Earticle

교통사고 감소를 위해 다양한 교통안전 활동을 펼친 결과, 국내 교통사고 사망자 수는 2013 년부터 감소세를 보이며 역대 최저 사망자 수(2023년)를 기록했다. 반면, 일반사고에 비해 치사 율이 6배 이상 높은 2차 사고는 지속적으로 발생하고 있어, 이에 대한 관심과 체계적인 대책 마련이 요구된다. 2차 사고는 1차 사고로 인하여 이미 안전장치가 소모되어 2차 충돌로 인한 충격을 흡수하지 못하며, 운전자가 무방비 상태에 놓여 심각도가 매우 높다. 이에 본 연구는 고속도로에서 발생하는 2차 사고의 심각도에 영향을 미치는 요인을 분석하여 2차 사고 심각도 를 줄이기 위한 방안을 제시하였다. 한국도로공사의 최근 10년간 고속도로 2차 사고 데이터를 기반으로 주요 요인들에 대한 통계분석을 실시하여 주야, 사고유형, 사고차종 등 사고 심각도 에 유의미한 영향을 미치는 요인을 도출하였다. 차량 간 통신시스템을 통해 전방사고에 대한 정보를 후속차량들에게 신속하게 전달할 수 있는 방안과 고광도 LED 경고등, 가로등의 깜빡임 과 같은 시각적 정보를 제공하는 방안 등을 모색하였다.

As a result of various traffic safety activities to reduce accidents, the number of traffic fatalities in Korea has been declining since 2013 and reached its lowest number ever in 2023. On the other hand, secondary incidents, which have a fatality rate more than six times higher than accidents in general, continue to occur and require attention and systematic countermeasures. Secondary incidents are serious because safety equipment has already been exhausted after dealing with the primary accident and emergency responders cannot properly deal with the secondary collision, leaving the vehicle occupants at risk. This study analyzes the factors that contribute to the severity of secondary incidents on expressways, and suggests measures to reduce the severity. Based on the most recent 10 years of secondary highway incident data from Korea Expressway Corporation, a statistical analysis was conducted to derive the major factors that significantly affect accident severity, such as day versus night, accident type, and vehicle type. The result is a plan to quickly transmit information about an accident to approaching vehicles by using an inter-vehicle communication system, including a proposal to provide visual information, such as high-brightness LED warning lights and blinking street lights.

연구목적: 본 연구는 원전 화재위험성 평가를 위한 심각도 추정에 활용되는 전기캐비닛의 열방출률 DB 구축을 목적으로 한다. 연구방법: 이를 위해 캐비닛의 형태 특이성(체적, 개구부, 가연물 등)을 기반으로 화재시나리오들을 도출하였고, 전기캐비닛 화재시험 설계를 위하여, 가연물 선정 및 버너 열량 도출을 위한 실험이 수행되었다. 연구결과: 개발된 시험 방법 및 선정된 화재시나리오에 대하여, 국내 원전 전 기캐비닛에 대한 열방출률 DB를 구축하였으며, FDS를 통한 신뢰성 검증이 수행되었다. 결론: 구축된 전기캐비닛 열방출률 DB는 원전 화재위험성 평가에 적용되는 심각도 추정을 위한 인자로서 적용된다. 향후 모든 전기캐비닛 화재 시나리오를 포괄하는 데이터베이스 구축이 계획되어 있으며, 후속 연구에 서는 국내 전기캐비닛의 화재 심각도를 정량적으로 추정할 수 있는 기법 개발이 진행될 예정이다. 이러 한 연구는 원자력 발전소 화재 안전성 평가의 정확성과 신뢰성 향상에 기여할 것으로 기대된다.

