말기 암환자의 임종 전 48시간 동안의 임상증상

심윤수,김도연,남은미,이순남,Sim, Yun-Su,Kim, Do-Yeun,Nam, Eun-Mi,Lee, Soon-Nam 한국호스피스완화의료학회 2007 한국호스피스.완화의료학회지 Vol.10 No.4

목적: 말기 암환자의 여명을 예측하는 것은 환자와 가족들에게 '평안한 임종'을 맞기 위한 준비를 할 수 있도록 하고, 의료진에게는 적극적 증상완화와 전인간적 돌봄을 가능하게 할 수 있다. 이에 본 연구는 말기 암환자에서 임종 전 48시간 동안의 임상증상을 파악하고 임종을 예측하는 임상증상을 확인하여 환자 가족 및 의료진에게 이 시기에 나타나는 변화들을 이해하여 준비된 평안한 임종을 맞는데 도움이 되고자 한다. 방법: 2003년 7월부터 2006년 3월까지 한 대학병원에 입원하여 사망한 말기 암환자 89명을 대상으로 하여 임종 전 48시간 동안의 임상증상을 조사하였고 입원 시, 임종 48시간-24시간전, 임종 24시간전$\sim$임종시까지 시간대별 증상의 빈도 변화를 분석하였다. 결과: 전체 대상 환자의 중앙 연령은 62세(범위, $16{\sim}97$세)였다. 임종 48시간전 임상증상의 빈도는 의식혼탁(57%)이 가장 흔하였으며 이외 통증(30%), 발열(22%), 호흡곤란(19%)의 순이었다. 원발암에 따른 임종 48시간전 임상증상도 유사한 빈도를 보였으나 담도계암환자에서 발열의 빈도가 다른 암종에 비해 유의하게 높았다(P=0.012). 임종이 임박할수록 입원 시에 호소하던 전신 쇠약감과 식욕부진은 감소한 반면 의식혼탁은 유의하게 증가하였다(P<0.001). 결론: 말기 암환자에서 의식혼탁은 임종이 임박했음을 나타내는 가장 중요한 임상 지표로 생각된다. Purpose: Individual cancer patients often experience many symptoms that impair their quality of life at the end of life. Identifying symptoms at the terminal stage of cancer patients and possible imminent death prediction by using that assessment can assist physicians and patients in preparing the 'peaceful death'. This study examines symptom experience during the last 48 hours of life of terminal cancer patients, and determines whether symptom experience change with proximal to death. Methods: The medical records of 89 patients who died with terminal cancer at a hospital between July 1, 2003 and March 31, 2006 were reviewed. Symptom prevalence at the last 48 hours was analyzed along with the change of symptom experience at the admission, $48{\sim}24$ hours, and $24{\sim}0$ hours before death. Results: Median age of all patients was 62 years old (range $16{\sim}97$). During the last 48 hours, symptom prevalence was described as follows; unclear consciousness (57%), pain (30%), fever (22%), and dyspnea (19%). According to the primary site, unclear consciousness was notified the most frequent symptom, but fever was relatively high prevalence in patients of biliary origin cancer rather than other site cancer (P=0.012). As death was Impending, the prevalence of poor appetite and general weakness were decreased, while that of unclear consciousness was increased, which were all statistically significant (P < 0.05). Conclusion: The presence of unclear consciousness could be regarded as the symptom indicator as imminent death of terminal canter patients.

대장에 발생한 샘암종에서 MUC1과 MUC2 점소 발현의 의의

이윤경,이주호,이용,심재영,박정훈,오수섭,박진실,기근홍 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2

Background : Mucins possess the unique function of protecting and lubricating the epithelial surface and other important functions such as call growth, direct implication in the fetal development, the epithelial renewal and differentiation, the epithelial integrity, carcinogenesis, immune regulation, cellular adhesion and metastasis. Purpose : This study was done to provide the significance of alteration of MUC1 and MUC2 expression in colorectal adenocarcinoma, A series of 131 colorectal adenocarcinomas including 11 mucinous carcinomas were screened immunohistochemically for their expression of MUCI and MUC2, Materials and mehtods : Of 131 carcinomas, 76 (58,5%) were MUCI positive and 91 (68, 9%) were MUC2 positive, In normal colonic goblet cells, MUCl was not expressed but MUC2 was expressed in cytoplasm, Conclusion There were up-regulation of MUCI and down-regulation of MUC2 in colorectal carcinomas, The frequency of MUC2 positivity according to differentiation was statistically reliable. (p=0.0001)

