체외수정시술로 출생한 쌍생아의 임상적 경과에 대한 비교 분석

김경아,민우경,임재우,전누리,원혜성,김정훈,김애란,이필량,이인식,김기수,김암,피수영,Kim, Kyung-Ah,Min, Uoo-Gyung,Lim, Jae-Woo,Jun, Nu-Lee,Won, Hye-Sung,Kim, Chung-Hoon,Kim, Ellen Ai-Rhan,Lee, Pil-Ryang,Lee, In-Sik,Kim, Ki-Soo,Kim, Ahm,Pi 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.3

목 적 : 불임의 증가와 함께 체외수정시술에 의한 신생아의 출생이 점차 증가하고 있으나, 이들에 대한 임상적 예후와 경과에 대한 연구가 미비한 실정으로 본원에서 출생한 체외수정 쌍생아의 임상적 경과 및 예후를 알고자 본 연구를 시행하였다. 방 법 : 1995년 1월부터 2000년 6월까지 6년간 서울아산병원에서 분만된 신생아 460쌍 중 250쌍의 자연 수정에 의한 쌍생아(대조군)와 체외 수정 시술에 의해 출생한 156쌍의 쌍생아를 대상으로 재태연령, 출생체중, 성비, 입원률, 1분/5분 Apgar 점수, 동맥관개존증의 발생 및 인도신 치료 여부, 신생아 호흡 곤란 증후군, 일과성 빈호흡, 황달, 미숙아망막증, 뇌출혈, 괴사성 장염, 패혈증, 전해질 이상, 선천적 기형의 발생 유무를 비교하였으며, 입원기간과 사망률을 알아보고 비교 분석하였다. 또한 산모의 나이와 출산력 및 조기양막파열, 임신성 고혈압, 조기진통의 발생 여부와 임신 중의 입원횟수와 입원기간을 비교하였다. 결 과 : 6년간 본원에서 출생한 쌍생아는 총 460쌍이었으며 이중 체외수정시술에 의해 출생한 쌍생아는 156쌍(34.1%)이었다. 산모의 과거력과 임신성 합병증, 임신기간, 출산 형태에 대한 비교에서 산모의 나이, 출산력, 입원기간 등은 두 군 사이에 차이가 없었으나, 체외수정시술을 받은 산모에서 조기진통의 횟수가 많았고, 입원 횟수가 의미있게 많았다. 분만 형태의 비교에서 체외수정시술을 받았던 군이 자연수정군에 비해 수술로 분만한 경우가 의미있게 많았으며(93% vs 82%) 응급 수술보다 정규 수술이 의미있게 많았다. 신생아의 비교에 있어서 몸무게, 성비, 동맥관개존증의 발생 및 인도신 치료 여부, 신생아 호흡 곤란 증후군, 일과성 빈호흡, 황달, 미숙아망막증, 뇌출혈, 괴사성 장염, 패혈증, 선천적 기형의 발생 유무, 생존율, 입원기간 등은 두 군간에 의미 있는 차이가 없었고, 1분, 5분 Apgar 점수가 자연수정군에서 높았으며, 전해질의 이상소견이 체외수정시술군에서 의미있게 많았다. 체외수정시술에 의한 쌍생아군에서 첫 번째 아가와 두번째 아가를 비교하였을 때 출생체중, 신생아 집중치료실 입원율, 입원기간 등은 차이는 없었으나, 신생아 호흡 곤란 증후군, 동맥간개존증, 패혈증, 괴사성장염 등은 두번째 아가에서 유의하게 많았다. 결 론 : 체외수정시술에 의한 쌍생아의 출생은 전체 쌍생아 출생아의 34.1%로 많은 부분을 차지하였고, 산과적 합병증 및 주산기 예후를 비교하였을 때 체외수정군과 자연수정군이 유의한 차이가 없었다. Purpose : To examine various neonatal outcomes and perinatal factors resulting from assisted reproduction compared to that of spontaneous conception. Methods : This is a retrospective study. The control cases were all twins of spontaneous conception born between periods from January 1995 to June 2000. The study cases were identified from twins conceived by assisted reproduction in the same time peried. A total of 460 sets of twins consisted of 250 twins of spontaneous conception and 156 twins of assisted reproduction were studied. The primary outcomes were neonatal morbidity and mortality and the secondary outcomes were perinatal factors including number, length and cost of hospitalization for the delivery. Results : No differences were seen in various neonatal factors including gestational age, birth weight and incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, hyperbilirubinemia, sepsis, intraventricular hemorrhage and the length of hospitalizations. Lower one minute and five minute Apgar scores and frequently encountered electrolyte abnormalities were observed in neonates of assisted reproduction. In general, the second twin of assisted reproduction had increased incidences of respiratory distress syndrome, sepsis and necrotizing enterocolitis than the first twin. Increased frequencies of preterm labor, hospitalization and elective cesarean section were seen among mothers who underwent artifical conception. However, overall hospital costs in terms of mothers hospitalization for the delivery and neonates hospitalization did not show differences. Conclusion : Assisted reproduction twins had similar neonatal morbidities, mortalities and perinatal morbidities compared to those born by spontaneous conception.

