• Journal of Chest Surgery
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• 제47권3호
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• pp.255-261
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• 2014

Background: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. Methods: We identified 103 patients (23 females; mean age, $64.1{\pm}12.3$ years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). Results: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was $80.9%{\pm}4.3%$ and $71.7%{\pm}5.9%$, respectively. Reoperation-free survival at 5 and 10 years was $77.3%{\pm}4.8%$ and $70.2%{\pm}5.8%$. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). Conclusion: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.

• 한국노년학
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• 제38권1호
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• pp.225-241
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• 2018

노인의 자가 운전은 노인의 활동범위를 확대시키고 사회참여의 기회를 제공한다는 점에서 노년기에 의미있는 활동을 위한 필요조건이다. 운전은 신체적, 인지적, 감각적 기능의 통합을 요구하며 인적, 심리적 요인의 영향을 받는 매우 복잡한 활동이기 때문에 노화로 인한 기능저하는 고령운전자의 운전수행능력에 영향을 준다. 본 연구는 체계적인 문헌고찰을 통해 고령운전자의 운전중단이나 사고위험 증가에 영향을 미치는 요소가 무엇인지 확인하는데 목적을 두고 있다. 문헌 검색을 위해 사용된 온라인 데이터베이스는 MEDLINE, Excerpta Medica database(EMBASE), Cochrane Library, KoreaMed, Pubmed 였으며, 사용된 MeSH용어는 'aged', 'aging', 'automobile driving', 'age factors'였다. 2007년 1월부터 2017년 9월까지 발표된 문헌을 검색하여 1,458건의 결과를 얻었으며 선정기준에 부합하는 18편의 연구를 추출하였다. 결과에서는 운전중단 요소 및 사용된 측정도구와 운전중단에 따른 인구학적 특성을 분석하였다. 운전중단 영역 중 신체적 영역에서 유의미한 결과를 나타내는 측정도구가 11개로 가장 높은 빈도를 보였으며, 운전중단과 관련된 요소에서는 정보처리속도, 수행기능, 운전능력, 운전습관이 각 4개씩으로 운전중단과 유의미한 결과를 나타냈다. 인구학적 특성에서는 성별과 연령에 따라 운전중단과 관련이 있었다. 본 연구결과는 노화로 인한 기능저하가 운전수행에 미치는 영향을 분석하여 운전중단 예측요소들을 파악하고 노인의 안전한 운전수행을 위한 대책 마련의 필요성을 강조한다. 또한 노인의 다양한 운전중단 예측요소를 바탕으로 개별적인 교육프로그램 등의 서비스를 체계적으로 구축할 필요성을 제시한다.

• 한국노년학
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• 제32권4호
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• pp.993-1011
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• 2012

본 연구의 목적은 각 집단별 노년기 장애발생과 변화에 관련이 있는 영향요인들을 분석하는 것으로 노동연구원의 "한국고령화연구패널(Korea Longitudinal Study of Aging: KLOSA)" 1차(2006년)와 2차(2008년) 기본조사자료를 사용하였다. 연구대상은 65세 이상 남성노인 1,454명(41.7%), 여성노인 2,032명(58.3%)으로 총 3,486명이다. 노년기 장애는 ADL장애와 IADL장애를 측정하였으며 전체노인을 정상노인, 만성질환노인, 치매의심노인, IADL장애노인, ADL장애노인으로 나누어 장애발생과 변화를 분석하였다. 연구결과를 살펴보면 2006년에 장애가 없는 노인들이 2008년에 장애가 발생하는데 영향을 미치는 요인들로는 부상, 시력제한, 인지능력저하, 우울, 건강행태, 사회경제적 특성, 연령 등을 들 수 있다. 부상과 시력으로 인한 일상생활제한 등의 경험은 2006년에 정상노인들이 2년 후 치매의심증상 발생이나 장애발생에 유의미한 영향을 미치고 있으며, 2006년에 인지능력저하를 경험한 노인들은 2년 후 치매의심증상이 나타날 확률이 정상노인의 2배 이상으로 나타났다. 2006년의 만성질환자가 우울증을 갖고 있는 경우는 그렇지 않은 경우에 비해 2년 이후 장애가 발생할 확률이 1.8배 높게 나타났다. 그 외에 흡연과 규칙적 운동의 경험뿐만 아니라 사회경제적 특징들도 비장애노인의 장애발생에 유의미한 영향을 미치고 있음을 알 수 있다. 2006년에 장애를 이미 갖고 있는 장애노인들의 2년 후 장애수준변화에서는 ADL장애노인의 경우는 유의미한 변수가 나타나지 않았으나 IADL장애노인의 경우는 도구적 지지를 적게 받을수록, 연령이 증가할수록 장애수준이 악화되는 가능성이 높게 나타났다. 본 연구결과를 바탕으로 노년기장애발생을 예방하고, 장애악화를 지연시키기 위해서 다양한 수준의 개입이 필요함을 제시하고 있다.

