난소기능평가를 위한 Gonadotropin Releasing Hormone Agonist Stimulation Test (GAST)의 효용성에 관한 연구

김미란,송인옥,연혜정,최범채,백은찬,궁미경,손일표,이진우,강인수,Kim, Mee-Ran,Song, In-Ok,Yeon, Hye-Jeong,Choi, Bum-Chae,Paik, Eun-Chan,Koong, Mi-Kyoung,Song, Il-Pyo,Lee, Jin-Woo,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2

Objectives: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. Design: Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. Materials and Methods: After blood sampling for basal FSH and estradiol $(E_2)$ on cycle day two, 0.5ml (0.525mg) GnRH agonist ($Suprefact^{(r)}$, Hoechst) was injected subcutaneously. Serum $E_2$ was measured 24 hours later. Initial $E_2$ difference $({\Delta}E_2)$ was defined as the change in $E_2$ on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by ${\Delta}E_2$; group A (n=30):${\Delta}E_2$<40 pg/ml, group B (n=52): 40 pg/ml${\leq}{\Delta}E_2$<100 pg/ml, group C (n=20): ${\Delta}E_2{\leq}100$ pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-ET was followed. Ratio of $E_2$ on day of hCG injection over the number of ampules of gonadotropins used ($E_2hCGday$/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as $E_2$ hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. Results: Mean age $({\pm}SEM)$ in group A, B and C were $33.7{\pm}0.8^*,\;31.5{\pm}0.6\;and\;30.6{\pm}0.5^*$, respectively ($^*$: p<0.05). Mean basal FSH level of group $A(11.1{\pm}1.1mlU/ml)$ was significantly higher than those of $B(7.4{\pm}0.2mIU/ml)$ and C $(6.8{\pm}0.4mIU/ml)$ (p<0.001). Mean $E_2hCGday$ of group A was significantly lower than those of group B or C, i.e., $1402.1{\pm}187.7pg/ml,\;3153.2{\pm}240.0pg/ml,\;4078.8{\pm}306.4pg/ml$ respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: $38.6{\pm}2.3,\;24.2{\pm}1.1\;and\;18.5{\pm}1.0$ (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: $6.4{\pm}1.1,\;15.5{\pm}1.1\;and\;18.6{\pm}1.6$, respectively (p<0.0001). By stepwise multiple regression, only ${\Delta}E_2$ showed a significant correlation (r=0.68, p<0.0001) with $E_2HCGday$/Amp, while age or basal FSH level were not significant. Likewise, only ${\Delta}E_2$ correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). Conclusions: These data suggest that initial $E_2$ difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial $E_2$ difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.

자궁내막증 환자의 자궁내막내 성호르몬 수용체, Integrins, Cyclooxygenase의 발현과 변이 양상

김미란,박동욱,권혁찬,황경주,주희재,조동제,김세광,오기석,Kim, Mi-Ran,Park, Dong-Wook,Kwon, Hyuek-Chan,Hwang, Kyoung-Joo,Joo, Hee-Jae,Cho, Dong-Jae,Kim, Sei-Kwaug,Oh, Kie-Suk 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.2

