소아기 붕괴성 장애의 양상을 보이는 PANDAS 1례

성덕규,조수철 대한소아청소년정신의학회 2001 소아청소년정신의학 Vol.12 No.1

베타 용혈성 A군 연구균(group A beta-hemolytic streptococcus)에 의한 류마치스성 열 이후에Sydenham무도병이 발현되는 환자 군에서 강박 증상 또는 틱 증상이 나타난다는 보고가 있은 후, A군 연구균 감염과 강박 장애 또는 틱 장애 사이의 관계가 주목받게 되었다. A군 연구균 감염 후에 강박 증상 또는 틱 증상이 유발되는 환자들은 갑작스런 발병과 극적인 증상 악화를 보이고 사춘기 이전에 발병하며 무도병 모양의 운동 및 독특한 양상의 운동 과잉 등의 신경학적 이상을 보이고 또 그 경과가 악화 및 완화를 반복하는 양상을 보인다. 이런 임상적 특징을 보이는 소아 환자 군을 PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)라고 부르게 되었다. 이후 현재까지 강박 장애와 틱 장애뿐 아니라 주의력 결핍/과잉운동 장애, 신경성 식욕부전증, 신체이형장애 환자들이 PANDAS 범주에 속한다는 보고들이 있어 왔다. 본 증례는 7세까지 정상적인 발달을 보이다가 A군 연구균 감염 수개일 후부터, 인지 기능, 사회성, 언어 및 의사소통에 장애를 보이고 틱 증상과 함께 얼굴과 손발에 이상 운동을 보이는 환자를 기술하였다. 이에 저자들은 본 증례가 소아기 붕괴성 장애의 양상을 보이는 PANDAS증례라고 생각되어 이를 문헌 고찰과 함께 보고함으로써, PANDAS가 틱 장애, 강박 장애, 주의력 결핍/과잉운동 장애, 신경성 식욕부전증, 그리고 신체이형장애 등의 양상을 보일 뿐 아니라 소아기 붕괴성 장애의 양상을 보일 수 있다는 사실을 보고하고자 한다. 중심단어 : A군 연구균 · PANDAS ㆍ 소아기 붕괴성 장애. After the fact that obsessive-compulsive symptoms or tic symptoms are common in Sydenham's chorea which is a sequale of rheumatic fever produced by group A beta-hemolytic streptococcus was reported, the association between group A beta-hemolytic streptococcus and a subgroup of obsessive-compulsive disorder (OCD) or tic disorder has been attentioned. This subgroup shared a unique clinical course, characterized by an abrupt onset of symptoms and/or dramatic exacerbations. And this subgroup was distinguished by pre-pubertal onset of symptoms, neurological abnormalities (chorei-form movements and a unique pattern of motoric hyperactivity) , as well as by relapsing and remitting symptom course. Acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) was used to denote a subgroup of OCD or tic disorder patients with these clinical characteristics. Then, there was a report suggesting that PANDAS category include some of attention-deficit/hyperactivity disorder (ADHD) and were two case reports of anorexia nervosa and body dysmorphic disorder with characteristics of PANDAS. This case is a patient who developed normally until age of 7, but after pharyngeal inflammation with high fever, he showed disturbance of cognition, social relationship, and language and communication, as well as tic symtoms and abnormal movement on face, hand, and foot. We report this case with review of literatures, because we think that this case belongs to the PANDAS category. Based on this observation, we suggest that PANDAS category include some of childhood disintegrative disorder as well as OCD, tic disorder, and ADHD. KEY WORDS : Group A beta-hemolytic streptococcus PANDAS ㆍ Childhood disintegrative disorder.