• 한국임상약학회지
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• 제31권1호
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• pp.44-52
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• 2021

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions: In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

• 한국엔터테인먼트산업학회논문지
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• 제15권7호
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• pp.181-192
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• 2021

이 연구의 목적은 만성 뇌졸중 환자의 낙상 전조 동작과 다양한 신체 기능과의 관련성을 알아봄으로써 뇌졸중 환자의 낙상 연구에 관한 기초 자료를 제공하고자 실시하였다. 연구 대상은 뇌졸중으로 편마비 진단을 받고 N병원에서 입원 치료를 받고 있는 환자 중 연구에 동의한 환자 75명을 대상으로 실시한 결과 낙상 유무에 따른 일반의학적 특성에서 성별, 연령, 신장, 체중, BMI, 진단명, 마비 유형, 유병 기간에서는 차이가 없었으나 보행 보조 도구 사용(독립보행, 네발 지팡이, 외발 지팡이)에서는 비낙상군이 1회 낙상군과 다발성 낙상군과 비교하여 차이가 있는 것으로 나타났다. 낙상 전조 동작에 영향을 주는 요인을 알아본 결과 일어서기에서는 STS, FM-하지 운동 기능 순이었으며, 일어서기 시도에서는 FM-하지 운동 기능, STS, 연령, TIS-동적 균형, OLST-마비측 순이었다. 일어선 직후 균형 잡기에서는 FM-하지 운동 기능이 영향을 주었고, 서서 균형 잡기에서는 FM-하지 운동 기능, OLST-마비측, TIS-협응력 순이었다. 살짝 밀기에서는 FM-총합이 영향을 주었으며, 서서 눈 감고 균형 잡기에서는 STS, 연령, OLST-비마비측, FM-하지 운동 기능, TIS-정적 균형, OLST-마비측, TIS-동적 균형 순이었다. 360도 회전하기에서는 TIS-협응력, FM-하지 운동 기능, FM-상지 운동 기능 순이었다. 이상의 결과로 볼 때, 만성 뇌졸중 환자의 낙상 전조 동작과 다양한 신체 기능과의 관련성을 확인함으로써 낙상을 예방하기 위한 마비측 하지 근력 강화와 더불어 정상적인 보행 주기 및 체중 부하에 입각한 집중적인 균형, 체간조절, 보행 대칭성 훈련 등이 필요하며, 외적인 자극에 대한 최적의 운동 반응을 유도할 수 있는 고유수용성 감각 훈련이 병행되어야 할 것이다.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.332-339
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• 2023

Objective : The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. Methods : A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. Results : A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). Conclusion : The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.

• 대한통합의학회지
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• 제12권1호
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• pp.27-39
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• 2024

Purpose : Smoking is a major factor in chronic obstructive pulmonary disease (COPD), but the effect of electrical cigarette smoking on COPD development is still uncertain. This study aimed to compare the functions of airways and lungs exposed to combustible cigarettes and electrical cigarettes based on the pulmonary function test (PFT) results from the Korean National Health and Nutrition Examination Survey (NHANES). Methods : This study used data from 8,942 participants with PFT results out of 47,309 total subjects from the 6th to 8th Korean NHANES (2014-2015, 2016-2018, and 2019, respectively). Individuals with diseases such as cancer, ex-smokers, and dual tobacco users were excluded. The PFT results were analyzed according to the COPD diagnostic criteria. After adjusting for confounding variables, a complex sample generalized linear model ANOVA test was performed to investigate the association between PFT results and combustible smoker or electrical cigarette user groups. Results : In an analysis based on the obstructive ventilatory disorders (forced expiratory volume in 1 second[FEV₁]/forced vital capacity[FVC]<.7), combustible cigarette smokers showed a 3.46 times higher risk of COPD compared to non-smokers, while electrical cigarette smokers exhibited no significant difference in terms of COPD-related risks compared to non-smokers. FEV₁ showed a negative relation with combustible cigarette smokers as reported elsewhere (B=-.07, p<.001). FEV₁/FVC was negatively related to both combustible cigarette smokers (B=-.03, p<.001) and electrical cigarette smokers (B=-.02, p<.001). Conclusion : FEV₁/FVC decreases were observed in the long-term exposure to both combustible and electrical cigarettes. The lower FEV₁ in the combustible cigarette group implies the worsening of the severity of COPD, suggesting more damage to the airways and lungs in the short term. Therefore, the temporary electrical cigarettes use for the transition period in order to smoking cessation potentially aids to reduce the harmful effect of combustible cigarettes in COPD development.

