• 제목/요약/키워드: Therapeutic function

검색결과 1,138건 처리시간 0.079초

종양세포에서의 capsaicin에 의한 apoptosis 유도와 항암제의 항암효과의 증가 (Capsaicin induced apoptosis and the enhanced anticancer effect of anticancer drugs in cancer cells)

  • 김선영;이유진;박은혜;이호근;조대선;김정수;황평한
    • Clinical and Experimental Pediatrics
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    • 제51권3호
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    • pp.307-314
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    • 2008
  • 목 적 : 한국인 음식에 널리 이용되고 있는 중요한 향신료인 고추에 많이 들어있는 capsaicin이 최근 많은 연구를 통해 암을 예방하고 더 나아가 치료할 수 있는 성분으로 밝혀지고 있다. 따라서 본 연구의 목적은 한국인이 많이 섭취하고 있는 식이성분인 capsaicin이 한국인에 많은 위암세포의 세포자멸사의 유도물질로 가능성을 알아보고 이를 항암치료의 일부분으로 시도하고자 하였다. 방 법 : 한국인의 위암세포주인 SNU-668 세포에 capsaicn를 처리한 후 세포 생존은 trypan blue 와 crystal violet 분석, 세포독성은 MTT 분석, 세포사 분석은 핵 응축과 DNA 분절화 실험, bcl-2와 bax의 mRNA 발현은 역전사 중합효소 연쇄반응, 세포사와 관련된 단백질 발현은 Western immunoblot analysis로 분석하였다. Capsaicin에 의해 항암제의 감수성이 증가되는 지를 알아보기 위하여 일정 농도의 capsaicin과 농도 별 각 항암제를 같이 처리하여 2일 간 배양 하고 MTT assay로 분석하였으며 이와 관련된 세포사와 관련된 단백질 발현을 분석하였다. 결 과 : capsaicin의 농도에 따라 SNU-668 위암세포의 증식을 현저히 억제하였으며, 이러한 capsaicin의 증식 억제는 DNA 단편화, 핵 응축과 caspase 활성화에 의해 세포자멸사의 유도에 의한 것으로 입증되었다. 더욱이 capsaicin에 의해 pro-apoptotic Bax에 대한 anti-apoptotic Bcl-2의 비율이 현저히 감소하고, caspase-3활성이 증가하였다. Capsaicin을 처리한 세포는 처리하지 않은 세포에 비하여 etoposide나 adriamycin에 의해 유도되는 세포사멸에 더욱 감수성을 보였다. 결 론 : 이상의 연구에서 capsaicin은 caspase-3 의존적 경로를 통하여 SNU-668 세포에서 세포자멸사를 유도하며 항암제의 감수성을 증가시키므로 위암의 효과적인 항암치료제와 항암제 민감성 유도제의 일환으로 가능성이 있다.

Hypoxia-dependent mitochondrial fission regulates endothelial progenitor cell migration, invasion, and tube formation

