중증 외상환자에서 염기 결핍수치의 유용성

문준동,김수진,문철규,최성혁,전정민,이성우,홍윤식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: This study's objective was to determine the prognostic value of the base deficit measured in the emergency department(ED) and to determine whether base deficit can provide information not provided by advanced injury scoring system. Methods: This study was a retrospective analysis of data collected for two years. Thirty-two severe trauma patients who were admitted to the Emergency Department of Korea University Hospital were included in this study. The patients were divided into two groups: the normal base deficit group(-3 mmol/L to 3 mmol/L) and the elevated base deficit group(>3 mmol/L). The base-deficit value, age, sex, head injury, organ failure rate, and survival were considered, and the also Revised Trauma Score(RTS), Acute Physiology And Chronic Health Evaluation(APACHE II), and Injury Severity Score(ISS) were measured. Result: The elevated base-deficit group showed a lower survival rate and a higher organ failure rate compared to the normal base deficit group. Logistic Regression showed a strong association between base deficit and mortality rate. Among the previous injury scoring Systems(RTS, APACHE II, ISS), base deficit had the strongest correlation with RTS. By using base deficit value and the RTS together, we obtained a higher positive predictive value than that obtained by using base deficit or RTS alone. Conclusion: The admission value of the base deficit in the ED is a useful tool in predicting the outcome in severe trauma patients, and it can be an adjunct to previous injury scoring systems. As an advanced injury scoring System is developed in the future, the base deficit may have some significant role.

태아 저산소증의 생화학적 지표

박교훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Perinatal asphyxia, whether prenatal, intrapartum, or neonatal is thought to be a significant contributor to newborn morbidity and mortality as well as long-term neurological deficits. Development of an intrapartum test that can reliably identify and discriminate between varying degrees of fetal acidemia and suggest whether it is respiratory or metabolic in nature would be highly desirable. Umbilical cord blood acid-base analysis may be used to assess the condition of fetus and newborn more objectively. Newborn acid-base status is an important criterion when we attempt to define perinatal asphyxia. It also has medicolegal ramifications because it enables the documentation of the presence of a biochemical milieu that is not related to the later development of cerebral palsy. Acidemia is defined as an umbilical artery pH value less than 7.2 because most studies have used this cutoff. However, this traditional level is probably too high. Recent studies suggest that the pH cutoff should be lower, perhaps as low as less than 7.0. We anticipate future research will focus on the redefinition of acidemia and its relationship to fetal and new-born outcomes.

외상환자에서 혈중 알코올이 염기결핍에 미치는 영향

강태경,류석용,조석진,오성찬,김성준,안지영,김홍용,이상래 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.3

Purpose: Alcohol intake is commonly found in injured patients, and alcohol affects base deficit independently with trauma. The purpose of this study was to evaluate the effect of alcohol on base deficit in trauma patients. Methods: Data was retrospectively collected from trauma patients over 18 years of age who were admitted at the emergency center between October 2005 and July 2006. Blood sampling for alcohol level, base deficit evaluation were done within first hour for all patients. Patients were divided according to the serum alcohol level into an alcohol group(serum alcohol level10 mg/dl) and a non-alcohol group. The patients were also stratified into minor (ISS15) and major (ISS16) injury groups according to their injury severity score (ISS). Results: The study enrolled 63 patients of whom 37 fell into the alcohol group and 26 into the non-alcohol group. The mean alcohol level within the alcohol group was 210±85 mg/dl. Base deficit and serum lactate were not found to be significantly different in minor and major injuries, and ISS, base deficit were not significantly different with serum alcohol level. Base deficit was somewhat higher on average but not statistically significant in the non-alcohol group than in the alcohol group (-3.0±4.5 vs. -1.8±6.7 mmol/L, p=0.444). The base deficit was higher for the major injury-alcohol group than for the major injury-non-alcohol group, but this difference also did not achieve statistical significance (-4.6 ±5.8 vs -2.4±8.1 mmol/L, p=0.117) Conclusion: In the severely injured patients, base deficit appears to be increased with alcohol but we found no statistically significant differences in base deficit and ISS between alcohol group and non-alcohol group of injured patients.