학습장애를 가진 초등학교 남학생의 자아상 개념과 우울-불안 특성 조사

신성웅,김봉수,성덕규,정영,유희정,조수철 대한소아청소년정신의학회 2001 소아청소년정신의학 Vol.12 No.1

학습장애를 가진 86명의 초등학교 남학생과 52명의 정상적인 초등학교 남학생의 자아상과 우울,그리고 상태-특성 불안에 관하여 피어스-해리스 자아상 척도, 소아우울척도(이하 CDI), 상태-특성불안 척도(이하 STAI)를 이용하여 조사하였다. 피어스-해리스 자아상 척도의 총점에서는 두 군 사이에 차이가 발견되지 않았으나, 지적 및 학업 상태 항목과 신체적 외모, 행복과 만족 소척도에서는 두 군 사이에 의미 있는 차이가 관찰되었다. 소아우울척토의 총점과 그 소척도 중 부적합함, 무쾌감증, 부정적인 자기 존중 항목에서 학습장애 아동이 정상 아동보다 더 높은 점수를 나타내었다. 상태불안은 정상 아동보다 학습장애 아동에서 높게 보고되었으나 특성 불안에 대해서는 차이를 보이지 않았다. 정상 아동에서는 나이에 따른 자아상과 우울척도, 불안척도의 의리 있는 변화가 관찰되지 않았으나, 학습장애 아동에서는 피어스-해리스 자아상 척도와 그 소척도의 대부분이 통계적으로 의미 있게 감소하였고, 소아우울척도의 부정적 감정과 무쾌감증, 부정적 자기 평가, 상태 불안, 특성 불안 등은 연령과 의미 있는 양의 상관관계를 나타내어서 학년이 올라갈수록 자아상은 저하되고 우울과 불만은 느끼는 강도와 범위가 증가하는 양상을 보였다. 두 군 모두에서 소아우울척도는 피어스-해리스 자아상 척도의 총점과 그 소척도들과 의미 있는 역의 상관관계를 나타내었고, 상태불안과 특성불안과는 정의 상관관계를 나타내었다. 조사 결과 학업과 관련된 자아상의 문제와 자신이 남들과 당당히 맞설 수 있는 자신감의 문제가 학습장애에서 더 많이 나타났고, 나이가 들수록 자아상이 저하되며 불안과 우울은 증가하는 것으로 나타났다. 회귀분석 결과 학습장애 아동의 자아상을 설명하는 변수들로는 나이와 자아상 척도의 행동문제, 지적 및 학업상태, 불안, 인기도, 행동과 만족, 그리고 소아우울척도의 부적합함, 대인관계문제, 부정적 자기-존중 및 상태 불안인 것으로 드러나서 학습 장애 아동의 자아상은 학업 문제와 자신을 또래와 비교하여 겪는 스트레스로 인해 부정적인 영향을 받는다는 것이 확인되었다. 결론적으로 학습장애를 가진 초등학교 남학생은 정상 초등학교 남학생보다 자아상이 낮고 우울과 불안을 더 많이 느끼며, 이런 차이는 학년이 올라갈수록 커졌다. 학습장애에서 우울증과 불안 장애가 많이 동반되기 때문에 임상에서 학습장애 아동을 치료할 때 정서 장애의 동반 여부를 확인하고 이를 적극적으로 치료하는 것이 중요한 과제이다. 중심단어 : 학습장애 ㆍ 자아상 ㆍ 상태-특성 불안 ㆍ우울증. We investigated the self-concept, subjective depression, and state-trait anxiety of the school boys with learning disabilities (abbr. LD, n=86) and compared them with normal boys (n=52) using Piers-Harris Self-Concept Inventory, Child Depression Inventory (abbr. CDI), and State-Trait Anxiety In-ventory (abbr. STAI). With regard to Piers-Harris Self-Concept Inventory total scores, there was no significant difference between two groups, but normal boys showed higher scores in intellectual and school status, physical appearance, and happiness-satisfaction subscales than patients with LD. The male patients with LD showed significantly higher ratings in CDI total scores, and CDI subscales - ineffectiveness, anhedonia, negative self-esteem than normal children. The patients with LD reported significantly higher state anxiety, but not trait anxiety. Correlation analyses revealed that self-concept decreased over time, and depression-anxiety increased across grades in the patients with LD, but not in normal children. Especially, negative mood, anhedonia, negative self-esteem subscales of CDI, and state-trait anxiety showed significant positive correlation with grades. In both groups, CDI scores were inversely correlated with Piers-Harris Self-Concept and positively with State-Trait anxiety. In conclusion, self-concept problems which were related with school achi-evement and self-esteem were more abundant in the patients with LD than normal children, self-image problem, depression and anxiety increased across grades. According to regression analysis, age, behavior subscale, intellectual - school status, anxiety, popularity, happiness- satisfaction, CDI-ineffectiveness, interpersonal problem, negative self-esteem, and state anxiety could explain the self-concept in the patients with LD, not in normal children. So, the self-concept of the patients with LD were found to be related to the school achievement and stress when comparing with peers. In conclusion, elementary school boys with LD showed lower self-concept, higher depression and anxiety, and these differences increased across grades. Since the patients with LD have concomitant depression and anxiety disorders, it is important that comorbidity with emotional problems should be explored and managed properly. KEY WORDS : Learning disability ㆍ Self-concept State ㆍ trait anxiety ㆍ Depression.