  • Kim, Da Yeon;Jung, Seok Yun;Kim, Yeon Ju;Kang, Songhwa;Park, Ji Hye;Ji, Seung Taek;Jang, Woong Bi;Lamichane, Shreekrishna;Lamichane, Babita Dahal;Chae, Young Chan;Lee, Dongjun;Chung, Joo Seop;Kwon, Sang-Mo
    • The Korean Journal of Physiology and Pharmacology
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    • 제22권2호
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    • pp.203-213
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    • 2018
  • Tumor undergo uncontrolled, excessive proliferation leads to hypoxic microenvironment. To fulfill their demand for nutrient, and oxygen, tumor angiogenesis is required. Endothelial progenitor cells (EPCs) have been known to the main source of angiogenesis because of their potential to differentiation into endothelial cells. Therefore, understanding the mechanism of EPC-mediated angiogenesis in hypoxia is critical for development of cancer therapy. Recently, mitochondrial dynamics has emerged as a critical mechanism for cellular function and differentiation under hypoxic conditions. However, the role of mitochondrial dynamics in hypoxia-induced angiogenesis remains to be elucidated. In this study, we demonstrated that hypoxia-induced mitochondrial fission accelerates EPCs bioactivities. We first investigated the effect of hypoxia on EPC-mediated angiogenesis. Cell migration, invasion, and tube formation was significantly increased under hypoxic conditions; expression of EPC surface markers was unchanged. And mitochondrial fission was induced by hypoxia time-dependent manner. We found that hypoxia-induced mitochondrial fission was triggered by dynamin-related protein Drp1, specifically, phosphorylated DRP1 at Ser637, a suppression marker for mitochondrial fission, was impaired in hypoxia time-dependent manner. To confirm the role of DRP1 in EPC-mediated angiogenesis, we analyzed cell bioactivities using Mdivi-1, a selective DRP1 inhibitor, and DRP1 siRNA. DRP1 silencing or Mdivi-1 treatment dramatically reduced cell migration, invasion, and tube formation in EPCs, but the expression of EPC surface markers was unchanged. In conclusion, we uncovered a novel role of mitochondrial fission in hypoxia-induced angiogenesis. Therefore, we suggest that specific modulation of DRP1-mediated mitochondrial dynamics may be a potential therapeutic strategy in EPC-mediated tumor angiogenesis.

THE CURRENT STATUS OF BIOMEDICAL ENGINEERING IN THE USA

  • Webster, John G.
    • 대한의용생체공학회:학술대회논문집
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    • 대한의용생체공학회 1992년도 춘계학술대회
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    • pp.27-47
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    • 1992
  • Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

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구강안면통증 환자의 치료결과와 예후에 관한 연구 (Treatment Outcome and Prognosis of the Outpatients with Orofacial Pain)

  • 최세헌;김기석;김미은;이동주;진상배
    • Journal of Oral Medicine and Pain
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    • 제31권2호
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    • pp.155-165
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    • 2006
  • 본 연구는 단국대학교 치과대학 부속병원 구강내과에 내원한 측두하악장애 환자를 포함한 구강안면동통 환자들을 대상으로 치료의 결과와 예후를 평가하기 위하여, 2002년 1월부터 2004년 12월까지 3년간 (치아질환을 제외한) 구강안면동통 환자 6300명 중에서 진료기록부 상에서 경과기록을 확인할 수 있는 환자들을, 측두하악장애, 신경병성동통장애, 연조직질환 및 이 중 둘 이상을 질환을 동시에 가지고 있는 복합질환으로 나누어 치료기간, 치료유형 및 치료효과를 비교하여 다음의 결과를 얻었다. 1. 평균 진료기간은 신경병성 동통장애에서 가장 길었고 연조직질환, 복합 질환, 관절장애, 근육-관절 복합장애, 근육장애의 순이었다. 2. 사용된 치료방법을 비교하면 약물요법은 연조직질환과 신경병성 동통장애에서, 장치요법은 관절장애군에서, 물리치료는 근육장애군에서 사용빈도가 높았다. 3. 진단분류별 물리치료의 사용경향은 근육장애군은 EAST와 초단파요법의 사용빈도가 높았고, 관절장애군은 초음파 치료, 신경병성 동통 장애와 연조직 질환은 저출력 레이저 요법이 많이 사용되었다. 4. 통증에 대한 치료결과는 통증이 지속되는 경향이 신경병성 동통장애에서 가장 높았으며, 완화되거나 완전 소실되는 경향은 측두하악장애에서 높았다. 5. 측두하악장애 환자에서 근육장애, 정복성 관절원판장애, 비정복성 관절원판 장애 및 근육-관절 복합장애 세분하여 치료 후 개구량의 변화를 조사하였을 때는 진단군 간에 유의한 차이를 볼 수 없었으나 개구량 측정방법간에는 무통성 최대개구량이 치료 후 가장 증가하였고, 환자 스스로가 벌리는 능동적 최대개구량은 비정복성관절원판장애에서 가장 증가하였다. 이상의 결과로 볼 때, 구강안면통증 영역에서 현재 시행하고 있는 치료법들은 측두하악장애에서는 동통조절 및 기능개선에 좋은 결과를 보여주고 있으므로 그 예후가 좋은 반면, 연조직질환이나 신경계 질환 같은 기타의 구강안면통증은 길고 지속적인 치료를 요구하는 어려운 질환이라고 할 수 있겠다.