직업적 음성사용자에서 날달걀 먹기 전과 후의 음성 변화

김경아,권순복,김성원,이형신,홍종철,김영록,이봉주,한영진,유태현,이강대,Kim, Kyung-A,Kwon, Soon-Bok,Kim, Sung-Won,Lee, Hyung-Shin,Hong, Jong-Cheol,Kim, Yong-Rok,Lee, Bong-Joo,Han, Yung-Jin,Yu, Tae-Hyun,Lee, Kang-Dae 한국음성학회 2007 음성과학 Vol.14 No.2

The purpose of this study was to observe the effect of eating a raw egg by professional or nonprofessional voice users on their voice quality and the duration of the effect. 20 professional voice users and 20 nonprofessional voice users participated in the experiment and they had gone through stroboscopy to have no vocal or laryngeal diseases. The voice exam was performed three times: before eating a raw egg (1st period), right after eating it (2nd period), and 10 minutes later (3rd period). By using Multi-dimensional Voice Program which is a software of Computerized Speech Lab 4500 as a voice analysis instrument, the authors checked the F0, Jitter, Shimmer, Noise to harmonic ratio (NHR), and Voice Range Profile (VRP). Results showed as follows: Firstly, vocal hygiene was good in 57.5% of the total subjects and was poor in 42.5%. 40% of professional voice users and 75% of nonprofessional voice users hand good quality. 77.5% of the total subjects had the vocal fatigue while 22.5% of the subjects did not. 95% of the professional voice users and 60% of nonprofessional voice users complained the vocal fatigue. 60% of the total subjects reported a subjective vocal symptom. 65.0% professional voice users and 70.0% of nonprofessional voice users reported a voice symptom. From the results above, we suggest that eating a raw egg may lead to imporve voice quality of the professional voice users.

와류 현상을 이용하는 호흡기류센서

김경아,이인광,박준오,이수옥,신은영,김윤기,김경천,차은종,Kim, Kyung-Ah,Lee, In-Kwang,Park, Jun-Oh,Lee, Su-Ok,Shin, Eun-Young,Kim, Yoon-Kee,Kim, Kyung-Chun,Cha, Eun-Jong 대한의용생체공학회 2009 의공학회지 Vol.30 No.5

The present study developed a new technique with no physical object on the flow stream but enabling the air flow measurement and easily incorporated with the devices for cardiopulmonary resuscitation(CPR) procedure. A turbulence chamber was formed in the middle of the respiratory tube by locally enlarging the cross-sectional area where the flow related turbulence was generated inducing energy loss which was in turn converted into pressure difference. The turbulence chamber was simply an empty enlarged air space, thus no physical object existed on the flow stream, but still the flow rate could be evaluated. Computer simulation demonstrated stable turbulence formation big enough to measure. Experiment was followed on the proto-type transducer, the results of which were within ${\pm}5%$ error compared to the simulation data. Both inspiratory and expiratory flows were obtained with symmetric measurement characteristics. Quadratic curve fitting provided excellent calibration formula with a correlation coefficient>0.999(P<0.0001) and the mean relative error<1%. The present results can be usefully applied to accurately monitor the air flow rate during CPR.

