중첩증후군:만성 폐쇄성 폐질환을 가 진 폐쇄성 수면무호흡-저호흡 증후군

최영미,Choi, Young-Mi 대한수면의학회 2008 수면·정신생리 Vol.15 No.2

Overlap syndrome can be defined as a coexistence of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome (SAHS). The association of COPD and SAHS has been suspected because of the frequency of both diseases. Prevalence of COPD and SAHS is respectively 10 and 5% of the adult population over 40 years of age. However, a recent study has shown that the prevalence of SAHS is not higher in COPD than in the general population. The coexistence of the two diseases is only due to chance. SAHS does not affect the pathophysiology of COPD and vice versa. Prevalence of overlap syndrome is expected to occur in about 0.5% of the adult population over 40 years of age. Patients with overlap syndrome have a more profound hypoxemia, hypercapnia, and pulmonary hypertension when compared with patients with SAHS alone or usual COPD patients without SAHS. To treat the overlap syndrome, nocturnal noninvasive ventilation (NIV) or nasal continuous positive airway pressure (nCPAP) can be applied with or without nocturnal oxygen supplement.

이공계 대학 학부생을 위한 MTP(Muti-grade Tutoring Project) e포트폴리오 평가 모형 개발

최영미,주문원,한영신,Choi, Young-Mee,Choo, Moon-Won,Han, Young-Shin 한국정보교육학회 2006 정보교육학회논문지 Vol.10 No.3

MTP(Multi-graded Tutoring Project) is a designed curriculum needed to perform a high quality project to improve teamwork and major skills for college student of science and engineering. Each student can experience teaching activities as a tutor and learning activities as a tutee in the MTP for three years. Through this curriculum, students are expected to obtain the capabilities to set up and search the goal of given projects, to make human network among multi-graded students and professionals which could be critical for finding careers, and to perform graduation projects in a more systematic and co-operated way, resulting in highly-qualified outputs. In this paper, MTP e-portfolio evaluation model is suggested. This model evaluates the individual-level performance operating in MTP curriculum. The evaluation model is described with three dimensional structure composed of participator, changes in learning, and learning processes. The resultant model could be utilized as tools for evaluating the curriculum set up for the multi-graded project-based teaching environment.

Lung Injury Indices Depending on Tumor Necrosis Factor-$\alpha$ Level and Novel 35 kDa Protein Synthesis in Lipopolysaccharide-Treated Rat

최영미,김영균,권순석,김관형,문화식,송정섭,박성학,Choi, Young-Mee,Kim, Young-Kyoon,Kwon, Soon-Seog,Kim, Kwan-Hyoung,Moon, Hwa-Sik,Song, Jeong-Sup,Park, Sung-Hak The Korean Academy of Tuberculosis and Respiratory 1998 Tuberculosis and Respiratory Diseases Vol.45 No.6