외상환자의 초기 사망 예측 지표로서의 내원 초기의 염기 결핍, 젖산 및 강이온 차이의 유용성 비교

박경혜 ( Kyung Hye Park ),이강현 ( Kang Hyun Lee ),김선휴 ( Seon Hyu Kim ),오성범 ( Sung Bum Oh ),문중범 ( Joong Bum Moon ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),김헌주 ( Heon Ju Kim ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Purpose: Currently, there is a variety of systems available for predicting prognosis of trauma patients such as trauma score, Injury severity score (ISS) and acid-base variables. But it is not clear that the initial acid-base variables are predictors of prognosis in trauma patients at the emergency department. The objective of this study is to compare the base deficit, lactate and strong ion gap as an early predictor of mortality in trauma patients. Methods: Retrospective record review of 136 trauma patients needed to admit to intensive care unit via emergency department (June 2004 to February 2005). Data included age, injury mechanism, ISS, Revised trauma score (RTS), Multiple organ dysfunction score (MODS), Acute physiology and chronic health evaluation III (APACHE III), Glasgow coma scale (GCS), laboratory profiles, calculated anion gap and strong ion gap. Patients were divided into survivors and non-survivors, shock group and non-shock group with comparison by t-test; significance was assumed for p<0.05. Correlation between acid-base variables and mean arterial blood pressure (MABP) was evaluated. Results: There was a significant difference between the RTS (p=0.00), APACHE III (p=0.00), MODS (p=0.00), GCS (p=0.00) of survivors and non-survivors. There was no significant difference between the ISS (p=0.082), lactate (p=0.541), base excess (p=0.468) and SIG (p=0.894) of survivors and non-survivors. There was a significant difference between the RTS (p=0.023), APACHE III (p=0.002), lactate (p=0.000), base excess (p=0.000) and SIG (p=0.000) of shock and non-shock group. There was no significant difference between the ISS (p=0.270), MODS (p=0.442) and GCS (p=0.432) of shock and non-shock group. The base excess was most correlated to MABP (r2=0.150). Conclusion: Initial base deficit, serum lactate and SIG are not predictors of mortality in moderate to severe trauma patients. Initial base deficit, serum lactate and SIG are correlated with the mean arterial blood pressure in trauma patients in emergency department.

두부손상을 동반한 다발성 외상환자에서 중증도 평가지표로서 염기결핍의 유용성

김봉주 ( Bong Joo Kim ),강태경 ( Tae Kyung Kang ),최승운 ( Seung Woon Choi ),김혜진 ( Hye Jin Kim ),오성찬 ( Sung Chan Oh ),조석진 ( Suk Jin Cho ),류석용 ( Seok Yong Ryu ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: The arterial base deficit and the serum lactate level are widely recognized indicators of injury severity, adequacy of resuscitation and outcome. The purpose of this study is to evaluate the usefulness of the arterial base deficit as an injury-severity indicator in multiple-trauma patients with head injuries. Methods: Data were retrospectively collected from trauma patients over 18 years of age who had been admitted at the emergency center between October 2005 and July 2006. The patients were divided into headinjury and non-head-injury groups. These patients were then sub-divided into minor (ISS≤15)-injury and major (ISS≥16)-injury groups according to their injury severity scores (ISS). We analyzed the differences in the base deficits and the serum lactate levels between the major- and the minor-injury sub-groups in both the head-injury and the non-head-injury groups. Results: In the non-head-injury group, we found statistically significant differences in the arterial base deficit between the major-injury and the minor-injury sub-groups(-6.86±2.40mmol/L vs. -1.37±0.73mmol/L, p=0.010). In the head-injury group, no significant differences were noted between the two sub-groups(-2.50±1.28mmol/L vs. -1.51±0.74mmol/L, p=0.897). Moreover, the differences in arterial base deficit between the major-injury and the minor-injury sub-groups were not significant both for either single-head-trauma or multiple-head-trauma patients (p=0.643 vs. p=0.832). Conclusion: We conclude that neither the arterial base deficit nor the serum lactate level can be used to predict injury severity in multiple-trauma patients with head injuries. (J Trauma Inj 2012;25:223-229)