수열 합성 공정 조건이 티탄산 납의 상 형성에 미치는 영향

김경아,김정석,천채일,Kim, Kyoung-A,Kim, Jeong-Seog,Cheon, Chae-Il 한국세라믹학회 2011 한국세라믹학회지 Vol.48 No.1

Lead titanate ($PbTiO_3$) powder was prepared from lead nitrate ($Pb(NO_3)_2$) and titania ($TiO_2$) by hydrothermal route. Phase formation process was investigated by observing the phases formed in various experimental conditions like different KOH concentration, reaction temperature and time. $PbTiO_3$ powder was fabricated when the KOH concentration was 0.8M or higher. An intermediate compound, $PbTi_{0.8}O_{2.6}$, was formed at first by a reaction between PbO and $TiO_2$ and changed into $PbTiO_3$ powder with a perovskite crystal structure. A $PbTiO_3$ phase was formed in a shorter time when a KOH concentration was increased from 0.8M to 8M because a driving force for a $PbTiO_3$ formation was increased due to an increase in a degree of supersaturation. And $TiO_2$ (rutile) and $3PbO{\cdot}H_2O$ were observed at room temperature in a 0.8M KOH solution and $TiO_2$(rutile) and PbO (litharge) in a 8M KOH. A $PbTiO_3$phase was also formed in a shorter time at a higher reaction temperature as a reaction temperature influenced the rates for a dissolution and a precipitation.

경기도에서 분리한 병원성대장균의 역학적 특성 및 PFGE, 항생제 내성 연구

김경아,용금찬,정진아,허정원,허은선,박성희,최연숙,윤미혜,이정복,Kim, Kyung-A,Yong, Kum-Chan,Jeong, Jin-A,Huh, Jeong-Weon,Hur, Eun-Seon,Park, Sung-Hee,Choi, Yun-Sook,Yoon, Mi-Hye,Lee, Jong-Bok 한국미생물학회 2014 미생물학회지 Vol.50 No.4

