• 제목/요약/키워드: $II_1$ factors

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폰탄 수술을 받은 환아들의 장기적 예후 (Long term prognosis of patients who had a Fontan operation)

  • 김현정;배은정;노정일;최정연;윤용수;김웅한;이정렬;김용진
    • Clinical and Experimental Pediatrics
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    • 제50권1호
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    • pp.40-46
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    • 2007
  • 목 적 : 폰탄 술식은 술전 환아관리 및 수술 적응증의 세분화, 수술 방법과 술후 관리의 발전에 힘입어 조기 생존율이 향상되고 있으나 추적 관찰 기간이 길어질수록 후기 합병증이 점차 대두되고 있다. 본 논문에서는 후기 합병증의 위험요인을 분석하고 현재까지 추적 관찰되고 있는 환아들의 임상경과를 알아보고자 하였다. 방 법 : 1986년부터 2000년까지 폰탄 수술을 받은 환아 302명(수술 연령; 3.5세(5개월-15세))을 대상으로 하여 후향적 분석을 하였다. 결 과 : 폰탄 수술을 받을 당시의 나이는 5개월에서부터 15세 사이로 평균 3.5세, 중앙값 2.4세였다. 수술방법은 Lateral tunnel (LT) 폰탄 154명, Atriopulmonary connection(APC) 폰탄 107명, Extracardiac(EC) 폰탄 37명이었다. 추적 관찰 기간은 3년 5개월에서 18년 사이로 평균 추적 관찰 기간은 수술 후 8.3년이었으며 조기 사망을 제외한 241명의 5년 생존율은 91.6%, 10년 생존율은 87.7%였다. 후기 사망의 원인으로는 심혈관 연관성이 55.5%로 가장 많았으며 급사가 22.2%이었다. 심방성 빈맥의 발생빈도는 11.2%였고 폰탄 수술 후 평균 $8.4{\pm}5.6$년 후 빈맥이 발생하였다. 심방성 부정맥은 혈전동반 유무와 수술방법이 유의하게 영향을 미쳤다. 혈전 발생은 9.3%의 환자에서 관찰되었으며 수술 후 발생한 서맥이 관련 있는 요인으로 서맥이 발생하지 않은 환아에 비해 혈전이 생길 위험도를 9.9배 높였다. 폰탄 수술 후 발생한 서맥 발생 환자의 빈도는 7.4%로 완전방실차단 8명, 동결절 기능 장애 8명이었다. 완전방실차단이 발생한 환아 모두 심박동기를 부착하였는데 폰탄 수술과 직접적인 연관성은 없었다. 혈전이 발생한 환아가 발생하지 않은 환아에 비해 서맥이 생길 위험도는 9.1배 높았다. 단백소실성 장증은 10명(4.6%)에서 폰탄 수술 후 평균 6.5년(1-12.9년)이 지나서 발생하였으며 수술 당시 나이가 많을수록 발생할 위험도는 2.3배 높았다. 폰탄 전환술을 시행한 환아는 총 19명이었으며, 적응증으로는 심방성 부정맥, 판막 역류, 혈전, 단백 소실성 장증이었다. 조기 사망한 2명 모두 단백소실성 장증이 동반되어 있었다. 결 론 : 폰탄 수술의 후기 생존율은 받아들일만큼 향상되었다. 그러나 생존해 있는 환아들의 상당수에서 부정맥, 혈전, 단백소실성 장증, 급사, 판막역류 그리고 심부전 등의 후기 합병증이 관찰되어 이들 환아들에 대한 철저한 추적 관찰과 조기 치료가 필요하다.

