• Toxicological Research
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• 제31권2호
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• pp.203-211
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• 2015

Trichloroacetonitrile is used as an intermediate in insecticides, pesticides, and dyes. In Korea alone, over 10 tons are used annually. Its oral and dermal toxicity is classified as category 3 according to the globally harmonized system of classification and labelling of chemicals, and it is designated a toxic substance by the Ministry of Environment in Korea. There are no available inhalation toxicity data on trichloroacetonitrile. Thus, the present study performed inhalation tests to provide data for hazard and risk assessments. Sprague-Dawley rats were exposed to trichloroacetonitrile at concentrations of 4, 16, or 64 ppm for 6 hour per day 5 days per week for 13 weeks in a repeated study. As a result, salivation, shortness of breath, and wheezing were observed, and their body weights decreased significantly (p < 0.05) in the 16 and 64 ppm groups. All the rats in 64 ppm group were dead or moribund within 4 weeks of the exposure. Some significant changes were observed in blood hematology and serum biochemistry (e.g., prothrombin time, ratio of albumin and globulin, blood urea nitrogen, and triglycerides), but the values were within normal physiological ranges. The major target organs of trichloroacetonitrile were the nasal cavity, trachea, and lungs. The rats exposed to 16 ppm showed moderate histopathological changes in the transitional epithelium and olfactory epithelium of the nasal cavity. Nasal-associated lymphoid tissue (NALT) and respiratory epithelium were also changed. Respiratory lesions were common in the dead rats that had been exposed to the 64 ppm concentration. The dead animals also showed loss of cilia in the trachea, pneumonitis in the lung, and epithelial hyperplasia in the bronchi and bronchioles. In conclusion, the no-observed-adverse-effect level (NOAEL) was estimated to be 4 ppm. The main target organs of trichloroacetonitrile were the nasal cavity, trachea, and lungs.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.148-155
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• 2018

Background: Although targeted therapy and immuno-oncology have shifted the treatment paradigm for lung cancer, platinum-based combination is still the standard of care for advanced non-small cell lung cancer (NSCLC). Pemetrexed continuation maintenance therapy has been approved and increasingly used for patients with nonsquamous NSCLC. However, the efficacy of this strategy has not been proven in patients without driving mutations. The objective of this study was to compare the clinical benefit of pemetrexed continuation maintenance to conventional platinum-based doublet in epidermal growth factor receptor (EGFR)-negative lung adenocarcinoma. Methods: A total of 114 patients with EGFR-negative lung adenocarcinoma who were treated with platinum doublet were retrospectively enrolled. We compared the survival rates between patients received pemetrexed maintenance after four-cycled pemetrexed/cisplatin and those received at least four-cycled platinum doublet without maintenance chemotherapy as a first-line treatment. Results: Forty-one patients received pemetrexed maintenance and 73 received conventional platinum doublet. Median progression-free survival (PFS), which was defined as the time from the day of response evaluation after four cycles of chemotherapy to disease progression or death, was significantly higher in the pemetrexed maintenance group compared to conventional group (5.8 months vs. 2.2 months, p<0.001). Median overall survival showed an increasing trend in the pemetrexed maintenance group (22.3 months vs. 16.1 months, p=0.098). Multivariate analyses showed that pemetrexed maintenance chemotherapy was associated with better PFS (hazard ratio, 0.73; 95% confidence interval, 0.15-0.87). Conclusion: Compared to conventional platinum-based chemotherapy, premetrexed continuation maintenance treatment is associated with better clinical outcome for the patients with EGFR wild-type lung adenocarcinoma.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.53-61
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• 2019

Background: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. Methods: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006-2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. Results: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025-162.343), low PE severity index (OR, 0.948; 95% CI, 0.917-0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040-1.307). Model II included age (OR, 0.930; 95% CI, 0.893-0.969) and aPTT (OR, 1.104; 95% CI, 1.000-1.217). Conclusion: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I-II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.

• Tuberculosis and Respiratory Diseases
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• 제72권6호
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• pp.481-485
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• 2012

Background: Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU). Methods: Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study. Results: Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and $PaO_2/FiO_2$ <300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores${\geq}20$ (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks. Conclusion: APACHE II scores${\geq}20$ and time delay for tracheostomy were associated with tracheostomy after 2 weeks.

• Clinical and Experimental Pediatrics
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• 제45권5호
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• pp.596-602
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• 2002

