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The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy (지속적 신대체요법을 받은 중환자에서 영양공급이 임상결과와 영양상태에 미치는 영향)

  • Kim, Ju Yeun;Kim, Ji-Myung;Kim, Yuri
    • Journal of Nutrition and Health
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    • v.48 no.3
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    • pp.211-220
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    • 2015
  • Purpose: This study was designed to investigate whether nutritional supply influences biochemical markers and clinical outcomes in patients who received continuous renal replacement therapy (CRRT) by evaluating adequacy of nutritional supply for patients. Methods: From January 2012 to December 2013, 239 adult patients who received CRRT in the intensive care unit for more than 3 days were included. General information from electronic medical records and nutritional status related biochemical data and clinical outcomes on the first day of CRRT and 2 weeks after CRRT were collected. Results: The rate of delivered energy and protein was 68.06% and 43.13% which was much lower than energy and protein supply based on their requirement. When the patients were divided into two groups according to 70% of energy received rate and 50% of protein received rate, the group with more than 70% of energy received rate showed significant decrease of length of hospital stay (p = 0.007), length of stay in intensive care unit (ICU) (p = 0.008), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) compared to less than 70% of energy received rate after adjusting for age. In addition, the group with more than 50% of protein received rate showed decreased mortality (p = 0.031), length of hospital stay (p = 0.008), length of ICU stay (p = 0.035), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) after adjusting for age. We found that the level of hematocrit (p = 0.006) was significantly improved in the group with more than 70% of energy received rate, and the level of TLC (p = 0.049), hematocrit (p = 0.041) was significantly improved in the group with more than 50% of protein received rate. We also found that energy delivery was negatively correlated with length of stay in ICU (p = 0.049) and positively correlated with level of calcium (p = 0.037). In addition, protein delivery was correlated with the levels of serum total protein (p = 0.021), serum albumin (p = 0.048), hematocrit (p = 0.009), and total cholesterol (p = 0.021) when dead patients were included, but was correlated with the levels of hematocrit (p = 0.034) and calcium (p = 0.024) when dead patients were excluded. Conclusion: Proper nutritional delivery may help patients' clinical outcomes for patients receiving CRRT. However, their actual intakes of energy and protein were not adequate for their requirements. Identification of patients with malnutrition is necessary and a multidisciplinary approach for systemic management is also required.

Nutritional Knowledge and Dietary Behavior of the 6th Grade Elementary School Students in Daejeon Area by Gender and Skipping Breakfast (대전지역 초등학교 6학년생의 성별과 아침 결식에 따른 영양지식 및 식행동)

  • You, Jeong-Soon;Kim, Sun-Mi;Chang, Kyung-Ja
    • Journal of Nutrition and Health
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    • v.42 no.3
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    • pp.256-267
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    • 2009
  • This study was conducted to investigate nutritional knowledge related to breakfast and dietary behavior of elementary school students by gender and skipping breakfast. The subjects of this study were the 6th grade elementary school students (Total 237; 119 males and 118 females) in Daejeon. The group who ate breakfast six to seven times per week was 58.6%; The group who ate breakfast zero to five times per week was 41.4%. Most of subjects' families (84.4%) were 'nuclear family' and 63.8% of mothers held jobs. There was a significant difference between family income and skipping breakfast. As for the type of breakfast, 79.0% of the male students and 81.4% of female students answered 'cooked rice' and the reasons for skipping breakfast were 'no appetite' followed by 'not enough time', 'over sleeping'. In the eating breakfast group, frequency of having breakfast with family was higher compared to the skipping breakfast group. Total scores of nutritional knowledge related to breakfast in the female students were significantly higher than those of the male students. Also significant differences were found on such questions as 'the relation between eating breakfast and body weight control' and 'importance of breakfast' by skipping breakfast. The dietary behavior scores of the group who ate breakfast were higher than those of the group who skipped breakfast. Therefore, a need exists to develop and distribute a simple breakfast menu that contains Korean-style food and can be more appetizing and appealing to Korean elementary school students. Also it is necessary to develop a systemic awareness program that emphasize the importance of breakfast and the harmfulness of skipping breakfast.

