• 지질동맥경화학회지
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• 제7권2호
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• pp.77-87
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• 2018

Lowering serum low-density lipoprotein cholesterol (LDL-C) is the mainstay for reduction of risk of cardiovascular disease (CVD), the second most common cause of death in Korea. The 2015 Korean guidelines for management of dyslipidemia strongly recommend the use of statins in patients at risk of CVD. Statin therapy, which is the gold standard for CVD, reduces LDL-C level by 40% to 60% and is generally well tolerated. However, many patients are intolerant to statins and discontinue therapy or become nonadherent to therapy because of actual/perceived side effects. The most common of these side effects is the statin-associated muscle symptom (SAMS). Discontinuation and repetitive re-challenge with statins can help identify SAMS. If serum creatinine kinase level is more than 10 times the upper limit of normal, statin therapy must be stopped immediately, and the physician should identify possible causes including rhabdomyolysis and treat appropriately. In other patients, it might help to switch to a less potent statin or to use statins at intermittent non-daily dosing. To achieve target LDL-C level, non-statin lipid-lowering therapies such as dietary modifications, ezetimibe, and bile acid sequestrants may be added. Several new drugs have recently been approved for lowering LDL-C level. Alirocumab and evolocumab are monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9, and both drugs cause large reductions in LDL-C, similar to statins. Lomitapide and mipomersen are orphan drugs used as adjuncts to other lipid-lowering therapies in patients with homozygous familial hypercholesterolemia.

• 한국미생물·생명공학회지
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• 제47권2호
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• pp.310-316
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• 2019

Distribution of Salmonella enterica serovars and their associated virulence determinants is wide-spread among food animals, which are continuously implicated in periodic salmonellosis outbreaks globally. The aim of this study was to determine and evaluate the diversity of five Salmonella serovar virulence genes (invA, pefA, cdtB, spvC and iroN) isolated from food animals and humans. Using standard microbiological techniques, Salmonella spp. were isolated from the feces of humans and three major food animals. Virulence determinants of the isolates were assayed using PCR. Clonal relatedness of the dominant serovar was determined via pulsed-field gel electrophoresis (PFGE) using the restriction enzyme, Xbal. Seventy one Salmonella spp. were isolated and serotyped into 44 serovars. Non-typhoidal Salmonella (NTS; 68) accounted for majority (95.8%) of the Salmonella serovars. Isolates from chicken (34) accounted for 47.9% of all isolates, out of which S. Budapest (14) was predominant (34.8%). However, the dominant S. Budapest serovars showed no genetic relatedness. The invA gene located on SPI-1 was detected in all isolates. Furthermore, 94% of the isolates from sheep harbored the spvC genes. The iroN gene was present in 50%, 100%, 88%, and 91% of isolates from human, chicken, sheep, and cattle, respectively. The pefA gene was detected in 18 isolates from chicken and a single isolate from sheep. Notably, having diverse Salmonella serovars containing plasmid encoded virulence genes circulating the food chain is of public health significance; hence, surveillance is required.

• Journal of Chest Surgery
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• 제52권1호
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• pp.1-8
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• 2019

Background: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. Methods: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (${\leq}35d$), and those who underwent esophagectomy more than 35 days after nCRT (>35d). Results: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ${\leq}35d$ cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ${\leq}35d$ cohorts (p=0.044), and between the ${\leq}35d$ and >35d cohorts (p=0.007). Conclusion: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.

• 한국콘텐츠학회논문지
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• 제19권1호
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• pp.24-36
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• 2019

본 연구는 중소병원 간호사의 윤리풍토와 윤리적 민감성 정도를 확인하고 조직의 목표달성 정도를 의미하는 조직유효성에 어떠한 영향을 미치는지 알아보기 위해 시도된 서술적 조사연구이다. 1년 이상 근무한 155명의 중소병원 간호사로 편의 추출하였고, SPSS/Win 20.0 통계프로그램을 사용하여 결과를 분석하였다. 중소병원 간호조직의 조직유효성에 영향을 미치는 요인으로 최근 2년이내 간호윤리교육 경험이 있고, 윤리풍토가 높을수록 조직유효성은 유의하게 증가한 것으로 확인되었다. 설명력은 60.6%였다. 따라서 중소병원 간호부서 조직유효성을 위해 구성원들이 다양한 업무와 절차를 수행함에 있어 윤리적 문제를 어떻게 다루어야 하는지에 대한 올바른 행동과 그 문제들을 다루는 방식에 대한 조직 내 공유되는 인식들이 필요하다. 이를 공유하고 확산할 수 있는 문화적 배경과 함께 지속적이고 규칙적인 간호윤리교육 프로그램 개발과 적용이 필요할 것으로 생각된다.

