• Journal of Korean Biological Nursing Science
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• 제21권4호
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• pp.249-258
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• 2019

Purpose: The purpose of this study was to assess the psychosocial status of candidates for deceased donor kidney transplantation (DDKT) in South Korea and identify factors associated with high-risk psychosocial status. Methods: The descriptive cross-sectional design included application of a standardized transplantation-specific assessment tool, the Psychosocial Assessment Candidacy Transplantation (PACT) instrument, and review of candidates' medical records. A total of 157 patients awaiting DDKT were recruited from a Korean organ transplantation center. The collected data were analyzed using descriptive statistics and binary logistic regression. Candidates were divided into high- and low-psychosocial risk groups using 3 as the cutoff point of PACT. Results: The mean score for the PACT final rating was 2.10, and the lowest average subscale score was 2.30 for understanding the processes of transplantation and follow up. Poor physical candidacy, especially due to comorbidities, and older age were associated with high psychosocial risk. Conclusion: The results of this study showed that the psychosocial status of Korean DDKT candidates was problematic. Development of systematic management programs for effective clinical strategies in the care of candidates is crucial to maintain their desirable psychosocial status in case of an emergency DDKT operation and improve post-transplantation outcomes. Continuous education is absolutely necessary to enhance understanding of the transplantation process for high-risk psychosocial candidates. Additionally, nurses and transplantation professionals should screen candidates with high-risk psychosocial status early in the process using transplantation-specific assessment tools and provide intensive interventions, particularly for poor physical candidacy patients and older candidates.

• 정신신체의학
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• 제6권1호
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• pp.59-69
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• 1998

Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.

• 대한두경부종양학회지
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• 제24권1호
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• pp.64-68
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• 2008

Purpose：The chronic use of immunosuppressive therapy in transplant recipients can increase the long-term risk of carcinoma. The aim of this study was to determine the incidence, biological behaviors, and treatment outcomes in PTC(papillary thyroid carcinoma) in renal allograft recipients. Material and Methods：The present study examined the incidence and biological behavior of PTCs in RA recipients. A total of 1,739 RA patients treated between January 1986 and December 1999 were followed-up for a median 137(84-238) months. During the follow-up period, 129(7.4%) recipients were identified as having posttransplant malignancies. Of those, 12(0.7%) had PTCs, and these comprised six male and six female patients with a median age of 41(23-57) years. Results：Nine cases(incidentalomas) were diagnosed based on ultrasonography(US) screening. Eight of those nine were TNM stage I, and two of the three clinical carcinomas were TNM stage IVa. During a median follow-up of 94(18-159) months, two(16.7%) PTC patients developed loco-regional recurrence, but no patients showed distant metastasis. Posttransplant PTC showed no gender bias, and was often associated with aggressive lymphatic metastasis. However, most incidentalomas showed a favorable treatment outcome. Conclusion：In conclusion, routine surveillance of the thyroid gland using US screening is recommended to ensure early detection, treatment and favorable prognosis in RA patients with PTC.

• 대한간호학회지
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• 제48권6호
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• pp.731-742
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• 2018

Purpose: The purpose of this study was to test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory. Methods: Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0. Results: The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients. Conclusion: It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.

• 한국간호교육학회지
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• 제30권3호
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• pp.263-279
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• 2024

Purpose: This study was conducted to evaluate the effects of nurse-led interventions on quality of life, medication adherence, anxiety, and depression in kidney transplant recipients. Methods: A systematic literature review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two researchers independently selected the final literature, and the quality assessment was performed using Cochrane's Risk of Bias tool. Additionally, a meta-analysis was conducted using the statistical software RevMan 5.4 to estimate effect sizes. Results: Among the reviewed 2,264 papers, 8 final papers, including 6 from the literature search and 2 from manual searches, were included in the analysis. The total number of participants included in the analysis was 477. Nurse-led interventions were found to be effective in improving quality of life (d=1.05) and reducing anxiety (d=-0.98) and depression (d=-1.25). Due to the heterogeneity of the measurement tools, the effect size for medication adherence could not be calculated. Despite this, nurse-led interventions were shown to improve medication adherence. In the cases of anxiety and depression, longer intervention periods showed a more significant reduction trend. Conclusion: The results of this study suggest that nurse-led interventions positively impact quality of life, medication adherence, anxiety, and depression in kidney transplant recipients. Therefore, it is important to recognize the crucial role of nurses and explore ways to provide continuous nursing interventions for kidney transplant recipients.

