(The) research for the application status of basic CPR and AED by the hospital nurse

응급간호전공/석사[한글]본 연구는 기본 심폐소생술 교육을 받은 간호사를 대상으로 기본 심폐소생술과 제세동기 교육 및 활용 현황을 파악한 조사연구이다.연구대상은 700병상 이상의 대학병원에서 기본 심폐소생술을 받은 간호사 400명중 연구의 참여에 동의한 172명을 대상으로 설문조사하여 결과분석에 사용된 설문지는 152부 이었다.연구도구는 본 연구자에 의해 개발된 37문항의 설문지를 사용하였다. BLS 교육현황, AED 교육현황, AED 교육현황, PAD와 AED 활용 현황에 대해서 빈도와 비율을 산출하였다.본 연구의 결과를 제시하면 다음과 같았다.1. 대상자의 70%가 72개월 이하의 경력을 가지고 있으며 약 85%가 중환자실 과 응급실에 근무하고 있었다. 현 근무 병원에 CPR 전담팀이 없는 경우가 80.3% 이었다.2. BLS 교육은 병원 내 자체 프로그램을 통하여 교육이 수행되고 있는 경우가 67.8%이었고 스스로의 필요성에 의한 자진 교육과 보수교육 차원에 의한 교육이 수행되고 있는 경우가 50% 이었으며, 교육 빈도는 1년에 1회 교육 을 실시하는 경우가 43.4로 가장 많았다.3. BLS의 교육중요성에 대해서는 10점 만점에 8점 이상이 76.9%이었으나, BLS의 임상공헌도는 10점 만점에 8점 이상이 47.8% 이었다.4. 연구대상자의 약 80%가 AED 작동교육을 받았고 약 62%의 대상자가 AED 작동 능력이 있는 것으로 나타났다.5. 연구대상자의 87.5%가 제세동기를 확보하고 있는 것으로 나타났으나 제세동기 적용 여부는 61.8%로 나타났다. 제세동기 적용 시 EKG 리듬은 ASYTOLE과 VF/VT이 61.9%로 나타났다. 또한 심정지 환자에게 제세동기를 통해 직접 “쇽”을 적용한 경험은 16.4%로 아주 낮은 것으로 나타났다.6. AED활용방안에 대해서는 심정지 환자의 의식 확인 후 연락과 AED 사용이 50.7%로 가장 많았고 심정지 환자 의식 확인 후 구조요청 시 AED를 선택한 이유는 리듬 확인의 책임이 없고 사용 방법이 간단한 것이 주된 이유로 나타났다. AED 사용자는 일반인보다 의료인에게 사용 권한을 주어야 한다는 의견이 더 높은 것으로 나타났다.결론적으로 병원 간호사의 기본 심폐소생술에 대한 교육은 병원 내 자체 프로그램으로 진행되고 있으며 스스로의 필요성과 보수교육 차원에서 교육에 참여하고 있었다. 또한 간호사의 대부분이 기본 심폐소생술의 교육이 중요하다고 인지하고 있으나 임상공헌도는 낮은 것으로 인지하고 있었다. 또한 심정지 환자 의식 확인 후 연락과 AED 사용이 필요하다고 인식하고 있으며 AED는 의료인이 사용해야 한다는 의견이 높았다.따라서 EKG 분석의 부담이 없으면서 모니터와 심실세동과 같은 중대 질환인 경우 쇽 치료를 바로 실행할 수 있는 AED가 병원 내 그리고 각 병동 내에 설치, 활용 될 수 있는 방법과 실제 환자발견의 일차적 의료인인 간호사들이 조기제세동을 시행할 수 있도록 방안 모색이 이루어져야 한다. [영문]This study is to research basic Cardiopulmonary Resuscitation(CPR) and the status of AED(Automatic External Defibrillator) education and utilization to a group of nurses who were educated basic CPR.The questionnaire was 152 copies about the target of 172 nurses who were attended to this study out of 400 nurses who were educated by basic CPR at university hospital of over 700 medical condition.A tool of this study used 37 questions of the questionnaires that were made by the researcher of this study.The frequency and the rate were produced about the status of BLS(Basic life Support) and AED education, the status of AED and PAD utilization.The following is the result of this study.1. 70% of nurses have career below 72 months and about 85% of them were working in Intensive Care Unit(ICU) and emergency room.The case which has no the team that takes full charge of CPR in current working hospital was 80.3%.2. About BLS education, it was 67.8% that was being carried out training through the educational program in own hospital and, about the education for the need in person and by filling up, it was 50%, and about the education frequency, it was 43.4% that the case that the education was being carried out 1 time in a year.3. 76.8% of them got over 8 points out of 10 about the importance of BLS education but, 47.8% of them got over 8 points out of 10 about the degree of clinic contribution of BLS.4. About 80% of nurses were educated by AED functioning education, and it was shown that about 62% of nurses had AED functioning ability.5. It was shown that about 87.5 % of nurses had AED, but it was 61.9% whether AED was applied or not.Also, it was shown that the experience that they applied for a shock to a cardiac arrest patient through AED directly was very low, it was 16.4%.6. It was strongest that contact after check up with the consciousness of a cardiac arrested patient and the use of AED for utilization plan of AED were 50.7%, and some of the reasons for selecting AED, the main reason was shown that it is not responsible for identification of rhythm and the method of use is simple.It was shown that the opinion that it has to be given the right of use to a paramedic than a public person about the use of AED.In conclusion, the education about basic CPR of a nurse in hospital is being carried out training through the program in own hospital and they were taking part in the education for the need in person and by filling up.Also, most of them recognized for the importance of the education of CPR, but most of them recognized that the degree of the clinic contribution was low.Besides, they were recognizing that the use of AED and contact after check up with the consciousness of a cardiac arrested patient are need and the opinion that a paramedic has to use AED was strongest.Therefore, with no burden for EKG(Electrocardiogram) analysis, in case of serious disease like Ventricular Fibrillation, it will have to be discussed that how to be made use of AED which is able to carry out shock medical cure immediately?and be installed a monitor within hospital and each ward, and it will try to look for ways for nurses who are the first paramedic of patient discovery in effect to carry out AED.ope