병원성 대장균은 최근 3년간 경기도에서 발생한 학교급식식 중독의 주된 원인균으로서 그 역학적 특성을 정리하고 PFGE typing과 항생제 감수성 시험으로 분리균주의 특성을 알아보고자 하였다. 2010년부터 2012년까지 19건의 학교급식 식중독에 대한 역학조사보고서를 분석한 결과, 급식의 주된 운영방식은 직영(18건, 95%)이며, 고등학교에서 주로 발생하였다. 계절적 요인으로는 13건(65%)이 6월부터 9월에, 특히 여름방학 후 학기 초인 8월말부터 9월에 더 많이 발생하였다. 수요일(7건, 37%)과 목요일(7건, 37%)에 최초환자가 발생되어, 목요일 7건(37%) 금요일 5건(26%)에 주로 신고가 이루어 졌다. 추정위험에는 월요일(4건, 21%), 화요일(7건, 37%), 수요일(4건, 21%)에 노출되었고, 추정원인체로서 가능성이 높은 식품은 김치류가 50%(5건)를 차지하였다. 분리된 98균주는 EPEC, ETEC, EAEC, EHEC가 각각 50%, 34%, 15%, 1%이며, 항생제 감수성 시험 결과 ampicillin, nalidixic acid, sulfamethoxazole/trimethoprim, tetracycline에 대하여 각각 40%, 37%, 24%, 19%의 내성을 나타내었고, 2, 3세대 cephalosporins계, cabarpenem계, aminoglycosides계, 2세대 quinolones계 항생제에는 감수성이 있었으며, cefalotin, ampicillin/sulbactam, chloramphenicol에는 각각 29%, 25%, 6%가 중간내성을, 그리고 70%에서 한 가지 이상의 항생제에 내성이 관찰되었다. PFGE 분석결과, 57.6%의 similarity로 8개의 group과 32개의 profiles로 분류되었다. 개별적인 소규모 식중독에서 항생제 감수성과 유전자형의 연관성을 찾기가 어려웠으며, 동시에 발생한 대규모 식중독의 경우, 항생제 내성과 PFGE 유형이 매우 유사하여 동일 기원으로부터 유래한 병원성대장균에 의해 식중독 사고가 발생한 것으로 추정이 가능하였다. This study was conducted to survey the epidemiological characteristics and the isolated strains for pathogenic E. coli which was the major causative organisms for food poisoning occurred at school food services in the Gyeonggi-do area during the past three years. We investigated 19 accidents of food-borne disease outbreaks by pathogenic E. coli at school food services from 2010 to 2012. Food-borne disease outbreaks by pathogenic E. coli were usually occurred at direct management type (18 accidents, 95%) and high schools. For the seasonal factors, 13 accidents (65%) were occurred in June to September, especially the end of August and September after the summer holidays. The first patients were occurred on Wednesday (7 accidents, 37%) and Thursday (7 accidents, 37%), and they were mainly reported on Thursday (7 accidents, 37%) and Friday (5 accidents, 26%). The exposure of risk was estimated in Monday (4 accidents, 21%), Tuesday (7 accidents, 37%) and Wednesday (4 accidents, 21%), and kimchi (5 accidents, 50%) was estimated as the food of the high risk responsible for the outbreaks. 98 isolates of pathogenic E. coli consisted of PEC (50%), ETEC (34%), EAEC (15%), and EHEC (1%). The antibiotic resistance of pathogenic E. coli showed in the descending order of ampicilline (40%), nalidixic acid (37%), trimethoprim/sulfamethoxazole (24%), and tetracycline (19%). The antibiotics of second and third generation cephalosporins, cabarpenem, aminoglycosides, and second generation quinolones had antimicrobial susceptibilities and cefalotin, ampicillin/sulbactam and chloramphenicol showed medium resistance at 29%, 25%, and 6% respectively, and 70% of isolates were resistant to more than one antibiotic. By the PFGE analysis, they were classified into nine major groups and 31 profiles with 57% pattern similarity. It was very difficult to find the correlation of antimicrobial susceptibilities and genotype in the small scale-food poisoning, but the similarity of antimicrobial resistance and PFGE patterns in the large scale-food poisoning enabled the outbreaks to estimate the same pathotype of E. coli derived from identical origins.

스마트 그리드, 미국.일본에서 실증시험 - '낙도형' 스마트 그리드의 국제표준 제정을 목표

김경아,Kim, Gyeong-A 기술표준원 2010 기술표준 Vol.101 No.-

압력 측정에 의한 요량 계측의 유용성 분석

김경아,최성수,이인광,박경순,김원재,이태수,차은종,Kim, Kyung-Ah,Choi, Sung-Soo,Lee, In-Kwang,Park, Kyung-Soon,Kim, Wun-Jae,Lee, Tae-Soo,Cha, Eun-Jong 대한의용생체공학회 2007 의공학회지 Vol.28 No.4

Uroflowmetry is non-invasive and easily performed to diagnose benign prostatic hypertrophy(BPH) frequent in aged men. Weight change during urination is usually measured to estimate the urinary flow rate by a load cell, but sensitive to any impacts against the bottom of the container, leading to unnecessary noise generation. Moreover, load cells are relatively expensive raising the production cost. The present study proposed a new technique, measuring hydraulic pressure on the bottom of the urine container to evaluate the urinary volume. Low cost pressure transducer enabled almost perfectly linear relationship between the urine volume and the hydraulic pressure. During both the simulated and human urination experiments, variance of the pressure signal was more than 50% smaller than the weight signal acquired by a load cell, which demonstrated that the impact noise was decreased to a great degree by pressure compared to weight measurement.