수술후 발생한 슬관절 강직의 관절경적 유리술 (Arthroscopic Adhesiolysis for Postoperative Arthrofibrosis of the Knee)

  • 김성재;신상진;이원용;김진용;김상곤
    • 대한관절경학회지
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    • 제4권1호
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    • pp.42-48
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    • 2000
  • 목적 : 수술후 발생한 슬관절 강직 환자에 있어서 관절경적 슬관절 유리술의 결과와 결과에 영향을 미치는 예후 인자에 대하여 살펴 보고자 하였다. 대상 및 방법 : 본 논문은 슬관절 주위 골절 및 인대 수술후 발생한 슬관절 강직 환자중 관절경적 슬관절 유리술을 시행받은 31례의 환자를 대상으로 하였다. 관절경적 슬관절 유리술은 3개월 이상의 적극적인 물리 치료에도 불구하고 술후 슬관절 운동 범위에 호전이 없거나 기능 제한이 있었던 경우에 시행하였다. 관절 강직의 선행 요인으로 인대 수술이 17례로 가장 많았으며 슬관절 주위의 관절면을 침범한 골절이 10례였고 그 밖의 경우가 4례였다. 결과 : 술전 관절 운동 범위가 평균 60도(14도-74도)에서 수술 직후 평균 120도(7도-127도)였으며 최종 추시 관찰시 129도(3도-132도)였다. 인대 수술후 관절 강직이 유발된 17례의 환자에서는 술전 65도에서 술후 135도로 향상되었고 이는 술후 약 1년간에 걸쳐 서서히 증가되었다. 관절내 골절후 관절 강직이 유발된 군에서는 술전 60도에서 술후 125도로 증가하였고 이는 술후 6개월에 걸쳐 운동 범위가 증가하였다. 또한 이환기간이 7개월 이내인 환자군에서는 관절경적 슬관절 유리술 시행후 관절 운동 범위가 평균 70도 증가하였고 7개월 이상인 군에서는 술후 평균 49도 증가하였다. 결론 : 관절경적 슬관절 유리술은 슬관절 내에서 기인된 관절 강직의 치료에 효과적이며 특히 인대 수술후에 유발된 관절 강직이나 증상이 7개월 이내의 관절 강직에서 보다 향상된 결과를 보였다.

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만성 재가 기동장애자의 가정병실 모델 개발을 위한 현장 연구 (A Ethnographic Field Study for a Model Development of the Chronic Bed-ridden Patient s Home-ward)