Purpose: This study aims to establish a database of heat release rates of electrical cabinets that can be utilized for severity estimation for NPP fire risk assessment. Method: For this purpose, fire scenarios were derived based on the specificity of the cabinet shape (volume, opening, combustibles, etc.), and for the design of the electrical cabinet fire test, a cone calorimeter test for combustibles selection and a cable vertical fire spread test for fire source calorific value selection were performed. Result: Based on the developed test method and selected fire scenarios, a Heat Release Rate (HRR) database for domestic nuclear power plant electrical cabinets was established, and its reliability was verified through FDS. Conclusion: The established electrical cabinet heat release rate DBs are applied as severity estimation factors for NPP fire risk assessment. In the future, a database covering all electrical cabinet fire scenarios is planned, and a follow-up study will be conducted to develop a technique to quantitatively estimate the fire severity of domestic electrical cabinets. These studies are expected to contribute to improving the accuracy and reliability of fire safety assessments for nuclear power plants.

연구목적: IEEE 383과 같은 원자력발전소(원전) 케이블의 표준 화재 안전성 시험은 신품을 대상으로 하므로, 장기 운영에 따른 열화가 난연성능에 미치는 영향에 대한 지식 공백이 존재한다. 본 연구는 가속 열화를 통해 장기 사용된 원전 케이블의 화재 안전성능 변화를 정량적으로 분석하고, 이를 평가할 새로운 지표를 개발하는 것을 목적으로 한 다. 연구방법: 안전등급 케이블 2종(A: XLPE, B: EPR/CSPE)에 대해 아레니우스 모델을 적용하여 최대 40년 등가 수 명에 해당하는 가속 열화를 수행하였다. 이후 IEEE 383 수직 화염 시험으로 난연성능을 평가하였으며, 화재 거동을 정량화하기 위해 화원으로부터 특정 거리에서의 최대 온도상승률(°C/s)로 정의되는 새로운 열성장지수(TEGRA)를 제안하였다. 연구 결과: 가속 열화는 케이블의 난연성능에 유의미한 영향을 미쳤으며, 그 영향은 케이블 종류에 따라 다르게 나타났다. 제안된 열성장지수는 평균 탄화 길이를 예측하는 유의한 변수임이 확인되었다. A 케이블의 회귀 모델은 가속열화온도에 의해 높은 설명력(R2>0.6)을 보인 반면, B 케이블 모델의 설명력은 상대적으로 낮아(R2= 0.313) 후자의 열화 거동이 더 복잡함을 시사했다. 결론: 본 연구는 기존 화재 안전성 표준이 경년 열화된 원전 케이블 의 위험성을 충분히 반영하지 못할 수 있음을 실험적으로 입증하였다. 제안된 열성장지수는 성능 기반의 화재 안전 성 평가를 위한 새로운 정량적 지표로서의 가능성을 제시하며, 원전의 경년 열화 케이블에 대한 보다 현실적인 화재 안전성 평가 기준 수립과 상태 기반 유지보수(CBM) 전략 개발의 기초 자료로 활용될 수 있을 것이다.

Purpose: This study aims to establish a database of heat release rates of electrical cabinets that can be utilized for severity estimation for NPP fire risk assessment. Methods: For this purpose, fire scenarios were derived based on the specificity of the cabinet shape (volume, opening, combustibles, etc.), and for the design of the electrical cabinet fire test, a cone calorimeter test for combustibles selection and a cable vertical fire spread test for fire source calorific value selection were performed. Results: Based on the developed test method and selected fire scenarios, a Heat Release Rate (HRR) database for domestic nuclear power plant electrical cabinets was established, and its reliability was verified through FDS. Conclusion: The established electrical cabinet heat release rate DBs are applied as severity estimation factors for NPP fire risk assessment. In the future, a database covering all electrical cabinet fire scenarios is planned, and a follow-up study will be conducted to develop a technique to quantitatively estimate the fire severity of domestic electrical cabinets. These studies are expected to contribute to improving the accuracy and reliability of fire safety assessments for nuclear power plants.