어촌지도사업의 평가 (An Evaluation on the Operating of Fisheries Extension Services)

  • 최정윤
    • 수산경영론집
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    • 제17권2호
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    • pp.65-106
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    • 1986
  • 1, The Purpose of Study This is a study on the Evaluation of the operating of Fisheries Extension Services of Korea, for performing the activities such as guiding fisheries technique as well as offering industrial information to the fishermen in fishing village. By doing so, the Fisheries Extension Sevices(FES) can materialize the continued growth of fisheries, the social and economic development of fishing village, and the increase in income by enhancing the knowledge level of Fishermen, etc. In performing fisheries policy, this activity plays a great role on the research and development activity, and it has become practical since 1976 in Korea. In order to meet immediately with the problem of fisheries technical innovation and rapid environmental changes surrounding the fisheries, the fishermen should not only enhance their scientific and comprehensive capacity in fisheries technique but abtain various effective information. Generally, as most of all the fishemen are poor in the managerial structure and scattered in fishing villages, they have little opportunity in the contact of information. As a result, it is nessessary for the FES to perform the fishing business by the extension service officials who has received special training and acquired fisheries know-how in these fields. And yet, FES is under the unfullfilled circumstance in such factors as manpower, technical know-how, equipment, and the service system etc., which is required in promoting the social, economic development of fishing village and in resolving the high technique demand of fisherman. This study on the fisheries extension services have been studied from those backgrounds. 2. Research Method The data of collecting methods which were necessary in carrying out this study was adopted by the questionaire research on the present extension service activity, through the subject of the extension services (driving agency of the work and the officials), the object(fishemen) and the 3rd observers to the extension services (the authorities concerned). The research sample was taken by the sampling extraction of total 1, 774 men from the above 3 groups. And the research was carried out from August, 1986 to October, 1986, supported from the Fisheries Extension Office (FEO) located in field during the research process. In this study, the levels of the extension operating were determined and estimated in accordance with the extension service method, morale of extension service officials and the extension service system, etc. through the collected data of the research questionaire paper. And based on this result, the essential conditions of the extension services were grasped, and also we tried to present the various activity plan necessary to promote the operating of the extension services. The questionaire research data was calculated by the computer center of National Fisheries University of Pusan, and the total result was again tried on the one demension analysis along with two dimension analysis to search out the relativity between the questionaire, and the statistical test was done $\chi$$^2$test in significance level of l~5%. 3. Contents of Study This study consists of 7 chapters and the contents are as follows : Chapter I : The object and method of the study Chapter II : The assessment and analysis of the extension services Chapter III : The contents and method of the extension services Chapter IV : Analysis of the essential conditions for the extension services Chapter V : The evaluation of activities of extension services Chapter Ⅵ : Conclusion.4. Results and RecommendationTherefore, the results of this study estimated by logical process and analysis are as follows : 1) Most of Korean fishing villages and coastal fishermen have shown much concerns about fisheries technique and social changes, thus many of them were confronted with new problems on how to adapt and to meet changes. 2) Majority of fishermen estimated FEO as an organization of specific technologies with all the thing concerning the fisheries technique in general. Therefore the fishermen wanted to utilize the FEO as an adaptable method for the modern fisheries techniques as well as the environmental changes. 3) In contrast with the fast changes of the fisheries technique, the complexity and variety of technical system and the broadness of fishing village and fishermen, it was revealed that the necessary factors such as the facilities, manpower, budget, and the level of applying techniques of the FEO located in field were highly insufficient. Accordingly, the guiding efficiency was low and the extension services did not provide full solution to the various request from fishermen. 4) It is possible to classify the activation factor for the extension service into two large dimension ; personal dimension relevant to guidance officials and work dimension relevant to the organization. And it was found that the activation level of the work dimension was far lower than the personal dimension between them. So, the activation should be done first in the dimesion to promote the activation of the extension services. 5) The extension services officials are now demoralized in general, thus it is necessary to take reality into consideration : the expense of activity, the adequate endowment of activity scope and the reasonable operation of the position class, etc to enhance its morale. However, in order to do the FES activation, first of all, the systems should be established which is lain unsettled stage until now. And there must be change in the understanding of government i.e. the fisheries extension services are the essential policy subject to build up the base of fisheries growth and modernize the fisheries management. And it should be driven positively with the recognition of the "lasting project".g project".uot;.