• 대한방사선기술학회지:방사선기술과학
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• 제42권2호
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• pp.137-143
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• 2019

The aim of this study was analyzed the setup error of breast cancer patients in intensity modulated radiation therapy(IMRT) with deep inspiration breath holding(DIBH) and was analyzed the dose distribution due to setup error. A total of 45 breast cancer cases were performed a retrospective clinical analysis of setup error. In addition, the re-treatment planning was carried by shifting the setup error from the isocenter at the treatment. Based on this, the dose distribution of PTV and OARs was compared and analyzed. The 3D error for small breast group and medium breast group and large breast group were 3.1 mm and 3.7 mm and 4.1 mm, respectively. The difference between the groups was statistically significant(P=0.003). DVH results showed HI, CI for the PTV difference between standard treatment plan and re-treatment plan of 14.4%, 4%. The difference in $D_5$ and $V_{20}$ of the ipsilateral lung was 5.6%, 13% respectively. The difference in $D_5$ and $V_5$ of the heart of right breast cancer patients was 6.8%, 8% respectively. The difference in $D_5$, $V_{20}$ of the heart of left breast cancer patients was 7.2%, 23.5% respectively. In this study, there was a significant association between breast size and significant setup error in breast cancer patients with DIBH. In addition, it was found that the dose distribution of the PTV and OARs varied according to the setup error.

• 대한종양외과학회지
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• 제14권2호
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• pp.95-101
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• 2018

Purpose: The standard treatment of esophageal cancer is the Ivor-Lewis operation, which consists of an abdominal phase involving gastric tube formation, and a chest phase involving esophagectomy and anastomosis. We aimed to report our experience of performing thoracic esophagectomy with the laparoscopic gastric pull up (LGPU) technique and its surgical outcomes. Methods: Clinicopathologic data and short-term surgical outcomes of 14 patients who underwent LGPU for thoracic esophageal cancer from August 2008 to May 2016 were retrospectively reviewed. Results: Mean age of the patients was 62.3 years and mean body mass index was $21.7kg/m^2$. Eleven patients had medical comorbidities. Patients' mean American Society of Anesthesiologists score was 2. Mean operation time was 428.5 minutes, with the mean abdominal operation time being 138.9 minutes. There was no open conversion case. Three patients had pneumonia, three patients had surgical site infection, and one patient had subcutaneous emphysema within 30 days after surgery. One patient had minor anastomosis site leakage. There was one 30-day mortality case. One patient with postoperative aspiration pneumonia developed acute respiratory distress disease, and died due to sepsis. Mean postoperative intensive care unit stay was 3.5 days, and mean postoperative hospital stay was 20.6 days. Nasogastric tubes were removed on average at 3.4 days, and mean oral intake time was 3.4 days. Conclusion: If the gastrointestinal surgeon has extensive experience in laparoscopic procedures, LGPU will be a safe and feasible technique for thoracic esophagectomy in patients with intrathoracic esophageal cancer.

• 한국방사선학회논문지
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• 제13권4호
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• pp.539-546
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• 2019

간조직 생검은 침습적이며, 합병증의 위험을 동반함에도 불구하고 간섬유화의 정도를 예측하는 표준 진단법으로 적용된다. 이러한 단점을 보완하기 위해 본 연구에서는 만성 C형간염 환자 200명을 대상으로 Fibroscan(R)을 이용하여 간섬유화 등급을 나누고, ROC 곡선을 측정하여 혈청학적검사로 계산되는 FIB-4, APRI, AAR의 유용성과 실질적인 Cut-off value를 알아보고자 하였다. 그 결과 간섬유화 평가를 위해 AAR을 적용하는 것보다는 APRI, FIB-4를 이용하는 것이 적절할 것으로 생각되며, 경한 섬유화 등급을 예측하기 위해서는 APRI, 간경변군인 F4등급에는 FIB-4를 사용하는 것이 유용하다고 판단된다. 혈청학적 간섬유화 표지자의 간편하고 반복 측정이 가능하다는 장점을 이용해 간 섬유화의 경과 관찰 기간을 줄일 수 있으므로 나아가 간경변과 간암의 유병률을 감소시킬 수 있을 것으로 사료된다.