Background : TNF-$\alpha$ appears to be a central mediator of the host response to sepsis. While TNF-$\alpha$ is mainly considered a proinflammatory cytokine, it can also act as a direct cytotoxic cytokine. However, there are not so many studies about the relationship bet ween TNF-$\alpha$ level and lung injury severity in ALI, particularly regarding the case of ALI caused by direct lung injury such as diffuse pulmonary infection. Recently, a natural defense mechanism, known as the stress response or the heat shock response, has been reported in cellular or tissue injury reaction. There are a number of reports examining the protective role of pre-induced heat stress proteins on subsequent LPS-induced TNF-$\alpha$ release from monocyte or macrophage and also on subsequent LPS-induced ALI in animals. However it is not well established whether the stress protein synthesis such as HSP can be induced from rat alveolar macrophages by in vitro or in vivo LPS stimulation. Methods : We measured the level of TNF-$\alpha$, the percentage of inflammatory cells in bronchoalveolar lavage fluid, protein synthesis in alveolar macrophages isolated from rats at 1, 2, 3, 4, 6, 12, and 24 hours after intratracheal LPS instillation. We performed histologic examination and also obtained histologic lung injury index score in lungs from other rats at 1, 2, 3, 4, 6, 12, 24 h after intratracheal LPS instillation. Isolated non-stimulated macrophages were incubated for 2 h with different concentration of LPS (0, 1, 10, 100 ng/ml, 1, or 10 ${\mu}g/ml$). Other non-stimulated macrophages were exposed at $43^{\circ}C$ for 15 min, then returned to at $37^{\circ}C$ in 5% CO2-95% for 1 hour, and then incubated for 2 h with LPS (0, 1, 10, 100ng/ml, 1, or 10 ${\mu}g/ml$). Results : TNF-$\alpha$ levels began to increase significantly at 1 h, reached a peak at 3 h (P<0.0001), began to decrease at 6 h, and returned to control level at 12 h after LPS instillation. The percentage of inflammatory cells (neutrophils and alveolar macrophages) began to change significantly at 2 h, reached a peak at 6 h, began to recover but still showed significant change at 12 h, and showed insignificant change at 24 h after LPS instillation compared with the normal control. After LPS instillation, the score of histologic lung injury index reached a maximum value at 6 h and remained steady for 24 hours. 35 kDa protein band was newly synthesized in alveolar macrophage from 1 hour on for 24 hours after LPS instillation. Inducible heat stress protein 72 was not found in any alveolar macrophages obtained from rats after LPS instillation. TNF-$\alpha$ levels in supernatants of LPS-stimulated macro phages were significantly higher than those of non-stimulated macrophages(p<0.05). Following LPS stimulation, TNF-$\alpha$ levels in supernatants were significantly lower after heat treatment than in those without heat treatment (p<0.05). The inducible heat stress protein 72 was not found at any concentrations of LPS stimulation. Whereas the 35 kDa protein band was exclusively found at dose of LPS of 10 ${\mu}g/ml$. Conclusion : TNF-$\alpha$ has a direct or indirect close relationship with lung injury severity in acute lung injury or acute respiratory distress syndrome. In vivo and in vitro LPS stimulation dose not induce heat stress protein 72 in alveolar macrophages. It is likely that 35 kDa protein, synthesized by alveolar macrophage after LPS instillation, does not have a defense role in acute lung injury. 연구배경 : 급성폐손상의 병태생리학적 기전에는 염증세포들이 분비하는 다양한 염증성 매개물질들이 매우 중요한 역할을 한다. 이중 특히 tumor necrosis factor-$\alpha$ (TNF-$\alpha$) 는 다른 염증세포들의 화학주성 및 각종 염증성 매개물질 분비에 영향을 미치는 proin-flammatory cytokine으로 작용하는 한편, 직접적으로 세포손상을 야기시키는 세포독성 cytokine으로도 작용하는데, 급성폐손상에서 TNF-$\alpha$와 폐조직 손상과의 직접적인 관련성에 대해서는 아직 구체적으로 확인된 바가 많지 않다. 또한, 최근에 생체내 방어기전으로 스트레스 단백질에 대한 관심이 높아지면서, 단핵구에 내독소를 처치하거나, 동물에 내독소를 투여하기 전에 미리 스트레스 단백질을 합성시킨 경우, 내독소에 의한 손상을 감소시켜 준다는 연구가 보고되었지만, 내독소 자극 자체만으로 스트레스 단백질 합성이 유도되는지는 아직 분명하지 않다. 이에 저자들은 내독소 유도성 급성 폐손상에서 TNF-$\alpha$ 분비와 폐조직 손상을 포함한 일련의 염증반응과의 관계를 분석하고, 생체내 내독소 자극에 대하여 폐포대식세포에서 스트레스 단백질을 포함한 새로운 단백질 합성이 유도되는지 여부를 분석하고자 하였다. 연구방법 : 흰쥐의 기관내로 내독소를 투여한 후 시간별로 기관지폐포세척액내 TNF-$\alpha$농도, 염증세포 백분율 변화, 병리조직학적 소견을 관찰하고, 또한 각 시간대의 폐포대식세포에서 sodium dodesyl sulfate-polyacrylamide gel electrophoresis와 inducible heat stress protein72에 대한 면역화학염색을 시행하여 단백질 합성양상을 분석하는 한편, 폐포대식세포에 다양한 농도의 내독소 자극과 열처리를 가한 후, 배양상층액에서 tumor necrosis factor-a 농도를 측정하고, 폐포대식세포의 단백질 합성양상을 분석하였다. 연구결과 : 내독소 투여 후 tumor necrosis factor-$\alpha$는 첫 1시간째부터 현저하게 증가하여 (p< 0.0001) 3시간째 최고치에 이르렀고 6시간째는 감소하기 시작하여 12시간째는 정상 대조군 수준으로 감소하였다. 내독소 투여 후 염증세포 백분율의 변화는 2시간째부터 시작하여 6시간째 최고에 이르러 12시간째까지 지속하였으며, 장시간째에 정상 대조군 수준으로 회복하였다. 병리조직학적 소견상 폐손상 지표 점수는 내독소 투여후 6시간째 최고치에 이르러 24 시간째까지 지속하였다. 내독소 투여 후 분리한 폐포대식세포에서 첫 1시간째부터 장시간째까지 정상 대조군에서는 관찰할 수 없던 35kDa의 새로운 단백질 띠가 관찰되었으며, 면역화학염색상 inducible heat stress protein72는 관찰되지 않았다. 내독소 자극을 가하지 않은 정상 대조세포군에 비해 내독소 자극을 가한 세포군의 배양상층액에서 tumor necrosis factor-$\alpha$ 농도가 유의하게 높았으며 (p<0.001), 내독소 자극만 가한 세포군에 비해 열충격 전처치후 내독소 자극을 가한 세포군의 배양상층액에서 tumor necrosis factor-$\alpha$ 농도가 10 ${\mu}g/ml$ 내독소 자극군만 제외하고 모두 유의하게 감소하였다 (p<0.05). 내독소 자극만 가한 세포군은 10 ${\mu}g/ml$의 고농도에서만 35 kDa 의 단백질 띠가 합성되었고 inducible heat stress protein72는 관찰되지 않았다. 열충격 전처치후 내독소 자극을 가한 세포군은 모두 inducible heat stress protein72가 관찰되었다. 결 론 : 기관내 내독소 투여에 의한 급성 폐손상에서 tumor necrosis factor-$\a

