심근경색 모델 흰쥐에서 스트레스가 B-type Natriuretic Peptide 발현 및 심박변이율 변화에 미치는 영향

이삼윤(Sam Youn Lee),이미경(Mi Kyoung Lee),김남호(Nam-ho Kim),주민철(Min Cheol Joo),조항정(Hyang Jeong Jo),강지숙(Ji Sook Kang),김병숙(Byung Sook Kim),윤선식(Sun Sik Yoon),최을식(Eul Sig Choi),이문영(Moon Young Lee) 대한스트레스학회 2010 스트레스硏究 Vol.18 No.3

심박변이율의 감소는 심근 경색 환자에서 예후의 악화와 관련되어 있다. 심박변이율 중 very low frequency가 심부전환자의 예후를 판단할 수 있는 독립적 인자로서 사용이 가능하다고 보고된 바 있으며, 심실의 압력 증가에 반응해서 생성되는 B-type natriuretic peptide가 심근 경색의 예후 인자로서 사용할 수 있음 역시 보고된 바 있다. 본 연구에서는 심근경색 모델을 제작하여 일정의 회복 기간을 거친 다음 다시 일정 기간의 스트레스를 겪게 한 후 심박변이율의 변화 및 심실 조직에서의 BNP 발현 정도를 비교하여 스트레스에 의한 영향을 관찰하고자 하였다. Sprague-Dawley계 수컷 흰쥐 15마리를 대상으로 하였다. 실험동물은 인위적 스트레스 및 수술을 받지 않은 대조군(CON, n=5), 심근경색 수술을 받은 후 restraint stress를 받지 않은 군(MI+No Stress, n=5), 심근경색 수술을 받은 후 1주일 동안 restraint stress를 받은 군(MI+Stress, n=5)으로 분류하였다. 심근경색 모델 제작 직후 15분 이상 심전도의 변화를 기록하였으며, 2개월 정도 후 심근경색 수술을 받은 동물을 두 군으로 나누어 그 중 한 군에는 1주일 동안 restraint stress를 가한 후 restraint stress를 가하지 않은 동물과 심박변이율을 비교 분석하였다. 심실 조직은 좌심실 전벽 부위의 위축을 관찰할 수 있었고, 대식세포에 의하여 응고, 괴사된 심근세포의 탐식과 혈관이 풍부한 육아조직 및 섬유 변화를 볼 수 있었다. 심박변이율은 심근경색 수술을 받은 직후 심박수는 유의한 증가를 보였고, standard deviation of the normal to normal intervals (SDNN), very low frequency (VLF) 및 low frequency (LF)의 유의한 감소를 보였다. 심근경색 수술을 받았던 동물에서 두 달 정도의 회복 기간을 거친 후 스트레스를 받지 않은 군은 심박수 및 기타 심박변이율 분석에서 SDNN 값을 제외하고는 정상군과 유의한 차이를 관찰할 수 없었던 반면 1주일 동안 스트레스를 받은 군에서는 심박수가 다시 유의하게 증가했을 뿐만 아니라 SDNN, VLF 및 LF 역시 정상군과 유의한 차이를 보였다. 이상의 결과를 종합하면 심근경색 동물에 대해 1주일 동안 스트레스를 가한 결과 심박변이율이 감소하고 심실에서의 BNP 발현은 더욱 증가하여 악화함을 보여주고 있다. Diminished heart rate variability (HRV) is associated with less favorable prognosis after myocardial infarction (MI). It has been reported that very low frequency (VLF) power in HRV analysis is an independent risk predictor in patients with congestive heart failure and B-type natriuretic peptide (BNP) can be used as a prognostic factor of MI. The purpose of this study was to investigate whether stress has an effect to the changes of BNP expression and/or heart rate variability in MI model in rats. Male Sprague-Dawley rats were divided into 3 groups: control group (CON), MI group (MI+No Stress), and MI followed by stress group (MI+Stress). MI+Stress group rats were raised for a two month recovery period after the operation, followed by being exposed to restraint stress for 2 hours per day for 1 week. Electrocardiogram was recorded after the operation and the last day after 1 week of stress. The frequency components of HRV were calculated in the frequency domain such as VLF, low frequency (LF), high frequency (HF) and so on. In HRV analysis, standard deviation of the normal to normal intervals (SDNN) was significantly reduced in both groups compared to the control group. VLF and LF also were significantly reduced in MI+Stress group compared to the control groups. In addition, BNP expression in western blotting was shown the strongest bands in MI+ Stress group among experimental groups. These results suggest that BNP and HRV were aggravated by stress in MI rat model. (Korean J Str Res 2010;18:275∼285)

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

Identification of a sensitive urinary biomarker, selenium-binding protein 1, for early detection of acute kidney injury

