신장 재이식 환자의 다발성 내장 침범 카포시육종에서 Sirolimus 치료를 통한 부분 관해 및 이식신 보존 1예

The use of immunosuppressant's increases the risk of developing malignancies in renal allograft patients. One of the most important malignancies, Kaposi's sarcoma, can cause mortality and graft failure among renal allograft patients. We report the case of a 39-year-old male diagnosed with multiple visceral Kaposi's sarcoma 6 months after a second cadaveric renal allograft. The patient's renal function was markedly deteriorated at admission and required hemodialysis initially. Radiologic studies revealed Kaposi's sarcoma in multiple lymph nodes, liver, lung, and peritoneum. The excisional biopsy of an inguinal lymph node confirmed this diagnosis. After diagnosis, tacrolimus treatment was gradually decreased, and sirolimus treatment initiated. The patient did not receive any chemotherapy or radiotherapy. The Kaposi's sarcoma lesions decreased dramatically (both in size and number) 1 month after sirolimus treatment, and kidney graft function improved. This case thus shows successful sirolimus treatment of visceral Kaposi's sarcoma in a renal allograft patient.ope

Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

BACKGROUND: Anemia is a common complication among patients with chronic kidney disease (CKD), and it is associated with unfavorable clinical outcomes in patients with CKD independent of the estimated glomerular filtration rate (eGFR). We assessed the association of the urinary albumin-to-creatinine ratio (ACR) and eGFR with anemia in CKD patients. METHODS: We conducted a cross-sectional study using baseline data from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Multiple regression analysis was performed to identify the independent association of albuminuria with anemia. Furthermore, odds ratios for anemia were calculated by cross-categorization of ACR and eGFR. RESULTS: Among 1,456 patients, the mean age was 53.5 ± 12.4 years, and the mean eGFR and ACR were 51.9 ± 30.5 mL/min per 1.73 m2 and 853.2 ± 1,330.3 mg/g, respectively. Anemia was present in 644 patients (40.5%). Multivariate analysis showed that the odds ratio of anemia increased according to ACR levels, after adjusting for age, sex, eGFR, body mass index, pulse pressure, cause of CKD, use of erythropoiesis stimulating agents, serum calcium and ferritin (ACR < 30 mg/g as a reference group; 30-299 mg/g, adjusted odds ratio (OR) = 1.43, 95% confidence interval (CI) = 0.88-2.33; ≥300 mg/g, adjusted OR = 1.86, 95% CI = 1.12-3.10). In addition, graded associations were observed in cross-categorized groups of a higher ACR and eGFR compared to the reference group with an ACR <30 mg/g and eGFR ≥60 mL/min per 1.73 m2. CONCLUSION: The present study demonstrated that albuminuria was a significant risk factor for anemia in CKD patients independent of the eGFR.ope

Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

Background: Geriatric nutritional risk index (GNRI) is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD) patients. Methods: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0) and worsening/stationary (delta GNRI ≤ 0) groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs). Results: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%). The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40). However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004). Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15-5.29; P = 0.02). In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04) and higher (P = 0.01) baseline GNRI groups. Conclusion: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.ope

Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?: A Prospective Observational Study

Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients.ope

An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock

INTRODUCTION: Mean platelet volume (MPV) is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV72h-adm) predicts 28-day mortality in severe sepsis and/or septic shock. METHODS: We prospectively enrolled 345 patients admitted to the emergency department (ED) who received standardized resuscitation (early goal-directed therapy) for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis. RESULTS: Thirty-five (10.1%) patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001) and survivors (P < 0.001); however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003). Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360). In multivariate analysis, ΔMPV72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01-2.06; P = 0.044). CONCLUSIONS: An increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.ope

Effect of Peritoneal Dialysis Modality on the 1-Year Rate of Decline of Residual Renal Function

PURPOSE: The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. MATERIALS AND METHODS: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. RESULTS: The RRF at 1 year after PD initiation was 1.98±2.20 mL/min/1.73 m² in CCPD patients and 3.63±3.67 mL/min/1.73 m² in NIPD patients, which were moderately lower than 4.23±3.51 mL/min/1.73 m² in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (β=-31.50; 95% CI, -63.61 to 0.62; p=0.052). CONCLUSION: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.ope

Clinical features and outcomes of focal segmental glomerulosclerosis pathologic variants in Korean adult patients