Low temperature electrical conduction of insulating granular In/InOx films

Maste

지방세포분화에서 HB-EGF의 억제효과

Dept. of Dental Science/박사[한글]비만은 우리 몸의 지방조직이 지방세포분화에 의해 비정상적으로 증가된 상태로 불균형적인 에너지의 과잉공급으로 유발된다. 비만은 고혈압, 고지질증, 동맥경화, 심장질환 및 인슐린 비의존형 제2형 당뇨병과 같은 성인성 질환을 유도하는 가장 중요한 위험인자로 작용하기 때문에 지방세포분화와 지방대사 조절에 대한 관심이 더욱 집중되고 있다.지방세포가 단순히 수동적인 에너지 저장고라는 개념에서 에너지 대사를 비롯한 체내 에너지 항상성을 유지시켜주는 기능을 수행하는 조직으로 생각되면서 지방세포의 다양한 기능에 대한 연구가 진행되고 있다. 지방세포에서 여러 가지 cytokine, hormone, lipid 등이 분비되는데 이러한 물질들의 비정상적인 분비가 비만과 당뇨와 같은 성인성 질병들의 원인으로 작용할 수 있다고 밝혀지고 있다. 지방세포에서 생성되며 다양한 신호 전달에 관여하는 leptin, adiponectin, resistin, IL-6 등의 물질들을 통칭해서 adipocytokine 이라고 명명하였고, 최근에는 HB-EGF 역시 지방조직에서 발현하는adipocytokine 중 하나로서 비만에 관련된 성장인자로 새롭게 인식되고 있다.본 연구에서는 adipocytokine중 하나인 HB-EGF가 지방세포분화에서 어떤 역할을 하는지 알아보았다. HB-EGF는 지방세포분화 유도 중 초기단계에서는 그 발현이 줄어 들었다가 후기단계에서 다시 발현하는 양상을 보였다. 3T3-L1, 3T3-F442A preadipocyte cell과 mesenchymal stem cell과 유사한 C3H10T1/2 cell에 HB-EGF를 처리하여 지방세포분화를 유도했을 때, HB-EGF는 이러한 세포의 지방세포분화를 억제시켰고, 흥미롭게도C3H10T1/2 cell의 지방세포분화에서 가장 큰 억제효과를 보였다. Adipocyte marker gene인 aP2, PPARγ 그리고 C/EBPα의 발현도 감소하였다. HB-EGF의 지방세포분화 억제효과 시기를 알아보기 위해 지방세포분화의 다양한 시기에 HB-EGF를 처리해 본 결과 지방세포분화 초기단계가 HB-EGF의 억제효과를 위해 중요한 시기임을 알았고, 중기나 후기 단계에서는 HB-EGF의 억제효과를 볼 수 없었다. 또한HB-EGF가 지방세포분화 유도 전단계인 commitment 단계에서도 억제효과를 보이는지 알아보기 위해 HB-EGF를 지방세포분화를 유도하기 전에 처리한 결과 뚜렷한 억제효과를 보였다. Pluripotent stem cell을 adipocyte lineage로의 commitment를 유도한다고 알려져 있는 BMP4와 함께 처리하여 지방세포분화를 유도했을 때도 억제효과를 보였다. 이러한 결과는 HB-EGF가 지방세포분화유도 초기단계에서뿐만 아니라 adipocyte lineage commitment 단계에서도 억제효과가 있음을 시사한다.따라서HB-EGF는 초기단계에서 지방세포분화를 억제하기 때문에 지방세포로 분화되는 초기단계 세포에서는 HB-EGF의 발현이 줄어들고, 후기단계에 다시 발현하는 HB-EGF는pluripotent stem cell과 preadipocyte의 지방세포분화 시작을 억제함으로써pluripotent stem cell의 potential을 유지시켜 주며 이로써 비만형성을 조절하는 역할을 할 것이라고 추정한다. [영문]Obesity poses a serious health risk contributing to the increased prevalence of a host of other diseases including type 2 diabetes, hyperlipidemia, hypercholesterolemia and hypertension. Adipose tissue is vital for maintaining whole body energy homeostasis. It has traditionally been considered a mere energy depot, synthesizing and storing triglycerides during periods of caloric excess and releasing free fatty acids and glycerol during periods of nutritional