소아에서 심에코도로 측정한 좌심실 용적과 심박출양에 대한 연구

홍영미 梨花女子大學校 醫科大學 醫科學硏究所 1992 EMJ (Ewha medical journal) Vol.15 No.3

The purpose of this study is to establish normal values for left ventricular volume and cardiac output, which might be used for evaluating patients with congenital heart disease or coronary artery disease. Two dimensional and Doppler echocardiography were performed in 111 pediatric normal subjects. Age ranged form newborn to 15 years. The results are as follows: 1) Left ventricular end-diastolic volume ranged from 6.3 to 73.7㎖ and left ventricular end systolic volume ranged from 1.1 to 16.0㎖ Left ventricular volume increased with advancing age or body weight. 2) Ejection fraction ranged from 78.3 to 83.5%. Lower limit of 5% of ejection fraction ranged from 69.3 to 73.1%. 3) Aortic flow integral was not significantly increased according to advancing age of body weight, but measurement of aortic diameter showed a steady increase with advancing age or body weight. 4) Cardiac output ranged from 0.68 to 4.3ℓ/min. Cordiac output increased significantly with advancing age or body weight. Echocardiography is a best noninvasive diagnostic tool to assess left ventricular function and cardiac output.

잡견에서 폐정맥 협착 형성 전후에 Endothelin-1의 변화에 대한 연구

홍영미,원용순,김성숙 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.6

Purpose : Endothelin-1(ET-1) is a potent vasoconstrictor peptide. It has potent contractile and proliferative effects on vascular smooth muscle cells. Congenital heart diseases are often accompanied by pulmonary hypertension, and the severity of pulmonary hypertension is important in the prognosis. The aim of this study was to elucidate changes of ET-1 after pulmonary venous stenosis in a dog model, and investigate the interaction between pulmonary venous pressure and ET-1. Methods : Plasma ET-1 levels were measured by radioimmuno-assay at the thoracic aorta, left pulmonary artery and left pulmonary vein. Pressures were also monitored at the same sites. Immunohistochemical staining of ET-1 was performed in the lung tissue. Results : Increased serum ET-1 levels were noted at 1 hour after left pulmonary vein stenosis in the left pulmonary vein and aorta, and at 2 days after stenosis in the left pulmonary artery. Left pulmonary venous pressure was significantly increased at 1 hour after pulmonary vein stenosis, and systolic pulmonary artery pressure at 2 days after stenosis. Increased expression of ET-1 was noted by immunohistochemical staining at the lung tissue at 7 days after stenosis of left pulmonary vein. Conclusion : Increased serum ET-1 level and expression of ET-1 in immunohistochemical staining at lung tissue were noted after stenosis of pulmonary vein. Serum ET-1 level would be useful in the diagnosis and prediction of pulmonary artery hypertension. 목 적 : ET는 내피 세포에서 유리된 펩타이드로 혈관 평활근 벽에서 수축성이 있고 증식하는 효과를 갖고 있다. 선천성 심질환으로 인한 폐동맥 고혈압에서 ET의 증가가 보고되었고 승모판 폐쇄시 ET의 증가가 있다는 보고가 있는 반면에, 그 반대의 보고도 있다. 폐정맥 협착이 ET에 미치는 영향에 대해서는 보고가 없는 실정이다. 잡견에서 폐정맥 협착을 유발시킨 후 폐조직에 미치는 영향을 알아보고, 폐조직과 혈중에서 ET-1의 변화를 관찰하기 위해 본 연구를 실시하였다. 방 법 : 10-15kg의 잡견 11마리를 대상으로 하였다. 우측 흉와위로 고정시킨뒤 5번째 늑골간으로 좌측 개흉술을 시행하였고, 폐정맥 협착을 만들기 전 상태에서 흉부 대동맥에서 동맥혈가스 분석을 위해 혈액을 채취하였다. 흉부 대동맥, 좌폐동맥, 좌폐정맥에서 ET- 1 검사용 혈액 4mL를 채취하였고, 좌폐동맥, 좌폐정맥, 좌심방의 압력을 측정하였다. 인위적으로 좌폐정맥 협착을 유발시킨 후에 1시간, 2일, 7일 후에 폐정맥 협착 전과 마찬가지로 동맥혈가스 분석과 ET-1 검사용 혈액을 채취하였고, 압력을 측정하였다. ET-1 검사용 혈액은 냉장 보관한 EDTA-aprotinin 용기에 담아서 -70℃ 냉동고에 보관 후 Amersham(United Kingdom)사의 kit를 이용하여 측정하였다.