  • 김태연;정연강
    • 대한간호학회지
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    • 제24권4호
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    • pp.597-615
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    • 1994
  • This study is designed to facilitate the creation of home environment conducive to the family taking care of chronic bed-ridden patients with more effective method. The need for this study has emerged against the background of marked changes in the structure of ailments and causes of death, resulting in the number and plights of chronic bed-ridden patients as well as of a rapid increase in demand for medical care and resulting premature discharge. Keeping these in mind, this study focused on home-wards where the majority of chronic bed-ridden patients are being cared for. Despite. their overriding importance, home-words are less than efficient in caring (or chronic bed-ridden patients. These circumstances require the designing of home-wards that can offer greater comfort to patients and at the same time make things easier for caregivers, on the basis of an overall analysis of patients' life and home - ward situation. According1y this study adopted a Participant Observation Method derived cultural anthropology, Toward this end, 3 patients were chosen as subjects of this study for intensive interviewing and participant observation. In the process of this field re-search efforts were made to collect emprical data, that is, to faithfully record the words of the subjects and their caregivers for analysis and interpretation. The findings of these analyses are as follows. Firstly, the chronic bed-ridden patients are mostly being taken care by close family members. Secondly, a room for the exclusive use of the patient, floor, kitchen, bathroom and multipurpose space were found to be necessary for proper caring of the patient. These spaces were respectively used with a view to 1) accomodating the patient as well as caregivers' activities, 2) keeping general and medical supplies and other appliances for patient's care and drying the patient's washing, 3) preparing and keeping the patient's foods and beverages, 4) keeping the supplies necessary for cleaning the patient's body and treating the patient's eliminations, 5) washing the patient's clothes, underwears and bedclothes. The patient's room in turn is subdivided into six portions in terms of uses : specifically the places for accomodating 1) the patient, 2) medical supplies, 3) medicines, 4) linens St clothes, 5) bedclothes and, 6) diapers. Thirdly, the activities of the caregiver are subdivided into seven key areas : hygiene, exercise, diet, elimination, therapeutic nursing, prevention of sore, and other activities. Each area is further classified into several different activities of caring. These activities we mainly carried out in the patient's room. Fourthly, the supplies for caring the chronic bed-ridden patient is divided into two large domains : medical and general supplies. Finally, three main problems areas were found in this study on the part of caregivers, that is, sore prevention, hygiene problem related frequent urination / defecation, the caregiver's physical, psych ological and emotional burden. In consideration of the aforesaid problem areas, a model home-ward was developed in this study. The newly-developed model has been found to have the following six advantages. Firstly, the time and effort required for maintaining the patient's hygiene are reduced, thus relievins the caregiver's physical and psychological bur-den. Secondly, the patient's hygiene can be maintained in satisfactory conditions, because the patient's eliminations are more easily removed. Thirdly, skin irritations caused by the patient's eliminations were remarkably reduced and so were the patient's sores due to moisture and bacteria. Fourthly, the home-ward have a tilt-table ef-fect thanks to the inclining room floor. This improves the patient's cardiovascular function as well as constantly changes pressed skin areas and thus prevents sores. Fifthly, improved shelf arrangements help make the best use of patient's supplies. Sixthly, the trouble of continuously changing clothes, underwears, diapers & bedclothes is remarkably reduced simply by covering the patient with cotton sheets when laid in bed. This is espected to cut down expenses by reducing the comsumptions of diapers and other disposable supplies.

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방사선 입체조형치료에 대한 종양치유확율과 정상조직손상확율에 관한 연구 (Study on Tumor Control Probability and Normal Tissue Complication Probability in 3D Conformal Radiotherapy)