Postprandial hypoglycemic effects of mulberry twig and root bark in vivo and in vitro (In vivo와 in vitro에서 상지 및 상백피 에탄올추출물이 식후 혈당 상승 억제 조절에 미치는 영향)

  • Park, Soo Yeon;Jin, Bo Ra;Lee, Yu Rim;Kim, You Jin;Park, Jeong Bin;Jeon, Young Hee;Choi, Sang Won;Kwon, Oran
    • Journal of Nutrition and Health
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    • v.49 no.1
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    • pp.18-27
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    • 2016
  • Purpose: Our previous study demonstrated the hypoglycemic effects of mulberry (Morus alba L.) leaf and the underlying mechanisms. Here we explored the potency of mulberry twigs (TW) and root barks (RB) in postprandial hypoglycemic effects in vitro and in vivo. Methods: The major components of TW and RB were determined by high performance liquid chromatography (HPLC). Alpha-glucosidase inhibition and glucose/fructose uptake inhibition in Caco-2 cells were determined for TW, RB, and their major components, followed by an oral sugar tolerance test (OSTT) in streptozotocin-induced diabetic rats. Male Wistar rats were fed a high-fat diet for 2 weeks and then a single dose of streptozotocin (35 mg/kg B.W) was administered by intraperitoneal injection. Rats with fasting blood glucose levels above 126 mg/dL were randomly divided into 5 groups (n = 8/group) for the following treatments by gavage for 4 weeks: vehicle (normal control and diabetic control), 200 mg/kg B.W of TW or RB or 100 mg/kg B.W of oxyresveratrol (OXY). Results: OXY and mulberroside A were identified as the major components of TW and OXY, mongolicin, and kuwanon H for RB. A significant inhibitory activity on ${\alpha}-glucosidase$ was found for TW, RB, and OXY (p = 0.0099). There was a dose-dependent inhibition of TW and RB on the intestinal sugar uptakes in Caco-2 cells, showing a greater impact on fructose compared to glucose. The OSTT showed that TW and RB significantly delayed time to maximal concentration (p = 0.0088) and decreased maximal concentration (p = 0.0043) compared to the control group. Conclusion: These results suggest that TW and RB may have a postprandial hypoglycemic effect, particularly in the case of high fructose or sucrose intake. OXY was suggested as a contributor to the hypoglycemic effect of TW and RB. Further studies are needed for the systemic effect of TW and RB in circulation.

Blockade of Thromboxane Influences Does Not Affect Renal Blood Flow Deficit in Anesthetized Diabetic Rats (마취된 당뇨 흰쥐의 신혈류량 감소에 관여하는 기전 : 내인성 쓰롬복산계의 무관성)

  • Ha, Hun-Joo;Dunham, Earl W.
    • The Korean Journal of Pharmacology
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    • v.24 no.2
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    • pp.221-232
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    • 1988
  • Studies were conducted to determine whether reduced renal blood flow (RBF) exhibited by rats with uncontrolled, streptozotocin (STZ)-induced diabetes is attributable to diabetes-associated, enhanced renal vasoconstrictor influence of endogenous thromboxane $(TX)A_2$. Rats which were injected with STZ after pretreatment with 3-O-methyl glucose (3OMG), an agent which prevents STZ-induced hyperglycemia, were also studied. Basal values of total RBF (RBF; ml $min^{-1}$ $gKw^{-1}$; electromagnetic flow probe), systemic arterial pressure (BP; mm Hg) and renal vascular resistance (RVR;BP $RBF^{-1})$in pentobarbital-anesthetized rats during a control period were $5.9{\pm}0.3$(P<0.1_{VS}. CR), $115{\pm}3$ and $20.3{\pm}1.0$(P<0.1_{VS}. CR) for STZR (n=15), and $8.4{\pm}0.4$, $123{\pm}3$ and $15.1{\pm}0.8$ for age-matched control rats (CR; n= 15), respectively. Basal values of RBF, BP and RVR in 3OMG pretreated STZR were identical to CR. In preparations shown capable of renal vasodilatation, OKY 1581 (1 mg/kg, i.v. followed by 0.4 mg/kg min infusion) abolished arachidonate-induced $(TX)A_2$ synthesis, but did not alter basal BP, RBF or RVR in either STZR or CR (n=4/group). Similarly, i.r.a. infusion of SQ29548 (100 ng/ml RBF) abolished renal vasoconstriction induced by a TX/prostaglandin endoperoxide mimic, U46619, but had no discern able affect on RVR in either STZR (n=8) or CR (n=8). The data indicates that $TXA_2$ does not participate in the elevated basal RVR of STZR which are associated with the diabetic state.