시설보호아동이 지각한 사회적 지지 및 자아존중감과 행동문제와의 관계

홍영미 한국청소년학회 2010 청소년학연구 Vol.17 No.12

The purpose of this study was to investigate the relationship among the institutionalized children's perceived social support, Self-esteem and behavior problems. The subjects were 161 4th and 6th graders(87 boys, 74 girls) who were institutionalized in Seoul. Instruments were the Social Support scales (Kim, 2002) and Self-Esteem scales (Oh, 2008) and Korean Youth Self-Report (Oh et al., 1997). The data were analyzed, In SPSS/Win 17.0 program, by t-test, one-way ANOVA, Pearson Correlations, and multiple regression analysis. The major findings of this study were as follows: First, institutionalized children's perceived social support made self-esteem increased. Second, institutionalized children's perceived social support made behavior problems decreased. Third, institutionalized children's high self-esteem made behavior problems decreased. Fourth, institutionalized children's perceived emotional support and high self-esteem made behavior problems decreased. And institutionalized children's perceived social support of care teacher(institution staff) and school teacher, and high self-esteem made behavior problems decreased. Just institutionalized children's self-esteem have great on effect behavior problems than social support. 본 연구에서는 시설보호아동이 지각한 사회적 지지 및 자아존중감이 행동문제와 어떤 상관관계가 있고 어떻게 영향을 미치는지를 알아보고자 하였다. 본 연구는 서울지역에 있는 아동양육시설 초등학교 161명의 4-6학년 아동을 대상으로 실시하였다. 연구도구는 사회적 지지척도(김수진, 2002), 자아존중감 척도(오환영, 2008), 그리고 K-YSR(오경자 외, 1997)를 사용하였다. 자료분석은 SPSS/WIN 17.0 프로그램을 사용하였으며, t검증, 일원배치 분산분석, Pearson의 적률상관분석, 위계적 중다회귀분석을 실시하였다. 이 연구의 결과는 다음과 같다. 첫째, 시설보호아동이 사회적 지지를 높게 지각할수록 자아존중감이 높은 것으로 나타났다. 둘째, 시설보호아동이 지각한 사회적 지지가 높을수록 행동문제는 감소하는 것으로 나타났다. 셋째, 시설보호아동의 자아존중감이 높을수록 행동문제는 감소하는 것으로 나타났다. 넷째, 시설보호아동이 정서적 지지를 높게 지각하고 자아존중감이 높을수록 행동문제가 감소하는 것으로 나타났다. 그리고, 시설보호아동이 시설선생님과 학교선생님의 지지를 높게 지각하고, 자아존중감이 높을수록 행동문제는 감소하는 것으로 나타났다. 이 연구를 통해 시설보호아동의 행동문제를 감소시키기 위해서는 사회적 지지도 중요하지만 개인 내적인 요인인 자아존중감을 키워줄 수 있는 사회적 지지가 더 효과적이라는 것을 알 수 있었다.