  • 추성실
    • 한국의학물리학회지:의학물리
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    • 제9권4호
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    • pp.227-245
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    • 1998
  • 방사선치료 성과의 기준을 정량적으로 평가할 수 있는 종양치유확율 (Tumor Control Probability)과 정상조직 손상확율(Normal Tissue complication Probability)의 수학적 관계식을 유도하여 방사선업체조형치료 (3-D conformal radiotherapy) 효과를 평가하며 간단한 동물실험과 임상결과를 참고하여 종양치료성적의 예측과 종양선량의 증가 및 치료의 질적상황을 정량적 척도로 평가하고져한다. 방사선량과 체적크기에 민감한 병렬반응구조 (Parallel architecture)로 구성된 장기중 발생빈도가 많은 간종양을 대상으로 업체조형치료방법에 따른 체적선량분포도 (Dose Volume Histogram)를 3차원 방사선치료계획 컴퓨터(ADAC-Pinnacle #3)를 이용하여 계산하고 각 선량에 대한 체적분포를 판별이 쉽도록 도표화하였다. 종양치유확율(Tumor Control Probability)과 정상조직 손상확율(Normal Tissue complication Probability)은 방사선량에 대한 세포생존곡선의 오차함수 (error function)를 기본수식으로하고 선량 체적인자를 삽입한 반실험식으로 구성되었으며 실효선량 또는 실효체적에 따라 각각 계산하였다. 정상간의 실질적 손상을 관찰하기 위하여 방사선치료를 받은 환자의 통계와 계획적 연구를 위하여 황구를 이용하였다. 방사선조사방법은 대항2문, 쐐기 3문, 4문 회전업체치료와 비회전축 5문입체조형치료로 구분하였으며 업체조형치료는 컴퓨터 조종형 선형가속기 (Varian Clinac-2100C/D)와 다엽콜리메이터(Multi Leaf Collimator, MLC-52LS)를 이용하였다. 방사선조사방법에 따른 체적선량분포 (DVH)는 종양과 주위건강조직에대한 체적과 방사선량을 직관적으로 판단할수있었다. 간종양의 방사선치료에서 TCP와 NTCP 의 체적인자는 0.32를 이용하였고 대항2문 입체치료 및 5문입체치료에서 종양중심선량 50Gy일 때 종양의 TCP는 각각 0.763과 0.793 이였으며 정상간의 NTCP는 각각 0.156와 0.008로서 수치상 완전 구별이 가능하였고 종양 투여 선량이 70Gy 일 때 종양의 TCP 는 각각 0.982 와 0.995로서 종양치유에 충분한 선량이며 정상간의 NTCP 는 각각 0.725 와 0.142로서 현저한 차이가 있었다. 간손상은 간염유발을 기준으로 하였으며 간손상정도와 NTCP의 관계는 상호비례하였고 일정한 발기점(Threshold value)을 구할수 있었다. DVH 와 확율적 수학식인 TCP, NTCP 동은 방사선치료성과를 판단할 수 있는 정량적분석방법으로 가능성이 있다고 생각된다. 또한 건강조직을 최대한 보호하고 종양에 집중 방사선을 조사할 수 있는 입체조형치료는 간, 폐, 신장등 방사선 병렬반응장기에 적합하며 DVH와 TCP, NTCP등 수학적 척도를 이용하여 평가함으로서 치료성과의 예측, 종양선량의 증가(Dose escalation), 방사선수술의 지표 및 방사선치료의 질적상황을 정량적 숫치로 평가할 수 있어 방사선치료성과 향상에 기여 할 수 있다고 생각한다.

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갠트리 회전에 의한 온-보드 영상장치 회전중심점의 정도관리 프로그램 개발 (Development of Quality Assurance Program for the On-board Imager Isocenter Accuracy with Gantry Rotation)

  • 정광호;조병철;강세권;김경주;배훈식;서태석
    • 한국의학물리학회지:의학물리
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    • 제17권4호
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    • pp.212-223
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    • 2006
  • 본 연구에서는 방사선치료용 선형가속기의 갠트리 회전에 따른 온-보드 영상장치(on-board imager, OBI)의 회전중심점의 위치 정확도 확인을 위해 제조사에서 제공된 고객인수시험절차서(customer accetpance procedure, CAP)상에서 명시된 방법을 비롯하여 OBI 선원 위치 $0^{\circ},\;90^{\circ},\;180^{\circ},\;270^{\circ}$에서 획득된 영상, 갠트리 각도 $10^{\circ}$ 간격으로 촬영된 영상, 콘빔 CT 재구성을 위한 미처리 투사영상 등에 디지털 영상처리 기법을 적용하여 자동으로 오차를 계산하는 새로 제안된 세 가지의 방법들을 각기 적용하여 그 오차를 평가하고 각 방법의 효용성에 대하여 검증하였다. 갠트리 회전에 따른 OBI 회전중심점의 오차 변화 양상 확인을 위해서는 $10^{\circ}$ 간격으로 영상 촬영 후 5차 다항식을 이용하여 조정함수(fitted function)를 구하는 방법이 적절하지만 정도관리 목적으로 최대 오차만을 구하고자 할 경우에는 $0^{\circ},\;90^{\circ},\;180^{\circ},\;270^{\circ}$ 등 네 방향에서 촬영된 영상을 이용하여 계산하는 것으로도 충분하였다. 각 방법을 적용하여 오차를 구한 결과 OBI 선원의 위치가 $90^{\circ}$부터 $180^{\circ}$ 사이일 경우 가장 크게 나타났으며 최대값은 0.44 mm였다. 또한 기간에 따른 OBI 회전중심점의 변화 양상은 최대 0.6 mm 이내로 안정적으로 유지되고 있음을 확인하였다. 본 연구에서 제안된 방법이 주기적인 정도관리에 적용된다면 간단하면서도 비교적 정확하게 평가를 수행할 수 있을 것으로 기대된다.