BACKGROUND: Many studies have shown that clinical characteristics and outcomes differ depending on pathologic variants of focal segmental glomerulosclerosis (FSGS). However, these are not well defined in Asian populations. METHODS: This retrospective study evaluated clinical features and outcomes of pathologic FSGS variants in 111 adult patients between January 2004 and December 2012. Primary outcome was the composite of doubling of baseline serum creatinine concentrations (D-SCr) or onset of end-stage renal disease (ESRD). Secondary outcome included complete (CR) or partial remission (PR). RESULTS: There were 70 (63.1%), 20 (18.0%), 17 (15.3%), 3 (2.7%), and 1 (0.9%) patients with not-otherwise specified (NOS), tip, perihilar, cellular, and collapsing variants, respectively. At presentation, nephrotic-range proteinuria occurred more commonly in tip lesion than in other variants. The overall 5-year renal survival rate was 76.8%. During a median follow-up of 34.5 months, only 1 (5.0%) patient with a tip lesion reached the composite end point compared to 2 (11.8%) and 12 (17.1%) patients in perihilar and NOS variants, but this difference was not statistically significant in an adjusted Cox model. However, tip lesion was associated with a significantly increased probability of achieving CR (P = 0.044). CONCLUSION: Similar to other populations, Korean adult patients with FSGS have distinct clinical features with the exception of a rare frequency of cellular and collapsing variants. Although pathologic variants were not associated with overall outcome, the tip variant exhibited favorable outcome in terms of achieving remission. Further studies are required to delineate long-term outcome and response to treatment of the pathologic variants.ope

The effect of specialized continuous renal replacement therapy team in acute kidney injury patients treatment

PURPOSE: Continuous renal replacement therapy (CRRT) has been established for critically ill acute kidney injury (AKI) patients. In addition, some centers consist of a specialized CRRT team (SCT) with physicians and nurses. To our best knowledge, however, ona a few studies have yet been carried out on the superiority of SCT management. MATERIALS AND METHODS: A total of 551 patients, who received CRRT between January 2008 and March 2009, were divided into two groups based on the controller of CRRT. The impact of the CRRT management on 28-day mortality was compared between two groups by Kaplan-Meier curve and Cox analysis. RESULTS: During the study period, the number of filters used, down-time per day, and intensive care unit length of day were significantly higher in non-SCT group than in SCT group (6.2 hrs vs. 5.0 hrs, p=0.042; 5.0 hrs vs. 3.8 hrs, p<0.001; 27.5 days vs. 21.1 days, p=0.027, respectively), while net ultrafiltration rate was significantly lower in non-SCT group than SCT group (28.0 mL/kg/hr vs. 29.5 mL/kg/hr, p=0.043, respectively). In addition, 28-day mortality rate was significantly lower in SCT group than with non-SCT group (p=0.031). Moreover, Cox regression analysis showed that 28-day mortality rate was significantly lower in SCT control group, even after adjusting for age, gender, severity scores, biomarkers, risk, injury, failure, loss, and end-stage renal disease, and contributing factors (hazard ratio 0.91, p=0.046). CONCLUSION: A well-trained CRRT team could be beneficial for mortality improvement of AKI patients requiring CRRT.ope

Optimal Proteinuria Target for Renoprotection in Patients with IgA Nephropathy

BACKGROUND: Proteinuria is a target for renoprotection in kidney diseases. However, optimal level of proteinuria reduction in IgA nephropathy (IgAN) is unknown. METHODS: We conducted a retrospective observational study in 500 patients with biopsy-proven IgAN. Time-averaged proteinuria (TA-P) was calculated as the mean of every 6 month period of measurements of spot urine protein-to-creatinine ratio. The study endpoints were a 50% decline in estimated glomerular filtration rate (eGFR), onset of end-stage renal disease (ESRD), and slope of eGFR. RESULTS: During a median follow-up duration of 65 (12-154) months, a 50% decline in eGFR occurred in 1 (0.8%) patient with TA-P of <0.3 g/g compared to 6 (2.7%) patients with TA-P of 0.3-0.99 g/g (hazard ratio, 2.82; P = 0.35). Risk of reaching a 50% decline in eGFR markedly increased in patients with TA-P of 1.0-2.99 g/g (P = 0.002) and those with TA-P≥3.0 g/g (P<0.001). ESRD did not occur in patients with TA-P<1.0 g/g compared to 26 (20.0%) and 8 (57.1%) patients with TA-P of 1.0-2.99 and ≥3.0 g/g, respectively. Kidney function of these two groups deteriorated faster than those with TA-P<1.0 g/g (P<0.001). However, patients with TA-P of 0.3-0.99 g/g had a greater decline of eGFR than patients with TA-P<0.3 g/g (-0.41±1.68 vs. -0.73±2.82 ml/min/1.73 m2/year, P = 0.03). CONCLUSION: In this study, patients with TA-P<1.0 g/g show favorable outcomes. However, given the faster eGFR decline in patients with TA-P of 0.3-0.99 g/g than in patients with TA-P<0.3 g/g, the ultimate optimal goal of proteinuria reduction can be lowered in the management of IgAN.ope