연구목적: 원자력발전소 화재 방호 설비의 신뢰성을 높이고 노심 손상 빈도(CDF) 저감을 위한 유지보 수 방법을 개발합니다. 연구방법: 본 연구에서는 CDF의 주요 요소(λ, SF, NSP, CCDP)를 분석하고, 트 리 구조를 활용해 이해를 도왔으며, CDF 저감을 위한 주요 요소를 도출합니다. 연구결과: CDF 요소 트 리 분석을 통해 화재진압 실패 확률에 대한 요소를 분석하고, 화재 감지 실패 확률과 소방대 진압 실패 확률 감소를 통해 CDF 저감을 기대합니다. 결론: 본 연구는 CDF 저감과 설비 신뢰성 향상을 통해 원자 력발전소의 화재 안전성을 강화할 수 있는 효율적이고 선제적인 방안을 제시할 수 있도록 CDF 저감의 주요 요소를 제안합니다.

Purpose: This study aims to develop a maintenance method for fire protection systems in nuclear power plants to enhance system reliability and reduce Core Damage Frequency(CDF). Method: In this study, the main elements of CDF(λ, SF, NSP, CCDP) are analyzed, and a tree structure is used to aid understanding. Key factors for CDF reduction are identified. Result: Through the analysis of the CDF element tree, factors affecting fire suppression failure probability are examined. It is expected that reducing the probabilities of fire detection failure and firefighter suppression failure will contribute to CDF reduction. Conclusion: This study proposes key elements for CDF reduction, providing an efficient and proactive approach to enhancing the fire safety of nuclear power plants by improving equipment reliability and reducing CDF.

본 연구에서는 실제 도박에 참여하고 있는 문제성 및 병적 도박자를 대상으로 탐색적, 확인적 요인분석을 통하여 5요인 도박동기 모형을 검증하고 도박동기가 도박 심각도에 미치는 직접효과 모형과 간접효과 모형을 비교, 검증하고자 하였다. 연구대상은 경마, 카지노, 불법 도박 등의 도박에 참여중인 도박자 221명이었다. 연구결과, 도박자에 대하여도 사교동기, 유희동기, 회피동기, 흥분동기, 금전동기의 5요인 도박동기 모형이 검증되었으며 직접효과 모형에 비하여 간접효과 모형의 부합도가 높았다. 금전동기는 도박문제의 심각도에 가장 강력하고 직접적인 영향력을 미치는 동기였다. 회피동기와 흥분동기는 도박 심각도에 직접적인 효과를 미치지 못하였으며 금전동기를 매개하여 작용하고 있었다.

The purpose of this study was first to verify five factor model of gambling motives by using exploratory and confirmatory factor analysis from current gambers and secondly to compare indirect model with direct model on gambling severity. Subjects were 221 gamblers participates in legal or illegal gambling such as casino, horse-racing, poker etc. The five motivational factors for gambling consist of the motives for socialization, the amusement, avoidance, excitement, and monetary. The extracted factors were adopted in order to construct an indirect model and a direct model, describing how gambling motives impact on gambling severity. The results showed that the fitness of the indirect effect model was more respectable than the direct model was: the motives for avoidance and excitement were indirectly mediated by the monetary motive in the effect on the gambling severity, whereas the monetary motive have the most powerful and direct effect among the extracted motivational factors. This previously underestimated monetary motive provides the first step towards developing more specialized instruments to predict the risk for problematic and pathological gambling behavior.