내원 초기에 측정한 외상환자의 동맥혈 염기결핍의 유용성

이은헌 ( Eun Hun Lee ),최재영 ( Jae Young Choi ),최영철 ( Young Cheol Choi ),황성연 ( Seong Youn Hwang ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: The arterial base deficit (BD) has proven to be useful in the evaluation and management of trauma patients. Indicators such as the Triage-Revised Trauma Score (t-RTS) and the systemic inflammatory response syndrome (SIRS) score have been used as triage tools for emergency trauma patients in Korea. The purpose of this study was to assess the usefulness of the initial BD in predicting injury severity and outcome in the trauma population. Methods: The medical records of 308 consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from January 2004 to December 2004 were carefully examined prospectively and retrospectively, and 291 patients were selected as subjects for this research. The SIRS score and the t-RTS were calculated based on the records from the emergency department, and the BD was calculated based on the arterial blood gas analysis obtained within 30 minutes of admission. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two - by - two matrices and by using a receiver operating characteristic (ROC) curve analysis. Results: When the mortality was used as the outcome parameter, the sensitivity and the accuracy of the initial BD were higher than those of the SIRS score (p<0.05) and were same as those of the t-RTS. The areas under the ROC curves of the initial BD, the SIRS score, and the t-RTS were 0.740±0.087, 0.696±0.082, and 0.871±0.072, respectively (95% confidence interval). When emergency operation and blood transfusion requirements were used as outcome parameters, the comparisons of the sensitivities and the accuracies of the initial BD and the other two indicators showed the same pattern as mentioned above. The areas under the ROC curves of the initial BD were 0.7~0.8 and were larger than those of the SIRS score (p<0.05). Conclusion: The ability of the initial BD to predict injury severity and outcome was similar to those of the t-RTS and the SIRS score. Therefore, the authors suggest that the initial BD may be used as an alternative to previous triage tools for trauma patients. (K Korean Soc Traumatol 2006;19:67-73)