Objectives: To develop a new immunohistochemical marker system for supplementation of the Noyes histological classification of the endometrium in women of child bearing age with regular menstrual cycles, and to employ this system to evaluate pathologic factors involved in endometriosis, and thus to ascertain if it is useful in diagnosis. Materials and Methods: Endometrial biopsies were sampled from the posterior fundus of 41 (24 proliferative phases, 17 secretory phases) women with regular menstrual cycles (28-32 days), and each sample was immunohistochemically stained according to Noyes et al (1975) for determination of expression for estrogen receptor (ER), progesterone receptor (PR), integrin ${\alpha}_1$, ${\alpha}_4$, ${\beta}_3$, COX-1 and COX-2. Then, the PR, integrin ${\beta}_3$ and COX-2 which were clearly expressed in the luteal phase was with endometrial samples were obtained from 20 cases of normal patients (group 1) and 25 cases with endometriosis (group 2) after confirming the day of ovulation by sex steroid level measurements 7-8 days after ovulation Results: In the regular menstruation group the expression of ER showed a tendency to be increased in the proliferative phase and decreased in the secretory phase, and was the highest in the proliferative phase. However, PR in the stromal cells showed no change in the entire menstrual cycle while in the epithelial cells, PR reached a peak in the late proliferative phase and was almost absent in the secretory phase. Integrin (${\alpha}_1$, ${\alpha}_4$, and ${\beta}_3$ expression in the epithelial cells was absent in the proliferative phase but ${\alpha}_1$ was strongly expressed starting from the early secretory phase into the entire secretory phase. ${\alpha}_4$ was expressed strongly in the early and mid secretory phases and disappeared in the late proliferative phase, while ${\beta}_3$ appeared after the mid secretory phase and continued to be expressed until the late secretory phase. Expression in the stromal cells was weak overall and did not show any cyclic pattern. COX-1 expression was shown as a cyclic pattern in the stromal and epithelial cells and was particularly strongly expressed in the mid secretory phase of epithelial cells, and in the mid secretory and menstruation phase of stromal cells. In the endometrial epithelial cells there was strong expression during the entire cycle with stronger expression in the secretory phase compared to the prolferative phase. COX-2 was clearly expressed in the late proliferative, early and mid secretory phases in the stromal cells. No expression was observed in the proliferative phase of the epithelial cells, but which began to appear in the early secretory phase reaching a significant pattern from the mid secretory phase onwards. There was almost no expression in the stromal cells. In the cases with endometriosis showing normal endometrial maturation according to the Noyes classification, PR expression was increased while Integrin-${\beta}_3$의 expression was significantly decreased compared to the normal group. Also, COX-2 expression was slightly decreased in the stromal cells of patients with endometriosis while it was significantly increased in the stromal cells. Conclusion: Immunohistochemical markers can supplement the original Noyes classification of histological endometrial dating and therefore ascertain existing pathologic conditions. Particularly for patients with endometriosis with normally mature endometrial cells, changes in COX-2 and integrin expression patterns may assist in elucidating pathophysiologic mechanisms and therefore aid in the diagnosis of abnormal implantation conditions, and consequently determine a treatment modality.

병원간호사가 인식한 고위험 정맥주사 투약오류 원인 분석

김미란,Kim Mi Ran 국제문화기술진흥원 2024 The Journal of the Convergence on Culture Technolo Vol.10 No.3

병원간호사의 고위험 정맥주사 약물의 투약오류에 대한 인식과 경험을 파악하고 투약오류의 원인과 개선방안을 파악하기 위해 시도되었다. 연구 대상은 D시에 위치한 일개 대학병원에 근무하는 고위험 정맥투약 관련 업무경험이 있는 간호사를 대상으로 2021년 5월 16일~30일 간 자료 수집하였다. 연구 결과 고위험 정맥주사 투약안전 문제점의 핵심요인으로 병동 별 주요 약물의 투약 protocol 부재, 투약 주입기기의 작동 교육 부족, 표준화 된 고위험 정맥주사 투약수행 절차 미확립, 간호사 대상의 개별화 투약교육 부족, 병원 자체 약물집 부족 혹은 미비치, 비슷한 용기의 포장 약물 확인 부족의 6가지가 도출되었다. 간호실무적 차원에서 고위험 정맥주사 투약안전 프로그램을 적용하고 안전결과 지표를 확인할 수 있는 추후 연구 수행을 제언한다. This study was attempted to identify the perception and experience of hospital nurses on medication errors of high-risk intravenous drugs, and to identify the causes of medication errors and ways to improve them. The subjects of the study were nurses with work experience related to high-risk intravenous administration working at a university hospital located in D City, and data were collected between May 16 ~ 30, 2021. As a result of the study, six key factors were identified as the key factors in the safety of high-risk intravenous injections: the lack of a protocol for the administration of major drugs in each ward, the lack of training in the operation of the injection machine, the lack of standardized procedures for administering high-risk intravenous injections, the lack of individualized medication training for nurses, the lack or lack of the hospital's own drug list, and the lack of identification of drugs packaged in similar containers. At the nursing practice level, it is proposed to apply a high-risk intravenous medication safety program and conduct a future study to identify safety outcome indicators.

일본의 고등교육 개혁 동향

김미란,Kim, Mi-Ran 한국대학교육협의회 2007 大學敎育 Vol.150 No.-

일본의 문부과학성에서는"지의 세기를 리드하는 최고 수준의 인재 육성"이라는 21세기 고등교육개혁의 목표를 실현하고자 다양한 개혁정책을 추진하고 있다. 이러한 개혁 추진으로 2007년 현재 1,276개 고등교육기관에 약 300만 명이 재학하고 있으며 대학, 단기대학, 전수학교 등의 고등교육기관 전체 진학률은 70.5%에 달하고 있다. 여기에서는 일본의 고등교육개혁 동향을 살펴봄으로써 우리의 고등교육개혁에 주는 시사점을 얻고자 한다.