학동기 아동의 정상 혈압치와 퍼센타일 곡선

홍영미,이재영,정조원,김남수,노정일,이순영,이희우 대한심장학회 2006 Korean Circulation Journal Vol.36 No.11

Background and Objectives:Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of the time-consuming procedures in the diagnosis of coronary artery disease (CAD). Moreover, the accuracy of DSE with 2DE depends on the operator's skill or bias during the image acquisition. This study was conducted to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for the diagnosis of CAD. Subject and Methods:62 patients (RT3DE: 36, 2DE: 26), suspected of angina pectoris and post-revascularization ischemia, underwent DSE and coronary angiography (CAG). Image acquisition was performed at the baseline, and at 4 times during the dobutamine infusion and recovery stages. The procedure time (from the baseline to the end of the peak dose stage) was recorded. Off-line analyses of the volumetric images acquired with RT3DE were performed using 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed using the 2DE review system (ProSolv 4.0). >50% luminal diameter stenosis of any coronary artery on CAG was defined as significant coronary artery stenosis. Results:The procedure time of DSE with RT3DE was significantly shorter than that of DSE with 2DE (25±4 vs. 37±4 mins, p<0.001). There was no significant difference in the sensitivity (p>0.05) or specificity (p>0.05) between the two procedures. Conclusion:DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure, probably providing comparable sensitivity and specificity for the detection of coronary artery stenosis, than DSE with 2DE. (Korean Circulation J 2006;36:737-743) 배경 및 목적:관상동맥 질환을 진단하는데 실시간 3차원 심초음파와 이면성 심초음파를 이용한 도부타민 부하검사의 유용성과 정확성을 알아보고자 본 연구를 시행하였다.방 법:대상 환자는 본원을 흉통을 주소로 내원한 협심증이 의심되는 환자와 관상동맥 혈관재형성 후 재협착이 의심되는 환자를 대상으로 하였다. 환자군을 무작위로 두 군으로 분류하여 이면성 심초음파와 실시간 3차원 심초음파를 이용한 도부타민 부하검사를 시행하였고, 도부타민은 초기 10 μg/kg/min부터 투여하여 약 3분 간격으로 최대 40 μg/kg/min까지 투여하였고 연령을 고려한 최대 심박수 85%에 도달하지 못하는 경우 atropine 0.25 mg을 정맥내로 정주하여 최대 1 mg까지 투여하였다. 결 과: 수축기 및 이완기 혈압은 연령, 신장, 체중, 체질량지수가 증가할수록 유의하게 증가하였다. 남학생에서는 수축기 혈압 과 체중(r=0.553), 신장(r=0.491), 체질량지수(r=0.470), 연령 (r=0.445)이 유의한 상관관계가 있었고, 여학생에서도 수축기 혈압과 체중(r=0.332), 신장(r=0.317), 체질량지수(r=0.286), 연령(r=0.213) 순으로 유의한 상관관계가 있었다. 결 론: 6~18세 사이에서 정상 소아의 백분위수와 백분위 곡선을 구하였으며 이 자료는 정상 소아에서 고혈압을 진단하는데 매 우 유용하게 사용될 수 있을 것으로 생각한다.

