• Ecology and Resilient Infrastructure
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• 제6권2호
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• pp.109-119
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• 2019

국내의 많은 저수심 저수지들은 다양한 수질오염물질의 유입으로 인해 부영양화가 진행되고 있으며, 해마다 반복적으로 표층의 녹조 발생과 저층의 빈산소화를 겪고 있다. 이를 방지하기 위한 대책으로 저수지의 성층현상을 완화하는 기존 기술들이 있으나 대부분 동력이 필요하며 비경제적인 측면으로 인해 도입이 어려운 실정이다. 본 연구에서는 바람과 수류의 자연에너지를 활용하는 무동력 수류순환시스템을 개발하고 상이한 조건을 갖는 두 저수지를 대상으로 테스트베드를 구축, 운영하여 현장적용성을 검토하였다. 수류순환시스템을 모사한 전산유체역학 (CFD) 모의 결과, 하향류가 유도되어 표층과 심층 사이의 성층현상을 완화시키고, 영향반경은 약 30 m에 달하는 것으로 해석되었다. 테스트베드에 대한 장기 모니터링 결과, 수류순환 작용에 의해 DO의 변동을 완만하게 하고, DO 과포화 현상을 저감하며, pH의 과도한 상승을 방지하는 등 다양한 수질개선 효과가 관찰되었다. 본 수류순환시스템의 현장적용성을 제고하기 위해서는 홍수시 및 저수심 조건에 대한 대응방안 마련이 필요한 것으로 판단된다.

• Tuberculosis and Respiratory Diseases
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• 제82권4호
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• pp.328-334
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• 2019

Background: Although the frequency of respiratory viral infection in patients with pulmonary acute respiratory distress syndrome (ARDS) is not uncommon, clinical significance of the condition remains to be further elucidated. The purpose of this study was to compare characteristics and outcomes of patients with pulmonary ARDS infected with influenza and other respiratory viruses. Methods: Clinical data of patients with pulmonary ARDS infected with respiratory viruses January 2014-June 2018 were reviewed. Respiratory viral infection was identified by multiplex reverse transcription-polymerase chain reaction (RT-PCR). Results: Among 126 patients who underwent multiplex RT-PCR, respiratory viral infection was identified in 46% (58/126): 28 patients with influenza and 30 patients with other respiratory viruses. There was no significant difference in baseline and clinical characteristics between patients with influenza and those with other respiratory viruses. The use of extracorporeal membrane oxygenation (ECMO) was more frequent in patients with influenza than in those with other respiratory viruses (32.1% vs 3.3%, p=0.006). Co-bacterial pathogens were more frequently isolated from respiratory samples of patients with pulmonary ARDS infected with influenza virus than those with other respiratory viruses. (53.6% vs 26.7%, p=0.036). There were no significant differences regarding clinical outcomes. In multivariate analysis, acute physiology and chronic health evaluation II was associated with 30-mortality (odds ratio, 1.158; 95% confidence interval, 1.022-1.312; p=0.022). Conclusion: Respiratory viral infection was not uncommon in patients with pulmonary ARDS. Influenza virus was most commonly identified and was associated with more co-bacterial infection and ECMO therapy.

• Journal of Nutrition and Health
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• 제54권5호
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• pp.489-500
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• 2021

본 연구는 부적절한 영양지원이 ECMO 환자의 영양상태 뿐만 아니라 사망률 등에도 부정적인 영향을 미칠 수 있음을 보여주었다. 대부분의 ECMO 환자는 중환자실 입실 초기부터 영양상태가 이미 영양불량이거나 영양불량 위험군이었고, 재원기간이 경과하면서 악화되는 것을 관찰하였다. 이는 ECMO 환자들이 가장 위중할 때에 필요로 하는 칼로리와 단백질의 영양 지원이 충분하지 않았음을 시사하는 것이며, 특히 PN과 EN의 개시 시점이 영양관리지침의 권고보다 지연되지 않도록 노력하는 개선이 시급하다. 또한, ECMO 환자의 영양상태 평가만 아니라 공급한 영양지원에 대한 환자의 반응까지 고려한 영양관리가 필요한데, 이를 위해서는 영양관리가 중환자 간호에서 우선시 되어야 하며, 영양사를 포함한 다학제간 접근이 반드시 포함되어야 한다. 점차 증가하는 ECMO 적용 사례를 고려한다면, 중환자실에서의 집중치료 과정에 영양관리도 비중있게 반영되어야 할 것이다. 차후에는 전향적 무작위통제 연구로 환자의 질환 유형이나 ECMO 배치형태에 따른 영양지원방법과 효과를 비교할 것을 제안한다. 더 많은 대상자 수 확보를 위하여 여러 병원의 자료를 취합하여 분석하거나 환자 상태에 따라 영양공급의 적정량을 평가하고 비교하는 연구를 제안한다.