흰쥐 부신 크로마핀 세포 칼슘통로 조절에 미치는 ATP의 효과

김경아,구용숙,Kim, Kyung Ah,Goo, Yong Sook 한국의학물리학회 2014 의학물리 Vol.25 No.3

뉴론에서 ATP는 분비 과립내에 신경전달물질과 함께 다량 저장되어 있다가 신경전달물질과 함께 분비되는 것으로 알려져 있으므로 신경전달물질의 자극-분비(stimulus-secretion) coupling 과정에 있어 중요한 조절작용을 할 것으로 기대된다. 그러므로 본 연구에서는 뉴론과 그 발생학적 기원이 동일한 부신수질 세포(adrenal chromaffin cell)를 대상으로 하여 세포막 칼슘통로를 통한 세포막 전류에 미치는 ATP의 영향을 측정함으로써 신경전달물질이 자극-분비 coupling 과정에 작용하는 ATP의 조절 작용을 알아보고자 하였다. 부신수질 세포의 칼슘통로를 통한 세포막 전류는 패치클램프 테크닉으로 기록하였다. 10 mM $Ba^{2+}$을 포함한 세포 외 용액에서, $Ba^{2+}$ current는 0.1 mM ATP를 세포외부에 처치했을 때, 평균 $36{\pm}6%$ (n=6) 감소되어 나타났고 ATP를 씻어준 후 전류는 다시 회복되는 가역적 반응을 보였다. ATP의 전류 억제 기전을 알아보고자 칼슘통로에서 관찰되는 현상 중의 하나인 소통(facilitation)현상을 기록하였다. +80 mV의 큰 prepulse를 준 후 바로 테스트 펄스를 주며 측정한 전류는 큰 prepulse에 의해 억제효과가 풀리는(disinhibition) 현상을 나타내었다. ATP 처치 후 큰 자극을 주어 $37{\pm}5%$ (n=11)의 $Ba^{2+}$ 전류 증가가 있었고 이는 ATP가 없는 상태에서 순수하게 큰 자극에 의해 소통되는 $25{\pm}3%$ (n=12)과 유의한 차이를 보였다(p<0.05). ATP의 억제 기전이 G-protein을 매개로 한 것인지를 알아보고자 가수분해 되지 않는 GTP 유도체인 $GTP{\gamma}S$를 세포 내에 준 후 $Ba^{2+}$ 전류를 기록하였다. $GTP{\gamma}S$에 의해 55%의 전류 크기의 감소가 있었고 이 환경에서 큰 prepulse를 인가하였을 때 $34{\pm}4%$ (n=19)의 소통현상을 보였다. 이는 $GTP{\gamma}S$가 없는 환경에서의 $25{\pm}3%$ (n=12)의 소통현상을 보인 것과 유의한 차이를 보였다(p<0.05). $Ba^{2+}$ current trace의 활성화 과정(activation)을 curve-fitting한 결과, control은 single exponential curve로 fitting된 반면, ATP 또는 $GTP{\gamma}S$를 처치한 경우, 그리고 ATP와 $GTP{\gamma}S$ 모두 처치한 경우에서는 double-exponential curve로 가장 잘 fitting이 되었다. 즉, ATP나 $GTP{\gamma}S$를 처치했을 때 모두 전류가 더 느리게 활성화되는 모양을 나타내었고, 이상의 결과로 미루어 ATP와 $GTP{\gamma}S$는 같은 방식으로 칼슘통로를 억제하고, 이러한 억제효과는 세포막에 아주 큰 전압을 걸어주면 칼슘 통로에 결합했던 G-protein이 막전압 의존적으로 떨어짐으로써 소실(disinhibition)된다고 해석된다. 본 연구에서 확인한 ATP의 칼슘통로 억제효과는 자체 크로마핀 세포 또는 주변 세포에서 아드레날린이 적게 분비되게 하는 autocrine 또는 paracrine inhibition 과정의 중요한 기전으로 작용할 것이다. ATP in quantity co-stored with neurotransmitters in the secretory vesicles of neurons, by being co-released with the neurotransmitters, takes an important role to modulate the stimulus-secretion response of neurotransmitters. Here, in this study, the modulatory effect of ATP was studied in $Ca^{2+}$ channels of cultured rat adrenal chromaffin cells to investigate the physiological role of ATP in neurons. The $Ca^{2+}$ channel current was recorded in a whole-cell patch clamp configuration, which was modulated by ATP. In 10 mM $Ba^{2+}$ bath solution, ATP treatment (0.1 mM) decreased the $Ba^{2+}$ current by an average of $36{\pm}6%$ (n=8), showing a dose-dependency within the range of $10^{-4}{\sim}10^{-1}mM$. The current was recovered by ATP washout, demonstrating its reversible pattern. This current blockade effect of ATP was disinhibited by a large prepulse up to +80 mV, since the $Ba^{2+}$ current increment was larger when treated with ATP ($37{\pm}5%$, n=11) compared to the control ($25{\pm}3%$, n=12, without ATP). The $Ba^{2+}$ current was recorded with $GTP{\gamma}S$, the non-hydrolyzable GTP analogue, to determine if the blocking effect of ATP was mediated by G-protein. The $Ba^{2+}$ current decreased down to 45% of control with $GTP{\gamma}S$. With a large prepulse (+80 mV), the current increment was $34{\pm}4%$ (n=19), which $25{\pm}3%$ (n=12) under control condition (without $GTP{\gamma}S$). The $Ba^{2+}$ current waveform was well fitted to a single-exponential curve for the control, while a double-exponential curve best fitted the current signal with ATP or $GTP{\gamma}S$. In other words, a slow activation component appeared with ATP or $GTP{\gamma}S$, which suggested that both ATP and $GTP{\gamma}S$ caused slower activation of $Ca^{2+}$ channels via the same mechanism. The results suggest that ATP may block the $Ca^{2+}$ channels by G-protein and this $Ca^{2+}$ channel blocking effect of ATP is important in autocrine (or paracrine) inhibition of adrenaline secretion in chromaffin cell.