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외식 프랜차이저의 사업성, 커뮤니케이션, 모럴해저드가 프랜차이지의 위험지각과 재계약의도에 미치는 영향 (The Study on the Influence of Selection Characteristics of Franchise System, business possibility, Communication, Moral Hazard on Franchisee's Perceived Risk, and Recontracting Intention in the Food Service Franchise Industry)

  • 우종필;이인호
    • 한국유통학회지:유통연구
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    • 제16권1호
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    • pp.1-27
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    • 2011
  • 본 연구는 프랜차이즈 본사의 선택속성으로서 사전지원, 사후지원, 지각된 사업성과, 가맹본부와 가맹점의 커뮤니케이션, 가맹본부의 모럴해저드 등 외생변수가 매개변수인 가맹점의 만족과 위험지각에 미치는 영향을 분석하고, 이들 매개 변수가 다시 신뢰와 결과변수인 재계약의도에 미치는 영향관계를 분석하였다. 기존의 연구들과 차별점으로, 가맹본부의 가맹점에 대한 지원을 개점 전 지원인 사전지원으로, 개점 후 지원인 사후지원으로 구분하였고, 가맹점이 실제 사업운영 과정에서 느끼는 가장 중요한 지각된 사업성, 그리고 가맹본부와 가맹점의 쌍방향성의 커뮤니케이션 정도, 또 가맹본부의 모럴해저드를 연구모델에 설정하여 가맹점 만족, 위험지각, 신뢰, 재계약의도 등의 관계를 프랜차이즈 시스템의 실질적 관점에서 조사한 점이라고 할 수 있다. 연구결과 (1)가맹본부의 사전지원, 사후지원, 지각된 사업성, 커뮤니케이션, 모럴해저드는 가맹점 만족에 영향을 미쳤고, (2)지각된 사업성, 커뮤니케이션, 모럴해저드는 위험지각에도 유의한 영향을 미쳤으며, (3)만족과 위험지각, 신뢰 모두 재계약의도에 유의한 영향을 미친 것으로 나타났다. 또한 이러한 결과를 바탕으로 본 연구는 향후 프랜차이즈 산업발전에 발전적인 시사점을 제시하였다.

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만성폐쇄성폐질환 발생에 Epoxide hydrolase와 GSTM1유전자 다형성의 의의 (Genetic Polymorphism of Epoxide Hydrolase and GSTM1 in Chronic Obstructive Pulmonary Disease)

  • 박상선;김은정;손창영;위정욱;박경화;조계중;주진영;김규식;김유일;임성철;김영철;박경옥;나국주
    • Tuberculosis and Respiratory Diseases
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    • 제55권1호
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    • pp.88-97
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    • 2003
  • 연구배경 : 90% 정도의 만성폐쇄성 폐질환(COPD) 환자들이 흡연력이 있으나 흡연자의 15~20%에서만 COPD가 발생하는 것은 유전자 감수성 등 다양한 다른 인자들의 영향이 있음을 암시한다. 담배 연기 속에 포함된 epoxide를 가수 분해하는 효소인 microsomal epoxide hydrolase(mEPHX)의 효소 활성은 두 개의 유전자 다형성 양상에 따라 서로 다르므로 이 다형성의 양상에 따라, 그리고 활성화된 유독 물질을 대사시키는 glutathione Stransferase의 M1 subunit 유전자 (GSTM1)의 homozygous deletion 여부에 따라 COPD의 발생 위험도 다를 것으로 예측된다. 대상 및 방법 : 전남 대학교 병원 호흡기 내과에 내원한 58예의 COPD군과 이와 연령이 비슷한 폐결핵 환자 59례 및 정상인들 20례로 구성된 대조군(79예)의 말초혈액 백혈구로부터 추출한 DNA를 이용하여 mEPHX 유전자의 다형성과 GSTM1 유전자의 결손 여부 그리고 임상 양상과의 관계를 관찰하였다. mEPHX 유전자의 exon 3과 exon 4를 각각 두 쌍의 primer를 이용하여 증폭하여 제한 효소 절단 양상으로 유전자 다형성 위치의 염기를 확인하였고 일부에서는 염기 서열을 직접 확인 하였다. 또한 GSTM1 유전자의 exon 4와 exon 5 부위를 PCR 증폭하여 homozygous deletion 여부를 혈액응고인자 V를 양성대조로 이용하여 확인하였다. 결 과 : COPD와 대조군 양군 간에 연령 ($63.7{\pm}10.9$ vs $60.4{\pm}8.1$세)은 차이를 보이지 않았고 흡연자는 COPD군(33/40, 82.5%)이 대조군(38/71, 53.5%)에 비하여 많았다(p<0.01). GSTM1은 73예가 결손되어 53.3%의 결손율을 보였는데 COPD군(32/58, 55.2%)과 대조군(41/79, 51.9%) 사이에 유의한 차이는 없었다. mEPHX는 29예(21.2%)가 slow, 73예(53.3%)가 normal, 32예(23.4%)가 fast enzyme activity를 보이는 유전자형이었는데, slow enzyme activity를 보이는 유전자형의 빈도가 COPD군(7/57, 12.3%)에서 대조군(22/77, 28.6%)보다 유의하게 낮았다(p<0.05). COPD 발생의 비교 위험도는 mEPHX의 낮은 효소 활성을 보이는 유전자형이 0.32 (95% 신뢰구간 0.14-0.75, p<0.01)를 보였으나, 흡연자들만을 이용하여 비교하였을 때는 mEPHX의 유전자형에 따른 COPD의 빈도는 차이가 없었다. 결 론 : 소수의 집단을 대상으로 한 본 연구에서 GSTM1 결손이나 mEPHX의 유전자형은 COPD 발생의 유의한 위험인자는 아니었다.