Synthesis of a Cr2AlC-Ti2AlC ternary carbide

Deock-Soo Cheong,김창삼,Sung Ik Hwang,하정수,강승민 한양대학교 세라믹연구소 2010 Journal of Ceramic Processing Research Vol.11 No.1

The Cr2AlC ternary carbide is excellent in chemical and oxidation resistances as well as mechanical properties at high temperatures. Therefore it satisfies most requirements for as an interconnector material in solid oxide fuel cells (SOFCs). However, its thermal expansion coefficient is higher than those of the anode and cathode so that a high thermal stress is generated unavoidably between them during heating and cooling SOFCs. Thus we attempted to reduce the thermal expansion coefficient through a solid solution with Ti2AlC which has a lower thermal expansion coefficient. Dense and single phase (Cr1-xTix)2AlC solid solutions with a relative density of 99.5% or more were synthesized by hot pressing a mixture of CrCx,Ti2C, Al powders at 1250 oC for 4 h. The limitation of Ti substitution was found to be less than 20 mol%. When Ti substitution exceeded this limit, unreacted Ti2C, Cr7C3, and Cr3C2 remained as second phases. The grain size decreased with Ti substitution. With 5 mol% Ti substitution, the thermal expansion coefficient could be lowered by 5% compared with the case without substitution in the temperature range of 700-800 oC.

Effect of Orientation on Plastic Deformation Behavior of Yttria Stabilized Zirconia Single Crystal

Cheong, Deock-Soo,Lee, Jeon-Kook Materials Research Society of Korea 2009 한국재료학회지 Vol.19 No.12

Yttria stabilized zirconia single crystals show plastic deformation at high temperatures by activating dislocations. The plastic deformation is highly dependent on crystallographic orientation. When the samples were deformed at different orientations, stress-strain curves changed by operating different slip systems. The strength of samples was also highly dependent on crystallographic orientation, i.e., samples without yield drop showed higher strength than that of samples exhibiting yield drop. The slip systems in the sample deformed along <112>, <111> and <001> agreed with the theoretical values of the plastic deformation, following Schmid's Law. Dislocations play a major role in the plastic deformation of this crystal. At the early stages of plastic deformation, all samples exhibited dislocation dipoles and, in the later stages, dislocation interactions occurred by forming nodes, tangles and networks. In this study, three different orientations, [11-2], [111] and [001] were employed to explain the plastic deformation behavior. A microstructural analysis was performed to elucidate the mechanism of the plastic behavior of this crystal.

