Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors

차선아,박훈석,김미희,임태석,김현호,장경윤,김형욱,위성헌,진동찬 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminateddisease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromisedhosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosismay also occur in the immunocompetent hosts without classical risk factors.

인지기능과 구강건강관련 삶의 질의 연관성에 대한 연구: 성향점수 분석과 회귀모델을 중심으로

차선아,배수영,남상훈,홍익표 대한신경계작업치료학회 2023 재활치료과학 Vol.12 No.3

Objective : This study analyzed the correlation between cognitive function and oral health-related quality of life (OHQoL). Methods : Demographic and clinical characteristics were extracted and utilized for subjects aged 45 years or older who participated in the 8th Korean Longitudinal Study on Aging in 2020. The dependent variable was the Geriatric Oral Health Assessment Index, and the independent variable was the level of cognitive function classified by the Mini-Mental State Examination scores. The analysis method used inverse probability of treatment weighting (IPTW). Then, the association between cognitive function and OHQoL was analyzed by multiple regression analysis. Results : Among the participants, 4,367 (71.40%) had normal cognition, 1,155 (18.89%) had moderate cognitive impairment, and 594 (9.71%) had severe cognitive impairment. As a result of analysis by applying IPTW, there was a negative correlation between the cognitive function group and OHQoL (normal vs. moderate: β = -2.534, p < .0001; normal vs. severe: β = -2.452, p < .0001). Conclusion : After propensity score matching, mild cognitive impairment showed a more negative association than severe cognitive impairment. Therefore, patients with cognitive impairment require oral health management education to improve OHQoL regardless of the level of cognitive impairment. 목적 : 본 연구는 노인들의 인지기능과 구강건강관련 삶의 질 사이의 연관성을 분석하기 위해 수행되었다. 연구방법 : 2020년에 수집된 제8차 고령화연구패널조사에 참여한 지역에 거주하는 45세 이상의 중고령자를 대상으로 인구통계학적 및 임상적 특성을 추출하여 활용하였다. 독립변수는 한국형 간이정신상태검사 점수를 기준으로 분류한 인지기능, 종속변수는 구강건강관련 삶의 질을 측정하기 위한 노인구강건강 평가지수이다. 인지기능 그룹 간 공변량의 차이를 보정하기 위해 성향점수 활용법 중 역확률가중치를적용 후 인지기능과 구강건강관련 삶의 질의 연관성을 분석하기 위해 역확률가중치 적용 전의 다중회귀분석과 적용 후의 다중회귀분석 결과에 차이가 있는지 결과를 비교하였다. 결과 : 연구 대상자는 총 6,116명으로 인지정상군 4,367명, 경도 인지손상군 1,155명, 중증 인지손상군 594명으로 구성되었다. 성향점수 역확률가중치 적용 결과로 표준화된 평균 차이(standardized mean difference)를 확인하여 0.2 이상인 변수를 다시 통제하고 분석한 다중회귀모델에서 인지기능 그룹과 구강건강관련 삶의 질 간의 부정적인 연관성이 있었다(정상 vs. 경도: β = -2.534, p < .0001; 정상 vs. 중증: β = -2.452, p < .0001). 결론 : 본 연구 결과에서 인지손상과 구강건강관련 삶의 질은 음의 연관성을 나타내었다. 성향점수 활용 후 중증 인지손상보다 경도 인지손상에서 더 부정적인 연관성을 나타낸 결과는 인지손상은 저하된 정도와 관계없이 구강건강관련 삶의 질에 부정적인 영향을 미치는 것을 의미한다. 따라서 인지기능의 감퇴가 나타난 모든 환자들은 구강관리의 중요성과 교육이 필요하다는 것을 시사한다.

복강경 조절형 위밴드 삽입술 시행 후 미란에 의한 패혈성 혈전문맥염과 간농양이 발생한 1예

차선아,김경훈,이종민,김현선,김지혜,박성균,김석찬 대한비만학회 2014 The Korean journal of obesity Vol.23 No.2

복강경 조절형 위밴드 삽입술은 고도 비만 환자의 체중 감량과 비만 관련 질환의 효율적인 치료 방법으로 알려져 있다. 수술 후 혈전 문맥염과 간농양의 발생이 보고된 예는 거의 없다. 저자들은 복강경 조절형 위밴드 삽입술 시행 후 위미란 및 복강내 농양이 발생하였으나진단이 지연되어 혈전 문맥염과 다발성 간농양, 이어 패혈증이 발생한 예를 경험하여 문헌 고찰과 함께 보고하는 바이다.