청소년의 심리적 선호경향과 가족기능과의 관계

김수연,심민보 한국심리유형학회 2001 심리유형과 인간발달 Vol.8 No.-

본 연구는 청소년의 심리적 선호경향과 가족기능과의 관계를 살펴본 연구이다. 청소년의 심리적 선호경향의 발달과 가족가능은 어떤 관계가 있는지, 심리적 선호경향 중에서 어떤 영향이 가족기능과 관련이 있는지를 알아보았다. 또한 아울러 심리적 선호경향의 다양한 조합 즉 기질, 기능 및 태도와 16가지 성격유형과의 관계를 알아보았다. 아울러 심리적 선호 경향과 가족기능에 대한 만족도의 관계를 다루었다. 본 연구는 청소년의 심리적 선호 경향과 성격 발달에 대한 가족의 역할에 대한 정보를 제공 하는데 의의가 있다. The purpose of this study was to investigate the relationships between Adolescence's Psychological Preference and Family Function. The subjects of this study were 1687 middle school second grade students. The psychological instrument used for this study were MMTIC and FACESⅢ. The data were analyzed by one-way ANOVA. Major finding were as follows : 1) The MBTI preference were related significantly to family function. Extraversion preferences were higher cohesion score than Introversion preferences. Extraversion, Intuition and Perceiving preferences were higher adaptability score than Introversion, Sensing and judging preferences. There were no significant differences between psychological preference and satisfaction of family function. 2) At the relationships between psychological attitude type and family function, EJ and EP functioned more effectively than IJ and IP. Psychological function type and psychological temperament type were related significantly to family function. Specially NT and NF showed higher adaptability score than ST/SF and SJ/SP. There were no significant relatioship between psychological function type/psychological temperament type and satisfaction of family function. 3) It also showed that EST J, ENTP, ENFP, ESTP, ESFP more than other 16 types tends to have higher score cohesion and adaptability.

Repaglinide, but Not Nateglinide Administered Supraspinally and Spinally Exerts an Anti-Diabetic Action in D-Glucose Fed and Streptozotocin-Treated Mouse Models

Sim, Yun-Beom,Park, Soo-Hyun,Kang, Yu-Jung,Kim, Sung-Su,Kim, Chea-Ha,Kim, Su-Jin,Lim, Su-Min,Jung, Jun-Sub,Ryu, Ohk-Hyun,Choi, Moon-Gi,Suh, Hong-Won The Korean Society of Pharmacology 2013 The Korean Journal of Physiology & Pharmacology Vol.17 No.6

We have recently demonstrated that some anti-diabetic drugs such as biguanide and thizolidinediones administered centrally modulate the blood glucose level, suggesting that orally administered anti-diabetic drugs may modulate the blood glucose level by acting on central nervous system. The present study was designed to explore the possible action of another class of anti-diabetic drugs, glinidies, administered centrally on the blood glucose level in ICR mice. Mice were administered intracerebroventricularly (i.c.v.) or intrathecally (i.t.) with 5 to $30{\mu}g$ of repaglinide or nateglinide in D-glucose-fed and streptozotocin (STZ)-treated models. We found that i.c.v. or i.t. injection with repaglinide dose-dependently attenuated the blood glucose level in D-glucose-fed model, whereas i.c.v. or i.t. injection with nateglinide showed no modulatory action on the blood glucose level in D-glucose-fed model. Furthermore, the effect of repaglinide administered i.c.v. or i.t. on the blood glucose level in STZ-treated model was studied. We found that repaglinide administered i.c.v. slightly enhanced the blood glucose level in STZ-treated model. On the other hand, i.t. injection with repaglinide attenuated the blood glucose level in STZ-treated model. The plasma insulin level was enhanced by repaglinide in D-glucose-fed model, but repaglinide did not affect the plasma insulin level in STZ-treated model. In addition, nateglinide did not alter the plasma insulin level in both D-glucose-fed and STZ-treated models. These results suggest that the anti-diabetic action of repaglinide appears to be, at least, mediated via the brain and the spinal cord as revealed in both D-glucose fed and STZ-treated models.

