• Pediatric Infection and Vaccine
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• 제24권1호
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• pp.65-70
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• 2017

거대세포바이러스 감염은 선천감염의 가장 흔한 원인 중의 하나이다. 본 증례는 쌍생아에서 다른 임상 양상을 보인 선천 거대세포바이러스 감염 증례에 대한 국내 첫 보고이다. 31세 초산부가 쌍생아(2 융모막, 2 양막)를 임신하였다. 임신 34주 산전 초음파에서 한쪽 태아의 크기가 작고 양측 뇌실 확장증이 발견되었으며 임신 37주경에 제왕절개로 분만하였다. 첫 번째 신생아는 남자로 출생 체중 2,410 g, 아프가 점수 8/9점으로 출생하였으며 두 번째 신생아는 여자로 출생 체중 1,380 g, 아프가점수 5/8점으로 출생하였다. 두 번째 신생아는 자궁 내 성장지연, 소두증, 소하악증, 사지 관절의 강직을 보였다. 불일치 쌍생아에 대한 원인을 찾기 위한 검사를 진행하였으며 두 번째 신생아의 혈액검사에서 거대세포바이러스 immunoglobulin M이 양성반응을 보였으며 소변과, 혈액, 뇌척수액에서 거대세포바이러스 중합효소연쇄반응이 양성소견을 보였다. 반면에 정상으로 출생한 남아의 거대세포바이러스에 대한 검사는 모두 음성이었다. 감염된 환자의 안과적 검진에서 거대세포바이러스 망막염이 관찰되었고, 후에 실시한 청력검사에서 양측의 감음 난청이 확인되었다. 환자는 ganciclovir 치료를 받았으며 현재 여아는 심한 발달지연이 있으며 침대에서 누워서 생활하는 중이다. 이와 같이 쌍생아에서의 선천 거대세포 바이러스 감염증이 한 명에게만 발생하는 경우의 원인은 현재까지 명확하지 않다. 하지만 이 증례를 통하여 심한 불일치 쌍생아의 경우에 선천 거대세포바이러스 감염의 가능성을 고려해 보아야 한다.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.43-53
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• 2005

저자(著者)는 사암침(舍岩鍼)을 응용한 수두증(水頭症) 환자(患者) 치료(治療) 2례(例)를 통한 임상적 고찰을 통한 결과 다음과 같이 요약(要約)할 수 있다. 1. 수두증(水頭症)이란 다양한 원인들에 의해서 뇌척수액(腦脊髓液)(cerebrospinal fluid; CSF)의 생성(生成)과 흡수(吸收)에 장애가 생겨 뇌척수액(腦脊髓液)이 뇌실(腦室)이나 두개강내(頭蓋腔內)에 축적되어 발생하는 질병이다. 2. 본 예(例)에서는 뇌경색과 병발(竝發)한 점진적(漸進的)인 정상뇌압수두증(正常腦壓水頭症) 환자(患者)에게는 담정격(膽正格), 신정격(腎正格)을 사용하였으며, 지주막하출혈 후(後) 병발(竝發)한 정상뇌압수두증(正常腦壓水頭症) 환자(患者)에게는 비정격(脾正格), 신정격(賢正格)을 사용하였다. 3. 전자(前者)의 예(例)에서는 별다른 호전(好轉) 양상(樣相)을 경험(經驗)하지 못한 반면, 후자(後者)의 예(例)에서는 치료(治療) 2주(週)만에 양호(良好)한 임상적(臨床的) 호전(好轉)을 보였다. 4. 수두증(水頭症)의 치료(治療)에 있어서 사암침(舍岩鍼)을 포함한 더 다양(多樣)한 한방적(韓方的) 임상연구(臨床硏究)를 기대(期待)하는 바이다.

