Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

김혜원,Kim Sejoong,Ohn Jung Hun,Kim Nak-Hyun,Lee Jong-chan,김은선,Lim Yejee,Cho Jae Ho,박희선,류지원,Kim Sun-wook 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.3

Background: Although bicarbonate has traditionally been used to treat patients with rhabdomyolysis at high risk of acute kidney injury (AKI), it is unclear whether this is beneficial. This study compared bicarbonate therapy to non-bicarbonate therapy for the prevention of AKI and mortality in rhabdomyolysis patients. Methods: In a propensity score-matched cohort study, patients with a creatine kinase (CK) level of >1,000 U/L during hospitalization were divided into bicarbonate and non-bicarbonate groups. Patients were subgrouped based on low-volume (<3 mL/kg/hr) or high-volume (≥3 mL/kg/hr) fluid resuscitation in the first 72 hours. Logistic regression analyses were used to identify the impacts of bicarbonate use and fluid resuscitation on AKI risk and need for dialysis. The Kaplan-Meier method was used to estimate survival. Volume overload and electrolyte imbalances were assessed. Results: Among 4,077 patients, we assembled a cohort of 887 pairs of patients treated with and without bicarbonate. Bicarbonate group had a higher incidence of AKI, higher rate of dialysis dependency, higher 30-day mortality, and longer hospital stay than the non-bicarbonate group. Further, patients who received high-volume fluid therapy had worse renal outcomes and a higher mortality than those who received low-volume fluids regardless of bicarbonate use. Bicarbonate use, volume overload, and AKI were associated with higher mortality. Volume overload was significantly higher in the bicarbonate group than in the non-bicarbonate group. Conclusion: Bicarbonate or high-volume fluid therapy for patients with rhabdomyolysis did not reduce AKI or improve mortality compared to non-bicarbonate or low-volume fluid therapy. Limited use of bicarbonate and adjustment of fluid volume may improve the short- and long-term outcomes of patients with rhabdomyolysis.

흰쥐에서 Iodine-131-Iododeoxyadenosine 의 생체분포 및 유방암 영상화에 관한 연구

김혜원,원종진,최시성,이현철,김창근,김선구,Yang, David J,이강무,민병철,이종덕,Kim, E Edmund 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.4

Purpose: I-131 labeled (2'-deoxy-2-iodo-β-D-arabinofuranosyl) adenine (IAD) may be involved in DNA synthesis during active proliferation of tumor cells. We conducted this study to find out the biodistribution of IAD and its feasibility for scintigraphic tumor imaging. Materisls and Methods: Tosyl acetyl-adenosine was dissolved in acetonitrile, and I-131-NaI was added and heated to synthesize IAD. Female Fisher 344 rats innoculated with breast tumor cells were injected witb 0.27 MBq of IAD. Rats were sacrificed at 0.5, 1, 2, 4, 24h and the % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy, rats bearing breast cancer were administered with 1.11 MBq of IAD and imaging was perforrned after 2 and 24h. Then, rat body was fixed and rnicrotomized slice was placed on radiographic film for autoradiography, Results: %ID/g of tumor wa.' 0.74 (0.5h), 0.73 (1h), 0.55 (2h), 0.38 (4h), and 0.05 (24h), respectively. At 1h after injection, %ID/g of tumor was higher than that of heart (0.34), liver (0.42), spleen (0.47), kidney (0,69), muscle (0.14), bone (0.33) and intestine (0.51). However, %1D/g of tumor was lower than blood (1.06), lung (0.77), and thyroid (177.71). At 4h, %ID/g of tumor in comparison with other tissue did not change. Tumor contrast expressed by tumor to blood ratio was 0.69 and tumor to muscle ratio was 5.11 at 1h. However, these ratios did not improve through 24h. On autoradiogram and scintigraphy at 2 and 24 hour, the tumor was well visualized. Conclusion: This results suggest that Ial) may have a potential for tumor scintigraphy. However, further work is needed to improve localization in tumor tissue. (Korean J Nucl Med 1998;32:374-81)

코로나19 팬데믹 상황에서 국내 의과대학생이 경험한 일상생활 변화, 정신건강 문제 및 스트레스 대처

김혜원,여상희,안신기,Kim, Hae Won,Yeo, Sanghee,An, Shinki 연세대학교 의과대학 2022 의학교육논단 Vol.24 No.3