deprivation. However, it is now recognized to play a more active role in regulating glucose and lipid metabolism as an endocrine organ secreting biologically active molecules (leptin, adiponectin, resistin, IL-6, etc.), so called adipocytokines. Adipocytokines are associated with adipocyte differentiation and metabolic disorders. Recently, Heparin-binding EGF-like growth factor (HB-EGF) was identified as an adipocytokine expressed in adipose tissue.In order to elucidate the biological characteristics of adipose tissue, this study investigated the effect of HB-EGF on adipocyte differentiation of 3T3-L1 and 3T3-F442A preadipocyte cells, and mecenchymal stem cell –like C3H10T1/2 (10T1/2) cells. HB-EGF decreased intracellular lipid accumulation in 3T3-L1, 3T3-F442A and 10T1/2 cells and significantly reduced expression of most adipocyte marker genes including aP2, PPARγ and C/EBPα, suggesting that HB-EGF inhibits adipogenesis. Upon adipogenic conversion, HB-EGF displayed dynamic changes in expression where an initial decrease was followed by increased levels of expression at later stages. Administration of HB-EGF for various periods during adipocyte differentiation revealed an inhibitory effect on adipocyte differentiation at the early induction stage but no effect at later stages. In addition, HB-EGF showed an inhibitory effect at the commitment stage in 10T1/2 cells, when pluripotent stem cells can be induced to commit to the adipocyte lineage prior to the induction, and even at the bone morphogenic protein (BMP) 4-triggering commitment stage. These data suggest that HB-EGF has inhibitory effects on commitment as well as the early induction stages. Due to the inhibitory effects of HB-EGF on the adipocyte differentiation, 3T3-L1, 3T3-F442A and 10T1/2 cells may halt the endogenous expression of HB-EGF at the early stage and the endogenous expression of HB-EGF at the late stage may negatively regulate initiation of the other adipocyte differentiation for the feedback.prohibitio

중학교 화학에 적용한 해결자·청취자 활동에서 의사소통 불안 수준에 따른 소집단 구성의 효과

학위논문(석사) --서울대학교 대학원 :과학교육과(화학전공),2008.2Maste

Heparin-binding epidermal growth factor-like growth factor inhibits adipocyte differentiation at commitment and early induction stages.