A Study on Visual Expression in Domestic Film Magazine Cover Design : Focused on this title

현대의 대중사회는 지속적인 발전과 함께 산업화와 전문화에 의한 대량적인 생산, 대량적인 정보의 전달에 의해 지배되어가고 여러 가지의 이미지의 홍수 속에서 많은 자극과 정보를 필연적으로 받아들이고 있다. 1990년대 이후 다양한 문화 콘텐츠 산업의 급속한 성장은 영화 콘텐츠를 자원으로 삼는 전문잡지의 발전을 가져왔다. 이렇게 점차 발전된 잡지들은 어려운 경제여건 속에서도 지속적인 판매량을 확보하고 인기 있는 매체로 자리잡아왔으나 오늘날 다양한 매체와 멀티미디어에 더 익숙해진 독자들은 인쇄매체를 조금씩 멀리하게 되었다. 이러한 정보이용 행태의 변화와 재정적 어려움으로 독자를 잃지 않으려는 기업들은 자구책으로 대중성이라는 미명하에 점차 엔터테인먼트 잡지로의 변모를 추구하게 되었다. 영화전문지만의 특성을 잃어버리자 개성은 점차 사라지고 대부분의 표지에서 시각 표현이 동일화되었다. 이러한 동일화 과정은 곧 영화잡지시장 전체에 한권만 보더라도 다른 영화잡지의 내용을 짐작할 수 있다는 인식을 심어주었고, 또한 비슷한 내용의 비슷한 표지라는 인식은 곧 특색 없는 잡지가 되어 전체 잡지시장에서 영화전문지의 위치를 좁아지게 만들었다. 영화전문지 시장이 위축되어가는 현실은 영화잡지의 정통성과 전문성을 원하는 마니아적인 독자층을 만들어냈고 더욱 세분화 된 소비자들은 영화전문지로서 정체성을 가지는 잡지를 요구하게 되었다. 정보화 사회에 걸맞게 정확한 타깃을 겨냥하여 파고들어야 하고 이에 걸맞은 표지디자인도 다양한 수요에 맞추어 호응을 해주어야 한다. 잡지의 표지가 판매수단에 절대적인 요소가 된 만큼 시각적 효과를 최대한 이용하여 설득력 있고 독자의 시선을 끌 수 있는 그 잡지만의 이미지를 만들어내는 것이 필요하다. 본 연구는 획일화 되어있는 표지디자인에서 벗어나 좀 더 독창적이고 개성적인, 차별화 된 표지디자인의 발전방향을 모색해 보는데 목적이 있다. 이를 위하여 문헌 조사를 통해 전문지의 개념과 영화전문지 현황, 잡지표지디자인의 특성과 구성요소, 기능, 조형요소에 대하여 알아보았다. 본 연구에서 필요한 자료들은 국내의 대표적인 영화전문지중 주간지인 〈씨네21〉, 〈필름2.0〉, 〈무비위크〉를 대상으로 표지디자인의 시각표현에 대해 조형요소인 레이아웃, 타이포그래피, 사진, 색채의 비교·분석을 통하여 수집되었다. 해당 전문지는 각각 2008년 5월에서 10월 사이에 발행된 25개의 잡지들을 대상으로 하였고 총 75개의 표지디자인이 분석에 사용되었다. 그 밖에 외국 영화잡지의 표지디자인 사례를 살펴보고, 또한 객관적인 문제점 파악을 위해 설문조사를 함께 실시하였다. 그 분석 결과를 토대로 현재 표지디자인의 문제점을 파악해본 후 개선방향을 고려한 별도의 샘플표지를 제작하여 디자인 모델을 제안해봄으로서 연구의 결론을 맺고자한다.;The contemporary mass media society has been accompanied by the steady development of mass production and information of industrialization and professionalism. Amid the plethora of images, a lot of stimuli and information are naturally accepted. Since the 1990s, a sharply increasing number of cultural content industry have given rise to much concern about the film industry. The growth of the film industry has brought about the development of professional magazine. These magazines have become popular media to maintain constant amounts of sale, even in financially-clinched situations, but the recently economic slump hit hard the printing industry. With today&amp;apos;s trend changing from printed media into multi-media, and the financial situations becoming in difficulties, the self-protective measures to attract readers have increasingly made film magazines lose their original status and reduce to weekly mass magazine, under the cause of mass popularity. The increasing pursuit of ‘entertainment magazine’ found the unique attributes of professional film magazines moving to disappear and instead, witnessed the uniform visual expressions in most magazine covers. The uniform characteristics led to an awareness that through even just a volume of film magazine, film magazine markets can assume what is described in the