• 대한이식학회지
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• 제28권3호
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• pp.165-168
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• 2014

The recipient candidate was a 51-year-old male with end-stage renal disease owing to diabetes mellitus. The initial immunosuppressive regimen included basiliximab for induction and tacrolimus, mycophenolate mofetil, and steroids. Urine output was 413 mL/day on the operative day and 100 mL/day on the postoperative day (POD) 1. There was no definite stenosis of the ureter or vessels. He had anuria on POD 2~4 and he had undergone hemodialysis. His serum creatinine level did not decrease. Therefore, a graft biopsy was performed on POD 4. The pathologic finding was consistent with acute calcineurin inhibitor (CNI) toxicity. There was no evidence of rejection or acute tubular necrosis. Anuria continued on POD 6; therefore, we started sirolimus instead of a CNI based regimen. Graft function was gradually recovered 1 day after reduction of CNI dose and hemodialysis was stopped. The serum creatinine level was normalized on POD 10. He was discharged on POD 21.

• Journal of Chest Surgery
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• 제42권5호
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• pp.566-575
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• 2009

배경: 심장 판막의 기능은 대부분 판엽의 성질에 의해 결정된다. 단방향성 압력 장력 검사로 광범위하게 연구 되었으나, 단방향성 압력 장력 검사는 자연 상태에서의 압력 부하를 측정할 수 없다. 이번 연구는 더 나은 이종 이식 판막의 개발을 위하여 돼지의 대동맥 판막과, 폐동맥 판막을 고정액에 따라 자연적인 상태에서의 물리적 변화 즉 앙방향성 압력-팽창성 변화를 알아 보고자 하였다. 대상 및 방법: 돼지의 대동맥 판막과 폐동맥 판막을 아무것도 처리하지 않은 신선한 판막과 글루타알데하이드(glutaraldehyde, GA)로 고정한 군, GA에 에탄올과 같은 용매로 고정한 군으로 나누어 판막의 방사방향과 원주 방향의 양방향성 압력-신장도 변화를 조사 비교하였다. 결과: 신선한, GA고정 후의, 그리고 GA+ 용매 고정 후의 대동맥 판막(p=.00), 폐동맥 판막(p=.00) 모두에서 방사방향이 원주방향보다 압력 증가에 따라 더 잘 늘어 났다. GA 고정 후와 GA+용매 고정후의 대동맥 판막이 폐동맥 판막보다 각각 원주 방향과, 방사방향 비교했을 때 폐동맥 판막이 같은 압력에 대해 더 많이 늘어 났다(p=.00). 돼지의 신선한 대동맥 판막을 GA 고정 후에 원주 방향과 방사 방향에서 모두 신장도가 유의하게 감소 하였다(p=.00). GA+용매 고정 시에 방사 방향에서는 신장도가 유의하게 감소 하였으나(p=.00), 원주 방향에서는 그렇지 않았다(p=0.785). 그리고 GA 고정 그룹과 GA+용매 그룹간의 비교에서 원주 방향(p=0.785), 방사방향(p=0.137), 신장도가 유의한 차이는 얼었다. 폐동맥 판막에서도 GA 고정 그룹과 GA+용매 그룹간의 비교에서 원주 방향(p=0.718), 방사방향(p=0.910), 신장도가 유의한 차이는 없었다. 걸론: 돼지의 대동맥 판막과 폐동맥 판막의 GA 고정 시, 용매의 첨가는 물리적 손실은 가져 오지 않으나 신장도는 더 나아지지 않았다. 돼지의 대동맥 판막과 폐동맥 판막은 고정방법에 관계 없이 방사방향 신장도가 원주 방향보다 더 낫다.

• 한국임상수의학회지
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• 제26권2호
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• pp.138-143
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• 2009

허혈/재관류 손상은 급성신부전의 주요 원인이며 이식된 신장의 기능지연을 유발하여 거부반응의 발생을 증가시킨다. 본 연구에서는 쥐의 허혈/재관류 손상모델에서 허혈시간에 따른 면역세포의 변화를 평가하였다. 8주령 수컷 SD rat의 좌신을 각각 30, 45, 60분간 허혈/재관류 동안에 우신을 적출 하였고, 대조군은 우신만 적출하였다. 신장기능은 0, 1, 2, 3, 5, 7일에 각각 평가하였으며, 허혈/재관류 후 1일과 7일에 신장조직을 채취하여 면역형광염색(DCs, NK cells, macrophages, B cells, CD4+ and CD8+ T cells)과 H&E 염색을 실시하였다. 허혈 시간이 증가할수록 신장기능이 감소되었으나, 신장 세뇨관괴사와 염증세포의 침윤이 증가하였다. 허혈/재관류 후 신장조직에서 DCs, NK cells, macrophages, CD4+ T cells, CD8+ T cells의 침윤 증가와 재관류 후 7일째 B cells의 침윤이 관찰되었다. 면역세포는 허혈시간 뿐 아니라 재관류 시간이 증가에 따라 뚜렷하게 관찰되었다. 이 결과는 허혈시간이 증가됨에 따라 면역반응이 증가될 수 있으며, 허혈재관류 손상이 비항원성 면역반응을 유도할 수도 있다는 것을 의미한다.

