Association of serum ferritin levels with smoking and lung function in the Korean adult population: analysis of the fourth and fifth Korean National Health and Nutrition Examination Survey

BACKGROUND: Iron-catalyzed oxidative stress contributes to lung injury after exposure to various toxins, including cigarette smoke. An oxidant/antioxidant imbalance is considered to play a critical role in the pathogenesis of COPD. Ferritin is a key protein in iron homeostasis, and its capacity to oxidize and sequester the metal preventing iron prooxidant activity implicates its possible role in the alteration of antioxidant imbalance. We investigated the relationship among cigarette smoking, lung function, and serum ferritin concentration in a large cohort representative of the Korean adult population. MATERIALS AND METHODS: Among 50,405 participants of the Korean National Health and Nutrition Examination Survey from 2010 to 2014, 15,239 adult subjects older than 40 years with serum ferritin levels and spirometric data were selected for this study. RESULTS: The mean age was 56.5 years for men (43%) and 56.9 years for women (57%). The prevalence of airway obstruction was 13.4%, which was significantly higher in men than in women, and increased in former or current smokers. The median levels of serum ferritin were highest in the airway obstruction group, followed by the restrictive pattern group, and lowest in the normal lung function group. The median ferritin levels were increased by smoking status and amounts in each spirometric subgroup. In multivariable regression analysis, serum ferritin was positively associated with forced expiratory volume in 1 second and forced expiratory volume in 1 second/forced vital capacity, whereas the smoking amount was negatively associated with the adjustment with age, sex, height, and weight. CONCLUSION: Serum ferritin levels were increased in former or current smokers and were increased with smoking amount in all subgroups of participants categorized according to spirometric results. The result was also evident in the subgroups divided by obstructive severity. While smoking amount was inversely related to lung function, higher levels of serum ferritin were associated with enhanced spirometric results in a representative sample of the general Korean adult population. Future prospective studies will be needed to clarify the causality between serum ferritin and lung functions and their role in COPD morbidity.ope

A case of bronchiolitis obliterans organizing pneumonia in an HIV-infected Korean patient successfully treated with clarithromycin

BACKGROUND: Bronchiolitis obliterans organizing pneumonia (BOOP) is a type of diffuse interstitial lung disease characterized by the pathology of fibroblastic plugs in the lumens of the respiratory bronchioles, alveolar ducts, and alveoli. The occurrence of BOOP in human immunodeficiency virus (HIV)-infected patients has rarely been described, and there have been no clinical case reports in Korea. CASE PRESENTATION: A 24-year-old female who had been diagnosed with HIV ten years prior was admitted due to a 1-year history of cough and sputum production and a 3-day history of fever. She had poor adherence to anti-retroviral therapy (ART) due to gastrointestinal troubles. At the time of admission, her CD4 T-cell count was 5 cells/mm(3). A high resolution computed tomography (CT) scan showed tiny centrilobular nodules with a tree-in-bud pattern in both lungs. Bacterial culture, Pneumocystis jirovecii polymerase chain reaction (PCR), Aspergillus galactomannan antigen (Ag) assay, and respiratory virus PCR were negative. Rapid chest x-ray improvement was seen after a 7-day treatment with anti-tuberculosis medication, ceftriaxone, and clarithromycin. Miliary tuberculosis seemed unlikely considering the rapid radiologic improvement and negative tuberculosis PCR results. Due to the unknown etiology, we performed video-assisted thoracoscopic surgery (VATS) to determine the cause of the diffuse lung infiltration. Pathologic findings were consistent with BOOP, while tissue acid-fast bacilli (AFB) stain and tuberculosis PCR results were negative. Tuberculosis medication and intravenous ceftriaxone were discontinued, while treatment with clarithromycin monotherapy was sustained. Five months after discharge, the patient was asymptomatic with a normal chest x-ray and as her adherence to ART improved, her CD4 T-cell count rose to 181 cells/mm(3). Clarithromycin was discontinued at that time and the patient is currently receiving regular outpatient follow-up. CONCLUSION: This case suggests that macrolides are a potential treatment option in HIV-infected patients with mild BOOP. In cases that are otherwise unexplained or unresponsive to treatment, BOOP should be taken into consideration and surgical biopsy performed to confirm a diagnosis of BOOP.ope

Usefulness of Bronchoscopic Rebiopsy of Non-Small Cell Lung Cancer with Acquired Resistance to Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor

Background: Approximately 50% of non-small cell lung cancer (NSCLC) patients with acquired resistance to EGFR-TKI harbor the EGFR mutation T790M. The recent development and wide use of third-generation EGFR-TKIs targeting T790M-mutant NSCLCs have increased the importance of rebiopsy after EGFR-TKI failure. We aimed to investigate the advantages of flexible bronchoscopy as a rebiopsy method and the prevalence of and factors affecting the T790M mutation after EGFR-TKI failure. Methods: We investigated 139 patients who had undergone bronchoscopic rebiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between Sep 2014 and Jul 2016. Results: Among the 139 patients, bronchoscopic rebiopsy yielded successful pathological diagnoses in 102 (73.4%). Among them, 41 patients with EGFR-mutant lung adenocarcinoma and EGFR-TKI progression were selected for an investigation of T790M mutation prevalence at rebiopsy. The initial EGFR mutations were exon 19 del (56.1%), L858R or L861Q (34.1%), and others (9.8%). The most common rebiopsy method was transbronchial lung biopsy (41.5%), followed by EBUS-TBNA (26.8%) and endobronchial biopsy (19.5%). The median interval to T790M emergence was the longest among cases with exon 19 deletion (14.1 months), followed by exon 21 L858R or L861Q (11.3 months) and other rare EGFR mutations (2.9 months). The T790M mutation was identified in 18 (43.9%) patients, and exon 19 del was the most significant factor affecting T790M mutation development (hazard ratio: 6.875, P = 0.014). Conclusions: Bronchoscopy was more useful than other rebiopsy approaches. The T790M emergence rate was highest in cases with exon 19 deletion, likely as a consequence of long-term EGFR-TKI exposure.ope