Severe Hypoglycemia and Cardiovascular or All-Cause Mortality in Patients with Type 2 Diabetes

차선아,윤재승,임태석,황세원,임은정,송기호,유기동,박용문,안유배,고승현 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.3

Background: We investigated the association between severe hypoglycemia (SH) and the risk of cardiovascular (CV) or allcause mortality in patients with type 2 diabetes. Methods: The study included 1,260 patients aged 25 to 75 years with type 2 diabetes from the Vincent Type 2 Diabetes Resgistry (VDR), who consecutively enrolled (n=1,260) from January 2000 to December 2010 and were followed up until May 2015 with a median follow-up time of 10.4 years. Primary outcomes were death from any cause or CV death. We investigated the association between the CV or all-cause mortality and various covariates using Cox proportional hazards regression analysis. Results: Among the 906 participants (71.9%) who completed follow-up, 85 patients (9.4%) had at least one episode of SH, and 86 patients (9.5%) died (9.1 per 1,000 patient-years). Patients who had died were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline, as compared with surviving patients. The experience of SH was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.39 to 5.02; P=0.003) and CV mortality (HR, 6.34; 95% CI, 2.02 to 19.87; P=0.002) after adjusting for sex, age, diabetic duration, hypertension, mean glycosylated hemoglobin levels, diabetic nephropathy, lipid profiles, and insulin use. Conclusions: We found a strong association between SH and increased risk of all-cause and CV mortality in patients with type 2 diabetes.

피담보채권액을 초과한 과잉담보설정 문제 : 독일의 판례를 중심으로

차선자(車善子) 한국민사법학회 2003 民事法學 Vol.23 No.-

Baseline-Corrected QT (QTc) Interval Is Associated with Prolongation of QTc during Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus

차선아,윤재승,임태석,강윤구,이강민,송기호,유기동,박용문,고승현,안유배 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.6

Background: We investigated an association between baseline heart rate-corrected QT (QTc) interval before severe hypoglycemia (SH) and prolongation of QTc interval during SH in patients with type 2 diabetes mellitus (T2DM). Methods: Between January 2004 and June 2014, 208 patients with T2DM, who visited the emergency department because of SH and underwent standard 12-lead electrocardiography within the 6-month period before SH were consecutively enrolled. The QTc interval was analyzed during the incidence of SH, and 6 months before and after SH. QTc intervals of 450 ms or longer in men and 460 ms or longer in women were considered abnormally prolonged. Results: The mean age and diabetes duration were 68.1±12.1 and 14.1±10.1 years, respectively. The mean QTc intervals at baseline and SH episodes were 433±33 and 460±33 ms, respectively (P<0.001). One hundred and fourteen patients (54.8%) had a prolonged QTc interval during SH. There was a significant decrease in the prolonged QTc interval within 6 months after SH (QTc interval prolongation during SH vs. after recovery, 54.8% vs. 33.8%, P<0.001). The prolonged QTc interval was significantly associated with baseline QTc interval prolongation (odds ratio, 2.92; 95% confidence interval, 1.22 to 6.96; P=0.016) after adjusting for multiple confounders. Conclusion: A prolonged QTc interval at baseline was significantly associated with prolongation of the QTc interval during SH in patients with T2DM, suggesting the necessity of QTc interval monitoring and attention to those with a prolonged QTc interval to prevent SH.

노인의 인지기능과 삶의 만족도 관계에서 구강건강관련 요인의 매개효과

차선아,홍익표 대한작업치료학회 2023 대한작업치료학회지 Vol.31 No.3

Objective: This study was conducted to analyze the mediating effect of oral health factors in the relationship between cognitive function and life satisfaction in the elderly. Methods: This study analyzed 6,169 elderly people aged 60 years or older described in the 8th Korean Longitudinal Study on Aging (2020). The oral health factors of the elderly were divided into "functional dimension factors," "psychosocial dimension factors," and "pain or discomfort factors" of the Geriatric Oral Health Assessment Index (GOHAI). To determine the mediating effect of each factor, a path analysis was conducted using Mplus 8.4. Results: Between cognitive function and life satisfaction, among the oral health factors in the elderly, the functional dimension factor showed the largest partial mediating effect at 23% (β = 0.207, 95% confidence interval; CI = 0.169, 0.207). The psychosocial dimension factor was 22% (β = 0.202, 95% CI = 0.171, 0.236), and the pain and discomfort factor was 16% (β = 0.146, 95% CI = 0.119, 0.175), showing a partial mediating effect. Conclusions: The influence of three oral health-related factors on cognitive function and life satisfaction was confirmed. Therefore, it is necessary to consider the cognitive level of the elderly and identify oral health factors in detail. Accordingly, it is necessary to establish a personalized rehabilitation treatment access strategy and increase the life satisfaction of the elderly.