Kim, Kyeong Seok,Yang, Hun Yong,Song, Hosup,Kang, Ye Rim,Kwon, JiHoon,An, JiHye,Son, Ji Yeon,Kwack, Seung Jun,Kim, Young-Mi,Bae, Ok-Nam,Ahn, Mee-Young,Lee, Jaewon,Yoon, Sungpil,Lee, Byung μ,Kim, Hyung TAYLOR & FRANCIS 2017 Journal of Toxicology and Environmental Health Vol.80 No.9

<P>Acute kidney injury (AKI) is associated with increased mortality rate in patients but clinically available biomarkers for disease detection are currently not available. Recently, a new biomarker, selenium-binding protein 1 (SBP1), was identified for detection of nephrotoxicity using proteomic analysis. The aim of this study was to assess the sensitivity of urinary SBP1 levels as an early detection of AKI using animal models such as cisplatin or ischemia/reperfusion (I/R). Sprague-Dawley rats were injected with cisplatin (6 mg/kg, once i.p.) and sacrificed at 1, 3, or 5 days after treatment. Ischemia was achieved by bilaterally occluding both kidneys with a microvascular clamp for 45 min and verified visually by a change in tissue color. After post-reperfusion, urine samples were collected at 9, 24, and 48 hr intervals. Urinary excretion of protein-based biomarkers was measured by Western blot analysis. In cisplatin-treated rats, mild histopathologic alterations were noted at day 1 which became severe at day 3. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were significantly increased at day 3. Levels of urinary excretion of SBP1, neutrophil gelatinase-associated lipocalin (NGAL), and a tissue inhibitor of metalloproteinase-1 (TIMP-1) were markedly elevated at day 3 and 5 following drug treatment. In the vehicle-treated I/R group, serum levels of BUN and SCr and AST activity were significantly increased compared to sham. Urinary excretion of SBP1 and NGAL rose markedly following I/R. The urinary levels of SBP1, NGAL, TIMP-1, and KIM-1 proteins excreted by AKI patients and normal subjects were compared. Among these proteins, a marked rise in SBP1 was observed in urine of patients with AKI compared to normal subjects. Based upon receiver-operator curves (ROC), SBP1 displayed a higher area under the curve (AUC) scores than levels of SCr, BUN, total protein, and glucose. In particular, SBP1 protein was readily detected in small amounts of urine without purification. Data thus indicate that urinary excretion of SBP1 may be useful as a reliable biomarker for early diagnosis of AKI in patients.</P>

2000년 제27회 시드니 올림픽 유도경기 대비: 세계 여자 우수선수들의 개인별 국제경기 기술 특성에 관한 연구

김의환,박순진,김관현,김도준,안병근,정훈,김미정 용인대학교 무도연구소 2000 武道硏究所誌 Vol.11 No.1

The purpose of this study was to analyze the competition techniques traits and of international contest levels each category individual scoring - losing techniques of world elite judokas who. were awarded in the international judo tournaments (I,J.T.) (part 1: ∼O.G'%, part 2 :from O.G'% to July ,2000), and who are expected to participate in the 27th Olympic Games(O.G.) Sydney 2000 to prepare the 27th O.G, which will be held from 16. to 22 September, 2000 at Exhibition Center, Darling Harbour, in Sydney, Australia. The records of the results and contents of competition were obtained out of 97 for women I.J,T., world elite judokas. To decide individual contest levels, groups were devided into 3(A,B,C)groups and points were graded by 3 ways. The I.J.T. that were devided into 3 groups are shown in the table 1.

심근 허혈-재관류 백서 모델에서 mitogen-activated protein kinase 활성화에 대한 α-lipoic acid의 효과

김연경,박은미,최준호,윤경호,유남진,이은미,김남호,정진원,김민선,박병림,오석규 圓光大學校 醫科學硏究所 2006 圓光醫科學 Vol.21 No.1

유도 '되치기 본'의 개선 방안에 관한 연구

김의환,김도준,김규수,김관현,김종달,최종삼,조용철,박순진,윤익선,안병근,정 훈,김미정,한성철 龍仁大學校 武道硏究所 1999 武道硏究所誌 Vol.10 No.1