This study aimed to examine the influence of the coronavirus disease 2019 (COVID-19) pandemic on areas of Korean medical students' lives, assess concerns, and investigate the strategies they used to cope with stress due to the pandemic. An online survey with a total of 53 items on the impact of COVID-19, concerns, and coping strategies was sent to medical students, and responses were collected from April 27, 2021 to May 30, 2021. In total, 1,329 students were included in the study. Analysis was performed using the chi-square test, independent-sample t-test, and one-way analysis of variance, and the post-hoc Scheffé test or Games-Howell test was performed for multiple comparisons. The main negative impacts of the pandemic were on hobbies/leisure activities and mental health, and medical students expressed the highest levels of concern regarding restriction of movement, returning to everyday life, and risk of infection for family and friends. Female students more strongly agreed that COVID-19 had increased their depressed mood and anxiety (p<0.001 and p=0.003, respectively). Furthermore, the negative impacts of the pandemic on different areas of life significantly affected current levels of depressed mood and anxiety. To cope with pandemic-related stress, students used several strategies such as talking with family or friends (91.5%), sleeping (83.1%), exercising (72.8%), using social networking services (60.8%), drinking alcohol (37.8%), and practicing meditation/mindfulness (24.4%); the effectiveness of these strategies ranged from 3.45 to 4.19 on a 5-point Likert-type scale (1-5). The study findings suggest that COVID-19 has influenced the mental health of medical students and raised concerns in many areas of their lives. Students used various strategies to cope with the pandemic-related stress; since the effectiveness of frequently used approaches varied, it is essential to guide medical students to develop effective coping strategies.

PET Imaging of Click-engineered PSMA-targeting Immune Cells in Normal Mice

김혜원,Won Chang Lee,In Ho Song,Hyunsoo Park,Sang Eun Kim 대한방사성의약품학회 2022 Journal of radiopharmaceuticals and molecular prob Vol.8 No.2

This study aimed to increase the targeting ability against PSMA in cell therapy using metabolic glycoengineering and biorthogonal chemistry and to visualize cell trafficking using PET imaging. Cellular membranes of THP-1 cells were decorated with azide(-N3) using Ac4ManNAz by metabolic glycoengineering. Engineered THP-1 cells were conjugated with DBCO-bearing fluorophore (ADIBO-Cy5.5) for 1 h at different concentrations and analyzed by confocal fluorescence microscopy and flow cytometry. For PSAM ligand conjugation to THP-1 cells, Ac4ManNAz treated THP-1 cells were incubated with DBCO-PSMA ligand (ADIBO-GUL) at a final concentration with 100 μM for 1 h. To evaluate the effect on cell recognition, PSMA ligand conjugated THP-1 cells(as effectors) were co-cultured with PSMA positive 22RV1 (as target cells) at 3 : 1 a effector-to-target cell (E/T) ratio. The interaction between THP-1 and 22RV1 was monitored by confocal fluorescence microscopy. For preparing the radiolabeled THP-1, the cells were treated at the activity of ~ 740 kBq of [89Zr]Zr(oxinate)4/5 × 106 cells. Radiolabeled cells were analyzed for determination of cell-associated radioactivity by gamma counting and viability using MTS assay. In the cytotoxicity assay, THP-1 cells did not have any cytotoxicity even when the Ac4ManNAz concentration was 100 μM. In confocal microscopy and flow cytometry, THP-1 cells were efficiently labeled ADIBO-Cy5.5 in a dose-dependent manner, and the dose of 100 μM was the optimal concentration for the following experiments. The clusters of PSMA ligand-conjugated THP-1 cells and 22RV1 cells were identified, indicating cell-cell recognition over the cell surface between two types of cells. Cell radiolabeling efficiency was 54.5 ± 17.8%. THP-1 labeled with 0.09 ± 0.03 Bq/cell showed no significant cytotoxicity compared to unlabeled THP-1 up to 7 days. We successfully demonstrated that Ac4ManNAz treated cells were efficiently conjugated with ADIBO-GUL for preparing the PSMA-targeting cells, and [89Zr]Zr(oxinate)4 could be used to label cells without toxicity. It suggested that PSMA-ligand conjugated cell therapy could be improved cell targeting and be monitored by PET imaging.

격려사

김혜원,Kim, Hye-Won 한국제품안전협회 2006 제품안전 Vol.1 No.-

하수슬러지의 Biochar특성을 이용한 토양내 중금속 제거 연구

김혜원,배선영,이재영,Kim, Hye-Won,Bae, Sunyoung,Lee, Jai-Young 한국지하수토양환경학회 2013 지하수토양환경 Vol.18 No.3

This study proposed a low temperature hydrothermal carbonization to treat and recycle sewage sludge and determined the optimal conditions for the biochar production. The physical and chemical properties of biochar were analyzed and its sorption capacity for heavy metals was evaluated. To produce biochar, 50 g of sewage sludge was heated at 220, 230, and $240^{\circ}C$ for 1, 2, 3, 5, 8, and 10 hours in a reactor. The optimal conditions to produce biochar was $230^{\circ}C$ and 8 hours. Sorption capacity tests were conducted for arsenic (As), cadmium (Cd), copper (Cu), lead (Pb), zinc (Zn) and nickel (Ni). Among them, lead was shown the highest heavy metal adsorption efficiency of biochar, followed by copper, cadmium, zinc, and nickel, but arsenic was hardly adsorbed overall.