Self diffusion of cation in yttria stabilized zirconia single crystal

Cheong, Deock-Soo The Korea Association of Crystal Growth 2009 韓國結晶成長學會誌 Vol.19 No.5

Dislocation dipoles were formed in the early stage of deformation of Y-CSZ single crystal at high temperatures. And the dipoles were pinched off to break into dipoles loops by dislocation climb. Dislocation loop annealing was peformed in Y-CSZ single crystal to evaluate the diffusivity of cation which was the rate-controlling ion.

Indium Tin Oxide (ITO) Coatings Fabricated using Nanoparticle Slurry and Sol

Cheong, Deock-Soo,Yun, Dong-Hun,Kim, Dong-Hwan,Han, Kyoung-R. The Korean Ceramic Society 2011 한국세라믹학회지 Vol.48 No.6

Indium tin oxide (ITO) coatings were made using an ITO slurry and an ITO sol. This was achieved by dispersing nanosized ITO powder in a mixed solvent without any dispersant and developing an adhesive ITO sol from indium acetate and tin tetrachloride in a mixture of DMF and n-butanol. Coating was carried out in one step by spin coating an ITO slurry, which was then followed by an ITO sol over it. Here, the sol penetrates into the nano ITO particle layers to make them adhere to each other as well as to a glass substrate. This is then followed by sintering at 500$^{\circ}C$ for 1 h to produce a uniform film consisting of ITO particles of about 50 nm and 10 nm. ITO films were obtained with sheet resistances from 450 to 1500 ohm/${\Box}$ by varying spin speed and concentration. Transmittance is higher than 90% at 550 nm.

Effect of Strain Rate on Plastic Deformation Behavior of Y-CSZ Single Crystal

Cheong, Deock-Soo,Kim, Chang-Sam Materials Research Society of Korea 2010 한국재료학회지 Vol.20 No.1

Yttria stabilized zirconia (Y-CSZ) single crystals show plastic deformation at high temperatures by activating dislocations. The effect of strain rate on the plastic behavior of this crystal was studied. As increasing strain rate from $\varepsilon=1.04\times10^{-5} sec^{-1}$ to $2.08\times10^{-5} sec^{-1}$ the yield drop was suppressed and resulted in higher Young's modulus and yield stress. Dislocation structures of the strained crystals were analyzed using a transmission electron microscope to elucidate the plastic behavior of these crystals. In the early stage of plastic deformation, dislocation dipoles and prismatic dislocation loops were formed in both samples. However, dislocation density was increased by increasing strain rate. Strong sessile dislocations were observed in the sample with higher strain rate, which may cause the higher work hardening.

A Simple Way to Prepare Nanosize NiO Powder by Mixing Acidic Ni Compound with Basic Ni Compound

Cheong, Deock-Soo,Yun, Dong-Hun,Park, Sang-Hwan,Kim, Chang-Sam The Korean Ceramic Society 2009 한국세라믹학회지 Vol.46 No.6

Nanosize NiO powder was prepared by mixing acidic nickel nitrate with basic nickel carbonate. The particle size and morphology of NiO were mainly governed by the mole ratio of the nitrate to the carbonate. The effects were studied by DSC, XRD, FTIR, and SEM. Heat treatment conditions influence the particle size distribution of produced NiO powder extensively for the case of 3N7C (3 moles of the nitrate and 7 moles of the carbonate) and 4N6C, but only slightly for 1N9C and 2N8C. Uniform pseudospherical NiO particles were obtained in $50{\sim}70$ nm for 1N9C and $30{\sim}60$ nm for 2N8C by calcination at $750{^{\circ}C}$ for 2 h.