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A Destructive Method in the Connection of the Algorithm and Design in the Digital media - Centered on the Rapid Prototyping Systems of Product Design - (디지털미디어 환경(環境)에서 디자인 특성(特性)에 관한 연구(硏究) - 실내제품(室內製品) 디자인을 중심으로 -)

  • Kim Seok-Hwa
    • Journal of Science of Art and Design
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    • v.5
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    • pp.87-129
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    • 2003
  • The purpose of this thesis is to propose a new concept of design of the 21st century, on the basis of the study on the general signification of the structures and the signs of industrial product design, by examining the difference between modern and post-modern design, which is expected to lead the users to different design practice and interpretation of it. The starting point of this study is the different styles and patterns of 'Gestalt' in the post-modern design of the late 20th century from modern design - the factor of determination in industrial product design. That is to say, unlike functional and rational styles of modern product design, the late 20th century is based upon the pluralism characterized by complexity, synthetic and decorativeness. So far, most of the previous studies on design seem to have excluded visual aspects and usability, focused only on effective communication of design phenomena. These partial studies on design, blinded by phenomenal aspects, have resulted in failure to discover a principle of fundamental system. However, design varies according to the times; and the transformation of design is reflected in Design Pragnanz to constitute a new text of design. Therefore, it can be argued that Design Pragnanz serves as an essential factor under influence of the significance of text. In this thesis, therefore, I delve into analysis of the 20th century product design, in the light of Gestalt theory and Design Pragnanz, which have been functioning as the principle of the past design. For this study, I attempted to discover the fundamental elements in modern and post-modern designs, and to examine the formal structure of product design, the users' aesthetic preference and its semantics, from the integrative viewpoint. Also, with reference to history and theory of design my emphasis is more on fundamental visual phenomena than on structural analysis or process of visualization in product design, in order to examine the formal properties of modern and post-modern designs. Firstly, In Chapter 1, 'Issues and Background of the Study', I investigated the Gestalt theory and Design Pragnanz, on the premise of formal distinction between modern and post-modern designs. These theories are founded upon the discussion on visual perception of Gestalt in Germany in 1910's, in pursuit of the principle of perception centered around visual perception of human beings. In Chapter 2, I dealt with functionalism of modern design, as an advance preparation for the further study on the product design of the late 20th century. First of all, in Chapter 2-1, I examined the tendency of modern design focused on functionalism, which can be exemplified by the famous statement 'Form follows function'. Excluding all unessential elements in design - for example, decoration, this tendency has attained the position of the international style based on the spirit of Bauhause - universality and regularity - in search of geometric order, standardization and rationalization. In Chapter 2-2, I investigated the anthropological viewpoint that modern design started representing culture in a symbolic way including overall aspects of the society - politics, economics and ethics, and its criticism on functionalist design that aesthetic value is missing in exchange of excessive simplicity in style. Moreover, I examined the pluralist phenomena in post-modern design such as kitsch, eclecticism, reactionism, hi-tech and digital design, breaking away from functionalist purism of modern design. In Chapter 3, I analyzed Gestalt Pragnanz in design in a practical way, against the background of design trends. To begin with, I selected mass product design among those for the 20th century products as a target of analysis, highlighting representative styles in each category of the products. For this analysis, I adopted the theory of J. M Lehnhardt, who gradated in percentage the aesthetic and semantic levels of Pragnantz in design expression, and that of J. K. Grutter, who expressed it in a formula of M = O : C. I also employed eight units of dichotomies, according to the G. D. Birkhoff's aesthetic criteria, for the purpose of scientific classification of the degree of order and complexity in design; and I analyzed phenomenal aspects of design form represented in each unit. For Chapter 4, I executed a questionnaire about semiological phenomena of Design Pragnanz with 28 units of antonymous adjectives, based upon the research in the previous chapter. Then, I analyzed the process of signification of Design Pragnanz, founded on this research. Furthermore, the interpretation of the analysis served as an explanation to preference, through systematic analysis of Gestalt and Design Pragnanz in product design of the late 20th century. In Chapter 5, I determined the position of Design Pragnanz by integrating the analyses of Gestalt and Pragnanz in modern and post-modern designs In this process, 1 revealed the difference of each Design Pragnanz in formal respect, in order to suggest a vision of the future as a result, which will provide systemic and structural stimulation to current design.