Case Reports : A Case of Pulmonary Hemorrhage Associated with Henoch- Schonlein Purpura

Yun Su Sim,Moon Young Choi,Ji Young Oh,Jin Hwa Lee,Jin Wook Moon,Kyu Bock Choi,Jae Ho Ahn,Yoo Kyung Kim,Sun Hee Sung,Jung Hyun Chang 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.3

Henoch-Schonlein purpura (HSP) is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tract, joints and kidneys. HSP is a common vasculitic syndrome in children who, in most cases, achieve complete recovery. Pulmonary hemorrhage is a very rare manifestation of HSP. The authors present a case of a 46-year-old male presenting with pulmonary hemorrhage and renal involvement and the diagnosis of HSP. The patient responded to prednisolone therapy.

Effect of GABA receptor agonists or antagonists injected spinally on the blood glucose level in mice.

Sim, Yun-Beom,Park, Soo-Hyun,Kang, Yu-Jung,Kim, Sung-Su,Kim, Chea-Ha,Kim, Su-Jin,Jung, Jun-Sub,Ryu, Ohk-Hyun,Choi, Moon-Gi,Suh, Hong-Won Kluwer Academic/Plenum Publishers 2013 Neurochem Res Vol.38 No.5

<P>The possible roles of gamma-amino butyric acid (GABA) receptors located in the spinal cord for the regulation of the blood glucose level were studied in ICR mice. We found in the present study that intrathecal (i.t.) injection with baclofen (a GABAB receptor agonist; 1-10 μg/5 μl) or bicuculline (a GABAA receptor antagonist; 1-10 μg/5 μl) caused an elevation of the blood glucose level in a dose-dependent manner. The hyperglycemic effect induced by baclofen was more pronounced than that induced by bicuculline. However, muscimol (a GABAA receptor agonist; 1-5 μg/5 μl) or phaclofen (a GABAB receptor antagonist; 5-10 μg/5 μl) administered i.t. did not affect the blood glucose level. Baclofen-induced elevation of the blood glucose was dose-dependently attenuated by phaclofen. Furthermore, i.t. pretreatment with pertussis toxin (PTX; 0.05 or 0.1 μg/5 μl) for 6 days dose-dependently reduced the hyperglycemic effect induced by baclofen. Our results suggest that GABAB receptors located in the spinal cord play important roles for the elevation of the blood glucose level. Spinally located PTX-sensitive G-proteins appear to be involved in hyperglycemic effect induced by baclofen. Furthermore, inactivation of GABAA receptors located in the spinal cord appears to be responsible for tonic up-regulation of the blood glucose level.</P>

Association of Bone Mineral Density with Airway Obstruction and Emphysema

Sim, Yun-Su,Lee, Jin-Hwa,Kim, Yoo-Kyung,Chang, Jung-Hyun The Korean Academy of Tuberculosis and Respiratory 2012 Tuberculosis and Respiratory Diseases Vol.72 No.3

Background: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. Methods: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. Results: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second ($FEV_1$) (r=0.330, p=0.011), $FEV_1$/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC ($FEF_{25-75%}$) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and $FEF_{25-75%}$ were predictive of BMD (p=0.012). Conclusion: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.

Determinants of Nicotine Dependence in Chronic Obstructive Pulmonary Disease

( Yun Su Sim ),( Jin Hwa Lee ),( Ki Uk Kim ),( Seung Won Ra ),( Hye Yun Park ),( Chang-hoon Lee ),( Deog Kyeom Kim ),( Kyeong-cheol Shin ),( Sang Haak Lee ),( Hun Gyu Hwang ),( Joong Hyun Ahn ),( Yong 대한결핵 및 호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.3

