Safety of Live Immunization in DiGeorge Syndrome: A Retrospective Single-Center Study in Korea, 2005-2021

Live immunization is contraindicated in patients with DiGeorge syndrome (DGS). We retrospectively investigated the occurrence of adverse events after live immunization in patients with DGS in Korea. The data of patients matching the International Classification of Disease-10 code of DGS (D82.1) at Severance Hospital Seoul, Korea, were extracted; patients without genetically diagnosed DGS were excluded. Based on T cell immunity status, the included patients were categorized into group A (CD3 < 500 or CD8 < 200 cells/mm3); group B (CD3 ≥ 500 and CD8 ≥ 200 cells/mm3); or group C (unknown). Among 94 patients, 38 (~40%, group A: 8 [21%]; group B: 30 [79%]) underwent immunological testing and 73 (~80%) received at least one live immunization (measles-mumps-rubella vaccination was most common [66/94, ~70%]). Fifty adverse events (fever [n = 29], upper respiratory infection [n = 9], diarrhea [n = 4], rash [n = 3], thrombocytopenia [n = 3], injection site pus [n = 1], and febrile convulsion [n = 1]) were observed; 13 (26%) occurred in group A, with no significant difference in incidence between groups A and B. Serious adverse events, including intensive care unit hospitalization or death, or diseases due to vaccine strains were not observed. In this study, live immunization was well tolerated by patients with partial DGS.ope

Risk of Dental Discoloration and Enamel Dysplasia in Children Exposed to Tetracycline and Its Derivatives

Purpose: To examine the risk of dental abnormalities after exposure to tetracycline and its derivatives (TCs) in Korean children. Materials and methods: Children aged 0-17 years with a claim for prescriptions of TCs between 2002 and 2015 were identified from the Sample Research Database 2.0 of the National Health Insurance Service. Children not exposed to TCs were selected as the control group by matching sex and age (1:4). Cumulative incidence rate and relative risk of dental abnormalities after TCs exposure were investigated. Results: The 10-year cumulative incidence rate in the 0-12 years group was 3.1% [95% confidence interval (CI), 2.3-3.9]. The 10-year cumulative incidence rates were 7.0%, 1.9%, and 1.6% in the 0-7, 8-12, and 13-17 years age groups (95% CI: 4.7-9.3, 1.2-2.6, and 1.3-1.9, respectively). There was no significant difference in the risk of dental abnormalities according to TC exposure among the age groups of 0-7 years [adjusted hazard ratio (aHR)=1.0], 8-12 years (aHR=1.1), and 13-17 years (aHR=1.2). Conclusion: Short-term exposure to TCs does not appear to increase the risk of dental abnormalities in children aged 0-7 and 0-12 years. Restrictions on the use of TCs in children aged 8-12 years, in some countries, may warrant consideration.ope

The Relation between cognitive belief about learning physics and understanding of wave concept

학위논문(박사)--서울대학교 대학원 :과학교육과 물리전공,2001.Docto

소크라테스식 대화법과 소집단 토론 활동이 대학생의 일반물리 역학 개념 변화에 미치는 영향

학위논문(석사)--서울대학교 대학원 :과학교육과 물리전공,1996.Maste

(A) clinical study of the effect of auditory stimulation on the arousal response of the stuporous patient with brain injury