Background: Psoriasis exerts a profound negative impact on health-related quality of life (QoL). Although the severity of psoriasis is one potential variable that contributes to decreased QoL, previous studies have shown only weak or no association between measures of psoriasis severity and QoL. We hypothesized that this relationship is moderated by temperament factors. Objective: We aimed to verify whether the relationship between disease severity and QoL is moderated by a constellation of temperament traits (i.e., temperament risk factors) and whether this moderation takes place via cognitive- appraisal and coping processes. Methods: One hundred fifty patients with psoriasis vulgaris participated in the study. Psoriasis severity was assessed by a standardized measure, the Psoriasis Area and Severity Index (PASI), and the patients also completed a battery of psychological questionnaires assessing QoL, temperament, disease-related cognitive appraisals, and coping strategies. Results: A specific constellation of temperament traits was found to moderate the strength of the association between the PASI and QoL. This constellation of temperament traits was associated with certain disease-related cognitive appraisals (i.e., threat, obstacle/ loss, harm, profit, value) and emotion-focused coping strategies (i.e., self-blame, avoidance, resignation, seeking social support, and seeking information). Conclusion: The constellation of temperament traits is a crucial individual variable that strongly moderates the negative impact of psoriasis severity on QoL, potentially through the activation of nonadaptive cognitive appraisals and coping strategies in susceptible individuals.

Purpose: Congenital diaphragmatic hernia (CDH) is rare but potentially fatal. The overall outcome is highly variable. This study aimed to identify a simple and dynamic parameter that helps predict the mortality of CDH patients in real time, without invasive tests. Methods: We conducted a retrospective chart review of 59 CDH cases. Maternal and fetal information included the gestational age at diagnosis, site of defect, presence of liver herniation, and lung-to-head ratio (LHR) at 20 to 29 weeks of gestational age. Information regarding postnatal treatment, including the number of days until surgery, the need for inhaled nitric oxide (iNO), the need for extracorporeal membrane oxygenation (ECMO), and survival, was collected. The highest respiratory severity score (RSS) within 24 hours after birth was also calculated. Results: Statistical analysis showed that a younger gestational age at the initial diagnosis (P<0.001), a lower LHR (P=0.001), and the presence of liver herniation (P= 0.003) were prenatal risk factors for CDH mortality. The RSS and use of iNO and ECMO were significant factors affecting survival. In the multivariate analysis, the only remaining significant risk factor was the highest preoperative RSS within 24 hours after birth (P=0.002). The area under the receiver operating characteristic curve was 0.9375, with a sensitivity of 91.67% and specificity of 83.87% at the RSS cut-off value of 5.2. The positive and negative predictive values were 82.14% and 92.86%, respectively. Conclusion: Using the RSS as a prognostic predictor with simple calculations will help clinicians plan CDH management.

Background: Recent clinical observation reported that there was a significant correlation between change in circulating vascular endothelial growth factor (VEGF) levels and the occurrence of severe acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the action mechanisms of VEGF in GVHD have not been demonstrated. Methods: This study investigated whether or not blockade of VEGF has an effect on acute GVHD in a lethally irradiated murine allo-HSCT model of $B6\;(H-2^b)\;{\rightarrow}B6D2F1\;(H-2^{b/d})$. Syngeneic or allogeneic recipient mice were injected subcutaneously with anti-VEGF peptides, dRK6 ($50{\mu}g/dose$) or control diluent every other day for 2 weeks (total 7 doses). Results: Administration of the dRK6 peptide after allo-HSCT significantly reduced survival with greaterclinical GVHD scores and body weight loss. Allogeneic recipients injected with the dRK6 peptide exhibited significantly increased circulating levels of VEGF and expansion of donor $CD3^+$ T cells on day +7 compared to control treated animals. The donor $CD4^+$ and $CD8^+$ T-cell subsets have differential expansion caused by the dRK6 injection. The circulating VEGF levels were reduced on day +14 regardless of blockade of VEGF. Conclusion: Together these findings demonstrate that the allo-reactive responses after allo-HSCT are exaggerated by the blockade of VEGF. VEGF seems to be consumed during the progression of acute GVHD in this murine allo-HSCT model.

Background and Purpose Serum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS). Methods This study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis. Results This study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24?0.80, p=0.01), while there was no significant association at 3 months. Conclusions This study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.