Background: Smoking cessation is the most powerful intervention to modify progress of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. We evaluated nicotine dependence status and investigated factors associated with moderate to high nicotine dependence in patients with COPD. Methods: We included 53 current smokers with COPD in the Korean Obstructive Lung Disease II cohort enrolled between January 2014 and March 2016. Nicotine dependence was measured by using Fagerstrom test for nicotine dependence (FTND). Cognitive function was assessed by Korean version of Montreal Cognitive Assessment. Results: The median FTND score was 3, and 32 patients (60%) had moderate to high nicotine dependence. The median smoking amount was 44 pack-years, which was not related to nicotine dependence. Multiple logistic regression analysis revealed that high education status (odds ratio, 1.286; 95% confidence interval, 1.036-1.596; p=0.023), age <70 (odds ratio, 6.407; 95% confidence interval, 1.376-29.830; p=0.018), and mild to moderate airflow obstruction (odds ratio, 6.969; 95% confidence interval, 1.388-34.998; p=0.018) were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

Impaired Expression of MAPK Is Associated with the Downregulation of TNF-${\alpha}$, IL-6, and IL-10 in Mycobacterium abscessus Lung Disease

Sim, Yun-Su,Kim, Su-Young,Kim, Eun-Joo,Shin, Sung-Jae,Koh, Won-Jung The Korean Academy of Tuberculosis and Respiratory 2012 Tuberculosis and Respiratory Diseases Vol.72 No.3

Background: Healthy individuals who develop nontuberculous mycobacteria (NTM) lung disease are likely to have specific susceptibility factors which can lead to a NTM infection. The aim of the present study was to investigate the mechanism underlying innate immune responses, including the role of mitogen-activated protein kinase (MAPK), in Mycobacterium abscessus lung disease. Methods: Extracellular signal-regulated kinase (ERK1/2) and p38 MAPK expression in monocytes from peripheral blood mononuclear cells were measured by Western blot analysis after stimulation by Mycobacterium avium in five patients with M. abscessus lung disease and seven healthy controls. A M. avium-induced cytokine assay was performed after inhibition of ERK1/2 and p38 MAPK pathways. Results: Mycobacterium avium induced p38 and ERK1/2 expression in monocytes from healthy controls and subsequently upregulated tumor necrosis factor (TNF)-${\alpha}$, interleukin (IL)-6, and IL-10 production. In monocytes from patients with M. abscessus lung disease, however, induction of p38 and ERK1/2 expression, and the production of TNF-${\alpha}$, IL-6, and IL-10 were significantly lower. Conclusion: Decreased activity of MAPK and cytokine secretion in monocytes from patients with M. abscessus lung disease may provide an explanation regarding host susceptibility to these uncommon infections.

Effect of Cholera Toxin Administered Supraspinally or Spinally on the Blood Glucose Level in Pain and D-Glucose Fed Animal Models

Sim, Yun-Beom,Park, Soo-Hyun,Kang, Yu-Jung,Kim, Sung-Su,Kim, Chea-Ha,Kim, Su-Jin,Jung, Jun-Sub,Ryu, Ohk-Hyun,Choi, Moon-Gi,Choi, Seong-Soo,Suh, Hong-Won The Korean Society of Pharmacology 2013 The Korean Journal of Physiology & Pharmacology Vol.17 No.2

In the present study, the effect of intrathecal (i.t.) or intracerebroventricular (i.c.v.) administration with cholera toxin (CTX) on the blood glucose level was examined in ICR mice. The i.t. treatment with CTX alone for 24 h dose-dependently increased the blood glucose level. However, i.c.v. treatment with CTX for 24 h did not affect the blood glucose level. When mice were orally fed with D-glucose (2 g/kg), the blood glucose level reached to a maximum level at 30 min and almost returned to the control level at 120 min after D-glucose feeding. I.c.v. pretreatment with CTX increased the blood glucose level in a potentiative manner, whereas i.t. pretreatment with CTX increased the blood glucose level in an additive manner in a D-glucose fed group. In addition, the blood glucose level was increased in formalin-induced pain animal model. I.c.v. pretreatment with CTX enhanced the blood glucose level in a potentiative manner in formalin-induced pain animal model. On the other hand, i.t. pretreatment with CTX increased the blood glucose level in an additive manner in formalin-induced pain animal model. Our results suggest that CTX administered supraspinally or spinally differentially modulates the regulation of the blood glucose level in D-glucose fed model as well as in formalin-induced pain model.