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입원환자의 투약체계와 방법의 개선을 위한 현장연구 (Field Study For The Improvement of Medication System and Method for Inpatients at General Hospital)

  • 유형숙;권영미;송미숙;김형애;박경숙
    • 간호행정학회지
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    • 제1권1호
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    • pp.147-211
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    • 1995
  • Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.

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B형 간염 바이러스 만성 감염 소아의 추적 관찰 (Follow-up of Children with Chronic Hepatitis B Virus Infection)

  • 황성현;김종현;강진한;허재균;이경일;오진희;이승희;고대균
    • Pediatric Infection and Vaccine
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    • 제11권1호
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    • pp.73-80
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    • 2004
  • 목 적 : 소아 HBV 만성 감염 환자들에 대한 연속적인 임상적 소견, 생화학 검사 및 혈청학적 표지자의 변화를 분석하여 이들간의 연관성을 알아보았다. 방 법 : 1995년 7월 1일부터 2000년 6월 30일까지 5년간 가톨릭대학교 성빈센트병원 소아과를 방문하여 6개월 이상 추적이 가능하였던 HBV 만성감염 소아 90명을 대상으로 하였다. 이들 모두는 HBV 표지자인 HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc IgG와 간기능 검사를 시행하였다. 결 과 : 첫 내원시 대상 모두가 무증상이었고 HBV 만성 감염의 가족력이 83%에서 있었다. HBeAg 양성이 81%, HBeAg 음성, anti-HBe 양성이 16%, HBeAg, anti-HBe 모두 음성인 경우가 3%로 성별간의 차이는 없었고, 대상군의 연령을 0~5, 6~10, 11~15세로 나누었을 때 HBeAg 양성은 각각 90%, 96%, 61%로 10세 이하의 양성률이 11~15세에 비해 의미있게 높았다(P=0.001). 혈청 ALT치는 40 IU/L 이하, 41~80 IU/L, 81~200 IU/L, 201 IU 이상인 경우가 각각 64%, 17%, 10%, 9%이었고 HBeAg 양성군이 음성군에 비해 ALT의 비정상인 경우가 의미있게 많았다(P=0.036). HBeAg에서 anti-HBe로 전환된 경우가 73명 중 11명에서 발생하였고 이들 모두에서 anti-HBe의 전환 전에 ALT치의 증가가 관찰되었다. HBeAg 및 HBsAg의 연간 자연소실율은 각각 9.7%, 0.6%이었다. 결 론 : HBV 표지자 및 생화학적 검사치의 변화양상을 숙지하는 것은 이와 관련된 연구를 시행할 때 대상을 선정하고 또한 질환에 대한 치료 여부, 치료제의 선택 및 효과를 검토할 때 필요한 사항이며 각 개인의 HBV 만성 감염의 악화 예후인자를 찾기 위하여 증상이 없더라도 보유자에 대한 계속적인 관찰은 매우 중요하다고 생각된다.

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