• 대한응급의학회지
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• 제29권5호
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• pp.509-518
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• 2018

Objective: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. Methods: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH <7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. Results: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. Conclusion: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.

• Journal of Chest Surgery
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• 제54권2호
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• pp.99-105
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• 2021

Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.

• 한국응용곤충학회지
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• 제61권1호
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• pp.173-195
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• 2022

척추동물과 유사하게 곤충도 인지질분해효소(phospholipase A₂)의 촉매 작용으로 다양한 아이코사노이드를 합성한다. 그러나 일련의 아이코사노이드 생합성과정은 척추동물과 차이를 보이는데, 이는 곤충의 인지질에는 전구물질인 아라키도닉산의 함량이 낮기 때문이다. 대신에 비교적 풍부하게 존재하는 다가불포화지방산인 리놀레익산을 기반으로 사슬 연장 및 불포화반응으로 아라키도닉산을 합성하여 척추동물과 같이 아이코사노이드 전구물질로 이용하는 것 같다. 이렇게 해서 형성된 아라키도닉산은 다시 척추동물의 cyclooxygenase와 유사한 peroxynectin이 PGH₂ 형태의 프로스타글란딘(prostaglandin: PG) 전구물질을 형성하게 된다. 이후 여러 이성체 효소들의 특이적 반응에 의해 PGA₂, PGD₂, PGE₂, PGI₂, TXB₂의 다양한 PG가 생성된다. 반면에 또 다른 형태의 아이코사노이드인 에폭시아이코사트리에노익산(epoxyeicosatrienoic acid: EET)은 척추동물과 유사한 단일산화효소의 산화반응으로 아라키도닉산을 전구물질로 5,6-EET, 8,9-EET, 11,12-EET, 14,15-EET를 형성하게 된다. 그러나 세 번째 아이코사노이드 부류인 류코트리엔(leukotriene)의 경우 곤충 체내 존재는 확인되었지만 생합성 과정은 아직 밝혀지지 않았다. 이들 아이코사노이드가 곤충의 대사, 배설, 면역 및 생식에 관여하는 생리작용을 중개한다. 따라서 아이코사노이드 생합성 과정을 교란하는 물질 탐색은 새로운 살충제 개발 전략이 된다. 본 종설은 이 가운데 PG의 곤충 면역 중개 기작을 소개한다.

• 감성과학
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• 제25권2호
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• pp.79-86
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• 2022

대기오염 등의 영향으로 실내 활동 시간이 증가하는 상황에서 뇌기능과 신체활동 측면에서 보다 건강한 실내 생활을 위한 다양한 방안에 대한 고려가 절실한 실정이다. 본 연구는 실내 산소의 농도와 호흡의 방법에 따라 인지능력과 생체신호에 어떤 영향을 미치는지에 대해 연구하여 보다 건강한 실내 일상생활을 제안하고자 한다. 건강한 성인 20명을 대상으로 공기 전달 시스템을 통해 공급된 공기를 산소마스크를 통해 흡입하도록 하였다. 호흡 방법과 산소농도에 따른 변화를 확인하기 위해 모든 피험자는 3가지 호흡(비강, 구강, 및 고농도 산소공급과 함께 구강 호흡)을 인지부하자극(눈 감은 휴식기, 눈 뜬 휴식기, 1-back 및 2-back 작업기억 과제) 별로 각각 수행하였다. 자극에 대한 반응시간, 정확도 및 생체신호를 측정하여 호흡에 따른 인지부하별 변화를 분석하였다. 그 결과, 3가지 호흡에서 모두 인지부하의 증가에 따라 심박동수는 유의하게 증가하면서 인지부하와 높은 상관성이 있는 생체신호임을 확인하였다. 또한 구강호흡에서는 분당 호흡 횟수가 인지부하증가에 따라 유의하게 증가하는 변화가 나타났으며, 인지활동 시 구강호흡에서 부족한 산소공급을 보완하기 위한 생체신호의 변화를 확인하게 되었다. 반면 고농도 산소공급과 함께 수행한 구강호흡에서는 비강호흡과 같이 분당 호흡 횟수의 유의한 변화는 없는 것으로 나타났다. 이는 고농도 산소공급이 구강호흡과 같이 비효율적인 산소 흡입이나 산소 농도가 부족한 환경에서 이를 보완해 주는 역할을 할 가능성이 있음을 시사한다. 본 연구 결과를 기반으로 후속 연구에서는 자율신경계 변화까지 분석하여 인지 뿐만 아니라 심리에 미치는 영향까지 종합적으로 규명하고자 한다.