목 적 : 체순환에서 중성구수의 감소는 과립구에 의해 발생하는 폐손상에서 공통적으로 발견되는 소견으로, 특히 말초 혈액에서 중성구 감소와 폐실질로의 중성구의 이동은 다양한 정도의 호흡 장애와 관련된 것으로 알려져 있다. 저자들은 조산아에서 생후 2시간내에 시행한 말초 혈액 검사에서 중성구수의 감소와 호흡 부전증과의 연관성을 알아보고자 본 연구를 시행하였다. 방 법 : 출생체중 500 gm에서 1,350 gm 사이의 조산아로 1993년 1월에서 1999년 12월까지 방지거병원에서 출생한 97례 중, 중성구수에 영향을 미칠 수 있는 경우를 제외한 44례를 대상으로 생후 2시간 이내 중성구수가 $1.0{\times}10^9/L$ 미만인 경우를 중성구 감소군 (17례), $1.0{\times}10^9/L$ 이상인 경우를 중성구 비감소군(27례)으로 나누고 후향적인 임상적 고찰을 통해 연구를 시행하였다. 재태연령, 출생체중, 분만방식, 1분 및 5분 Apgar점수를 조사하여 기록하였고, 환아의 입원기간, 기계적 환기요법 기간, 산소 보충요법 기간, 최고 흡기압력, 최고 인공환기 횟수, 최고 흡기농도 등의 호흡지표와 동맥관 개존증의 유무, 폐렴, 기흉, 신생아 호흡부전증, 기관지폐 이형성증, 뇌실내출혈, 미숙아 망막증의 유무를 연구하였다. 결 과 : 중성구 감소군의 출생체중은 $1,046.50{\pm}180.76gm$, 1분 Apgar점수는 $3.41{\pm}1.18$, 5분 Apgar 점수는 $5.41{\pm}0.87$이었고, 중성구 비감소군에서는 출생체중 $1,156.70{\pm}124.99g$, 1분 Apgar점수는 $4.30{\pm}1.46$, 5분 Apgar점수는 $6.15{\pm}0.95$로 출생체중(P=0.021)과 1분 및 5분 Apgar점수(P=0.049, P=0.024)에서 통계적 유의성을 나타냈다. 또한, 신생아 호흡부전증의 발생은 두 군간에 차이가 없었고, 기관지폐 이 형성증은 중성구 감소군에서 12례로 중성구 비감소군의 7례보다 유의하게 많이 발생하였다(P=0.0036). 그리고 재원기간에서 각각 $55{\pm}25$일, $29{\pm}15$일로 나타 났으며 기계적 환기요법기간에서는 각각 $41{\pm}20$일, $29{\pm}16$일, 그리고 산소 보충요법 기간에서는 각각 $35{\pm}18$일, $23{\pm}13$일로 유의한 차이를 보였다(P=0.014). 그리고 동맥관 개존증, 뇌실내 출혈, 미숙아 망막증, 폐렴, 기흉, 사망률은 두 군간 다소 차이는 있었으나 통계적 유의성은 발견할 수 없었다. 또한, 두 군간 주요 독립적인 변수은 출생체중(Odds ratio=5.457, 95% CI=1.551-27.525, P=0.0172), 초기 백혈구수(Odds ratio= 8.308, 95% CI=2.054-52.699, P=0.0087), 기관지폐 이형성증(Odds ratio=0.099, 95% CI=0.017-0.397, P=0.0034) 등으로 나타났다. 결 론 : 본 연구에서는 초기 2시간내에 시행한 혈액 검사상 중성구 감소증을 보이는 군에서 기관지폐 이 형성증의 발병이 증가하면서 폐손상이 심해진다는 것을 확인하였다.

• 대한원격탐사학회지
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• 제36권6_3호
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• pp.1721-1732
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• 2020

초등학생들은 학교에서 많은 시간을 보내고 있으며 실내 공기오염에 더 많이 노출된다. 또한 초등학생들은 신체적으로 성장기에 있으며 어른에 비해 단위체중당 호흡량이 많으므로 실내 공기오염에 대한 민감도가 큰 것으로 알려져 있다. 따라서 학교 실내공기질은 초등학생들의 건강을 위한 중요한 요소이다. 본 연구에서는 서울지역 5개 초등학교에서 측정한 실내외 미세먼지 (Particulate matter: PM) 농도를 이용하여 상관분석을 실시하였다. 이를 통해 실외 PM이 실내 PM에 미치는 영향을 평가하였다. 또한 PM ratio, I/O ratio 등과 같은 통계분석을 진행하였다. 그 결과 초등학교의 실내외 PM의 상관성은 PM10보다 PM2.5와 PM1에서 더 유의미하게 나타났다. Indoor/outdoor (I/O) ratio의 경우 PM10에서 SD를 제외한 4개 초등학교에서 모두 1보다 높게 나타났다 (BB: 2.21, NS: 1.67, IS: 1.73, SI: 1.17). 이는 실내 학생의 활동도가 PM10의 농도에 큰 영향을 미친다는 것을 의미한다.