김숙자 도살풀이춤의 무대화 전이과정에 관한 연구

The purpose of this study is to help understand 'shamanism' or a source of our traditional dance and recognize the dance based on the value and exorcism of shamanism as a form of art and emphasize its qualification to be preserved. For this purpose, Kim Sook-ia'sDosalpuri da ce based on Kyonggidodangguts to inherit the traditional dance and adapt and develop it into a stage art was reviewed in terms of is transition and stage pattems. Out of various shamanism faiths, Dodangguts were designed to pray in group to the guardian deity keeping the village for a good fortune. They are sort of inherited dances, which have been succeeded by families, so they seem to be more artistic. As a student of such inherited shamanism dances, Kim Sook-ja sidely mastered Kyonggidodangguts and attempted to try new stage pattems for Dosalpuri dancd. Namely, her Dosalpuri dance is more shamanistic than other Salpuri dances, but was adapted to stage pattems to be established as a stage art. In this study, Kim Sook-ja's Dosalpuri dance is revieed in terms of its transition from a Dodanggut to a stage art, and its stage pattems are examined in terms of dance, music, towel and costume. In particular, the stage pattems are examined by dividing them into historical stage form changes, external forms for using the stage space and internal expressions shown on the stage space. Through this study, Dodangguts which influenced Dosalpuri dance could be understood, and unique characteristics of Dosalpuri dance be determined. This study can be concluded as follows; First, it may be certain that the prototype of Dosalpuri dance was derived from Kyonggidodangguts and that it was tuned to a Kyonggishamanism music or Dosalpuri song, but assuming that Kim Sook-ja learned about songs and various dances inherited by entertainer girls' association, it seems that her Dosalpuri dance belongs to Kyobang (music administration during Chosun dynasty) folk dances. Second, the extemal formality of using the stage space and the intemal expressions shown on the stage for Dosalpuri dance were examined in terms of structural se, extablished forms and dance movements. As for the extemal formality, such aspects as planar dance lines centered about foot movements and cubic moving method and body directions and arms' use of space were reviewed. As a result, it was found that for the dance line formed with foot movements, the space is used gradually by menas of zigzag or oval forms or use of side, and that for the cubic space using towels and arms' movements, a continuum of space continues to be created by using the long towels. In addition, use of the stage on the front and before the oblique line serves to express dancer's inner emotion, while it is well adapted to the proscenium stage. The dance movements formed with the strong breathing of internal expressions sugest a strong sense of tension and dynamics, while connoting a human will to console an inner grudge. Inaddition, such movements as <caressing movement>, <stopping movement>, <towel-dispersing movement> and <uvula play> may be uniquely expressed by Kim Sook-ja only who has mastered Kyonggidodangguts. She expresses inner grudge and a sense of divinity, or symbolic expressions