자연적으로 유발된 고혈압 백서에서 안지오텐신 전환효소를 억제하는 Small Hairpin RNA 투여 효과

홍영미,이혜련,김관창 대한고혈압학회 2012 Clinical Hypertension Vol.18 No.3

Background: Interfering RNA (iRNA) represents a recent breakthrough in effective blocking of the target genes in mammalian cells. Angiotensin-converting enzyme (ACE) has been shown to play an important role in the pathogenesis of hypertension. The purposes of this study were to investigate the effects on blood pressure, myocardial hypertrophy and gene expressions of iRNA targeting ACE. Methods: Twelve week old male Wistar-Kyoto rats were grouped as follows: control group (C group), spontaneously hypertensive rat (SHR) group (H group), and ACE-iRNA group (A group) in which SHR was treated with recombinant lentiviral vectors carrying small hairpin RNA targeting ACE. Reverse transcriptionpolymerase chain reaction and western blot analysis of ACE, endothelin (ET)-1, angiotensin (AT) II receptor type 1A,neutrophil cytosolic factor, caspase 3, Bax, and Bcl-2 were performed in the heart tissues. Serum AT, ACE, and high sensitive-C reactive protein were estimated. Results: Systolic blood pressure was significantly decreased in the A group compared with the H group in weeks 3 and 5. Serum AT level was significantly lower on day 1, weeks 3 and 5 after ACE-iRNA treatment. ACE protein contents were significantly lower after ACE-iRNA treatment in week 5. ET-1 and Bcl-2protein contents were significantly lower after ACE-iRNA treatment in weeks 3 and 5. Bax protein contents were significantly lower after ACE-iRNA treatment in week 3. Conclusions: Recombinant lentiviral vectors carrying shRNA targeting ACE prevented hypertension. Serum AT and gene expressions such as ACE, ET-1, Bax, and Bcl-2 were significantly decreased after ACE-iRNA treatment. 연구배경: RNA interference는 이중 가닥의 RNA (double-stranded RNA)가 dicer에 의해 절단되어 생성되는 21-25 뉴클레오타이드 크기의 작은 RNA조각으로 상보적인 서열을 갖는 mRNA에 특이적으로 결합하여 단백질 발현을 억제하는 것으로 밝혀졌다. 본 연구에서는 자연적으로 유발된 고혈압 쥐(spontaneously hypertensive rat, SHR) 모델에서 안지오텐신 전환효소(angiotensinconverting enzyme, ACE)에 대한 small hairpin RNA (shRNA)가 주입된 렌티바이러스 벡터를 투여하여 혈역학적, 해부학적 변화를 알아보고, 이와 같은 조절 효과가조직학적 변화 또는 유전자 수준에서 어느 시기에 어느정도 일어나는지를 규명하고자 하였다. 방법: 12주의 자성 성숙 Wistar-Kyoto 백서를 대조군으로 SHR을 고혈압군(H군)으로 shRNA가 주입된 렌티바이러스 벡터를 투여한 치료군을 ACE-interfering RNA (iRNA) (A군)으로 하였다. shRNA 투여는 렌티바이러스에 형질주입된 상태로 1 mL를 실험 시작일에 SHR의 꼬리에 정맥투여하였다. 대조군 및 실험군 모두 21일, 35일에 도살하였다. 혈청 알도스테론, ACE, 안지오텐신치를측정하였고, reverse transcription-polymerase chain reaction과Western blot분석을 이용하여 endothelin (ET)-1,ACE, angiotensin II receptor (AT II R) 1A, neutrophil cytosolic factor (NCF), caspase-3, Bax, Bcl-2 유전자 발현을 측정하였다. 결과: 혈압은 H군에서 유의하게 증가하였고 A군에서유의하게 감소하였다. 혈청 안지오텐신치는 H군에서 유의하게 증가하였고, A군에서 유의하게 감소하였다. ACE 농도는 세 군 간에 유의한 차이가 없었다. ACE 농도는 5주에, ET-1와 Bcl-2 단백질 농도는 ACE-iRNA 치료 후 3주, 5주째 유의하게 감소하였디. Bax 단백질 농도는ACE-iRNA 치료 후 3주에 유의하게 감소하였다. AT II R, NCF, caspase-3 단백질 농도는 ACE-iRNA 치료 후 유의한 감소가 없었다. 결론: ACE에 대한 shRNA가 주입된 렌티바이러스 벡터는 항고혈압 효과가 뚜렷하였고, ACE, ET-1, Bax,Bcl-2 유전자 발현의 감소를 초래하였다. 향후 shRNA 주입 양을 증량시킨 연구가 추후에 이루어져야 할 것으로생각한다.

The Prescription Pattern of Acetaminophen and Non-Steroidal Anti-Inflammatory Drugs in Patients with Liver Cirrhosis

홍영미,윤기태,허정,우현영,임원,안대성,한준희,조몽 대한의학회 2016 Journal of Korean medical science Vol.31 No.10

Analgesics, known to be hepatotoxic drugs, are frequently prescribed to patients with liver cirrhosis who are prone to drug-induced liver injury. No guidelines are available regarding the prescription of analgesics in these patients. Therefore, we aimed to evaluate the prescription pattern of most frequently used analgesics in patients with cirrhosis. We assessed the prescription pattern of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with liver cirrhosis registered in Health Insurance Review Assessment Service database between January 1, 2012 and December 31, 2012. A total of 125,505 patients with liver cirrhosis were registered from January 1, 2012 to December 31, 2012. Of that group, 50,798 (40.5%) patients claimed reimbursement for at least one prescription for acetaminophen or NSAIDs during the one year follow-up period. Overall, NSAIDs (82.7%) were more prescribed than acetaminophen (64.5%). NSAIDs were more prescribed than acetaminophen even in decompensated cirrhosis compared with compensated cirrhosis (71.5% vs. 68.8%, P value<0.001). There was a marked difference in prescription preference between acetaminophen and NSAIDs among physicians. Internists more frequently prescribed acetaminophen than NSAIDs compared to other physicians (50.9% vs. 76.2%, P<0.001). Gastroenterologists more frequently prescribed acetaminophen over NSAIDs compared to other internists (80.9% vs. 51.2%, P<0.001). Analgesics were prescribed in 40.5% of patients with cirrhosis. NSAIDs were more frequently prescribed although they should be avoided. The prescription pattern of analgesics were different significantly among physicians in patients with liver cirrhosis. The harmful effects of NSAIDs in patients with cirrhosis should be reminded to all physicians prescribing analgesics.