A Case of T-cell Primary Pulmonary Lymphoma Diagnosed by $TCR{\gamma}$ gene rearrangement

최영미,김승준,권순석,김영균,김관형,문화식,박성학,송정섭,Choi, Young Mee,Kim, Seung Joan,Kwon, Soon Seog,Kim, Young Kyoon,Kim, Kwan Hyoung,Moon, Hwa Sik,Park, Sung Hak,Song, Jeong Sup The Korean Academy of Tuberculosis and Respiratory 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6

반복되는 흉막염 및 폐렴을 주소로 내원한 30세 남자환자에서 경기관지 폐생검과 흉수내 림프구에 대한 유세포 분석 및 T세포 수용체 유전자 재배열 분석을 실시하였다. 경기관지 폐생검 조직의 연역조직화학 염색상 대부분의 림프구가 T세포 표식자인 UCHLl 에 대해 강하게 염색되었고, B세포 표식자인 L26에 대해서는 거의 염색되지 않았다. 흉수에서 추출한 림프구의 유세포 분석상 CD3양성 CD2양성인 T림프구가 대부분이었고, 이들 림프구에 대해 중합효소연쇄반응을 이용한 T세포 수용체 유전자 재배열 분석을 하였더니 $TCR{\gamma}$ 유전자 재배열과 클론성을 관찰할 수 있었다. T세포 원발성 폐림프종으로 진단하였고, 문헌고찰과 함께 보고하는 바이다.

폐쇄성 수면 무호흡 증후군과 상기도 저항 증후군의 진단적 및 임상적 차이

최영미,Choi, Young-Mi 대한수면의학회 2011 수면·정신생리 Vol.18 No.2

It has been controversial whether upper airway resistance syndrome (UARS) is a distinct syndrome or not since it was reported in 1993. The International Classification of Sleep Disorders classified UARS under obstructive sleep apnea syndrome (OSAS) in 2005. UARS can be diagnosed when the apnea-hypopnea index (AHI) is fewer than 5 events per hour, the simultaneously calculated respiratory disturbance index (RDI) is more than 5 events per hour due to abnormal non-apneic non-hypopneic respiratory events accompanying respiratory effort related arousals (RERAs), and oxygen saturation is greater than 92% at termination of an abnormal breathing event. Although esophageal pressure measurement remains the gold standard for detecting subtle breathing abnormality other than hypopnea and apnea, nasal pressure transducer has been most commonly used. RERAs include phase A2 of cyclical alternating patterns (CAPs) associated with EEG changes. Symptoms of OSAS can overlap with UARS, but chronic insomnia tends to be more common in UARS than in OSAS and clinical symptoms similar with functional somatic syndrome are also more common in UARS. In this journal, diagnostic and clinical differences between UARS and OSAS are reviewed.

디지털큐레이션을 활용한 팀프로젝트 기반 유튜브 생태계 설계 및 적용

최영미,Choi, Youngmee 한국멀티미디어학회 2020 멀티미디어학회논문지 Vol.23 No.12

The purpose of this study is to design and apply YouTube ecosystem using digital curation to improve the interaction of untact class. The untact digital instructional model for building the YouTube ecosystem is composed of four modules: domain, tutor, student, and interface, and the role of each module is described. As an application example, the team project "Development and Operation of Instructional Assistant YouTube" is performed in the Introduction to Media Software class. The learning experience is described in terms of professor, peer tutors, and learners, and learning outcomes are presented through surveys.