Indium Tin Oxide (ITO) Coatings Fabricated Using Mixed ITO Sols

Cheong, Deock-Soo,Yun, Dong-Hun,Park, Sang-Hwan,Kim, Chang-Sam The Korean Ceramic Society 2009 한국세라믹학회지 Vol.46 No.6

ITO films were achieved by sintering at $500{\sim}550{^{\circ}C}$. This was possible by inducing a seeding effect on an ITO sol by producing crystalline ITO nanoparticles in situ during heat treatment. Two kinds of ITO sols (named ITO-A and ITO-B) were prepared at 2.0 wt% from indium acetate and tin(IV) chloride in different mixed solvents. The ITO-A sol showed a high degree of crystallinity of ITO without any detectable Sn$O_2$ on XRD at $350{^{\circ}C}$/1 h, but the ITO-B sol showed a small amount of Sn$O_2$ even after annealing at $600{^{\circ}C}$/1 h. The 10 wt% ITO-A//ITO-B showed the sheet resistance of 3600$\Omega$/□, while the ITO-B sol alone showed 5200 $\Omega$/□ by sintering at $550{^{\circ}C}$ for 30 min. Processing parameters were studied by TG/DSC, XRD, SEM, sheet resistance, and visible transmittance.

노인장기요양보험 인정등급 갱신절차 개선을 위한 연구

김덕수 ( Kim Deock Soo ),심철재 ( Shim Cheol Jae ),최승규 ( Choi Seung Gyu ),김지영 ( Kim Ji Young ),박명주 ( Park Myung Joo ),김수경 ( Kim Su Kyoung ) 한국고령친화건강정책학회 2016 대한고령친화산업학회지 Vol.8 No.2

연구목적 본 연구에서는 장기요양등급판정 결과 등을 분석하여 현 장기요양 인정 유효기간 설정의 문제점을 확인하고 해결방안을 논의하고자 시도되었다. 연구방법 2015 노인장기요양보험 통계 연보 및 국민건강보험공단의 등급판정 현황을 획득하고 국외 장기요양에 대한 선행연구와 문헌연구를 통해 진행되었다. 연구결과 2010년 최초 등급인정자 중 60%가 넘는 수급자가 3년 이내 사망한 것으로 나타나 장기요양 등급을 받은 수급자는 고령과 만성 및 중증질환으로 인하여 사망률이 높게 나타남을 확인하였다. 장기요양 유효기간 경과 후 상태변화를 살펴보기 위하여 2009년부터 2015년까지 수급자의 갱신결과를 보면 인정자의 73.5%가 등급이 유지된 경우로 최초 인정 시와 비교했을 때 기능 상태에 대한 큰 변화가 없는 것으로 나타났고, 장기요양인력의 갱신조사 업무는 인정조사 업무 중 44.2%를 차지하고 있다. 결론 향후 급속한 인구 고령화와 5등급 확대에 따라 수급자 수는 증가할 것으로 이와 함께 인정조사업무는 급증할 것으로 예상된다. 보험자 측면에서도 행정비용을 과도하게 발생시키고 있어 현재와 같이 모든 인정신청 건을 방문하여 조사하는 것은 제도의 지속성과 업무 효율성 측면에서 많은 문제점을 초래하므로 제도 재설계가 필요한 시점이다. Objective : This research aims to identify the problem in setting approval valid period of present long-term and discuss the solution through a result on long-term grade judgement. Methods : The survey was conducted on gaining statistics annual report of Long-Term Care Insurance for the Aged and present condition of grade judgement in National Health Insurance Service and studying precedence and literature on overseas long-term care. Results : It is confirmed that mortality of receiver who gets long-term care grade is high because of old age, chrome and severely illness by showing over 60% receivers of the first people admitted grade are passing within 3 years. In case of the renewal results for the receivers from 2009 to 2015 to look change of condition after valid period in long-term care, the grades of 73.5% approval people are maintained and it means it is produced that there is no big change about situation of function compared to time of the first recognition. Also, the task in renewal examination of long-term manpower is occupied 44.2% among the tasks in approval examination. Conclusion : It seems that the number of receivers and tasks in approval examination is going to increase by extending the rapid Population Aging and enlargement of fifth grade. Due to in terms of insurer, administration cost is occurred excessively, investigating every approval request by visiting like now causes many problems in durability of system and work efficiency. It is time to redesign system.