The purpose of this study was to reform practically a Korean Judo's Doechigi-Bon(Forms of Counterattack, judo's Gaeshi no Kata, Judo's Uradori no Kata, Judo's Gonosen no Kata) that was established in 1955 Korea, according to changing of techniques by Judo's modernization, in order to have Judo's carefulness and systematic diffusion. Reform procedure of Judo's Doechigi-Bon was 1st stage, Questionnaire survey 303 judokas, 2nd stage, Technical seminar by judo experts(12 judo professor) 4 times, 3rd stage, wording report for reform, 4rd stage, Discussion and judgement of Teaching and Judgement commission of Korean judo Association(KJA), 5th stage, Public hearing for reform in KJA, 6th stage, Report and decision of board of directors in KJA, 7th stage, public publication of Judo News(No.53) in KJA. Basic principle of reform of Judo's Doechigi-Bon were as table 1. Table 1. Basic principle of reform of Judo's Doechigi-Bon ------------------------------------------------------------------------------- Items Reformed Key Points of Judo's Doechigi-Bon ------------------------------------------------------------------------------- 1. Structure 1) Grand classification : Classified by 3 parts(1,2,3Gyo) 2)Medium classification : Te waza, Goshi waza, Ashi waza devided per each part(Gyo) 3)Sub-classification : Classified five techniques per each part(Gyo) 2. Contents 1) Selected established techniques as possible 2) Considered rationalty and overlapping of counterattack techniques 3. Decision of Conterattack techniques 1) Refered to results of Basic Questionnaire survey 2) Priority to decisions of Judo expert technical seminar -------------------------------------------------------------------------------- Reformed Korean Judo's Doechigi-Bon(Forms of Counterattack techniques-KJA, 1999) are as follows: 1. Gyo; ① Uki otoshi -> Uchi mata ② Harai goshi -> Harai goshi gaeshi ③ O soto gari -> O soto gake ④ Ko uchi gari -> Sasae tsurikomi ashi ⑤ O uchi gari -> Ko soto gari 2. Gyo; ① Ippon seoi nage -> Okuri eri jime ② Tsuri domi goshi -> Uki waza ③ Okuri ashi harai -> Okuri ashi harai ④ Ko soto gari -> Tai otoshi ⑤ Hiza guruma -> Hiza guruma 3. Gyo; ① Kata guruma -> Sumi gaeshi ② Tai otoshi -> Ko soto gari ③ Hane goshi -> Harai tsurikomi ashi ④ Uchi mata -> Tai otoshi ⑤ Tomoe nage -> O uchi gari

수면량과 집중력의 상관관계

김병우,류지근,박우진,박계원,김미정,임지은,백대현,최재덕,최윤호,이가현,이관,김덕수 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

수면, 기억 그리고 학습의 연관성은 실제 매우 복잡하다. 많은 연구에도 불구하고 명확한 연구결과는 아직 없다. 우리는 이 연구에서 평소와는 달리 시험 전날 수면 변화 양상이 집중력에 어느 정도 영향력을 미치는지 알아보고자 하였고, 이를 이용해 효율적인 수면 관리를 할 수 있는 기초자료로 삼고자 하였다. 동국대 의대 본과 1학년생 중 지원자 30명과 본과 2학년생 10명을 대상으로 평상시 상태와 시험 직후 수면이 부족한 상태에서 각각 K-PES TEST를 실시하여 총 8항목에 걸쳐 암기력, 판단력, 단순반응의 변화정도를 검사하였다. 또 설문조사를 병행하여 결과에 영향을 미칠 수 있는 다른 인자들도 파악하였다. 수면량에 대한 부호 숫자 짝짓기(순간 판단력)을 검사한 결과, 인간의 최대 생리학적 기능은 꼭 수면부족에 의해 좌우되는 것은 아니다. 그러나, 수면감소는 피로를 증가시키고, 동기부여를 감소시키나 단, 새로운 사실을 학습하는 데에는 큰 영향을 끼치지 않는다. 즉, 수면부족으로 장시간 깨어있는 것은 정확성과 반응성을 떨어뜨린다. 흡연에 대한 부호 숫자 짝짓기(순간 판단력)을 검사한 결과, 니코틴의 수면에 대한 상호관계는 알려지지 않았고, 인간의 감정이나 의식, 인식에 영향을 주는 것으로 알고있지만, 장기적은 측면에서 흡연이나 알코올은 인식능력과 무관한 것 같다. 카페인에 대한 숫자 외우기(암기력)검사 결과, 카페인은 spacial selective attention에는 특별한 영향을 주지 않지만 지각과정이나 주의 집중에 큰 효과를 주며, 인간의 의식 수행에 긍정적인 효과를 준다. 즉 카페인은 활력, 혼란, 피로상태를 변화시키고 visual analog scales에서 휴식상태에 가까운 양상을 나타낸다. 또 48시간 동안 수면을 취하지 않은 사람에게 카페인은 집중력과 장시간의 좋은 기분을 유지하게 하였다. 그러나 규칙적, 비규칙적으로 먹는 사람간에는 인지수행력의 차이를 보이지 않으며 상용자에서는 상당한 내성이 보인다. 수면패턴에 대한 숫자 더하기(순간 판단력)검사 결과, 집중력은 수면패턴에 의해서도 영향을 받고, 수면패턴이 바뀌게 되면 순간판단력을 저하시킨다. This study was performed to evaluate relationship of sleep and attention, and to control sleep effectively. We conducted a K-PES test of 40 medical students. K-PES contains eight elements, for example, simple response, selective response, color pairing, OddEven discrimination, number addition, number-symbol matching, memory, right-tapping, left tapping. Through these, we tested changes of memory, judgement, simple response. And we conducted a questionnaire survey to exclude bias. Results are as follows. As a results of number-symbol matching test, we know that sleeplessness is not complete responsible for physiologic function for humans. But, decreased sleep increases fatigue and decreases motivation, but no influence on learning new materials. So, long term sleeplessness decreases precision and responsibility. As a results of number-symbol matching test on smoking, a relationship of nicotine and sleep is not certain. A point of view in long term period, smoking and drinking is not related cognition, even if we know that those influence mood, consciousness and cognition. As a results of memory work test on caffeine, caffeine does not influence spacial selective attention, but mainly does perception, attention and consiousness process. Namely caffeine changes energetic activities, chaos, fatigue states and shows resting state in visual analog scales In sleeplessness for 48 hours, caffeine produced attention and good mood for a long time. But, in case of cognitive process no significance shows in regular or irregular diet. Regular diet shows high resistance. As a results of number addition test on sleep patterns, seep patterns influence attention, changes of sleep patterns decrease a moment judgement.