• 대한간호
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• 제36권2호
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• pp.73-83
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• 1997

Bed rest is recommended to prevent postlumbar puncture headaches(PLPHA), but the period of bed rest varies in the literature from 6 hours to 24 hours. In clinical practice the period of bed rest varies but nursing methods for adults and children have little difference. In Seoul National University Hospital, children have been given at least 6 hours bed rest after a lumbar puncture. Pediatric oncology patients require a lumbar puncture for an initial diagnosis, follow up treatment or administration of chemotherapeutic agent. But it is difficult for young children to lie supine or to refrain from their usual activities in any way, and unpleasant problems related to a shortage of beds often occurs during discharge or in an outpatient setting. The purpose of this study is to substantiate the preventive effect of PLPHA by the period of bed rest, to identify the other factors that influence PLPHA, and to use the nursing methods proper to children. The subjects were 65 children, ages 1-17, undergoing treatment in the children's cancer center at SNUCH during the period June 1, 1995, to Aug. 31, 1995. The team nurses asked questions about PLPHA of the parents and children in order to fill out a questionnaire. The data were evaluated by percent, t-test, Chi-square test and Mann-Whitney U test. Result; 1. There was no significant difference relating the bed rest time spent to the occurrence of postspinal headaches (t-test). 2. There was a significant risk of PLPHA in the children who were irritable before procedure and/or had experienced previous PLPHA(p<0.05, ${x^2}-test$). 3. The following factors were not found to be associated with increased risk of PLPHA: previous puncture experience, giving analgesics, the choice of puncturist, inpatient/outpatient status, gauge of needle, purpose, the amount of CSF removed, gender, diagnosis, the number of peripheral WBCs, previous lumbago experience after LP, position after bed rest, age, the number of aural puncture at the time. A longer period of bed rest is unlikely to be more effective to prevent PLPHA and seems impractical. A shorter period will save time and effort. Perhaps it will also allay some of the fears which surround LP. So 1 hour bed rest after LP is suggested and nursing methods for emotional support should be investigated to reduce PLPH.

• 한국병원경영학회지
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• 제21권4호
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• pp.1-12
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• 2016

The purpose of this study are suggest to performance measurement model of Electronic Medical Record(EMR) and Key Performance Index(KPI). For data collection, 665 questionnaires were distributed to medical record administrators and insurance reviewers at 31 hospitals, and 580 questionnaires were collected(collection rate: 87.2%). Regarding methodology, Critical Success Factor(CSF) and index of the information system were derived based on previous studies, and these were set as performance measurement factors of EMR system. The performance measurement factors were constructed by perspective using BSC, and analysis on causal relationship between factors was conducted. A model of causal relationship was established, and performance measurement model of EMR system was proposed through model validation. Analysis on causal relationship between performance management factors revealed that utility cognition of the learning & growth perspective factor had causal relationship with job efficiency(${\beta}=0.20$) and decision support(${\beta}=0.66$) of the internal process perspective factors, and security had causal relationship with system satisfaction(${\beta}=0.31$) of the customer perspective factor. System quality had causal relationship with job efficiency(${\beta}=0.66$) and decision support(${\beta}=0.76$) of the internal process perspective factors, all of which were statistically significant(P<0.01). Job efficiency of the internal process perspective had causal relationship with system satisfaction(${\beta}=0.43$), and decision support had causal relationship with decision support satisfaction(${\beta}=0.91$) and job satisfaction (${\beta}=0.74$), all of which were statistically significant(P<0.01). System satisfaction of the customer perspective had causal relationship with job satisfaction(${\beta}=0.12$), job satisfaction had causal relationship with cost reduction(${\beta}=0.53$) of the financial perspective, and decision support satisfaction had causal relationship with productivity improvement(${\beta}=0.40$)of the financial perspective(P<0.01). Also, cost reduction of the financial perspective had causal relationship with productivity improvement(${\beta}=0.37$), all which were statistically significant(P<0.05). Suitability index verification of the performance measurement model whose causal relationship was found to be statistically significant revealed that $X^2/df=2.875$, RMR=0.036, GFI=0.831, AGFI=0.810, CFI=0.887, NFI=0.838, IFI=0.888, RMSEA=0.057, PNFI=0.781, and PCFI=0.827, all of which were in suitable levels. In conclusion, the performance measurement indices of EMR system include utility cognition, security, and system quality of the learning & growth perspective, decision support and job efficiency of the internal process perspective, system satisfaction, decision support satisfaction, and job satisfaction of the customer perspective, and productivity improvement and cost reduction of the financial perspective. In this study, it is expected that the performance measurement indices and model of EMR system which are suggested by the author, will be a measurement tool available for system performance measurement of EMR system in medical institutions.