• 한국방사선학회논문지
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• 제13권4호
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• pp.667-674
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• 2019

Technegas를 사용한 검사는 단순 확산 누적을 통해 폐 영상을 이미지화하기 때문에 검사를 마친 후에 검사실이 오염될 수 있다. 따라서 방사선 작업 종사자와 검사를 기다리는 환자는 technegas 흡입으로 인한 내부 피폭의 영향을 받게 된다. 이에 중력환기 전후의 시간경과에 따른 공간선량율 분포를 비교, 분석함에 따라 방사선사, 의료진, 대기 환자의 피폭선량 저감화 방법을 모색하고자 한다. 중력환기 전후 환자의 호흡기 위치에서 거리별, 각도별로 공간선량율을 10분 동안 측정하고 평균값, 표준 편차 및 감소율을 계산하였다. 실험 결과, 중력 환기 전후 감소율은 최고 95.31%였고 가장 높은 감소율은 1 ~ 3분 사이에서 나타났다. 중력환기를 통해서 방사선 작업종사자, 대기환자, 환자 보호자 및 간호사의 피폭선량을 감소시킬 수 있다. 결론적으로 중력환기를 통한 피폭선량 감소 결과는 방호 최적화를 이루는 역할을 할 것이며 ICRP 103에서 권고한 의료 피폭 저감화에 부합된다.

• 대한한방소아과학회지
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• 제33권3호
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• pp.30-41
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• 2019

Objectives Development of objective clinical measure for analyzing pediatric weakness has been studied. However, there is no gold standard clinical measures with acceptable validity and reliability were not provided yet and these has been major issue for clinics. Methods Some Korean medicine hospital outpatients (n=324) were recruited as participants, and 55 preliminary questions were given. Pediatric Weakness Scale (PWS) with five subscales and thirty questions were developed using factor analysis and item analysis. The internal consistency of PWS subscales were examined with using Cronbach's alpha. The correlations between PWS subscales and physical characteristics of Body Mass Index (BMI) and Ponderal Index (PI) were attested using Pearson's correlation. The differences between PWS subscale scores and profiles among 3 to 13 years old children were examined using profile analysis and ANOVA by gender. Results PWS five subscales explained 49.1% of total variance, and the range of Cronbach's alpha was from 0.700 to 0.803. The range of correlation coefficient between PWS total score and five subscales was from 0.643 to 0.748, and the PWS total score was significantly (p<0.001) correlated positively with BMI (r=-0.237) and negatively with PI (r=-0.280). The scores and profiles of PWS five subscales, BMI and PI were found to be significantly different among the all age groups. Conclusions Objective and validated clinical measure for analyzing pediatric weakness with five subscales was developed in current study, and foundations for screening, managing and treating pediatric weakness during the development were established as well. This study would contribute to the integrative education and clinical practice of the Eastern and Western medicine.

• 중환자간호학회지
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• 제12권3호
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• pp.74-83
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• 2019

Purpose : The routine evaluation of gastric residuals (RGR) is considered standard care for premature infants. This study evaluated the usefulness of RGR in premature infants. Methods : The study retrospectively investigated 208 premature infants (gestational aged under 34 weeks) who underwent gavage feeding in a neonatal intensive care unit at a tertiary hospital. The patients were divided into two groups: RGR (n=104) and no-RGR (n=104). Those in the no-RGR group had their gastric residuals checked only if signs of feeding intolerance were present. Clinical outcomes, including the time to reach full enteral feeding (FEF) and the incidences of gastrointestinal disorders such as feeding intolerance (FI) and necrotizing enterocolitis (NEC), were compared. Data were analyzed with SPSS ver. 21, using a Mann-Whitney U test, chi-squared test, and Fisher's exact test. Results : There was no statistically significant difference for the time to FEF (z=-0.61, p=.541), incidence of FI ($X^2=0.38$, p=.540), and NEC ($X^2=1.42$, p=.234) between the two groups. Conclusion : No-RGR did not increase the risk for FI or NEC. These results suggest that RGR evaluation may not improve nutritional outcomes in premature infants. Recommendations for further research and practice guidelines will be provided.