of people's dances. Third, 'Dosalpuri' a kind of Kyonggimuaks cannot well e inherited and preserved because Kyonggisinawi shaman music performers passed away, and therefore, it is now being tuned to 'Salpuri', a kind of Namdosinawis. Fourth, On the other hand, the long towel, a characteristic of Dosalpuri dance, was derived from rice bag, coin belt or cloth roll. IN Suwon and Ansung regions, performers used a twin towel, but the towel was extended by Kim Sook-ja when she performed Dosalpuri on the stage. In other words, diverse ceremonial dances of Dodangguts which fundamentally affected Dosalpuri dance seems to have their fundamental background from the traditional dances. Such a background was also effective for the unique dance aesthetics of Kim Sook-ja's Dosalpuri dance. Kyonggidodangguts seem to have provided for a framework for Kim Sook-ja's traditional dances to be adapted to stage pattems. ;본 연구는 전통춤의 근원이 되는 무(巫)를 이해하고 무속의 가치와 굿에의한 춤이 예술의 한 형태로 인정받고, 또 보존적인 가치를 충분히 지니고 있다는 점을 표명하기 위한 하나의 방법으로 경기도당굿을 유지하고 무대예술로 변화ㆍ발전하여 전통춤의 맥을 이어온 김숙자의 도살풀이춤을 무대화 된 특성과 전이과정을 중심으로 분석 하였다. 여러 종류의 무속신앙 중 도당굿은 같은 마을사람들이 한데 모여 그마을을 지키는 수호신에게 복을 비는 굿으로 세습무적인 성격을 지니는데, 세습무는 가계적으로 내려오기 때문에 다른 굿에 비해 예술성이 두드러 진다. 이러한 세습무가의 후예로 경기도당굿을 두루 경유한 김숙자는 도살풀이춤의 무대양식을 시도하였다. 즉 김숙자의 도살풀이춤은 다른 살풀이춤에 비해 무속적인 성향이 가장 질으면서도 무대양식화를 거쳐 무대예술로 정착된 양면성을 지닌 춤으로 볼 수 있다. 따라서 본 연구는 이러한 의미를 갖는 김숙자 도살풀이춤을 도당굿에서부터 무대위에 올려지기 까지의 전이된 과정 연구를 통해 무용과 음악 그리고 도구인 수건과 의상으로 나누어 분석하였고, 무대공간 활용에 나타난 외형적형태성과 무대공간에 나타난 내면적표현성으로 분류하여 규명하였다. 이에 도살풀이춤에 기초적 영향을 준 도당굿에 대하여 이해 할 수 있었으며, 무대위에서의 도살풀이춤에서만 볼 수 있는 독특한 점을 발견하여 다음과 같은 결론을 지을 수 있었다. 첫째. 무용적 측면을 살펴 본 결과 도살풀이춤외 원형이 경기도당굿에서 추어졌다는 근거와 경기무악인 도살풀이곡에 맞추어 추어진 것은 확실하나 김숙자가 소리와 권번에서 전수되던 각종 춤을 배우게 된 것을 바탕으로 짐작하여 보면 김숙자의 도살풀이춤은 창우들에 의해 미적형식을 갖추게 된 교방계열의 민속무용으로 볼 수 있다. 둘째. 무용적 측면의 외형적형태성에는 평면적구조인 발동작을 중심으로한 춤길과 입체적구조인 무진법을 통한 무대위에서의 봄통방향과 팔의 공간사용을 중심으로 살펴 본 결과 발동작과 함께 이루어진 춤길에서는 반복적이고 점진적인 공간활용과 함께 무대 전체를 지그재그형식이나 타원형식, 측면의 사용 등으로 골고루 사용하였고, 수건과 팔동작을 이용한 입체적 공간은 긴수건을 이용하여 끊임없는 연속적 공간성을 만들어 낸다. 또한 정면과 사선앞의 무대사용은 무용수의 내면감정을 잘 표현하고 프로시니엄 무대에 맞게 형식화 되어진 사실을 발견할 수 있었다. 내면적표현성의 강한 호흡과 함께 이뤄진 춤사위에는 강한 긴장감과 역동성이 느껴지며 이는 내면적 한의 맺힘을 풀어내고자 하는 인간적 의지를 내포하고 있다. 또한<어르는 사위>, <멈추는 사위>, <수건을 뿌리는사위> 와 <목젖놀음>의 춤사위에서는 경기도당굿을 두루 경유한 김숙자만의 옥특한 표현으로, 여기서는 한과 신명을 표현한 것으로 서민무용의 상징적인 표현이라 할 수 있다. 셋째. 음악적 측면의 결과 정기무악인 '도살풀이' 곡은 경기사나위 무악연주자들외 작고로 인하여 전승과 보존이 어려워 현재 도살풀이춤은 남도시나위곡인 '살풀이' 곡에 맞추어지고 있다. 넷째. 도구적 측면에는 도살풀이춤의 특징인 긴수건과 의상의 전이과정을 살펴 보았는데, 긴수건은 도당굿에서 들고 추었던 쌀자루, 전대, 필목의 변형으로 수원ㆍ안성지방에서 쌍수건을 들고 추었던 것이 김숙자에 의해 무대에 올려지면서 길게 변형된 것이다. 의상의 경우 무속적 색체가 가장 짙은 것으로 도살풀이춤이 무속에 가깝다는 것을 느끼게 하는 도구가 된다. 따라서 도당굿에서의 다양한 의식무들은 전통무용의 근원적 배경을 가지고 있는 것으로 이는 김숙자 도살풀이춤이 무대화 하는데 기틀을 마련하게 된 계기가 되었고, 시대적 특이성으로 인하여 도살풀이춤이 무대에 자주 올려지게 되면서 춤이 무대에 맞게 현식화 되어 전이되는 결과를 초래하였다. 이렇듯 본 연구에서 밝힌 김숙자외 도살풀이춤은 경기도당굿의 무속에서부터 출발하였고, 현재 그명맥을 유지하여 무대예술로 발전 된 전통적인 춤의 맥을 느낄 수 있는 작품인 것이다.논문개요 = vi I. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구내용 및 방법 = 3 C. 연구의 제한점 = 4 II. 경기도당굿의 내용과 구성 = 8 A. 경기도당굿의 내용 = 8 B. 경기도당굿의 구성 = 12 III. 김숙자 도살풀이춤의 내용과 시대적 특이성 = 20 A. 김숙자의 생애 = 20 B. 김숙자 도살풀이춤의 내용 = 21 C. 도살풀이춤의 시대적 특이성 = 24 IV. 김숙자 도살풀이춤의 무대화 전이과정 연구 = 28 A. 무용적 측면 = 28 1. 무대공간활용에 대한 외형적 형태성 = 32 2. 무대공간에 나타난 내면적 표현성 = 41 B. 음악적 측면 = 51 C. 도구적 측면 = 56 V. 결론 = 61 참고문헌 = 64 ABSTRACT = 6

