha,Lee Jae Chul,Choi Sung-Woo,Kim Kyungbum,Shin Byung-Joon 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%–35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
Bacillus subtilis 급여가 비육돈의 육질 특성, 생산성 및 분내 유해가스 발생에 미치는 영향
장해동,유종상,이제현,김효진,신승오,황염,주천상,진영걸,강대경,Jang, Hae-Dong,Yoo, Jong-Sang,Lee, Je-Hyun,Kim, Hyo-Jin,Shin, Seung-Oh,Hwang, Yan,Zhou, Tain-Xiang,Chen, Ying-Jie,Kang, Dae-Kyung 한국축산식품학회 2008 한국축산식품학회지 Vol.28 No.3
This study was conducted to evaluate the effects of dietary Bacillus subtilis on meat quality, growth performance and fecal malodor gas emission in finishing pigs. Thirty-six pigs (Landrace ${\times}$ Yorkshire ${\times}$ Duroc, $83.53{\pm}1.01\;kg$ average initial body weight) were used in a 35 d growth assay. Dietary treatments were 1) CON (basal diet), 2) B1 (basal diet + B. subtilis 0.1%) and 3) B2 (basal diet + B. subtilis 0.2%). The pigs were distributed into four pigs per pen with three replicate pens per treatments by completely randomized design. For the entire period, the final weight, ADO, ADFI and gain/feed were not significantly different among the treatments. There were no significant differences in meat quality (sensory evalution, meat color, TBARS, water holding capacity, drip loss, cooking loss and M. longissimus dorsi area) among the treatments. $H_2S$ was significantly decreased in B2 treatment compared to CON and B1 treatments (p<0.05). However, ammonia, mercaptans and acetic acid were not significantly different among the treatments. In conclusion, B. subtilis 0.2% treatments decreased fecal $H_2S$ gas emission in finishing pigs.
산란계에 Microbial Phytase 첨가시 산란율, 계란 품질, 인 이용율 및 영양소 대사율에 미치는 영향
장해동,김인호,유종상,조진호,현영,김희성,황일환,김효진,신승오,황염,주천상,진영걸 한국가금학회 2008 韓國家禽學會誌 Vol.35 No.2
The study was conducted to evaluate the effects of dietary microbial phytase on egg productivity, egg quality,phosphorus utilization and nutrient digestibility in laying hens. The animals used in the experiment were a total of 120 Hy-Line Brown laying hens (32 weeks old). Dietary treatments included 1) CON (basal diet), 2) LP (low phosphorus diet) 3) NP (low phosphorus diet + 0.03% normal microbial phytase) and 4) CP (low phosphorus diet + 0.03% coated microbial phytase). Six laying tly increased in CON and CP treatments compared to LP treatment (P<0.05). CON, CP and NP treatments significantly increased their egg shell breaking strength and egg shell thickness compared to LP treatment (P<0.05). CON, CP and NP treatments resulted higher yolk color and Haugh unit than LP treatment (P<0.05). Calcium and inorganic phosphorus contents in blood were higher in CP treatment compared to LP treatment (P<0.05). Dry mater digestibility and nitrogen digestibility were greater in CP treatment than CON, LP and NP treatments (P P<0.05). Calcium digestibility and phosphorus digestibility were significantly improved in CP and NP treatments than CON and LP treat-ments (P<0.05). Calcium retention of CON, CP and NP treatments were higher than LP treatment (P<0.05). Phosphorus retention was increased in CP and NP treatments compared to CON and LP treatments (P<0.05). LP treatment significantly increased their nitrogen, calcium excretion compared to CON, CP and NP treatments (P<0.05). Phosphorus excretion was decreased in LP, CP and P<0.05). In conclusion, CP treatment improved egg production, egg quality, inorganic calcium and phosphorus in blood, calcium and phosphorus retention and nutrient digestibility and decreased nitrogen and calcium excretion in laying hens.
미국산과 중국산 DDGS의 급여가 비육돈의 육질 및 아미노산 함량에 미치는 영향
장해동,홍종욱,이종하,이운선,이철영,유종상,이제현,김종규,강대경,김인호,Jang, Hae-Dong,Hong, Jong-Wook,Lee, Jong-Ha,Lee, Un-Sun,Lee, Chul-Young,Yoo, Jong-Sang,Lee, Je-Hyun,Kim, Jong-Gyu,Kang, Dae-Kyung,Kim, In-Ho 한국축산식품학회 2008 한국축산식품학회지 Vol.28 No.5
This study was conducted to evaluate the effects of com distillers dried grain with soluble (DDGS) in American and Chinese on quality and amino acid of meat in finishing pigs. 120 pigs (Landrace$\times$Yorkshire$\times$Duroc, 64.50 kg average initial body weight) were used in 56 day growth assay. Dietary treatments were included CON (basal diet), ADS (basal diet + DDGS from American) and CDS (basal diet + DDGS from Chinese). The pigs were allotted into four pigs per pen with ten replicates per treatments by completely randomized design. Backfat thickness and lean percentage were not affected by treatment (p>0.05). For the meat color, redness was significantly increased in DDGS treatments compared to CON treatment (p<0.05). CDS treatment was higher than in ADS treatment (p<0.001). Water holding capacity was higher in CON and CDS treatments compared to ADS treatment (p<0.05). pH was greater in DDGS treatments than CON treatment (p<0.05), and ADS treatment was higher than in CON treatment (p<0.05). For the amino acid of meat, CDS treatment significantly increased their arginine, isoleucine, leucine and lysine compared to other treatments (p<0.05). DDGS treatment was higher than in CON treatment (p<0.001). Methinonine, phenylalanine, threonine and valine were significantly increased DDGS treatments than CON treatment (p<0.05). Cysteine was greater in CDS treatment than CON and ADS treatments (p<0.001). DDGS treatments was higher cysteine than in CON treatment (p<0.001). Proline significantly improved in CON treatment compared to CDS treatment (p<0.05). Tyrosine was greater in DDGS treatments than CON treatment (p<0.01). In conclusion, redness and amino acids of meat were affected by DDGS treatments.