Background: Psoriasis is associated with increased risk of cardiovascular morbidities, especially in severe cases. Severity of the disease has been known to be associated with higher prevalence of these risk factors. However, in the absence of robust measurements, studies to date relied mostly on treatment spectrum as a proxy for the severity. Objective: To evaluate the relationship between psoriasis area and severity index (PASI) and cardiovascular risk factors in Korean patients. Methods: Presence of diabetes mellitus (DM), hypertension, smoking history was surveyed through questionnaires and serum lipid profile analysis were done after fasting overnight. The severity of psoriasis was assessed using PASI scores: mild, ＜10; moderate to severe, ≥10. Cardiovascular risk factors such as smoking, hypertension, diabetes and dyslipidemia were compared between the mild group and moderate to severe group. The prevalence of diabetes and hypertension was compared among these two groups of psoriasis patients and the general population based control; age and gender were matched among three groups accordingly prior to analysis. Results: A total of 256 patients with plaque type psoriasis were included. Between mild group and moderate to severe group, significant differences of cardiovascular risk factors including lipid profile were not discovered except in triglyceride level. Comparing to general population, prevalence of diabetes was found significantly higher in psoriasis patients while that of hypertension was similar. Conclusion: Our results suggest that among cardiovascular risks, presence of DM and triglyceride level seem to be associated with the presence of psoriasis in Korean psoriasis patients, while other factors may not contribute meaningfully.

Serum rheumatoid factor (RF) is important in the diagnosis and prognosis of rheumatoid arthritis (RA). The purpose of this study is to compare the clinical characteristics and treatment patterns of RA according to the presence of RF in Korean patients. A retrospective analysis was performed on the records of 109 patients who were followed for at least 2 years, among 230 RA patients who visited at the rheumatology clinic in Ajou University Hospital and who fulfilled the 1987 revised American College of Rheumatology criteria for RA. Sixty-four patients were RF positive (58.7%) and 91 patients were female (83.5%). There was no significant difference in demographic characteristics, joint involvements, or percentage of morning stiffness between seropositive and seronegative groups. Antinuclear antibody was detected more frequently in the seropositive group (p<0.05). At initial diagnosis, the seropositive group had higher white blood cell and platelet counts than the seronegative group (p<0.01). However, the difference was disappeared at the last follow-up. Inflammatory markers such as ESR and CRP were also higher at diagnosis in the seropositive group (p<0.01). These inflammatory markers were still greater than the seronegative group at the last follow-up (p<0.01). There was no significant difference in the use of disease modifying antirheumatic drug (DMARD) and steroid dosage between groups. However, DMARD combination therapy was more commonly used in the seropositive group (p<0.05), especially triple DMARD combination. These results suggest that disease activity is more severe in the seropositive than the seronegative group, and more aggressive treatments are needed in the seropositive group.

Background/Aims: Growth differentiation factor 15 (GDF- 15) belongs to the transforming growth factor-β superfamily. GDF-15 is emerging as a biomarker for several diseases. The aim of this study was to determine the clinical performances of GDF-15 for the prediction of liver fibrosis and severity in chronic liver disease. Methods: The serum GDF-15 levels were examined via enzyme immunoassay in 145 patients with chronic liver disease and 101 healthy individuals. The patients with chronic liver disease consisted of 54 patients with chronic hepatitis, 44 patients with compensated liver cirrhosis, and 47 patients with decompensated liver cirrhosis. Results: Of the patients with chronic liver diseases, the decompensated liver cirrhosis patients had an increased serum GDF-15 (3,483 ng/L) level compared with the patients with compensated liver cirrhosis (1,861 ng/L) and chronic hepatitis (1,232 ng/L). The overall diagnostic accuracies of GDF-15, as determined by the area under the receiver operating characteristic curves, were as follows: chronic hepatitis= 0.656 (>574 ng/L, sensitivity, 53.7%; specificity, 79.2%), compensated liver cirrhosis=0.886 (>760 ng/L, sensitivity, 75.6%; specificity, 92.1%), and decompensated liver cirrhosis= 0.984 (>869 ng/L, sensitivity, 97.9%; specificity, 94.1%). Conclusions: This investigation represents the first study to demonstrate the availability of GDF-15 in chronic liver disease. GDF-15 comprised a useful biomarker for the prediction of liver fibrosis and severity in chronic liver disease.