간호학과/석사[한글] 인간은 변화하는 외부환경과 상호작용하며 이에 적응하면서 생리, 정신, 사회적으로 정상적인 성장과 발달, 성숙을 해가는 존재이다. 환경적 요소로서의 감각자극은 신체의 감각기관이 지속적이고 다양한 자극에 노출되게 하며 인간은 외부환경의 정보를 수용, 뇌의 인지적 과정을 통해 감각을 분석하여 보다 복합적인 재반응을 하면서 인간실존의 기본적인 상호작용을 이뤄가고 있다. 그러므로 환경의 자극은 인간에게 필수적이고 상호의존적인 것이라 할 수 있다. 그러나 뇌출혈, 뇌경색, 뇌진탕, 저산소증등 여러 원인에 의해 뇌손상을 받아 수 일에서 수 년동안 무의식상태에 놓이는 한자들은 외부환경과의 의미있고 조화로운 상호작용과정에 장해를 받아 감각박탈이 되기 쉽고, 외적자극의 질적, 양적 감소는 정상적인 신체 뿐 아니라 생리·심리적 측면의 결핍을 초래하게 된다. 또한 뇌손상 후 회복기간동안 풍부한 환경과의 활발한 상호작용은 신경전달기능과 대뇌활동의 활성화 및 각성에 매우 중요한 영향을 주는 것으로 알려지고 있다. 이에 본 연구는 뇌손상 후 무의식 상태에 있는 황자에게 음악을 이용한 청각자극을 적응하였을 떼 상행성 신경섬유를 따라 고위중추로 전달되면서 대뇌 피질을 활성화시켜 의식의 구성요소인 각성을 일으키는지를 뇌파검사와 생리적 반응 관찰을 통해 확인해 보고자 시도되었다. 이는 무의식 환자에게 청각자극을 적응하는 것이 의식각성에 어떤 효과를 주는지에 대한 근거를 제시하여 의식수준향상을 위한 새로운 간호중재 방법으로써 청각자극을 적극 활용토록 하기 위함이다. 본 연구는 원시실험연구로서 자료수집은 1992턴 4월부터 5월까지 서울Y 대학부속병원 신경외과에 입원 중인 뇌손상 환자 중 의식수준이 혼미한 환자 11명을 연구대상자로 하였으며, 11명의 유발전위 검사결과 뇌간기능장애를 보인 1명을 제외한 나머지 10명에게 3회의 청각자극을 적용하여 그 결과 30례의 뇌파 및 생리적 반응을 수집하였다. 청각자극에 사용된 연구도구는 문헌고찰과 임상 전문가의 의견을 근거로 한국인에게 가장 익숙한 가곡 1곡, 민요 1곡을 선택하여 75 dB로 혜드폰을 통해 적용하였다. 청각자극의 의식각성 효과를 측정하기 위해서 청각자극 적용 전·중·후 뇌파검사를 통해 각성반응 및 심박동수, 호흡수를 측정하였고 기록지를 통해 청각자극 적용시 자발적 움직임을 관찰하였다. 수집된 자료의 분석 중 뇌파변화는 신경과 전문의 2인의 2회 반복 판독과정을 거쳤으며, 심박동수와 호흡수의 변화는 paired t-test로 분석하였다. 연구결과는 다음과 같다. 1. 청각자극을 적용하였을 때 총 30례 중 17례 (56.7%) 에서 뇌파상 각성반응이 나타났으며, 13례(43.3%)에서는 뇌파상 특별한 반응을 보이지 않았다. 또한 3회의 청각자극 적용시 1회이상 각성반응을 보인 경우가 9명, 3회 모두 각성반응이 나타나지 않은 경우가 1명으로 나타났다. 2. 청각자극 적용 전·중·후 시간경과에 따른 심박동수 변화를 분석한 결과 청각자극 적용 중 3분동안 통계적으로 유의하게 심박동수가 증가됨을 보였다. 3. 청각자극 적용 전·중·후 시간경과에 따른 호흡수의 변화를 분석한 결과 통계적으로 유의한 차이가 나타나지 않았다. 4. 청각자극 적용 전·중·후 시간경과에 따른 자발적 움직임을 관찰한 결과 총 30례 중 청각자극 적용 전에는 눈을 감고 자던 환자가 청각자극 적용중에 눈을 크게 뜬 경우가 8례, 눈을 반쯤 뜨다가 곧 감은 경우가 2례, 고개를 돌린 경우가 2례 나타난 것을 관찰할 수 있었다. 이상과 같이 청각자극이 뇌손상후 혼미한 환자의 대뇌활동의 활성화를 일으켜 의식각성의 효과를 주는데 어느 정도 유효한 것으로 확인되었다. 그러므로 본 연구의 결과에 따라 뇌손상 후 외부환경의 의미있는 자극과의 지속적이고 풍부한 상호작용의 결핍을 경험하는 환자들에게 청각자극을 적용할 때 각성효과가 있으리라 사료된다. 본 연구의 결과를 기초로 다음과 같은 제언을 하고자한다. 1) 뇌손상 초기부터 계속적인 청각자극을 적응하여 장기적인 효과를 측정하는 연구가 요구된다. 2) 청각자극 이외에 시각, 촉각, 미각, 후각자극 각각의 효과와 오감각 모두를 통합하여 적응하였을 때의 효과를 규명하는 추후연구가 필요하다. 3) 뇌손상의 정도와 의식장애 정도에 따라 감각자극이 의식수준향상에 미치는 효과를 비교하는 연구가 요구된다. [영문] Stimulation or interaction between the environment and the human has been found to be essential for normal physiological, physiological, and social growth and development. Brain injury results in disorganization of the neural accessory pathways. A brain injured patient is in a sensory-deprived environment because of decreasing interaction with the environmental and decreased stimulation related to altered sensory input, altered neural transmission and synaptic connection, and altered perceptive and cognitive function. Therefore specific, active interaction with the environment are important to recovery following brain injury. Providing appropriate, nonthreatening sensory stimulation to these individuals may enhance synaptic connections and provide adequate stimulation to the activating system of brain, and thus enhance arousal, resulting in increased levels of consciousness. The purpose of this pre-experimental study was to determine the effect of a specific auditory stimulation input on the arousal response as an activation of cortical activity in selected patients with brain injuries. Data was collected from April to May, 1992 at Y University Hospital in Seoul. The subjects were four female and six male adults between 