재정수지, 재정준칙 및 발생주의 회계기준과 정부의 재량적 회계처리

최효순,손욱 (사)한국정부회계학회 2023 정부회계연구 Vol.21 No.1

This study examines the impacts of fiscal deficit, fiscal rule and accrual-based accounting on government creative accounting using discretionary accruals estimated by Jones model(1991) and other accounting adjustments. The key findings of the regression analysis using fiscal statistics from 2010 to 2020 of 54 countries, including OECD member countries, are as follows. First, as pre-adjustment fiscal balance moves away from zero, the discretionary accruals that adjust it toward zero increase. In other words, when the fiscal deficit increases, the discretionary accruals are increased, and when the fiscal surplus increases, the discretionary accruals are reduced. Second, the enforcement of fiscal rules encourages the use of discretionary accruals to avoid budgetary constraints, which may hinder the achievement of the purpose of the rules operation. Third, the accrual-based accounting system strengthens the incentive for using discretionary accruals to balance the fiscal surplus and deficit, but weakens the incentive to increase discretionary accruals due to the existence of fiscal rules. Fourth, discretionary accruals have a substantive relationship with other methods of accounting adjustments. The results of this study suggest that it is necessary to strengthen the monitoring system for discretionary accounting when the fiscal balance is significantly out of balance or when the introduction of fiscal rules is considered. 본 연구는 재정수지, 재정준칙 및 발생주의 회계기준이 정부의 재량적 회계처리에 미치는 영향을 Jones 모형(1991)을 이용하여 추정한 재량적 발생액과 기타회계조정액에 의하여 분석한다. OECD 회원국을 포함한 54개 국가의 2010년부터 2020년까지의 재정통계를 이용한 회귀분석 결과 주요 발견 사항은 다음과 같다. 첫째, 재량적 발생액을 통한 조정 전 재정수지가 균형에서 멀어질수록 수지균형을 추구하기 위한 재량적 발생액을 증대시킨다. 즉, 적자가 증가할 경우 재량적 발생액을 증대시키고 흑자가 증가할 경우 재량적 발생액을 축소시킨다. 둘째, 재정준칙을 도입, 운영할 경우 재량적 발생액이 증대하여 준칙 운영의 목적 달성이 저해될 가능성이 있다. 셋째, 발생주의 회계기준은 재정준칙 운영에 따른 재량적 발생 증대 유인을 약화시키지만 재정수지 균형 추구 유인을 강화시킨다. 넷째, 재량적 발생액은 다른 재량적 회계처리 수단인 기타회계조정액과 대체적 관계에 있다. 본 연구 결과는 발생주의 회계기준 아래에서 재정수지가 균형에서 크게 이탈하거나 재정준칙의 도입 효과를 담보하기 위하여 재량적 발생액에 대한 감시체제를 강화할 필요성이 있음을 시사한다.

한국인 주의력결핍-과잉행동장애에서 DRD4 유전자 다형성에 대한 예비적 연구

임명호,박태원,김영신,조수철,김현우,송은영,이창민 대한정신약물학회 2009 대한정신약물학회지 Vol.20 No.2

Objective:Attention deficit hyperactivity disorder (ADHD) has a strong genetic basis, and the relationship between the allele frequency distribution and ADHD has been researched actively. We investigated the association between the DRD4 genotype and ADHD patients in Korea, in comparison with case control and family based control groups. Methods:The study enrolled 118 patients diagnosed with ADHD according to the DSM-Ⅳ diagnostic criteria and their parents (n = 70), and 84 normal children were recruited as controls. The clinical features of the patients were confirmed using the Korean versions of the Child Behavior Checklist (CBCL), Conners’ parent rating scale, Attention Deficit Diagnostic System, and Spielberger state/trait anxiety scale. Blood samples were taken from the 272 subjects. DNA was extracted from blood lymphocytes. PCR was performed to examine DRD4 polymorphisms. Allele and genotype frequencies were compared using the Chi-square test for the casecontrol analysis and the transmission disequilibrium test (TDT) for the family-based analyses. Results:In comparing the ADHD transmitted group with the not transmitted group, no significant differences were seen in the DRD4 genotype, allele distribution, or ADHD. Conclusion:However, there was a trend to an association between the DRD4 genotype, allele distribution, and ADHD for the case-control analysis. Follow-up studies with more patients or pure subgroups are needed. 주의력결핍-과잉행동장애는 유전적인 성향이 높은 질환으로 알려져 있으며, 최근 대립유전자의 분포 변이와 주의력결핍-과잉행동장애의 관련성을 입증하려는 연구들이 활발하게 진행되고 있다. 저자는 국내의 주의력결핍-과잉행동장애 환아와 가족 및 일반대조군을 대상으로 한 연합연구 방법으로 DRD4 Gene의 유전자형 및 대립유전자의 연관성을 살펴보고자 하였다. DSM-Ⅳ 진단기준에 따라 주의력결핍-과잉행동장애로 진단된 118명의 환아를 대상으로 하였으며 한국판 아동행동조사표, 한국판 단축형 Conners’ 부모 평가척도, ADS(Computerized Attention Deficit Diagnostic System), 한국판 소아용 Spielberger 상태-특성 불안 평가 척도 등을 이용하여 진단 및 임상적 특징을 확인하였다. 대조군으로서는 가족대조군으로 환아의 부모 70명과 일반대조군으로는 초등학교 아동 84명을 각각 대상으로 하였으며 총 272명의 말초혈액을 채혈하였다. 혈액의 임파구로부터 유전자를 추출하였으며 DRD4 Gene에 해당되는 유전자 서열에 따른 시발체를 이용하여 DRD4 exon Ⅲ 48 염기쌍 유전자의 중합효소 연쇄반응을 시행하였으며 빈도결과에 대하여 가족대조군 연구에서는 TDT방법으로, 일반대조군 연구에서는 Chisquare검사를 시행하여 비교하였다. 가족기반 연합연구방법으로 주의력결핍-과잉행동장애 환아군과 환아 부모군을 TDT방법을 이용하여 비교하였을 때 transmitted군과 not transmitted군간에 대립 유전자의 분포는 유의미한 차이를 나타내지 않았다. 그러나 4/4 유전형과 그 외의 유전형, 두 군으로 분류하여 주의력결핍-과잉행동장애 환아군과 일반대조군을 대상으로 빈도를 비교한 결과에서는 유전자 및 대립 유전자의 분포는 연관 경향을 나타내었다. 추후 주의력결핍-과잉행동장애의 다수환아군을 대상으로 한 연구 및 순수한 아형군간의 비교를 기대한다.