• IMMUNE NETWORK
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• 제22권2호
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• pp.16.1-16.20
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• 2022

The gastrointestinal tract is the first organ directly affected by fasting. However, little is known about how fasting influences the intestinal immune system. Intestinal dendritic cells (DCs) capture antigens, migrate to secondary lymphoid organs, and provoke adaptive immune responses. We evaluated the changes of intestinal DCs in mice with short-term fasting and their effects on protective immunity against Listeria monocytogenes (LM). Fasting induced an increased number of CD103⁺CD11b^- DCs in both small intestinal lamina propria (SILP) and mesenteric lymph nodes (mLN). The SILP CD103⁺CD11b^- DCs showed proliferation and migration, coincident with increased levels of GM-CSF and C-C chemokine receptor type 7, respectively. At 24 h post-infection with LM, there was a significant reduction in the bacterial burden in the spleen, liver, and mLN of the short-term-fasted mice compared to those fed ad libitum. Also, short-term-fasted mice showed increased survival after LM infection compared with ad libitum-fed mice. It could be that significantly high TGF-β2 and Aldh1a2 expression in CD103⁺CD11b^- DCs in mice infected with LM might affect to increase of Foxp3⁺ regulatory T cells. Changes of major subset of DCs from CD103⁺ to CD103^- may induce the increase of IFN-γ-producing cells with forming Th1-biased environment. Therefore, the short-term fasting affects protection against LM infection by changing major subset of intestinal DCs from tolerogenic to Th1 immunogenic.

• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1234-1240
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• 2009

목 적:Enteroviruse (EV)는 영아와 소아에서 가장 흔한 감염의 원인으로 경한 발열성 질환에서 뇌수막염이나 치명적인 심근염까지 다양한 질환을 일으키는 원인이다. 본 연구에서는 국내 중부지역의 EV 유병율에 대해 알아보고자 하였다. 방 법:2005년 4월부터 2006년 10월까지 국내 중부지역에서 발열성 질환이나 뇌수막염이 의심되어 입원한 소아에서 얻은 검체를 모아 RT-PCR을 시행하여 EV를 확인하였고, genotype과 phylogenetic 분석을 위해 direct sequencing을 시행하였다. 결 과:뇌척수액과 대변검체에서 PCR을 시행한 305명의 환아 중 51명(16.7%)에서 EV가 양성을 보였다. 그중 다음의 serotype이 44명에서 확인되었다: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), EV74 (1 case, 1.9%). 2005년 6월과 8월 사이에는 ECV18과 CVB5가 가장 많이 검출되었다. 2006년 7월과 8월 사이에는 ECV25가 가장 많이 검출되었다. 결 론:지속적인 enterovirus 감염의 감시가 필요하며 임상적인 의의가 밝혀져야 할 것이다. 특히 EV74가 처음으로 국내에서 발견되었기에 이를 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.156-161
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• 2008

목 적 : 막창자염은 면역기능이 저하되고 호중구가 감소된 소아암 환자에서 호발하는 괴사성 장염으로 사망률이 매우 높은 것으로 알려져 있다. 저자들은 항암치료 중 발생한 막창자염에 대하여 적극적인 내과적 치료와 항생제 치료를 시행하여 그 치료성적을 분석하고자 본 연구를 시행하였다. 방 법 : 2002년 8월부터 2007년 7월까지 영남대학교병원 소아과에 입원하여 항암화학요법을 받은 소아암 환자 207명 중 막창자염으로 진단받은 12명을 대상으로 의무기록을 분석하였다. 진단은 임상증상과 신체검진소견, 복부단순촬영검사, 복부초음파검사와 복부전산화단층촬영으로 하였다. 항암화학요법 시행 후 증상 발생일, 백혈구수, 절대호중구수, 치료항생제의 종류 및 치료기간과 치료결과를 분석하였다. 결 과 : 막창자염으로 임상적 진단을 받은 환자는 12명(5.7%)이었으며, 임상증상은 복부통증 및 압통 12명(100%), 발열 12명(100%), 설사 9명(75%), 구토 5명(41%), 반발압통 3명(25%) 등이었다. 항암화학요법 종료일로부터 증상 발생일까지의 기간의 중앙값은 12일(범위 3-18일)이었다. 백혈구수의 중앙값은 340 / L$(30-1,270/{\mu}L)$이었으며, 절대호중구수의 중앙값은 $116/{\mu}L(0-648/{\mu}L$)이었다. 치료는 항생제 요법과 충분한 수분 공급 및 장의 휴식 등 보존적 요법을 시행하였으며 환자 12명 모두 증상이 호전되었고, 수술적 치료를 받은 경우는 없었다. 항생제 조합의 선택에 따른 항생제 사용기간의 통계적인 차이는 없었다(P=0.74). 결 론 : 항암화학요법을 받는 소아암 환자에서 발열, 우하복부 압통, 호중구감소증이 있을 때는 막창자염을 의심하여야 하며, 조기진단 및 적극적인 내과적 치료와 항생제 요법을 시행하여 좋은 결과를 얻을 수 있다고 생각된다.