Adipocytokines, bioactive molecules secreted from adipose tissues, play important roles in physiology, development, and disease. Recently, heparin-binding epidermal growth factor-like growth factor (HB-EGF) was identified as an adipocytokine whose expression correlates with obesity. However, the biological role of fat-secreted HB-EGF is still unclear. In this study, we investigated the effects of HB-EGF on the adipocyte differentiation of C3H10T1/2 pluripotent mesenchymal cells. Upon adipogenic conversion of C3H10T1/2 cells, HB-EGF displayed dynamic changes in expression where an initial decrease was followed by increased levels of expression at later stages. HB-EGF treatment during adipogenic induction inhibited lipid accumulation and decreased the expression of adipocyte molecular markers (fatty acid-binding protein, peroxisome proliferator-activated receptor gamma, and CAAT enhancer-binding protein alpha) and lipogenic genes (glucose transporter, fatty acid synthetase, and lipoprotein lipase). Therefore, HB-EGF has an inhibitory effect on adipocyte differentiation. Administration of HB-EGF at various intervals during adipocyte differentiation revealed that HB-EGF acts during the early stages of adipocyte differentiation, but not at the later stages of differentiation. Furthermore, HB-EGF was able to block the commitment of pluripotent mesenchymal cells to the adipocyte lineage triggered by bone morphogenic protein 4 treatment. These data suggest that HB-EGF acts as a negative regulator of adipogenesis by inhibiting the commitment and early differentiation of the adipose lineage. The inhibitory role of HB-EGF on adipocyte differentiation of pluripotent mesenchymal cells sheds light on potential mechanisms that control adipose tissue homeostasis.ope

Effects of heparin-binding epidermal growth factor-like growth factor on cell repopulation and signal transduction in periodontal ligament cells after scratch wounding in vitro

BACKGROUND AND OBJECTIVE: A growing amount of attention has been placed on periodontal regeneration and wound healing for periodontal therapy. This study was conducted in an effort to determine the effects of heparin-binding epidermal growth factor-like growth factor on cell repopulation and signal transduction in periodontal ligament cells after scratch wounding in vitro. MATERIAL AND METHODS: Human periodontal ligament cells were acquired from explant tissue of human healthy periodontal ligament. After the wounding of periodontal ligament cells, the change in expression of heparin-binding epidermal growth factor-like growth factor and epidermal growth factor receptors 1-4 mRNA was assessed. The effects of heparin-binding epidermal growth factor-like growth factor on periodontal ligament cell proliferation and repopulation were assessed in vitro via the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and by photographing the injuries, respectively. Extracellular signal-regulated kinase (Erk)1/2, p38 and Akt phosphorylation was characterized via western blotting. RESULTS: Scratch wounding resulted in a significant up-regulation of heparin-binding epidermal growth factor-like growth factor mRNA expression, whereas wounding had no effect on the expression levels of epidermal growth factor receptors 1-4. Interestingly, no expression of epidermal growth factor receptors 2 and 4 was detectable prior to or after wounding. Heparin-binding epidermal growth factor-like growth factor treatment promoted the proliferation and repopulation of periodontal ligament cells. The scratch wounding also stimulated the phosphorylation of Erk1/2 and p38, but not of Akt, in periodontal ligament cells, and heparin-binding epidermal growth factor-like growth factor treatment applied after wounding amplified and extended the activations of Erk1/2 and p38, but not of Akt. Furthermore, Erk1/2 inhibition blocked the process of cell repopulation induced by heparin-binding epidermal growth factor-like growth factor, whereas the inhibition of p38 delayed the process. CONCLUSION: These results indicate that heparin-binding epidermal growth factor-like growth factor may constitute a critical factor in the wound healing of human periodontal ligament cells by a mechanism that requires the activation of Erk1/2 via specific interaction with epidermal growth factor receptor 1.ope