• 대한소아치과학회지
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• 제32권4호
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• pp.709-716
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• 2005

구순구개열 환자에서는 이른 시기에 시행된 수술로 인한 구순이나 구개부의 반흔 형성으로 섭식장애나 발음장애를 동반한 상악의 열성장이 나타나게 된다. 때로는 집중적인 교정치료 후에도 심한 상악골 저형성증을 보이며 이러한 경우성장이 완료 된 후에 골이식을 동반한 악교정 수술로 상악골을 전방이동시켜 안모의 개선을 도모하기도 한다. 그러나 이러한 상악골의 전방이동은 연조직의 과도한 신장으로 인한 술후회귀현상, 추가적인 골이식이 필요하다는 한계를 가지고 있다. 골신장술은 이러한 한계점을 극복하는 최신 치료방법으로 구순구개열 환자, 두개골 융합증을 나타내는 환자 등에서 상악골을 포함한 두개 안면골의 개선에 많이 이용되고 있다. 특히 구외장치를 이용하는 골신장술은 골신장기간 중에 견인 방향의 조절이 보다 쉬우며, 충분한 양의 골신장이 가능하여 보다 좋은 결과를 얻을 수 있다. 본 증례는 상악 열성장을 보이는 구순구개열 6세 7개월의 여자 환아로, 변형된 구내 르포씨 1형 골절단술(modified Le Fort I osteotomy) 후 두개골을 고정원으로 이용하는 견고 구외 골신장술을 통해 상악골을 전진시켜 양호한 결과를 얻었기에 이를 보고하는 바이다.

• 한국임상약학회지
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• 제13권2호
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• pp.97-105
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• 2003

아스코마이신(ascomycin)의 macrolactam 유도체인 피메크로리무스(pimecrolimus; 엘리델 [Elidel], SDZ ASM 981; Novartis Pharma AG, 바젤, 스위스)는 세포선택성을 지닌 염증성 사이토카인(cytokines) 억제제로서 아토피피부염, 알레르기성 접촉피부염, 자극성 접촉피부염 및 판형 건선 등 염증성 피부질환의 치료제로 개발되었다. T세포와 비만세포의 염증성 사이토카인 생산 분비를 억제하고 사전 형성된 염증성 매개물질의 비만 세포 분비를 저해한다. 국소 투여된 피메크로리무스는 알레르기성 접촉피부염(allergic contact dermatitis [ACD]) 돼지 모델에서 고역가 코르티코스테로이드 클로베타졸-17-propionate(corticosteroid clobetasol-17-propionate)와 동등한 효과를 나타낸다. 하지만 피메크로리무스는 클로베타졸과는 달리 피부 위축을 일으키지 않는다. 경구 투여시 피메크로리무스는 마우스와 랫트 ACD 치료에 있어서 타크로림무스(tacrolimus [FK 506])와 동등한 혹은 더 우수한 효과를 나타낸다. 또한 피메크로리무스는 아토피피부염 급성 징후 유사 모델인 저마그네슘 혈증 탈모 랫트(hypomagnesemic hairless rat)의 피부 염증과 소양증을 효과적으로 감소시킨다. 피메크로리무스는 랫트에서 다음과 같은 측면의 전신 면역반응 손상 효과가 타크로리무스 와 비교하여 낮게 평가된다: (1)국소 이식편대 숙주 반응, (2)양(sheep) 적혈구에 대한 항체 형성, (3)신장이식. 시험관내 평가시 돼지 피부를 통한 피메크로리무스 투과 속도가 타크로리무스보다 10배 낮게 측정되므로 생체에서 경피 흡수가 더 적게 될 것으로 판단된다. 상기 자료로 판단컨대 피메크로 리무스는 피부에 대한 항염증 활성이 높을 뿐 아니라 전신 면역반응 손상 부작용이 낮은것으로 사료된다.