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Exotic Weeds Flora in Crop Fields in Republic of Korea (우리나라 농경지에 발생하는 외래잡초 현황)

  • Kim, Chang-Seok;Kim, Jin-Won;Oh, Young-Ju;Hong, Sun-Hee;Heo, Su-Jeong;Lee, Chae-Young;Park, Kee-Woong;Cho, Seng-Hyun;Kwon, Oh-Do;Im, Il-Bin;Kim, Sang-Kuk;Seong, Deok-Gyeong;Chung, Young-Jae;Lee, Jeongran;Lee, In-Yong
    • Weed & Turfgrass Science
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    • v.7 no.1
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    • pp.1-14
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    • 2018
  • We surveyed the distribution of exotic weeds in Korean paddy fields, uplands, orchards and pastures from 12,568 sites during 3 years, 2013, 2014 and 2015. As a result, 166 species in 28 families were identified and 7, 130, 126, and 80 species were surveyed from paddy fields, uplands, orchards, and pastures, respectively. Among the 166 species, 128 species were annual weed and 38 species were perennial weed. Especially, winter annual exotic weeds were 63 species (37.8%). 46, 16, and 104 exotic weeds were classified to their introduction period of $1^{st}$ (1876-1921), $2^{nd}$ (1922-1963), and $3^{rd}$ (1964-now) period, respectively. The exotic weeds introduced in $2^{nd}$ and $3^{rd}$ period, included 12 Invasive Alien Species. The weeds from $1^{st}$ period, however, could be grouped into native weeds as the 'naturalized weed' and managed the same as the native weeds. Especially, some exotic weeds such as common groundsel were widely distributed in Korean crop lands, and they will become more problematic in near future. Therefore, systemic research from the biology to management should be conducted and the results from the studies should be applied practically.

Active Prosthetic Valve Endocarditis: The Clinical Profile, Laboratory Findings and Mid-term Surgical Results (활동성 인공판막 심내막염: 임상 양상, 검사 소견 및 중기 수술 성적)

  • Kim, Hwan-Wook;Joo, Seok;Kim, Hee-Jung;Choo, Suk-Jung;Song, Hyun;Lee, Jae-Won;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.447-455
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    • 2009
  • Background: Prosthetic valve endocarditis usually presents with clinical symptoms that are more severe than native valve endocarditis, and prosthetic valve endocarditis shows the spread of infection into the surrounding tissue as well as into the superficial endocardial layers. The postoperative prognosis is especially poor for valve re-replacement for the cases of active endocarditis that are unable to receive a full-course of pre-antibiotic therapy due to complications and the ensuing clinical aggravation. The aim of this study was to evaluate the clinical profiles, laboratory findings and mid-term surgical results of active prosthetic valve endocarditis. Material and Method: Among the 276 surgically treated infective endocarditis patients who were treated during the period from January 1998 to July 2008, 31 patients were treated for prosthetic valve endocarditis. Among these patients, 24 received surgical treatment for an 'active' state, and they were selected for evaluation. Result: The most frequently encountered symptom was a febrile sensation. Eight cases (33.3%) were accompanied by systemic thromboembolism, among which 5 cases (20.8%) had an affected central nervous system. 'Vegetations' were most commonly found on transesophageal echocardiography, and the 'Staphylococcus species' were the most frequent pathogens. There were 4 deaths in the immediate postoperative period, and an additional 4 patients died during the follow-up period (Mean$\pm$SD, 42.1$\pm$36.9 months). The cumulative survival rate was 79% at 1 year, 73% at 3 years, 66% at 5 year, and 49.5% at 7 years. Conclusion: The cases of active prosthetic valve endocarditis that were unable to receive a full course of preoperative antibiotics therapy generally have a poor prognosis. Nevertheless, early surgery and extensive resection of all the infected tissue is pivotal in improving the survival rate of patients with surgically treated active prosthetic valve endocarditis.

Patient Specific Quality Assurance of IMRT: Quantitative Approach Using Film Dosimetry and Optimization (강도변조방사선치료의 환자별 정도관리: 필름 선량계 및 최적화법을 이용한 정량적 접근)

  • Shin Kyung Hwan;Park Sung-Yong;Park Dong Hyun;Shin Dongho;Park Dahl;Kim Tae Hyun;Pyo Hongryull;Kim Joo-Young;Kim Dae Yong;Cho Kwan Ho;Huh Sun Nyung;Kim Il Han;Park Charn Il
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.176-185
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    • 2005
  • Purpose: Film dosimetry as a part of patient specific intensity modulated radiation therapy quality assurance (IMRT QA) was peformed to develop a new optimization method of film isocenter offset and to then suggest new quantitative criteria for film dosimetry. Materials and Methods: Film dosimetry was peformed on 14 IMRT patients with head and neck cancers. An optimization method for obtaining the local minimum was developed to adjust for the error in the film isocenter offset, which is the largest part of the systemic errors. Results: The adjust value of the film isocenter offset under optimization was 1 mm in 12 patients, while only two patients showed 2 mm translation. The means of absolute average dose difference before and after optimization were 2.36 and $1.56\%$, respectively, and the mean ratios over a $5\%$ tolerance were 9.67 and $2.88\%$. After optimization, the differences in the dose decreased dramatically. A low dose range cutoff (L-Cutoff) has been suggested for clinical application. New quantitative criteria of a ratio of over a $5\%$, but less than $10\%$ tolerance, and for an absolute average dose difference less than $3\%$ have been suggested for the verification of film dosimetry. Conclusion: The new optimization method was effective in adjusting for the film dosimetry error, and the newly quantitative criteria suggested in this research are believed to be sufficiently accurate and clinically useful.