폐쇄성 수면 무호흡 증후군과 폐동맥 고혈압에서 엔도텔린-1의 역할

최영미,Choi, Young-Mi 대한수면의학회 2010 수면·정신생리 Vol.17 No.2

Obstructive sleep apnea syndrome is associated with significant cardiovascular morbidity and increased mortality. However, it was controversial whether obstructive sleep apnea syndrome could cause pulmonary hypertension. The controversy was resolved by several studies that have shown pulmonary hypertension in 20% to 40% of patients with obstructive sleep apnea syndrome without underlying other cardiopulmonary diseases and reductions in pulmonary arterial pressure in patients with obstructive sleep apnea syndrome after treatment with nocturnal continuous positive airway pressure. Recent studies provide strong evidence for endothelial dysfunction in obstructive sleep apnea syndrome and pulmonary hypertension. Endothelin-1 is a 21 amino acid peptide with diverse biologic activity such as highly potent vasoconstrictor and mitogen regulator that may play a key role in obstructive sleep ap-nea syndrome and pulmonary hypertension. Continuous positive airway pressure therapy is moderately effective in reducing pulmonary arterial pressure. Further researches are needed to assess the therapeutic efficacy of pharmacologic therapy with agents that inhibit the action of endothelin-1 in obstructive sleep apnea syndrome patients with pulmonary hypertension.

BCG 접종후 발생한 결핵성 농양 및 골수염 1례

최영미,강현호,조병수,차성호,임성직,이주희,Choi, Young Mi,Kang, Hyeon Ho,Cho, Byung Soo,Cha, Sung Ho,Lim, Sung Jic,Lee, Ju-Hee 대한소아감염학회 1998 Pediatric Infection and Vaccine Vol.5 No.1

BCG osteomyelitis is rare comlication and the incidence rate has been estimated to be 1/milion vaccinated neonate and infants. BCG osteomyelitis is also reported as a complication of intravesical BCG treatment for bladder carcinoma. We had experienced a 14 months old infant who presented swelling, tenderness and redness on left upper arm suspicious due to BCG vaccination. The MRI finding showed $2{\times}4{\times}4cm$ subcutaneous abscess with cortical defect on proximal humerus and axillary lymph adenopathy. The histologic finding showed diffuse caseous necrosis and Langhans type giant cell. We report A case of BCG osteomyelitis.

한중일 삼국의 FTA 전략

최영미(CHOI Young-Mi, 崔英美) 신아시아연구소(구 신아세아질서연구회) 2014 신아세아 Vol.21 No.2

본 연구는 동아시아 지역주의에 대한 통합적 전망 제시를 목적으로 현재 역내에서 추진되고 있는 주요 다자 FTA 논의인 한중일 자유무역협정(CJK FTA), 동아시아 자유무역협정 (EA FTA), 역내포괄적경제동반자협정(RCEP), 그리고 환태평양경제동반자협정(TPP)에 대한 한국, 중국, 일본 삼국의 전략 분석을 그 목적으로 한다. 먼저 일본은 지역 내 급속하게 성장하고 있는 중국의 리더십을 미국의 주도 하에 견제할 수 있는 TPP를 가장 선호하고 있으며 중국 주도의 RCEP 그리고 EA FTA를 통한 동아시아 지역주의 형성을 가장 꺼리고 있다. 반대로 RCEP과 EA FTA를 통한 지역주의의 형성은 중국이 가장 바라는 결과이며 TPP를 통한 아태자유무역지대(FTAAP)의 체결은 중국에게 있어 최악의 결과라 할 수 있다. 이렇듯 미국, 일본 대 중국의 이익이 충돌하는 양상 아래 한국의 선택이 동아시아 지역주의 발전에 커다란 영향을 미칠 것이라 예상된다. 한국은 양자택일적 사고에서 벗어나 미일 대 중국의 경쟁구도를 전략적으로 이용하여 미국 주도의 TPP에 보다 적극적으로 참여해야하며 중국이 이끌고 있는 CJK FTA, EA FTA, 그리고 RCEP 모두에 참여하고 있음을 중국에게 강하게 어필해야 한다. This study examines the free trade agreement (FTA) strategies of South Korea, China and Japan as evidenced by the China-Japan-Korea FTA (CJK FTA), the East Asia FTA (EA FTA), the Regional Comprehensive Economic Partnership (RCEP), and the Trans-Pacific Partnership (TPP) discussions to anticipate the future of East Asian regionalism. For Japan, the best outcome is to develop regional cooperation by expanding the TPP led by the US i to contain China's leadership; the worst outcome is East Asian regionalism that results from the China-led FTAs, RCEP and the EA FTA. For China, in contrast, the best result is East Asia regionalism led by establishment of China-led FTAs, RCEP and the EA FTA while the worst is conclusion of the TPP and then the Free Trade Area of the Asia Pacific (FTAAP). Given the competition between the US and Japan and China in developing East Asia regionalism, Korea is likely to hold the key to any ultimate outcome.. The best strategy for Korea is to participate in US-led TPP discussions as well as the China-led FTA discussions, the CJK FTA, the EA FTA, and the RCEP.