• 간호행정학회지
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• 제5권2호
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• pp.237-251
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• 1999

The purpose of this study is to suggest successful strategies through which the effect of the information system of a hospital can be forecasted at the nursing department. In order to set up successful strategies, in the first place, both the methods of CSF(Critical Success Factor: Rockart, 1979) and ULD(User-Led Development) method and the method suggested by the Korea Productivity Center were applied. In order to measure the improvement of nursing productivity, the Dissonance theory was used. The data were collected from 100 employees serving at the clinic department of Kwangju Patriots' and Veterans' Hospital from July 4 to July 25, 1998 with reference to all 222 cases, for sampling work; then the part of the efficiency of the treatment or management of hospital business - simplification of the process of the treatment of hospital business and reduction of the time of the treatment of hospital business were measured; and in order to forecast organizational behavior, 100 cases of organization behavior were analysed, based on the well structured, questionnaires. In order to forecast the user's organizational behavior, a tool(Ronald. 1988; Stephen, 1982: Senn, 1992: Olsen, 1980: Anderson, 1988: Kim. 1992: Cho. 1994) to measure the extent or degree of the user's recognition or understanding whose reliability coefficient is 0.63 was used: and regarding the items expected by the users concerning the convenience of the system, a tool created by Bernadett, Szajna and Richard W. Scamell(1993) whose reliability coefficient is 0.88 was used. And finally, those data were analysed, utilizing the statistical package of SPSS/PC 6.0. successful strategies are suggested as follows: 1. In order that the Kwangju Patriots' and Veterans' Hospital's purpose can be successful through its strategic, information system, the quality of its services should be elevated. and for elevating the quality of medical services, elevation of the quality of medical expertism or specialty is an important factor in determining such quality. 2. In order to make the hospital information system to be successful, the hospital's top manager should participate in the effort making it successful with helping hands of the members or personnel of the hospital. 3. In order to make users participate in the hospital information system, it is prerequisite that all nurses in a hospital should voluntarily participate in the system 4. In order to reduce the expense, the time in coping with business per duty should be reduced by 10${\sim}$33.23%. The time of the direct nursing care which added value is relatively high should be elongated in order to elevate the quality of hospital services. 5. Since the introduction and spread of the hospital information system are influenced by the duration in the experience of computer use, the user of the hospital information system should have a plan to receive well-planned computer education. Finally it is suggested that the forecast of long-term productivity through a review of the user's expectation of the system should be inspected and tested through continuous studies of its effectiveness.

• Parasites, Hosts and Diseases
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• 제28권2호
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• pp.101-108
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• 1990