Generalization과 Filtering을 이용한 무선 지도 데이터베이스의 동적 생성 기법

김미란,최진오,Kim, Mi-Ran,Choe, Jin-O 한국정보처리학회 2001 정보처리학회논문지D Vol.8 No.4

이동 매제를 통한 진자지도 서비스는 전송 정보의 용량이 크고 출력 장치의 자원을 많이 요구하기 때문에 기존의 지도 데이터베이스를 그대로 사용하여 서비스할 수 없는 문제점이 있다. 또한 무선 서비스 전용 지도 데이터베이스를 별도로 구축하는 것은 막대한 중복 비용이 발생하므로 받아들이기 어렵다. 본 논문에서는 기존의 지도 데이타베이스로부터 무선 서비스에 적합한 지도를 동적으로 생성하는 새로운 기법을 제시한다. 이 기법은 기존 지도의 데이타 크기를 줄이기 위한 generalization과 생성된 지도의 데이타 크기가 임계값을 넘지 않도록 제어하는 filtering을 수행한다. Generalization은 레이어를 통합하는 단계, 세부 객체를 간소화하는 단계, 그리고 사용자 인터페이스를 처리하는 단계로 나누어 처리된다. Filtering은 약도에 포함된 객체를 카운터하는 모듈과 검색 객체와 거리에 따른 중요도로 선택하는 모듈로 데이터 크기를 대역폭 임계값 이내로 처리한다. For the electronic map service by wireless, the existing map database cannot be used directly. This is because, the data volume of a map is too big to transfer by wireless and although the map is transferred successfully, the devices to display the map usually don’t have enough resources as the ones for desktop computers. It is also not acceptable to construct map database for the exclusive use of wireless service because of the vast cost. We propose new technique to generate a map for wireless service dynamically, from the existing map database. This technique includes the generalization method to reduce the map data volume and filtering method to guarantee that the data volume don’t exceed the limit of bandwidth. The generalization is performed in 3 steps :ㅁ step of merging the layers, a step of reducing the size of spatial objects, and a step of processing user interface. The filtering is performed by 2 module, counter and selector module. The counter module checks whether the data blume of generated map by generalization, exceeds the bandwidth limit. The selector module eliminates the excess objects and selects the rest, on the basis of distance.

원예활동 프로그램이 호스피스환자의 자존감 향상에 미치는 효과

김미란,나송숙,Kim, Mi-Ran,Na, Song-Sook 한국호스피스협회 2008 호스피스 학술지 Vol.8 No.1

목적: 본 연구의 목적은 원예활동 프로그램이 호스피스 환자의 자아존중감에 미치는 영향을 확인하고자 하였다. 방법: 2007년 10월 3일부터 2007년 12월 2일까지 G시에 소재한 G교회 호스피스에 등록된 환자와 G병원 호스피스 병동 환자 31명을 대상으로 설문조사를 하여 분석하였다. 연구도구로는 Rosenberg(1965)의 자아존중감 측정도구를 사용하였다. 수집된 자료는 SPSS를 이용하여 백분율과 paired t-test로 분석하였다. 결과: 원예활동 프로그램이 호스피스 환자의 자아존중감에 미치는 영향을 확인하기 위하여 프로그램 실시 전과 후를 분석한 결과, 실시 전은 5.31점, 실시 후는 5.97점으로 향상된 것으로 나타나서 호스피스 환자에 있어 원예활동 프로그램이 자아존중감을 향상시키는 것으로 확인되었다. 결론: 원예활동 프로그램을 호스피스 환자의 자아존중감을 중재하는데 대체방법으로 활용할 수 있을 것으로 사료된다. Purpose: In order to evaluate effects of horticulture program on self-esteem of hospice patients, this study was conducted. Methods: Study population consists of 31 patients who had been registered in hospice care of "G" church and hospice unit of "G" hospital in G-city from Oct. 3rd 2007 to Dec. 3rd. As estimation method of self-esteem, self-esteem scale of Rosenberg(1965) was used. Results: The data were analyzed by frequency, paired t-test of SPSS. Self-esteem score before horticulture program was 5.31 and self-esteem score after horticulture program was 5.97. Conclusion: We concluded that horticulture programs had positive effect in self-esteem improvement, and it could be replaced with an intervention method of self-esteem improvement in hospice patients.