공법분야 투고논문 : 허용되는 양육방식과 금지되는 아동학대의 기준 -폭력인식의 문화적 관점을 중심으로-

차선자 ( Seon Ja Cja ) 한양대학교 법학연구소 2013 법학논총 Vol.30 No.4

Today it is difficult to find unifying definition about child abuse, since people understand it differently in the era and by the cultural feature. Despite this the nations for instance America and Germany etc, regard child abuse as the prohibited action by the related act. However, if the cultural backgrounds which provide a basis for personal behavior are very diverse in modern society, child rearing methods would be very various. Considering the cultural diversities, what we can define as child abuse in the law? Furthermore how can the particular action be regarded as child abuse and where can we get its justification, if the assailants assert that their behavior to child is generally accepted child rearing method in their culture? Under the critical aspect, this paper examined how the cultural backgrounds interact with the legal systems and how the provisions related with the child abuse are interpreted and applied. In addition to it, it is examined that respecting cultural background in deciding child abuse is effective to protect child. To attain the goal, it is looked into how the cultural background influences on interpreting and applying the law related with child abuse in America and Germany. In Germany child abuse is decided by german law. In principle the cultural background of the assailants is not considered. On the other hand in America it is not clear whether in deciding child abuse the cultural background of their care givers should be considered or not. Strictly speaking, in the position in which the cultural background should be considered in deciding child abuse, the important culture is the assailants, not the children. Futhermore, in that position children are perceived as objects in abuse case, even though they are the most important subjects of the victims. Moreover, that position is not effective to prevent child abuse, because by it the decision of the child abuse depends on the motive and circumstance of the assailants, not on the objective injury to the children. For this reason, that position should be sublated.

박태원「적멸」연구

차선일 경희대학교 대학원 원우회 2008 高凰論集 Vol.42 No.-

창업교육프로그램이 특성화고등학교 학생의 창업의지에 미치는 효과

차선아(Cha, Seon-A),최지연(Choi, Jiyeon),이건남(Lee, Gun-nam) 학습자중심교과교육학회 2020 학습자중심교과교육연구 Vol.20 No.15

이 연구의 목적은 특성화고등학교 학생을 대상으로 한 창업교육프로그램 적용이 학생들의 창업의지에 어떠한 효과를 미치는지 검증하는데 있었다. 이를 위해 경기도 A특성화고등학교 2학년 1개반 23명을 실험집단으로, 동학년 1개반 23명을 통제집단으로 선정하고 실험집단과 통제집단의 학생들에게 창업의지 검사도구를 사용하여 사전검사를 실시하였고 그 결과 통계적으로 유의미한 차이가 없음을 확인한 후 수업을 실시하고 실험집단과 통제집단에 대해 사후검사를 실시하여 t검증을 실시하였고 유의수준 .05에서 그 효과를 검증하였다. 연구 결과는 다음과 같다. 첫째, 창업의지는 실험집단과 통제집단 간에 유의미한 차이가 있는 것으로 나타났다. 창업의지의 하위요인 중 혁신성, 위험감수성, 진로탐색, 창업체험/준비에서 실험집단과 통제집단의 사후검사 결과 간 유의미한 차이가 있는 것으로 나타났으며, 정보수집은 유의미한 차이를 나타내지 않았다. 둘째, 실험집단의 창업교육프로그램 실시 전과 후의 창업의지를 검증한 결과 창업의지가 사전보다 사후에 더 높게 나타났으며, 유의미한 차이를 보였다. 이상의 연구 결과를 종합해 볼 때, 창업교육프로그램을 적용한 수업은 학생들의 창업의지를 향상시키는데 효과적인 것으로 밝혀졌으며, 창업의지의 여러 하위요인들 중 혁신성, 위험감수성, 진로탐색, 창업체험/준비 영역을 향상시키는데 효과적이라고 할 수 있다. The purpose of this study was to examine how the application of the entrepreneurship education program for specialized high school students affects the students intention to start a business. For this purpose, 23 students in the second grade of a specialized high school in Gyeonggi-do were selected as the experimental group, and 23 students in the same grade were selected as the control group. The experimental group applied the entrepreneurship education program, and the control group conducted the general career class. After the class, the post test was conducted on the experimental group and the control group to verify the effect. The results were follows: The intention to start a business was found to have a significant difference between the experimental group and the control group. There was a significant difference between the control groups, but one area of information collection did not show a significant difference. In regard to experimental groups, the will to start a business before and after the entrepreneurship education program was verified, and the will to start a business was shown to be higher posthumously than in the dictionary, and there was a significant difference. Among the sub-variables of the will to start a business, there were significant differences in innovation, risk sensitivity, career search, and experience / preparation of entrepreneurship before and after the start of the entrepreneurship education program, and information collection did not have any significant impact.