• 대한한방소아과학회지
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• 제16권2호
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• pp.69-81
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• 2002

The Purpose of this study was to collect statistics of pediatric problems, and so to investigate the new effective oriental medicine treatments in pediatric disease and its clinical applicability. The Study was composed of 698 new patient who had been treated at the pediatric unit in th Dong Sea Oriental Medical Hospital for 1 year, from 1 September 2001 to 31 October 2002, and aged between 0 and 18 years. The Chief complaints and their care-givers. Result: 1. In the study, male children are 403 and female children are 295. So the sex ratio between male and female is 1.37 : 1. 2. In age distribution, 0-3 years : 317(45.4%), 4-6 years : 148(21.2%). 7-9 years 98(14.0%), 10-12 years: 66(9.5%), 13-15 years : 40(5.7%), 16-18 years 29(4.2%). 3. The chief complaint according to systemic division was Respiratory diseases covers 30.1%, Digestive diseases covers 20.8%, Physique diseases covers 10.6%. 4. The Respiratory diseases tended to increase in autumn and appeared mostly in the age group between 0 and 9 years. The Digestive diseases increase in summer and appeared mostly in the age group between 10 and 12 years. The physique diseases increase in winter and appeared mostly in he age group between 13 and 18 years. 5. Most of patient came to the hospital from diseases such as common cold, weakness, dyspepsia, atopic dermatitis, rhinitis, take a easy cold, short stature, sweating, Bell's palsy, abdominal pain, etc. Conclusion : 1. The chief complaint In pediatric diseases that needed an oriental medical treatment was mainly the disease that tends to take long time and the weakness, and appeared frequency in respiratory and digestive disease. 2. The oriental medical treatment was still preferred as a way to improve the weakness by patients, rather than a way to overcome their disease. in particular, the study shows that the oriental medical treatment should be emphasized in terms of preventing the disease. 3. The new disease, which were developed with change of human life and environment, should be investigated as a new fie of oriental medical treatment.

• 대한간호학회지
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• 제44권6호
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• pp.743-750
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• 2014

Purpose: The objective of this study was to provide a trend analysis of the prevalence of diabetes relative to the socioeconomic, lifestyle, and physiologic risk factors among Korean adults aged over 30 years for a 10-year period using data from the Korean National Health and Nutrition Examination Survey. Methods: Prevalence difference and the slope index of inequality were calculated for each risk factors using binomial regression by considering the repeated cross-sectional features of the data. The prevalence ratio and the relative index of inequality were calculated using log-binomial regression. Linear trend tests were performed using SAS 9.2. Results: Crude prevalence of diabetes increased over the 10-year period, and was higher for men than for women. It was very high for adults 60 years or over, consistently increasing over time. The prevalence among unemployed men, women with higher level of stress, women with hypertension, and adults with serum triglyceride levels over 135 mg/dL increased over the 10-year period in comparison with the respective control group. Conclusion: Considering the rapid economic development and associated lifestyle changes in Korea, action should be taken to control the prevalence of diabetes by both preventing and consistently monitoring these identified risk factors using a public-health approach.

• 말소리와 음성과학
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• 제1권2호
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• pp.37-42
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• 2009

The purpose of the present study was to determine the effect of the management program known as vocal function exercise (VFE) on voice quality. Typical VFE was modified and applied to patients with vocal nodules by controlling intensity of voice and relieving the vocal fold to solve hyperfunctional problems in VFE. Eight female subjects aged between 28 and 54 who had been diagnosed with vocal nodules took part in the study. The patients performed VFEs once a week for eight weeks. Vocal function exercises consist of voice hygiene, respiratory training, phonation training, and glide training. The subjects' voices were analyzed pre and post therapy on the aspects of acoustics, maximum phonation time (MPT), GRBAS, and voice handicap index (VHI). As a result, it was found that fundamental frequency ($F_o$) was significant increased, shimmer decreased remarkably and that noise to harmonic ratio (NHR) lowered obviously in the acoustic parameter. In addition, MPT was increased significantly. The scale of GRBAS indicated significant improvement in grade, roughness, and strained voice. VHI indicated significant improvement in an emotional part. In conclusion, VFE was effective in improving voice quality for patients with vocal nodules.

• Journal of Chest Surgery
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• 제17권2호
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• pp.244-249
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• 1984

Surgical treatment of partial endocardial cushion defect was accomplished in Feb. 1984 in this department. The 5 year old male patient had history of frequent upper respiratory tract infection and since his age of 3 years dyspnea on exertion and palpitation were noted but there were no cyanosis and clubbing. A thrill was palpable on the apex and grade IV/IV harsh systolic ejection murmur and diastolic murmur was audible on it. Liver was palpable about 3 finger breadths and no ascites. Chest X-ray revealed increased pulmonary vascularity, moderate cardiomegaly [C-T ratio; 0.69], and enlarged left atrium. EKG showed first degree heart block, RVH, LVH, and LAD. Echocardiogram showed paradoxical ventricular septal movement and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted left to right shunt [Qp:Qs:2.1:1 ] and moderate pulmonary hypertension [60/40 mmHg]. Left ventriculogram showed mitral regurgitation [Grade III/IV] and filling of left atrium and right atrium nearly same time. Operative findings were: 1.Primum type atrial septal defect [3x2 cm] 2.Cleft on the anterior leaflet of mitral valve. 3.No interventricular communication and cleft of tricuspid valve leaflet. The mitral cleft was repaired with 4 interrupted sutures. The primum type atrial septal defect was closed with Dacron patch intermittently at endocardial cushion and continuously remainder. The post operative course was uneventful and discharged on 22nd postoperative day in good general conditions.