포도낭미충증을 포함한 유구낭미충증 환자의 신경외과적 수술 과정에서 수거한 낭미충 낭액의 성분 단백질을 비교 검토하였다. 7.5% gel에서 Disc-PAGE와 reducing condition의 10~15% gel에 SDS-PAGE를 실시하여 다음과 같은 결과를 얻었다. 1. 7.5% gel에서 실시한 Disc-PAGE 소견상 제주도와 Ecuador에서 수집한 돼지의 유구낭미충 낭액은 U, A, B, C, E, S의 6개 band로 구성되어 있었고 그 중 band C가 주 구성 성분이었다. 그리고 인체에서 수집한 낭액 은 band C가 주 구성 성분이었고 경우에 따라 band E가 주 구성 성분으로 관찰되고 있었다. 정상 뇌척수액은 band C, E 위치에서 ${\gamma}-globulin$과 albumin이 보이고 있었다. 2. 10~15% gel에서 실시한 SDS-PAGE상 제주도 낭액은 최소 25개 이상의 subunit로 구성되어 있었고 그 중 95, 64, 48, 39, 34, 24, 15, 10및 7 kDa band가 주 구성 성분이었다. 그리고 Ecuador감염 돼지의 유구낭미충 낭액은 전체적으로 비슷했으나 48, 39, 34, 24 kDa band가 의미한 반면 21, 17 kDa가 진하게 염색되었다. 인체 뇌낭미충증 환자에서 수집한 낭액들은 15~21개 정도의 band가 보이고 있었다. 그 중 94, 64, 15, 10 그리고 7 kDa band는 모든 낭액에 공통적으로 포함되어 있었다. 한편, 정상 뇌척수액의 SDS-PAGE에서는 77, 66 (albumin), 55 (heavy chain of ${\gamma}-globulin$), 22.5 (light chain of ${\gamma}-globulin$) 그리고 17 kDa band가 보였다. 환자의 낭액은 77, 66, 55, 22.5 kDa에서 진하게 염색되는 경우가 있었다. 이상의 결과로 인채 유구낭미충증에서 수집한 낭액에도 15, 10, 7kDa의 subunit로 구성된 150kDa의 band C protein이 주 성분으로 구성되어 있으며 수술장에서 수집하는 과정에서 뇌척수액이 섞이는 경우가 많음을 알 수 있었다.

• Molecular & Cellular Toxicology
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• 제4권2호
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• pp.106-112
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• 2008

Parkinson's disease (PD) progresses severely by a gradual loss of dopaminergic neurons in the substantia nigra (SN). Epidemiological studies showed that the incidences of PD were reduced by smoking of which the major component, nicotine might be neuroprotective. But the function of nicotine, which might suppress the incidences of PD, is still unknown. Fortunately, recently it was reported that a glial reaction and inflammatory processes might participate in a selective loss of dopaminergic neurons in the SN. The levels of tumour necrosis factor (TNF)-${\alpha}$ synthesised by astrocytes and microglia are elevated in striatum and cerebrospinal fluid (CSF) in PD. TNF-${\alpha}$ kills the cultured dopaminergic neurons through the apoptosis mechanism. TNF-${\alpha}$ release from glial cells may mediate progression of nigral degeneration in PD. Nicotine pretreatment considerably decreases microglial activation with significant reduction of TNF-${\alpha}$ mRNA expression and TNF-${\alpha}$ release induced by lipopholysaccharide (LPS) stimulation. Thus, this study was intended to explore the role of nicotine pretreatment to inhibit the expressions of TNF-${\alpha}$ mRNA in human fetal astrocytes (HFA) stimulated with IL-$1{\beta}$. The results are as follows: HFA were pretreated with 0.1, 1, and $10{\mu}g/mL$ of nicotine and then stimulated with IL-$1{\beta}$ (100 pg/mL) for 2h. The inhibitory effect of nicotine on expressions of TNF-${\alpha}$ mRNA in HFA with pretreated $0.1{\mu}g/mL$ of nicotine was first noted at 8hr, and the inhibitory effect was maximal at 12 h. The inhibitory effect at $1{\mu}g/mL$ of nicotine was inhibited maximal at 24 h. Cytotoxic effects of nicotine were noted above $10{\mu}g/mL$ of nicotine. Moreover, Nicotine at 0.1, 1 and $10{\mu}g/mL$concentrations significantly inhibited IL-$1{\beta}$-induced TF-${\kappa}B$ activation. Collectively, these results indicate that in activated HFA, nicotine may inhibit the expression of TNF-${\alpha}$ mRNA through the pathway which suppresses the NF-${\kappa}B$ activation. This study suggests that nicotine might be neuroprotective to dopaminergic neurons in the SN and reduce the incidences of PD.