It is well known that depression is associated with asthma symptoms. We assessed the combined effects of genetic factors and depression on asthma symptom severity using Bayesian network (BN) analysis. The common 100 topranked single-nucleotide polymorphisms (SNPs) were obtained from two genome-wide association studies of symptom severity in two childhood asthmatics trials (CAMP (Childhood Asthma Management Program) and CARE (Childhood Asthma Research and Education)). Using SNPs plus five discretized variables (depression, anxiety, age, sex, and race), we performed BN analysis in 529 CAMP subjects. We identified two nodes (depression and rs4672619 mapping to ERBB4 (Erb-B2 receptor tyrosine kinase 4)) that were within the Markov neighborhood of the symptom node in the network and then evaluated the interactive effects of depressive status and rs4672619 genotypes on asthma symptom severity. In childhood asthmatics with homozygous reference alleles, severe depression was related to less severe symptoms. However, in childhood asthmatics with heterozygous alleles and homozygous variant alleles, depression and symptom severity showed a positive correlation (interaction permutation P value = 0.019). We then tried to evaluate whether the interactive effects that we found were sustained in another independent cohort of elderly asthmatics. Contrary to the findings from childhood asthmatics, elderly asthmatics with homozygous reference alleles showed a positive correlation between depression and symptom severity, and elderly asthmatics with heterozygous alleles and homozygous variant alleles showed a negative correlation (interaction permutation P value = 0.003). In conclusion, we have identified a novel SNP, rs4672619, that shows interactive effe

Objective : Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors. Methods : Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity. Results : A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain. Conclusion : We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.

Purpose: Vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2) are major mediators of angiogenesis and are induced by tissue inflammation and hypoxia. The purpose of this study was to investigate whether serum VEGF and Ang-2 are associated with the presence of hemoptysis and the extent of systemic inflammation in patients with inflammatory lung diseases. Materials and Methods:We prospectively enrolled 52 patients with inflammatory lung disease between June 2008 and October 2009. Results: The median values of VEGF and Ang-2 were 436 pg/mL and 2383 pg/mL, respectively. There was a significant positive correlation between serum Ang-2 and VEGF levels. VEGF levels were not significantly different according to the presence of hemoptysis. C-reactive protein (CRP) and Ang-2 level were significantly higher in patients without hemoptysis (n=26) than in those with hemoptysis (n=26; p<0.001 and p<0.001, respectively). CRP and arterial oxygen tension (PaO2) were significantly correlated with both serum VEGF (p=0.032 and p=0.016, respectively) and Ang-2 levels (p<0.001 and p=0.041, respectively), after adjusting for other factors. Age and the absence of hemoptysis were factors correlated with serum Ang-2 levels. Conclusion: Our study suggests that serum VEGF and Ang-2 levels are associated with PaO2 and the severity of inflammation rather than the presence of hemoptysis in patients with inflammatory lung diseases. Thus, hemoptysis may not be mediated by increased serum levels of VEGF and Ang-2 in patients with inflammatory lung diseases, and further studies are required to determine the mechanisms of hemoptysis.

Cutaneous lesions of leukemia cutis (LC) by chronic neutrophilic leukemia (CNL) have been merely reported due to the rare occurrences of CNL. Furthermore cutaneous lesions in relation to clinical severity have been far less studied. A 70-year-old man presented with multiple violaceous papules and excoriations on both lower extremities. The diagnosis was LC based on histologic and laboratory evaluation and the origin was elaborated as CNL with the confirmation of colony stimulating factor 3 receptor (CSF3R) mutation. Interestingly, the patient presented clinical severity in a parallel manner to the hematologic abnormality. To the best of our knowledge, there has been no reported case of CSF3R confirmed LC in CNL featuring explicit skin eruption in relation to laboratory findings.