Genome-Wide Analysis Reveals Four Novel Loci for Attention-Deficit Hyperactivity Disorder in Korean Youths

Kukju Kweon,Eun-Soon Shin,Kee Jeong Park,Jong-Keuk Lee,Yeonho Joo,Hyo-Won Kim 대한소아청소년정신의학회 2018 소아청소년정신의학 Vol.29 No.2

Objectives: The molecular mechanisms underlying attention-deficit hyperactivity disorder (ADHD) remain unclear. Therefore, this study aimed to identify the genetic susceptibility loci for ADHD in Korean children with ADHD. We performed a case-control and a family-based genome-wide association study (GWAS), as well as genome-wide quantitative trait locus (QTL) analyses, for two symptom traits. Methods: A total of 135 subjects (71 cases and 64 controls), for the case-control analysis, and 54 subjects (27 probands and 27 unaffected siblings), for the family-based analysis, were included. Results: The genome-wide QTL analysis identified four single nucleotide polymorphisms (SNPs) (rs7684645 near APELA, rs12538843 near YAE1D1 and POU6F2, rs11074258 near MCTP2, and rs34396552 near CIDEA) that were significantly associated with the number of inattention symptoms in ADHD. These SNPs showed possible association with ADHD in the family-based GWAS, and with hyperactivity-impulsivity in genome-wide QTL analyses. Moreover, association signals in the family-based QTL analysis for the number of inattention symptoms were clustered near genes IL10, IL19, SCL5A9, and SKINTL. Conclusion: We have identified four QTLs with genome-wide significance and several promising candidates that could potentially be associated with ADHD (CXCR4, UPF1, SETD5, NALCN-AS1, ERC1, SOX2-OT, FGFR2, ANO4, and TBL1XR1). Further replication studies with larger sample sizes are needed.

아동 청소년기 장애의 근거기반 치료

조선미 한국임상심리학회 2018 Korean Journal of Clinical Psychology Vol.37 No.4

This article is an introduction to the special edition of the Korean Journal of Clinical Psychology on evidence-based treatments for children and adolescents, including those for attention deficit hyperactivity disorder, autism spectrum disorder, depression, post-traumatic stress disorder, and disruptive behavior. Each article presented in this special issue describes the diagnostic criteria, prevalence, and evidence-based treatment for mental disorders; criteria for evidence-based treatments or empirically supported treatments; and issues concerning psychotherapy research. Each paper will help improve treatment efficiency in clinical settings by providing a well-founded treatment for specific disorders.