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투석이 필요했던 중증 급성 신손상 환자에서 신장기능의 예후
최경아 ( Kyung A Choi ),권정아 ( Jeong Ah Kwon ),김영훈 ( Young Hoon Kim ),이유지 ( Yu Ji Lee ),오하영 ( Ha Young Oh ),김대중 ( Dae Joong Kim ),김윤구 ( Yoon Goo Kim ),허우성 ( Woo Seong Huh ),이정은 ( Jung Eun Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
Purpose: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. Methods: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. Results: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54±16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77%, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. Conclusion: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.
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SLC6A18 유전자의 minisatellites 5 (SLC6A18-MS5)의 고혈압과의 관련성 및 진화적 의미
허창환(Chang-Hwan Heo),이상엽(Sang-Yeop Lee),설소영(So-Young Seol),권정아(Jeong-Ah Kwon),정윤희(Yun Hee Jeong),정정남(Chung-Nam Chung),선우양일(Yangil Sunwoo) 한국생명과학회 2008 생명과학회지 Vol.18 No.12
SLC6A18은 neurotransmitter로서 고혈압과 연관성이 보고 되었고, 유전자 내에 총 8개의 minisatellites가 존재함이 밝혀졌다. 본 연구에서 8개 minisatellites 중 가장 높은 heterozygosity를 나타내는 SLC6A18-MS5 영역에 대하여 생물정보학적 방법으로 Transfac software를 이용하여 transcription factor binding site를 분석한 결과, Pax4와 HNF4의 binding site를 발견하였다. HNF4는 당뇨병 대사에 관여하는 것으로 고혈압과의 연관성이 있을 것으로 사료된다. 그러므로 본 연구에서는 SLC6A18-MS5 영역과 고혈압과의 연관성을 조사하기 위하여, 대조군 301명과 고혈압 환자군 184명의 genomic DNA를 이용하여 대립형질의 패턴을 조사하였다. SLC6A18-MS5의 대립형질 분포와 고혈압은 직접적인 영향을 주지 않는 것으로 나타났다. 반면 높은 heterozygosity를 나타내는 SLC6A18-MS5에 친자확인 및 DNA typing 마커로서의 유용성을 알아보기 위해 20가족의 샘플을 이용하여, 감수분열 후 자손에의 분리 형태를 조사한 결과 부모에게서 자손으로 정확히 전달되는 멘델의 법칙에 의해 분리됨을 확인하였다. 또한 SLC6A18 유전자 내의 minisatellites들의 진화적 관계를 조사한 결과, 인간과 원숭이에서만 보존적으로 나타났다. 이러한 결과는 intron영역의 minisatellites 분석이 영장류의 비암호화 영역의 중요한 진화 마커로 사용될 수 있음을 나타내어, 영장류 특이적 진화를 이해하는데 도움이 될 것으로 사료된다. In this study, SLC6A18-MS5 sequence which showed the highest heterozygosity among seven minisatellites was analyzed using the Transfac software, the putative binding sites for the transcription factor Pax4 and HNF4 were discovered as a result. The HNF4 is involved in the diabetes pathway and suggested the relationship to hypertension. Thus, we investigated the putative functional significance of allelic variation in this minisatellites with respect to susceptibility for hypertension. To address this possibility, we analyzed genomic DNA from the blood of 301 hypertension-free controls and 184 cases with hypertension. A statistically significant association was not identified between the allelic distribution of SLC6A18-MS5 and occurrence of hypertension. We then examined the meiotic segregation of SLC6A18-MS5 and it was transmitted following Mendelian inheritance. Therefore, this locus could be useful markers for paternity mapping and DNA fingerprinting. Moreover, we undertook a comprehensive analysis of the genomic sequence to address the evolutionary events of these variable repeats. SLC6A18 minisatellites regions are only conserved in human and primates. This result suggestedthat intronic minisatellites analysis is powerful evolution marker for the non-coding regions in primates and can provide a great insight to the molecular evolution of repeated region in primates.
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인공호흡기 적용환자에서 폐쇄형 기도흡인 전·후 과환기와 과산소 적용의 효과
신현주,김정아,권은옥,노화경,김미영,노진숙,권영옥,권정아,손희경,김세현,서미희,김선영,이영진,남지현,우정희,김명애 병원간호사회 2006 임상간호연구 Vol.12 No.2
Purpose: The purpose of this study was to identify the effects of hyperventilation and hyperoxygenation before and after endotracheal suctioning using closed-suction system on mechanically ventilated patients. Method: We selected 20 patients who were mechanically ventilated and randomly assigned into 4 groups according to the type of treatments using repeated measure. We applied 3 types of treatment, hyperventilation, hyperoxygenation, hyperventilation+hyperoxygenation, and no treatment and measured physiologic effects-SpO_(2), HR and, mena BP. Result: There were no significant differences between the group with no treatment and the group with hyperventilation, before and after endotracheal suctioning using closed-suction system(SpO_(2)(p=.693), HR(p=.970) and mean BP(p=.638)). There were no significant differences between the group with no treatment and the group with hyperoxygenation before and after endotracheal suctioning using closed-suction system(SpO_(2)(p=.693), HR(p=.970) and mean BP(p=.638)). There were no significant differences between the group with no treatment and the group with hyperventilation hyperoxygenation before and after endotracheal suctioning using closed-suction system(SpO_(2)(p=.693), HR(P=.970) and mean BP(P=.638)). Conclusion: As the results, all of the methods, hyperventilation, hyperoxygenation, and hyperventilation hyperoxygenation can be used when nurses apply endotracheal suctioning using closed-suction systems. In case of hypoxemic patients, hyperoxygenation is recommended for prevention of deoxygenation due to endotracheal suctioning using closed-suction systems.
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정성주,김성범,박대원,정혜원,기세윤,권정아,박만석,박미연,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3
브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중에 하나로서, 본 증례는 국내에서 감염된 가축에 대한 노출력이 없는 집단에서 현증 브루셀라증이 발생한 첫 증례이기에 문헌 고찰과 함께 보고한다. 또한 환자가 근무하였던 축산물 부산물 시장에서 역학 조사를 실시하여, 현증환자 및 기감염자를 발견하여 축산물 부산물 시장 근무자에서 현증 브루셀라증이 발생할 위험성을 평가하였다. 역학 조사 결과 축산물 부산물을 다루는 일을 하는 사람들에서 감염된 가축과의 직접 접촉이 없이도 브루셀라증이 발생할 수 있음을 알 수 있었다. Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.
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