Utilization of health care services among with multimorbid ambulatory patients

만성질환은 장기간에 걸쳐 서서히 진행되는 질병으로 예방접종이 불가능하고 약물로 치유되지 않으면서 완전히 사라지지도 않는 특성을 가지며 연령이 증가함에 따라 유병율이 증가하는 경향을 보인다. 복합질환(multimorbidity)이란 한 사람에게 여러 가지(multiple) 급성이나 만성 또는 내과적인 상태가 존재하는 것(co-occurance)'으로 정의되며 치료나 관리 중인 주된 질환에 더하여 발생하는 동반질환(comorbidity)와는 구별되는 개념이다. 복합만성질환을 가진 사람은 개인의 삶의 질(Quality Of Life), 노동능력, 장애정도, 사망률에 영향을 받으며 의료이용에 있어서는 고비용을 초래하는 것으로 알려져 있다. 복합만성질환자의 의료이용 부담을 알아보기 위해 한국의료패널 자료를 이용하여 만성질환을 2개 이상 가진 사람과 1개 가진 사람의 2008년도 외래 이용현황을 분석하였다. 그 결과 총 연구대상자의 58.3%가 2개 이상의 만성질환을 갖고 있었고 평균 보유 만성질환수는 2.20개 였다. 가장 많은 만성질환은 고혈압(18.23%)이었고 다음으로는 관절증(7.51%), 당뇨병(6.80%) 였다. 흔한 질병은 남자는 고혈압(20.63%), 당뇨병(8.65%), 위염 및 십이지장염(3.81%) 이었고 여자는 고혈압(16.79%), 관절증(9.99%), 당뇨병(5.69%) 이었다. 2개의 만성질환을 가진 사람에서도 위 3가지 질병의 조합이 가장 많았다. 만성질환을 2개 이상 가진 사람과 1개 가진 사람의 일반적 특성은 차이가 있었고, 복합만성질환자의 외래 이용현황을 보면 만성질환을 1개 가진 사람보다 만성질환을 2개 이상 가진 사람이 연간 평균 외래 방문횟수, 연간 평균 방문기관수가 더 많았고 이 결과는 일반적 특성을 고려한 회귀분석에서도 그대로 지지되었다. 즉 만성질환을 1개 가진 사람에 비해 만성질환을 2개 가진 사람은 외래 방문횟수가 1.44배(95% CI : 1.41-1.47) 많았고 3개 가진 사람은 1.93배(95% CI : 1.88-1.97), 4개 가진 사람은 2.31배(95% CI : 2.25-2.37), 5개 이상 가진 사람은 2.69배(95% CI : 2.62-2.76) 외래를 더 자주 방문하는 것으로 나타났다. 평균 방문기관수를 보면, 만성질환을 1개 가진 사람에 비해 만성질환을 2개 가진 사람은 방문기관수가 3.14배(95% CI : 2.79-3.53) 많았고 3개 가진 사람은 4.57배(95% CI : 4.05-5.17), 4개 가진 사람은 5.56배(95% CI : 4.87-6.35), 5개 이상 가진 사람은 6.91배(95% CI : 6.07-7.87) 외래 방문기관수가 많은 것으로 나타났다. 따라서 이는 인구의 고령화와 함께 전체 의료체계에 부담이 될 복합만성질환의 효율적인 관리방안 마련에 대한 필요성을 시사하고 있다. 또한 앞으로 복합만성질환의 정도를 고려한 진료비용에 대한 연구가 더 필요할 것으로 생각된다.Ⅰ. 서론 1 1. 연구 배경 1 2. 연구 목적 2 Ⅱ. 이론적 배경 3 1. 복합만성질환의 개념 3 2. 복합만성질환자와 의료이용 부담 7 Ⅲ. 연구 방법 9 1. 연구 자료 및 대상 9 2. 연구 분석에 사용된 주요 변수 10 3. 분석 방법 11 Ⅳ. 연구 결과 13 1. 연구대상자의 일반적 특성 13 2. 복합만성질환 현황 14 3. 외래 이용현황 22 4. 복합만성질환자의 외래 이용현황 32 Ⅴ. 고찰 38 Ⅵ. 결론 41 참고문헌 42 Abstract 44Maste

A Simplified Mortality Score Using Delta Neutrophil Index and the Thrombotic Microangiopathy Score for Prognostication in Critically Ill Patients

BACKGROUND: This study was conducted to assess the prognostic value of a simplified mortality score (SMS) using the delta neutrophil index (DNI) and thrombotic microangiopathy (TMA) score, both easily obtained from the complete blood count, to identify critically ill patients at high risk of death. METHODS: This was a retrospective study performed in the medical ICU at Yonsei University College of Medicine from June 2015 to February 2016. The primary end point was 28-day all-cause mortality. Participants were divided into two groups: a training (n = 232) and a test (n = 57) set. We used Cox proportional-hazards analysis, Harrell's C index, and Kaplan-Meier survival analysis to derive the SMS and test its internal validity. RESULTS: We enrolled 289 patients. The 28-day mortality rate was 31.1% (n = 90). Nonsurvivors had higher APACHE II, SOFA, and TMA scores, and DNI. The SMS, derived by Cox proportional-hazards analysis, consisted of age, sex, DNI, and TMA score. We assigned a weighted point to each variable in the SMS, as follows: age + 11 if male + (2 x DNI) + (61 [TMA = 1], 76 [TMA = 2], 74 [TMA = 3], 26 [TMA = 4], 99 [TMA = 5]). Nonsurvivors had a higher median SMS than survivors, and the Harrell's C index was 0.660. Analysis of survival by risk group according to SMS (low, intermediate, high risk) showed a significant difference among these three groups (P < 0.001). We then investigated this SMS in the test set to determine internal validity; the results were similar to those of the training set. CONCLUSIONS: The SMS is a more rapid, simple prognostic score for predicting 28-day mortality and stratifying risk than the APACHE II or SOFA scores. However, external validation using a larger sample is needed.restrictio