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        Differential Prognostic Impacts of Diabetes over Time Course after Acute Myocardial Infarction

        김학령,강시혁,윤창환,조영석,연태진,조구영,채인호,김효수,채성철,조명찬,김영조,김주한,안영근,정명호,최동주,김종 대한의학회 2013 Journal of Korean medical science Vol.28 No.12

        This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n=21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P=0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P=0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.


        Helicobacter pylori Infection is Associated with Elevated Low Density Lipoprotein Cholesterol Levels in Elderly Koreans

        김학령,전한호,박인영,강지선,민경완,최진만 대한의학회 2011 Journal of Korean medical science Vol.26 No.5

        This study was conducted to investigate the association between Helicobacter pylori (H. pylori) infection and the lipid profile among elderly Koreans. A total of 462 subjects (mean age 66.2 ± 7.6 yr, 84% males) who underwent health check-up were investigated. Each subject underwent gastroduodenoscopy with gastric mucosal biopsy, and H. pylori infection was determined by histopathological examination using the updated Sydney System score. The presence of H. pylori infection was significantly associated with the elevated serum levels of total cholesterol and low density lipoprotein (LDL) cholesterol (P <0.05 for each) in univariate analysis. H. pylori infection was not associated with triglyceride and high density lipoprotein (HDL) cholesterol levels (P > 0.05 for each). After controlling confounders, multiple logistic regression analysis showed that the odds ratio of H. pylori infection for high LDL cholesterol level (> 140 mg/dL) was 3.113 (95% confidence interval,1.364-7.018; P = 0.007). There were no significant associations between the presence of H. pylori infection and elevated total cholesterol levels (> 200 mg/dL) in this model (P =0.586). The results of this study demonstrate that H. pylori infection is associated with the elevated serum LDL cholesterol levels in elderly Koreans, supporting the hypothesis that H. pylori plays a role in promoting atherosclerosis by modifying lipid metabolism.

      • KCI등재

        The incidence and predictors of overall adverse effects caused by low dose amiodarone in real-world clinical practice

        김학령,서재빈,정우영,김상현,김명아,조주희 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.5

        Background/Aims: Most current knowledge regarding amiodarone toxicity derivesfrom clinical trials. This study was performed to investigate the incidenceand risk factors of overall adverse effects of amiodarone in real-world practice usinga large sample size. Methods: Between January 1, 2000 and March 10, 2012, a total of 930 consecutivepatients who had been treated with amiodarone for arrhythmia were reviewedretrospectively. An amiodarone-associated adverse event was considered in casesof discontinuation or drug dose reduction due to an unexpected clinical response. Results: The mean daily dose of amiodarone was 227 ± 126 mg, and the mean durationwas 490 ± 812 days. During the mean follow-up duration of 982 ± 1,137 days,a total of 154 patients (16.6%) experienced adverse effects related to amiodarone,the most common being bradycardia or conduction disturbance (9.5%). Major organtoxicities in the thyroid (2.5%), liver (2.2%), eyes (0.6%), and lungs (0.3%) wererare. All patients recovered fully without complications after amiodarone discontinuationor dose reduction. The only independent predictor of adverse effectswas the duration of amiodarone treatment (odds ratio, 1.21; 95% confidence interval,1.03 to 1.41; p = 0.016, per year). Conclusions: Low-dose amiodarone is well tolerated in a real-world clinical population. Further studies with a prospective design are needed to confirm thisfinding.


        A Decline in Renal Function is Associated With Loss of Bone Mass in Korean Postmenopausal Women With Mild Renal Dysfunction

        김학령,박인영,최진만,황세민,김효상,임재성,김민,손민정 대한의학회 2011 Journal of Korean medical science Vol.26 No.3

        This study was conducted to assess the relationship between estimated glomerular filtration rate (eGFR) and bone mineral density (BMD) in Korean postmenopausal women with mild renal dysfunction. A total of 328 postmenopausal women who underwent BMD measurement during health check-up was investigated. BMD was measured in lumbar spine (L1-L4), femoral neck, total proximal femur and femoral trochanteric areas by dual energy radiography absorptiometry and renal function was estimated by eGFR using Cockcroft-Gault equation. Of the 328 subjects, 317 (96.6%) had an eGFR ≥60 mL/min/1.73 m2. By using simple linear regression analysis, age, height, weight and eGFR were significantly associated with BMD for the 4 aforementioned anatomic sites, while serum levels of creatinine and blood urea nitrogen did not influence BMD. When multiple regression analyses were applied, age and body weight still had significant associations with BMD at 4 different anatomic sites (P < 0.001). A significant association of eGFR with BMD remained in the lumbar spine, femoral neck and proximal total femur (P < 0.05) but not in the trochanteric area (P = 0.300). Our study suggests that a decline of renal function is associated with lower BMD in the lumbar spine, femoral neck and total proximal femur areas in Korean menopausal women with mild renal dysfunction.