Trends and Patterns of Hepatocellular Carcinoma Treatment in Korea

홍영미,윤기태,조몽,강대환,김형욱,최철웅,박수범,허정,우현영,임원 대한의학회 2016 Journal of Korean medical science Vol.31 No.3

Multiple therapeutic modalities are available for hepatocellular carcinoma (HCC) treatment. We aimed to evaluate the trends for HCC treatment in Korea. Recent trends and patterns in treatment modalities were assessed in HCC patients who first registered for the Health Insurance Review Assessment Service between 2008 and 2012. From 2009 to 2012, 57,690 patients were diagnosed with HCC. Transcatheter arterial chemoembolization (TACE) was the most common treatment modality for initial treatment. Curative treatment modalities like hepatic resection, liver transplantation, and local ablation therapy increased gradually. The 3 most common treatment modalities (hepatic resection, local ablation therapy, TACE) used after initial treatment in 2009 were studied. Following initial hepatic resection, 44.5% of patients required re-treatment. TACE was the most common modality (in 48.3% of cases), while 15.0% of patients received local ablation therapy. After local ablation therapy, 55.4% of patients were re-treated, wherein 45.0% of patients received TACE and 31.5% received local ablation therapy. Following initial TACE, 73.9% patients were retreated, most commonly with TACE (57.7%) followed by local ablation therapy (12.8%). While there were no significant differences between the initial and re-treatment modalities, various multiple treatments followed the initial treatment. The treatment modalities were interchangeable.

스피노자의 코나투스 이론

홍영미 철학연구회 2006 哲學硏究 Vol.0 No.73

문 스피노자 철학에서 코나투스 이론은 그의 철학 전반의 근본적인 토대를】이루는 것이다 본고는 스피노자의 코나투스 이론의 의미를 분명하게 밝혀보려는 의..음과 같은 문제 들을 다루려고 한다 먼저 스피노자의 코나투스 개념을 규정하고 그. ,것의 성격에 대해 간단히 언급할 것이다 둘째로 코나투스 개념이 어떤 의미를 가지. ,.스의 의미를 논의할 것이다 셋째로 모든 사물의 본질인 코나투스가 인간 존재에게 구.체적으로 어떻게 나타나는가를 논의한다 이로부터 논자는 스피노자가 코나투스의 적..

정상 소아에서 Doppler 심에코도로 측정한 심장 판막 혈류속도에 대한 연구

홍영미 梨花女子大學校 醫科大學 醫科學硏究所 1990 EMJ (Ewha medical journal) Vol.13 No.2

One hundred and 66 normal subjects were studied by two dimensional pulsed Doppler echocardiography to estimate velocity within heart and great vessels. Velocities were obtained at a beam flow intercept angle close to 0°in ascending aorta, main pulmonary artery, tricuspid and mitral valve orifice. Quantative angle corrected peak flow velocities were generally lower on the right side than on the left side of the heart. Differences in tricuspid(mean 58.3cm/sec) versus mitral (mean 70.8cm/sec) value orifice and pulmonary(mean 75.7cm/sec) versus ascending aorta (mean 111.7cm/sec) were significant(p<0.05). Only signifcant relationship between mitral valve velocity and body surface area was noted, but there was no significant difference between other value velocity and age or body surface area. These normal Doppler data should be useful for comprisons with data obtained in children with various forms of congenital heart disease that affect flow dynamics.

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홍영미 서강대학교 신학연구소 2004 신학과 철학 Vol.- No.6