20and 67 years of age, who had a brain injury as the result of cerebral contusion, intracranial hemorrhage or hypoxic brain damage. The level of consciousness was stupor in all subjects. A portable cassette player with headphones was used to provide the specific auditory stimulus: 3 minutes recording of two familiar Korean songs with the average sound level at 75 dB SPL. This was repeat 3 times for each subject. In order to determine the function of the brainstem, all subjects were examined using the Brainstem Auditory Evoked Potential(BAEP). According to the BAEP results, one subject who had brainstem dysfunction on bilateral BAEP was dropped. Finally for ten subjects who had normal brainstem function on bilateral or unilateral BAEP, baseline EEGs were taken for evaluation as the pre-experimental data EEG. Then, the arousal response was recorded by EEG, EKG, EOG and Respiration recorder at three time periods: pre, during and post auditory stimulation. Each subject was observed and measurements were taken for one minute (pre stimulation observation), then the tape recording was played for three minutes and measurements were taken(during stimulation period). Finally the subject was observed and measurements were taken for three minutes (post stimulation period). This was repeated three times for each subject. Additional measures of the subjects' voluntary movement following stimulation were obtained by observation at the pre, during and post period of the auditory stimulation. This data collection resulted in 30 measures of all variables pre, during and post stimulation for each of ten subjects. Data analysis were as follows: 1) The result of the EEG during auditory stimulation was analysed by two Neurology doctors whose subspecialty was EEG reading. 2) Paired t-test was used to determine the level of significance for changes in heart rate and respiration rate in subjects at during and post auditory stimulation in comparison with pre stimulation. The findings indicated that persons in a stupor do respond to auditory stimulation. 1) For 17 (56.7%) of the measurements during stimulation demonstrated arousal response on EEG. Nine subjects demonstrated arousal response on stimulation more than once, only one subject did not demonstrate arousal response on stimulation. 2) A Statistically significant increase in heart rate was found during auditory stimulation. 3) No significant change in respiration rate was found. 4) Voluntary movements (especially eye opening) were observed in twelve observations during stimulation. The findings mean that the nurse who care for the unconscious patient with brain injury can prevent sensory deprivation and provide appropriate, continuous auditory stimulation for arousal to increase interaction with environment and to improve the level of consciousness. But questions remain concerning the optical type and amount of stimulation necessary to activate on the patient arousal. Further studies are necessary to determine the long-term value of ear auditory stimulation including the level of consciousness, the effect of other stimulation (visual, tactail, olfactory and gustatory) or the integration of all stimulation. Further work needs to be done to compare the effect of sensory stimulation on the level of consciousness according the level of brain iajury and impaired consciousness.restrictio