The Role of Radiotherapy in Patients with Brain Metastasis (고형암의 뇌전이시 방사선치료 효과)

  • Lee Soon Nam;Choo Mi-Soon;Lee Kyung-Ja;Nam Eunmi
    • Radiation Oncology Journal
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    • v.17 no.4
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    • pp.281-286
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    • 1999
  • Purpose : Brain metastases are the most frequent metastatic neurologic complication of systemic cancer. Even if the prognosis of brain metastases is grave, with available treatments, most patients experience effective palliation of neurologic symptoms and meaningful extension of life. We evaluated the clinical features and prognostic factors of the patients who were diagnosed as solid tumors with brain metastasis and received radiotherapy for brain metastases. Materials and Methods: Between January 1987 and January 1998, 71 patients with brain metastases from solid malignancy were included. We reviewed neurologic symptoms and signs of patients and evaluated improvememt of neurologic symptoms and signs. Survival durations after brain metastasis were ana lysed according to several factors such as age, performance status, primary malignancies, the pre-sence of brain metastasis at initial diagnosis of primary tumor, multiplicity of brain metastass, the presence of metastases other than brain, and treatment method. Results: Frequent symptoms associated with brain metastasis were headache (47.9$\%$), motor weakness (40.8$\%$), nausea and vomiting (19.7$\%$) and mental change (19.7%). Palliation of these symptoms was accomplished in 64.9$\%$ of cases. The overall median survival time was 16 weeks and 1- and 2-year survival rates were 15.0$\%$ and 5.1$\%$ respectively. Patients without extracranial metastases (n=27) had longer median survival than patients with extracranial metastases (33 weeks vs 10 weeks, p=0.0018). In patients with single brain metastasis (n=37), the median survival time was longer in patients treated with surgery plus radiotherapy than in patients treated with radiotherapy alone (40 weeks vs 16 weeks, p=0.0438). Conclusion: Patients who has brain metastases only constitute a prognostically favorable group and they may be benefited from radiotherapy and surgery if indicated.

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Effects of Smoking on Oral Health : Preliminary Evaluation for a Long-Term Study of a Group with Good Oral Hygiene (흡연이 구강 건강에 미치는 영향 : 구강 위생이 양호한 집단의 장기적 연구를 위한 예비 평가)

  • Lee, Hyun-Suk;Kim, Mee-Eun
    • Journal of Oral Medicine and Pain
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    • v.36 no.4
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    • pp.225-234
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    • 2011
  • Tobacco smoking is a major risk factor of systemic health and also impairs oral health, which is related to development of oral cancers, periodontitis, delayed wound healing, tooth loss, failure of implant, etc. Aside from smoking, many other risk factors can be related to oral health and long-term effects of smoking on salivary flow and taste threshold are still in controversy. Authors considered dental students to be an appropriate group with good oral hygiene for a long-term study to reveal effects of smoking on oral health. This study was performed to compare smoking patterns and current oral health conditions between smokers and nonsmokers in dental students prior to long-term evaluation. 192 volunteers (85.7%) of 224 male dental students in Dankook University were evaluated through questionnaires and clinical examination in 2010. Questionnaires included smoking pattern, alcohol use, nicotine dependence, preventive care, psychological profile and clinical examinations comprised assessment of teeth or periodontal status, nicotine pigmentation, salivary flow, electrical taste thresholds and halitosis. From the study, (current) smokers were older, and drank more frequently with more alcohol intake compared to former smokers and nonsmokers(p<0.05). There was no significant difference among them in salivary flow rate, halitosis and electrical taste threshold. However, there was significant difference in DMFT rate, periodontal treatment need, nicotinic pigmentation between smokers and nonsmokers(p<0.05), irrespective of their levels of preventive care. The smokers in this study, who are young dental students with relatively shorter duration of smoking, less use of cigarettes and low level of nicotine dependence, did not reveal significant impairment of oral health. However, their oral health was found to be relatively impaired compared to nonsmokers', which suggests negative effect of smoking on the oral health and a need of smoking cessation.