magazine. In effect, the public awareness that all magazine contain similar contents triggered film magazines to become too worthless to secure their high status. With magazine mania readers requesting for the authenticity and professionalism of film magazines, the magazines in pursuit of identity as professional film magazines are given attention. But, the accurate targets are to be made in accordance with information society. And, the relevant cover design must be created in line with various demands. A cover of magazine has to create special visual expression to the public and create its own image as it&amp;apos;s becoming primary essential to magazine sales. The aim of this research thesis is at abandoning uniform cover design and, instead, developing more unique, individualistic and professional film magazine identity-based cover design. In this regard, this thesis made the exploration on the concepts, ongoing situations of professional film magazines along with the traits, components, function and formative factors of magazine cover design, based on preceding and pertained literary research data. As to data necessary for this research, 〈CINE21〉,〈FILM2.0〉,〈movieweek〉, professional weekly film magazines typical in the nation, were gathered to make the comparative analysis on visual formative factors of cover design, such as layout, typography, photo and color. Each pertained magazine was surveyed of 25 magazines published from May to October 2008, respectively. And, total 75 cover designs were used for the analysis. Besides, this thesis shed light on cases of cover design of foreign film magazines, and at the same time, conducted a survey for the purpose of comprehending more objective questions. Through the analytic results, this research thesis is to illuminate the ongoing problems of cover design, and devise sample covers necessary for making the better design, and lead to the conclusion of this research, giving insight to design model.1. 서론 = 1 1.1. 연구 목적 = 1 1.2. 연구대상 및 방법 = 3 2. 이론적 배경 = 6 2.1. 잡지의 일반적 고찰 = 6 2.2. 전문지의 특성 = 8 2.3. 국내 영화전문지의 현황 = 9 2.3.1. 국내 영화전문지의 변천 = 9 2.3.2. 잡지시장에서의 위치 = 14 3. 표지디자인에 대한 이해 = 17 3.1. 표지디자인의 특성과 구성요소 = 17 3.2. 표지디자인의 기능 = 20 3.3. 표지디자인의 조형요소 = 26 4. 영화전문지 표지디자인의 조형요소 분석 = 34 4.1. 국내 영화잡지 표지디자인의 조형요소 분석 = 34 4.1.1. 레이아웃 분석 = 35 4.1.2. 타이포그래피 분석 = 36 4.1.3. 사진 분석 = 38 4.1.4. 색채 분석 = 39 4.1.5. 조형요소 분석결과 = 41 4.2. 외국 영화잡지 표지디자인의 사례 = 42 4.2.1. Sight &amp;amp; Sound (영국) = 42 4.2.2. Positif (프랑스) = 44 4.2.3. American Cinematographer (미국) = 45 4.3. 영화잡지 표지디자인에 관한 실증조사 = 46 4.3.1. 조사 개요 = 46 4.3.2. 영화잡지 표지디자인에 관한 설문조사 분석 = 47 5. 작품제작 = 50 5.1. 분석결과에 따른 개선방향 = 50 5.2. 제작의도 및 방법 = 53 5.3. 작품제작 및 해설 = 55 6. 결론 = 64 6.1. 연구의 결과 = 64 6.2. 한계점 및 제언 = 65 참고문헌 = 67 부록 1-1. 국내 영화전문지 표지 = 69 부록 2. 설문지 = 87 ABSTRACT = 9