• The Korean Journal of Physiology and Pharmacology
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• 제18권5호
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• pp.411-418
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• 2014

Vascular remodelling is an adaptive mechanism, which counteracts pressure changes in blood circulation. Nicotine content in cigarette increases the risk of hypertension. The exact relationship between nicotine and vascular remodelling still remain unknown. Current study was aimed to determine the effect of clinically relevant dosage of nicotine (equivalent to light smoker) on aortic reactivity, oxidative stress markers and histomorphological changes. Twelve age-matched male Sprague-Dawley rats were randomly divided into two groups, i.e.: normal saline as control or 0.6 mg/kg nicotine for 28 days (i.p., n=6 per group). On day-29, the rats were sacrificed and the thoracic aorta was dissected immediately for further studies. Mean arterial pressure (MAP) and pulse pressure (PP) of nicotine-treated vs. control were significantly increased (p<0.05). Nicotine-treated group showed significant (p<0.05) increase tunica media thickness, and decrease in lumen diameter, suggesting vascular remodelling which lead to prior hypertension state. The phenylephrine (PE)-induced contractile response in nicotine group was significantly higher than control group ($ED_{50}=1.44{\times}10^5M$ vs. $4.9{\times}10^6M$) (p<0.05~0.001). However, nicotine-treated rat showed significantly lower endothelium-dependent relaxation response to acetylcholine (ACh) than in control group ($ED_{50}=6.17{\times}10^7M$ vs. $2.82{\times}10^7M$) (p<0.05), indicating loss of primary vascular function. Malondialdehyde (MDA), a lipid peroxidation marker was significantly higher in nicotine group. Superoxide dismutase (SOD) enzymatic activity and glutathione (GSH) were all reduced in nicotine group (p<0.05) vs. control, suggesting nicotine induces oxidative imbalance. In short, chronic nicotine administration impaired aortic reactivity, probably via redox imbalance and vascular remodelling mechanism.

• 한국수소및신에너지학회논문집
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• 제25권5호
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• pp.509-515
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• 2014

At the fuel processing system (FPS) of fuel cell vehicle, hydrogen recirculation blower (HRB) is used for the recirculation of remained hydrogen after reaction. In this paper, noise and vibration improvement of HRB is studied by changing design and control. It is checked the campbell diagram and critical speed for stability of rotor, and housing stiffness is improved using simulation of frequency response function (FRF). A method is suggested that can decrease the unbalance amount of the rotor and impeller which main source of noise and vibration. In order to reduce the noise during deceleration of blower, electrical braking is applied and tested the risk impact of durability. Founded the optimum switching frequency of the motor control, and reduced the idle rpm by increasing of aerodynamic performance. The superiority of paper is proved by measurement of the improved product's noise and vibration.

• 대한간호학회지
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• 제45권2호
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• pp.231-239
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• 2015

Purpose: This study was conducted to examine the prevalence of successful aging and factors influencing successful aging. Methods: This was a secondary analysis study. Data were analyzed from 10,462 elderly people who participated in the 2011 National Elderly Survey. According to the use of community senior facilities, participants were divided into 4 groups: those who used senior centers (group A, n=580), village senior clubs (group B, n=3,240), both of the 2 facilities (group C, n=339), and neither of the 2 facilities (group D, n=6,303). Cross-tabulation and logistic regression were performed. Results: The prevalence of successful aging was highest in group C (20.94%) and lowest in group D (10.41%). The physical & mental function and active engagement domains were highest in group C, while they were lowest in group D. The disease & risk factors domain were highest in group A, while lowest in group B. An educational level of middle-school or higher and income level in the third or higher quintile were significant factors for predicting successful aging in all groups. Conclusion: These results provide a basis for designing prevention and management programs as interventions to increase the prevalence of successful aging in Korean older adults.