      • KCI등재후보

        The comparison of the impact of arterial stiffness and central pressure on left ventricular geometry and diastolic function

        김학령,Woo-Hyun,Lim,Jae-Bin,Seo,Sang-Hyun,Kim,Zoo-Hee,Zo,Myung-A,Kim 대한고혈압학회 2019 Clinical Hypertension Vol.25 No.4

        Background: This study was performed to compare the associations of brachial-ankle pulse wave velocity (baPWV) and central blood pressure (CBP) measurements with left ventricular (LV) geometry and diastolic function. Methods: A total of 77 subjects (64.5 ± 10.8 years, 67.5% females) without documented cardiovascular disease were prospectively recruited. All subjects underwent transthoracic echocardiography, baPWV and noninvasive measurement of CBP on the same day. Results: In simple linear correlation analyses, neither baPWV nor CBP was associated with LV mass index or relative wall thickness (P > 0.05 for each). Although baPWV significantly correlated with septal e´ velocity in simple linear correlation analyses (r = 0.258, P = 0.025), the significance was lost after controlling for potential confounder (P = 0.881). In simple linear correlation analyses, central systolic blood pressure (CSBP) and central pulse pressure (CPP) significantly correlated with both septal e´ velocity or E/e´ (P < 0.05 for each); however, neither central diastolic nor mean arterial pressures was associated with both septal e´ velocity and E/e´ (P > 0.05 for each). After controlling for confounders, including age, sex and body mass index, CSBP correlated with septal e´ velocity (β = − 0.258, P = 0.025), but not with E/e´ (P = 0.074). CPP correlated with both septal e´ velocity (β = − 0.300, P = 0.014) and E/e´ (β = 0.428, P = 0.002) in the same multivariable model. Conclusions: In subjects without documented cardiovascular disease, CSBP and CPP may be more strongly associated with LV diastolic function than baPWV. Further studies with a larger sample size are needed to confirm our results.

      • KCI등재SCOPUS

        Simultaneously Presented Acute Ischemic Stroke and Non-ST Elevation Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation

        김학령,Jae-Bin,Seo,정우영,Joo-Hee,Zo,김명아,김상현 대한심장학회 2013 Korean Circulation Journal Vol.43 No.11

        Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.

      • SCOPUSKCI등재

        현탁중합에 의한 폴리스티렌 입자의 크기

        김학령,김호기 한국화학공학회 1977 Korean Chemical Engineering Research(HWAHAK KONGHA Vol.15 No.1

        스티렌의 懸濁重合을 위한 回分式 攪拌槽內에서 懸濁系의 物性이나 機械的 攪拌이 重合體의 크기와 粒度分布에 주는 영향에 관해 實驗的으로 考察하였다. Polyvinyl Alcohol (PVA)를 현탁安定劑로, Benzoyl Peroxide (BPO)를 開始劑로 使用하여 常壓, 90℃의 條件下에서 重合反應을 시켰을 때 다음과 같은 結論을 얻었다. (1) 平均粒度는 攪拌速度가 증가함에 따라 다음 식에 의하여 감소하는 것이 나타났다. (터빈형 임펠라의 경우) log d=-0.00070 (ND)+0.97 (2) 프로펠라형 임펠라를 사용했을 때가 터빈형의 것을 사용했을 때보다 넓은 粒度分布를 나타낸다. The effects of the stirring rate and the stabilizer concentration on the particle size of the suspension polymerized polystyrene were experimentally investigated. The reaction was carried out in an unbaffled mixing vessel with benzoyl peroxide as the initiator and polyvinyl alcohol as the stabilizer. The measurement of the product particle size by standard sieves showed that: (1) The average particle size decreased with the increase in stirring rate according to the following relationship, log d=-0.00070 (ND)+0.97 and (2) The propeller type impeller produced the products with broader size distributions than the turbine type impeller of the same dimension.