자기주도적 학습능력이 간호학생의 임상실습만족도에 미치는 영향

김경아,Kim, Kyeong-Ah 한국임상보건과학회 2016 한국임상보건과학회지 Vol.4 No.2

Purpose. This study was to identify the relationship between self-directed learning and nursing student's satisfaction of clinical practice. Methods. This study was designed to measure the level of satisfaction according to the contents, guidance, environment, time, and the evaluation of clinical practice. Two hundred thirty-one nursing student from baccalaureate program in H-gun was sampled. A scale consisting of 75 questions, developed by the researcher, was used to gather data from September 14 through 27, 2012. The data was analyzed by descriptive statistics, paired t-test, pearson correlation, and multiple linear regression using the SPSS WIN 18.0 program. Results. The results were summarized : Self-directed learning didn't show a significant different by grade(t=0.83, p=.934). Nursing student's satisfaction of clinical practice didn't show a significant different by grade(t=0.26, p=.798). The relationship between self-directed learning correlated with the degree of nursing student's satisfaction in clinical practice(r=.44, p<.001). The factors of self-directed learning described nursing student's satisfaction of clinical practice as $R^2$=.215(F=9.858, p<.001). Conclusions. It was found that a higher degree of satisfaction in clinical practice depends on a higher degree of self-directed learning. Therefore, nursing faculty should plan intervention to improve satisfaction level of clinical practice by fostering self-directed learning.

원발성 부갑상선항진증에 의한 악골의 다발성 갈색종양

김경아,고광준,Kim, Kyoung-A,Koh, Kwang-Joon 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.3

Brown tumor is usually diagnosed at the terminal stage of hyperparathyroidism. Diagnosis of this tumor is confirmed by endocrinologic investigations along with clinical and radiographic examination. Radiographical differential diagnosis of this tumor includes central giant cell granuloma, aneurysmal bone cyst, metastatic tumor, multiple myeloma, and Paget disease. This report presents a rare case of multiple brown tumors occurring at the maxilla and mandible, which was initially misdiagnosed as central giant cell granuloma. Plain radiographs demonstrated multiple well-defined multilocular radiolucency. CT images showed soft tissue mass with low attenuated lesions, perforation of the lingual cortical plate, and a heterogeneous mass at the right thyroid lobe. These findings were consistent with parathyroid adenoma. The patient had hypercalcemia, hypophosphatemia, and elevated alkaline phosphatase level. Surgical excision of the tumor was performed. No recurrence was observed during a 28-month follow-up.