연구배경: 만성폐쇄성폐질환은 질병의 중증도를 추정 정상치에 대한 $FEV_1$의 백분율을 기준으로 분류해 왔다. 그러나, 같은 폐기능 검사소견을 보이는 환자들 사이에서도 환자가 느끼는 주관적 호흡곤란에는 차이가 있다. 본 연구에서는 호흡곤란이 $FEV_1$를 비롯하여, 건강관련 삶의 질, 주변으로부터 받는 도움의 정도, 직업 등에 영향을 받는지에 대해 알아보고자 하였다. 방법: 2002년 6월부터 2004년 5월까지 경북대학교병원 호흡기 내과에서 만성폐쇄성폐질환으로 추적관찰 중이며, 임상적으로 안정되어 있고 비가역적인 폐쇄성 폐기능 장애를 가진 환자 36명을 대상으로 하였다. 만성 폐쇄성 폐질환의 병기는, GOLD 병기를 따랐으며, 호흡곤란 척도는 MRC 호흡곤란 척도를 사용하였다. 건강 관련 삶의 질은 한국어 St. Goerge's respiratory questionnaire(SGRQ)를 사용하였다. 결과: 환자들의 평균 $FEV_1$은 추정 정상치의 32.0%였다. GOLD 병기와 호흡곤란 정도사이에 유의한 상관관계는 없었다(p=0.114). 호흡곤란이 심할수록 SGRQ 값의 증상(symptom)(p=0.041), 활동력(activity)(p=0.004), 영향력(impact)(p=0.001), 총점(total)(p<0.001) 수치 모두에서 의미있게 높은 수치를 보였다. 호흡곤란 정도와 직업간에 의미있는 상관관계는 없었으며(p=0.259), 호흡곤란이 심할수록 환자가 주변으로부터 받는 도움 정도는 적다고 느끼는 상관관계가 뚜렷하였다(p=0.011). 결론: 만성폐쇄성폐질환자의 진료에서 환자가 느끼는 주관적인 호흡곤란은 $FEV_1$에 따른 병기 외에도 건강관련 삶의 질 및 주변의 지지 정도와 더 연관성을 가질 수 있다는 점이 고려되어야 할 것으로 사료된다.

Background: Chronic obstructive pulmonary disease(COPD) is categorized by the percentage of the predicted $FEV_1$(Forced expiratory volume in 1 second) result which is highly correlated with disease severity(morbidity and mortality). In COPD patients, dyspnea seems to be different from disease severity. We investigated whether dyspnea is correlated with disease severity, as measured by $FEV_1$, quality of life(QoL), occupation, and supporting level of family members and neighbors. Method: Thirty-six clinically stable patients with chronically irreversible airflow limitation were enrolled. We used the Medical Research Council(MRC) dyspnea scale to assess the level of dyspnea and the Korean St. Goerge's respiratory questionnaire(SGRQ) as measure the QoL. Result: The mean percentage of the predicted $FEV_1$ was 32.0%. Dyspnea was not correlated with GOLD stage using $FEV_1$(p=0.114). With deteriorating level of dyspnea the scores of symptoms(p=0.041), activity(p=0.004), impact(p=0.001), and total SGRQ score(p<0.001) were significantly increased. Dyspnea was not correlated with the level of occupation(p=0.259). The supporting level of family members and neighbors was significantly negatively correlated with dyspnea scale(p=0.011). Conclusion: In the management of COPD patients, we have to remember that the level of subjective dyspnea is correlated with QoL(symptom, activity and impact on society) and social supporting level as well as GOLD stage($FEV_1$).