말단 비대증의 임상적 특성

박은미,안용환,김현정,김병수,임종주,김하영,박병현,조정구 圓光大學校 醫科學硏究所 2004 圓光醫科學 Vol.19 No.2

Adipose sirtuin 6 drives macrophage polarization toward M2 through IL-4 production and maintains systemic insulin sensitivity in mice and humans

Song, Mi-Young,Kim, Sang Hoon,Ryoo, Ga-Hee,Kim, Mi-Kyung,Cha, Hye-Na,Park, So-Young,Hwang, Hong Pil,Yu, Hee Chul,Bae, Eun Ju,Park, Byung-Hyun Nature Publishing Group UK 2019 Experimental and molecular medicine Vol.51 No.5

<▼1><P>Adipose tissue inflammation is a reproducible feature of obesity and obesity-linked insulin resistance. Although sirtuin 6 (Sirt6) deficiency has previously been implicated in diet-induced obesity and systemic insulin resistance, the adipocyte-specific role of Sirt6 in the regulation of adipose tissue inflammation and systemic metabolic dysfunction in mice fed normal chow and in humans remains elusive. Here, using <I>Adipoq-Cre</I>-mediated adipocyte-specific Sirt6 knockout (aS6KO) mice, we explored whether adipocyte Sirt6 inhibits adipose tissue inflammation and its underlying mechanism. aS6KO mice fed normal chow gained more body weight and fat mass than wild-type mice and exhibited glucose intolerance and systemic insulin resistance. Measurement of plasma and tissue cytokines and flow cytometric analysis of adipose stromal vascular cells indicated a decrease in alternatively activated M2 macrophages in the adipose tissue of aS6KO mice. Mechanistically, Sirt6 regulated the expression of the canonical type 2 cytokine IL-4 by adipocytes in a cell autonomous manner, which in turn affects M2 macrophage polarization. Consistent with animal experimental data, the degree of obesity and insulin resistance demonstrated by the body mass index, fasting blood glucose and HbA1c correlated negatively with the expression of Sirt6 in human visceral fat tissues. Collectively, these results suggest that adipocyte Sirt6 regulates body weight gain and insulin sensitivity independent of diet, and the increased IL-4 production by Sirt6 and resultant M2 polarization of adipose tissue macrophages may attenuate proinflammatory responses in adipose tissue.</P></▼1><▼2><P><B>Obesity and diabetes: A control protein in fat</B></P><P>A protein in adipose tissue (composed of fat cells) helps protect against inflammation and the development of resistance to insulin that develops in obesity and can lead to type 2 diabetes. Researchers in South Korea, led by Eun Ju Bae at Woosuk University, Wanju, and Byung-Hyun Park at Chonbuk National University, Jeonju, investigated the role of Sirt6 in mice and in human adipose tissue. Deleting the mouse gene that codes for Sirt6 in adipocytes promoted the impaired response to insulin and associated increase in blood glucose levels that are two key aspects of diabetes. Changes in biochemical signaling pathways controlling immune cells called macrophages were implicated in these effects and suggest an anti-inflammatory role for Sirt6. Analysis of human adipose tissue supported these findings. The research will help understand how obesity promotes type 2 diabetes.</P></▼2>