Scenedesmus quadricauda var. biornatus Kiss 의 형태변이

김미란,안선숙,장윤경 ( Mi Ran Kim,Seon Sook An,Yoon Kyung Chang ) 한국하천호수학회 1991 생태와 환경 Vol.24 No.2

6 strains of S. quddricauda var. biornatus Kiss which is new to Korea were isolated from 6 different localities in Seoul and Kyunggi-do area in order to examine their taxonomic identity. Morphological variations of the coenobia, percentage of coenobia formed and the ultrastructure of the cell wall were observed in both synchronized and stationary cultures. Three different coenobial types, i.e. abundans type, biornatus type and quadricauda type were produced in all isolates. The percentages of coenobial types produced in different strains varied depending on the culture period. The cell wall structure of all but one (st. QB-6) strain were identical and constant through out the culture period. The cell wall structure of S. quadricauda var. biornatus were unique in its smooth surface and the presence of 1 or 2 rosette, and could be easely distinguished from those of S. quadricauda, S. armatus, S. ellipsoideus and S. intermedius which produce biornatus type coenobia during early log phase of growth.

모바일 벡터지도 서비스를 위한 클라이언트/서버 시스템의 설계 및 구현

김미란,최진오,Kim, Mi-Ran,Choi, Jin-Oh 한국정보처리학회 2002 정보처리학회논문지D Vol.9 No.5

The mobile vector map services for mobile devices, specially for PDA, are being popularized with the advent of KVM (Kilobytes Virtual Machine). However, the services for cellular phone have some problems for implementation, which are the restrictions of bandwidth, resource of the phone, etc. Thus, these restrictions force to develop new map database exclusively for cellular phone services. But, this approach needs high costs and could not support multi user view for a same area. Therefore, we suggest new client/server system for mobile vector map services, using existing general map database, and design and implement the system. The suggested system, which has minimized functions at client and processes map simplification works at sever, makes it possible to serve mobile vector map without developing new map database only for cellular phone. 휴대용 단말기를 이용한 모바일 벡터지도 서비스는 KVM(Kilobytes Virtual Machine)의 등장으로 인하여 PDA를 중심으로 보편화되고있는 추세에 있다. 그러나, 휴대폰 단말기에서 벡터 지도서비스는 대역폭과 단말기의 자원 제약 등으로 인하여 구현이 쉽지 않은 문제점이 있다. 그러므로, 별도의 휴대폰 전용 지도 데이터베이스를 개발하여 서비스할 수 밖에 없다. 그러나, 간소화된 휴대폰 전용 지도 데이터베이스의 개발은 많은 비용을 초래할 뿐더러, 동일한 지역에 대한 다양한 사용자 뷰를 제공하기 어려운 문제점을 안고 있다. 따라서, 본 논문에서는 기존의 지도 데이터베이스를 그대로 이용하여 휴대폰에서의 모바일 벡터 지도서비스를 지원하는 JAVA 기반 서버/클라이언트 시스템을 새로 설계하고 구현하여 제시한다. 본 제안 시스템은 클라이언트 모듈의 기능을 최소화하고 서버에서 지도 간소화 작업을 수행하여, 기존의 지도 데이터베이스로부터 직접 모바일 벡터지도 서비스가 가능하게 하였다.

보조생식술에 있어서 황체기 보강요법

김미란,황경주,Kim, Mi-Ran,Hwang, Kyung-Joo 대한생식의학회 2007 Clinical and Experimental Reproductive Medicine Vol.34 No.1

나에게 맞는 열량과 운동량

김미란,Kim, Mi-Ran 사단법인 한국당뇨협회 2007 당뇨 Vol.206 No.-

당뇨병환자의 식사요법은 단순히 음식을 줄이거나 제한하는 것이 아니라 정상적인 활동을 하면서 자신에 맞는 칼로리에 따라 알맞은 영양소를 골고루 섭취하는 것이다. 그렇다면 나는 하루에 몇 칼로리를 먹고 얼마나 움직여야 적절한 체중을 유지하고 혈당조절에 도움이 될까? 나의 열량과 움직임을 계산해보자.