산욕초기 초산모의 모성 정체성과 영아돌보기 활동 자신감에 관한 연구

김혜원,황문숙,홍경자,Kim, Hae-Won,Hwang, Moon-Sook,Hong, Kyung-Ja 한국여성건강간호학회 1998 여성건강간호학회지 Vol.4 No.1

In this study the levels and influencing characteristics of maternal identity and self confidence for caring the baby were identified during the immediate postpartum period. 114 primiparous women who delivered vaginally normal baby participated in the survey from August 1 to October 31, 1996. SD scale was to measure maternal identity which consisted of 11 items for mother and 6 items for baby. Likert scale was to measure self confidence for caring the baby (38 items). Cronbach's alphas for evaluating internal consistency as follows : .86 for maternal identity and .96 for self confidence scale for caring the baby. The study showed these results : 1. Mean score of maternal identity(82.03 : 52.65 for mother, 29.38 for baby) was considered relatively low. 2. Mean score of self confidence for caring the baby(113.91) was considered relatively low. 3. There were significant influencing characteristics of primiparous to maternal identity : age(total ; F=3.53, p=.0329, for mother ; F=2.60, p=.0719, for baby ; F=3.12, p=.0481), prenatal infant care preparation(total ; t=2.31, p=.0306, for mother ; F=2.62, p=.0160), knowledge about infant care during the hospitalization(for baby ; F=3.94, p=.02222), colostrum feeding(total ; t=1.95, p=.0541, for baby ; t=2.71, p=.0080), frequency of breast feeding during the hospitalization(for baby ; F=3.91, p=.0228)and feeding type after discharge(for baby ; F=3.18, p=.0456). 4. There were significant influencing characteristics of primiparous to self confidence for caring the baby : routine husband support(F=6.09, p=.0031), prenatal infant care preparation(t=2.04, p=.0574), knowledge about infant care during the hospitalization(F=3.15, p=.0467), education of breast feeding during the hospitalization(t=-1.79, p=.0850). 5. Correlation between maternal identity and self confidence for caring the baby was r=.37608(p=.0001). This study implies that special education programs for primipara are needed. For the future, this study suggest that maternal role variables need to be monitored through the home visiting follow up. Also intervention programs related to prenatal care, discharge education, home visiting follow up need to be developed and then evaluated their effectiveness.

A Study on the Mechanism of Calcium Binding Inhibition of Cardiac Sarcoplasmic Reticulum by Oxygen Free Radicals

김혜원,정명희,김명석,박찬웅,Kim, Hae-Won,Chung, Myung-Hee,Kim, Myung-Suk,Park, Chan-Woong The Korean Society of Pharmacology 1985 대한약리학잡지 Vol.21 No.2

심근 세포의 칼슘 조절에 중요한 역할을 하는 sarcoplasmic reticulum (SR)의 칼슘운반 능력이 허혈 심근에서 현저히 억제됨이 알려져 있다. 이와같은 허혈 심근에서의 SR 칼슘운반승력 저하에 유독성 산소 대사물이 관여할 것으로 생각되고 있으나 그 기전에 관하여는 아직 알려진 바 없다. 본 연구에서는 그 기전의 일단을 규명하기 위하여 산틴 산화효소계에 의하여 발생된 유독성 산소대사물긴 돼지 심실근에서 추출한 sarcoplasmic reticulum의 칼슘흡수 및 막지질 과산화, sulfhydryl group 그리고 단백질 변성에 미치는 영향을 관찰하여 다음과 같은 결과를 얻었다. 1) 산틴 산화 효소계와 반응시킨 sarcopl smic reticulum의 칼슘흡수는 반응시간 경과에 따라 현저히 억제되었다. 2) sarcoplasmic reticulum 막지질 과산화는 산딘 산화 효소계에 의하여 현저히 증가되었다 3) 항산화제 ${\beta}$-phenylenediamine은 막지질 과산화의 증가는 효과적으로 억제하였으나, 칼슘흡수 억제는 부분적으로 회복시켰다. 4) 산틴 산화 효소계에 의하여 SH-group은 현저히 감소되었으며, 항산화제 첨가에 의하여 그 감소가 일부 억제되었다. 5) sarcoplasmic reticulum을 DTNB로 처리하여 SH-group을 산소 대사물에 의한 산화반응으로부터 보호했을 경우 칼슘흡수의 억제가 부분적으로 방지되었다. 6) Sephadex G-200 크로마토그라피 상에서 산틴 산화효소계와 반응시킨 sarcoplasmic reticulum의 단백질분해가 관찰되었다. 7) 단백질의 polymerization은 관찰되지 않았으며, 아울러 polymerization을 억제하는 semicarbazide로 칼슘흡수 감소를 방지하지 못하였다. 이상의 결과에서 유독성 산소대사물에 의한 sarcoplasmic reticulum의 칼슘흡수 억제는 sarcoplasmic reticulum의 막지질 과산화, SH-group의 산화 및 막 반백절의 분해 등으로 초래되는 복합적인 기전으로 추정되었다. Mechanism of calcium transport inhibition of cardiac sarcoplasmic reticulum (SR) by oxygen free radicals was examined. Effects of oxygen free radicals generated by xanthine/xanthine oxidase (X/XO) system on isolated porcine ventricle SR were studied with respect to its calcium binding, lipid peroxidation, SH-group content and alteration of membrane protein components. The results are as follows. 1) Calcium binding of isolated SR was markedly inhibited by X/XO. 2) During the incubation of sarcoplasmic reticulum with xanthine/xanthine oxidase, there were marked inclose in lipid peroxidation and reduction of SH-group content. 3) An antioxidant, p-phenylenediamine effectively prevented the lipid peroxidation but partially prevented the calcium binding inhibition of X/XO treated SR. 4) The reduction of SH-group content of SR treated with X/XO was partially prevented by p-phenylendiamine. 5) When modifying SH-group of SR by treatment with DTNB, the inhibition of calcium binding activity was partially prevented. 6) On gel-permeation chromatography of X/XO-treated sarcoplasmic reticulum, there was an increase of small molecular weight products, probably protein degradation products. 7) Semicarbazide, which prevents the cross-linking reaction of protein components, did not affect the calcium binding inhibition of X/XO-treated SR. From these results, it is suggested that the inhibition of calcium binding of SR by oxygen free radicals results from the consequence of multiple changes of SR components, which are lipid peroxidation, SH-group oxidation and degradation of protein components.