가정의 소득수준과 부모의 훈육방식 및 유아의 자기조절능력 간의 관계

최영미 ( Choi Youngmi ),이희영 ( Lee Heeyeong ) 열린부모교육학회 2017 열린부모교육연구 Vol.9 No.1

본 연구는 부모의 훈육방식이 유아의 자기조절능력에 어떠한 영향을 미치는지 알아보고 부모의 훈육방식과 유아의 자기조절능력간의 관계에서 소득수준의 조절효과를 알아보았다. 연구대상은 만 3~5세 유아의 부모를 대상으로 설문조사하여 최종 207부를 기술통계(평균, 표준편차), Pearson 상관관계, 다중회귀분석, 위계적 회귀분석으로 통계처리 하였다. 연구결과를 요약하면 다음과 같다. 첫째, 가정의 소득수준과 부모의 훈육방식 및 유아의 자기조절능력 간에 유의미한 상관이 있었다. 구체적으로 살펴보면, 가정의 소득수준은 지지적 훈육, 행동통제적 훈육과 유의미한 정적 상관을, 정서조절과는 유의미한 부적상관을 보였다. 심리통제적 훈육은 정서조절과 유의미한 정적상관을, 행동조절과는 유의미한 부적상관을 보였다. 지지적 훈육은 행동조절과 유의미한 정적상관을, 정서조절과는 유의미한 부적상관을 보였다. 아울러 행동통제적 훈육과도 유의미한 정적상관을 보였다. 행동통제적 훈육은 행동조절과 유의미한 정적상관을 보였다. 둘째, 부모의 지지적 훈육방식이 유아의 정서조절에 영향을 주었고, 부모의 심리통제적 훈육방식과 행동통제적 훈육방식이 유아의 행동조절에 영향을 주었다. 셋째, 부모의 훈육방식과 유아의 정서조절 간의 관계에서 소득수준의 조절효과는 없었고, 부모의 훈육방식 중 행동통제적 훈육방식과 유아의 행동조절 간의 관계에서는 소득수준의 조절효과가 있었다. 본 연구결과는 유아의 자기조절능력 증진을 위한 중재프로그램 개발과 저소득가정의 정서지원을 위한 부모교육 프로그램 개발 과정의 기초자료를 제공해 줄 수 있을 것이다. The purpose of this study was to investigate the influence of disciplinary style on self-regulation ability and to examine the moderating effect of the level of income between parental disciplinary style and self-regulation of young children. The subjects of the study were 207 parents with 3-5 year old children.. The PDI(The Parenting Dimension Inventory) developed by Judith and Christopher(1979) and Young Children`s Self-regulation developed by Lee Jung-Ran(2003) were used to collect data. Collected data were statistically analyzed using descriptive statistics (mean, standard deviation), Pearson correlation, multiple regression analysis, and hierarchical analysis. The results were as follows: First, there were significant relations between the level of income, parental discipline and self regulation of young children. Specifically, the level of income was significantly positively related to supportive discipline and behavioral controlling discipline, but negatively related to emotional regulation. Psychological controlling discipline was significantly positively related to motional regulation, but negatively related to behavioral regulation. Supportive discipline was significantly negatively related to emotional regulation, but positively related to behavioral regulation. Also supportive discipline was significantly positively related to behavioral controlling discipline. Behavioral controlling discipline was significantly positively related to behavioral regulation. Second, parental supportive discipline influenced emotional regulation of young children and parental psychological controlling and behavioral controlling discipline influenced behavioral regulation of young children. Third, the level of income was not moderate the relationship between parental income and emotional regulation of young children, but the level of income moderated the relationship between behavioral controlling discipline and behavioral regulation of young children. The results of this study may provide basic data for the development of intervention program for self-regulation of young children and the development of parent education programs for emotional support of low-income families.