      • KCI등재

        개인-가족-환경요인이 정신장애인의 신체건강행동에 미치는 영향-Theory of Triadic Influence의 적용을 중심으로

        김학령 한국정신건강사회복지학회 2019 정신보건과 사회사업 Vol.47 No.2

        In this study, physical health behaviors of people with mental illness were divided into health promotion behaviors and health hindrance behaviors. Based on the theory of triadic influence, the relationships among factors at multiple levels were investigated by establishing the 3X3 framework based on the three streams of influence such as intrapersonal, interpersonal-social, and cultural-environmental stream that affect physical health behaviors of people with mental illness and three levels of causation such as ultimate, distal, and proximal levels. The study participants include 613 adults aged 19 and older who use 49 community mental health centers, community psychiatric rehabilitation centers and residential facilities located in Seoul, Gyeonggi and Incheon. The conclusions of the study were: First, people with mental illness were making an action effort for their own health. Second, as an intrapersonal stream, the ability to manage symptoms of mental illness and self-care for disease is a major factor in physical health behavior. Third, family relationships have a positive effect on health promotion behavior through interaction with various factors. Fourth, awareness of physical health-related services and health attitude play a role in reducing health-related behavior. Therefore, interventions are necessary to foster individual ability and to take into account indirect factors of influence to encourage physical health behavior as a lifestyle. 본 연구는 Theory of Triadic Influence를 이론적 기반으로 성인 정신장애인의 신체건강행동에 영향을 미치는 요인을 분석하였다. 신체건강행동은 건강증진행동과 건강저해행동으로 구분하였으며, 이론에 따라 개인내적 흐름, 대인관계적 흐름, 문화-환경적 흐름의 세 축과 신체건강행동에 미치는 영향의 거리에 따른 본원적 수준, 원격 수준, 그리고 근접수준의 다차원적 요인의 영향관계를 살펴보았다. 연구참여자는 서울, 경기, 인천 지역에 위치한 49개 정신보건센터, 사회복귀시설, 주거시설을 이용하는 19세 이상 성인 정신장애인 613명이다. 연구의 결론은 다음과 같다. 첫째, 정신장애인은 자신의 건강을 위한 행동적 노력을 하고 있었다. 둘째, 개인내적 흐름으로서 정신질환의 증상관리, 질병에 대한 자기관리능력은 신체건강행동의 주요 영향요인이다. 셋째, 가족관계는 다양한 원인들과의 상호작용을 통해 건강증진행동에 긍정적인 효과를 보인다. 넷째, 신체건강관련 서비스에 대한 인식과 건강태도는 건강저해행동을 줄이는데 역할을 하고 있다. 따라서 생활양식으로서 신체건강행동을 격려하기 위하여 개인의 능력함양과 간접적 영향요인을 고려한 개입이 필요하다.


        The Positive Association between Peripheral Blood Cell Counts and Bone Mineral Density in Postmenopausal Women

        김학령,조화영,박인영,최진만,김민,장호진,황세민 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.5

        Purpose: Accumulating evidence has shown a close connection between hematopoiesis and bone formation. Our aim was to evaluate the association between peripheral blood cell counts and bone mineral density (BMD) in a sample of postmenopausal women. Materials and Methods: Three hundreds thirty eight healthy postmenopausal women who underwent BMD measurement during their health check-up were investigated. BMD was measured by dual energy X-ray asorptiometry at L1-L4 spine, femoral neck and total proximal femur. BMD was expressed as a T-score: among T-scores obtained from three different sites (L1-L4 spine, femoral neck and total proximal femur), the lowest T-score was considered to be the subject's T-score. Results: The prevalence of osteopenia and osteoporosis diagnosed by T-score in the study participants were 49.4% (167/338) and 5.0% (17/338), respectively. Peripheral blood white blood cell (WBC), red blood cell (RBC) and platelet counts had significant positive correlations with T-scores (p<0.001) upon simple linear regression analysis. A multiple linear regression analysis, after controlling of confounders including age, body weight, systolic blood pressure, alkaline phosphatase and creatinine, showed that WBC (β=0.127; standard error=0.043; p=0.014), RBC (β=0.192; standard error=0.139; p<0.001) and platelet (β=0.097; standard error=0.001; p=0.050) counts still had significant positive association with T-scores. Conclusion: The study results showed a positive relationship between blood cell counts and bone mineral density in postmenopausal women, supporting the idea of a close connection between hematopoiesis and bone formation. The study results also suggest that blood cell counts could be a putative marker for estimating BMD in postmenopausal women.

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