DITI를 통한 불임여성의 체열에 대한 연구

김혜원,김용석,이경섭,Kim, Hye-Won,Kim, Yong-Suk,Lee, Kyung-Sub 대한한방체열의학회 2002 대한한방체열의학회지 Vol.1 No.1

Causes of infertility include a wide range of physical, as well as emotional factors. In Oriental medicine, women's infertility is believed to be caused by the deficiency of the Chung and Ren vessel. Then the Kidney Qi is collapsed and cold. Many infertility women complain the cold hypersensitivity and/or body coldness, especially on the lower abdomen, back and knee. The aim of this study is to examine the interrelationship between infertility and body surface temperature. The 25 infertility women were allocated as infertility group and 25 fertility women (experienced delivery or pregnancy), as control group at the Kangnam Korean Hospital, KyungHee University, Seoul, Korea, from April to December 2000. Thermographic observations for this study were made using the Dorex DITI on 3 different areas's cold hypersensitivity: lower abdomen, back and knee. All data were coded for computer analysis and significances were tested by Mann-Whitney Test. The mean ${\Delta}T$ for abdomen cold hypersensitivity was $0.25{\pm}1.77^{\circ}C$ On control group and $1.00{\pm}0.39^{\circ}C$, infertility group. The mean ${\Delta}T$ for back cold hypersensitivity was $1.75{\pm}0.40^{\circ}C$ on control group and $1.21{\pm}0.58^{\circ}C$, infertility group. The mean ${\Delta}T$ for knee cold hypersensitivity was $0.65{\pm}0.70^{\circ}C$ on control group and $1.32{\pm}0.58^{\circ}C$, infertility group. It was revealed that the cold hypersensitivity on the lower abdomen, back and knee are significantly inter-related to the women infertility. These results do not conflict with the view of Oriental medicine. According to the above results, it is concluded that the body surface temperature, cold hypersensitivity and/or body coldness, have a great effect on women infertility.

허혈성 심질환(Ischemic heart disease) 환자(患者)의 사상(四象) 처방(處方) 투여 1례(例)에 대한 임상보고(臨床報告)

김혜원,송정모,김정호,Kim, Hye-Won,Song, Jeong-Mo,Kim, Jeong-Ho 사상체질의학회 2002 사상체질의학회지 Vol.14 No.2

An ischemic heart disease(IHD) is a anemic state of heart caused by disproportion between heart's demand and supply of oxygen. A patient who has this IHD feels serious chest pain called angina pectoris. In a keen condition it leads to a necrosis of heart muscles, known as myocardial infarction. In an ischemic heart disease the ECG waves gives us useful information of patients' heart. And CK(creatine kinase) in serum and Troponin T are the principal factors in diagnosis of IHD. In this study, the IHD patient classified by Sasang Constitutional Medicine had a notable medical effects. The symptoms of patient are disappeared and waves of ECG is closed to normal. The result of CK in serum is also recovered. So we report the healing process and results of this patient in this study.