• 대한간호학회지
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• 제53권4호
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• pp.468-479
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• 2023

Purpose: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. Methods: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann-Whitney U test, and area under the curve (AUC). Results: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. Conclusion: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

• 대한의용생체공학회:의공학회지
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• 제44권6호
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• pp.450-464
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• 2023

Pulse oximetry, a non-invasive technique for evaluating blood oxygen saturation, conventionally depends on isolated measurements, rendering it vulnerable to factors like illumination profile, spatial blood flow fluctuations, and skin pigmentation. Previous efforts to address these issues through imaging systems often employed red and near-infrared illuminations with distinct profiles, leading to inconsistent ratios of transmitted light and the potential for errors in calculating spatial oxygen saturation distributions. While an integrating sphere was recently utilized as an illumination source to achieve uniform red and near-infrared illumination profiles on the sample surface, its bulkiness presented practical challenges. In this work, we have enhanced the pulse oximetry imaging system by transitioning illumination from an integrating sphere to a multi-wavelength LED configuration. This adjustment ensures simultaneous emission of red and near-infrared light from the same position, creating a homogeneous illumination profile on the sample surface. This approach guarantees consistent patterns of red and near-infrared illuminations that are spatially uniform. The sustained ratio between transmitted red and near-infrared light across space enables precise calculation of the spatial distribution of oxygen saturation, making our pulse oximetry imaging system more compact and portable without compromising accuracy. Our work significantly contributes to obtaining spatial information on blood oxygen saturation, providing valuable insights into tissue oxygenation in peripheral regions.

• Korean Journal of Radiology
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• 제20권5호
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• pp.830-843
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• 2019

Objective: To examine the potential of intravoxel incoherent motion (IVIM) and blood oxygen level-dependent (BOLD) magnetic resonance imaging for detecting renal changes after iodinated contrast-induced acute kidney injury (CI-AKI) development in a diabetic rabbit model. Materials and Methods: Sixty-two rabbits were randomized into 2 groups: diabetic rabbits with the contrast agent (DCA) and healthy rabbits with the contrast agent (NCA). In each group, 6 rabbits underwent IVIM and BOLD imaging at 1 hour, 1 day, 2 days, 3 days, and 4 days after an iohexol injection while 5 rabbits were selected to undergo blood and histological examinations at these specific time points. Iohexol was administrated at a dose of 2.5 g I/kg of body weight. Further, the apparent transverse relaxation rate (R2^*), average pure molecular diffusion coefficient (D), pseudo-diffusion coefficient (D^*), perfusion fraction (f) were calculated. Results: The D and f values of the renal cortex (CO) and outer medulla (OM) were significantly decreased compared to baseline values in the 2 groups 1 day after the iohexol injection (p < 0.05). A marked reduction in the D^* values for both the CO and OM was also observed after 1 hour in each group (p < 0.05). In the OM, a persistent elevation of the R2^* was detected for 4 days in the DCA group (p < 0.05). Histopathological changes were prominent, and the pathological features of CI-AKI aggravated in the DCA group until day 4. The D, f, and R2^* values significantly correlated with the histological damage scores, hypoxia-inducible transcription factor-1α expression scores, and serum creatinine levels. Conclusion: A combination of IVIM and BOLD imaging may serve as a noninvasive method for detecting and monitoring CI-AKI in the early stages in the diabetic kidney.