자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료 (Rectal Bleeding and Its Management after Irradiation for Cervix Cancer)

  • 전미선;강승희;길훈종;오영택;손정혜;정혜영;유희석;이광재
    • Radiation Oncology Journal
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    • 제20권4호
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    • pp.343-352
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    • 2002
  • 목적 : 자궁경부암의 경우 종양에 충분한 양의 방사선을 조사하기 위해서는 직장도 고선량의 방사선을 받게 된다. 이로 인해 직장염을 비롯한 만성부작용이 발생하며 직장 출혈 빈도를 $5\~30\%$ 보고하고 있다. 저자는 완치 목적의 방사선치료를 받은 자궁경부암 환자들을 대상으로 직장 출혈 빈도와 그와 관련된 위험인자들을 분석하고 치료 방법을 살펴보고자 한다. 대상 및 방법 : 1994년 9월과 1999년 12월 사이에 방사선 단독치료를 받은 213명의 자궁경부암 환자를 대상으로 하였다. 90명이 외부 방사선치료의 일부를 하루 2회씩 받았다(변형된 다분할 방사선치료). 자궁주위조직의 외부 방사선량은 총 $51\~59\;Gy$였고 근접방사선치료로 A점에 총 $28\~30\;Gy$ (4 Gy씩 7회 혹은 5 Gy씩 6회)를 조사하였다. 직장에 조사된 선량은 ICRU 38에서 정한 위치와, 모의촬영필름에서 바리움에 의해 구분되는 직장 앞쪽 벽의 한 점을 선정하여 계산하였다. 직장출혈의 정도는 LENT/SOMA에 따라 분류하였다. 추적관찰 기간은 $12\~86$개월(중앙값 39개월)이었다. 결과 : 27명$(12.7\%)$의 환자에서 직장출혈이 발생하였다(등급 2와 3:각각 16명과 2명, $8.5\%$). 이들 중에서 추적관찰 기간동안 질-직장루 또는 폐쇄로 진행된 경우는 없었다 발생시기는 대부분의 환자에서$(92.6\%)$ 치료 종료 후 2년 이내였다(중앙값 16개월). 단변량분석에서 위험인자로 icruCRBED (직장이 받은 총 생물학적 동등선량), 자궁주위조직의 방사선량, 및 병기였다. icruCRBED가 100 미만인 경우와 100 이상인 경우 $4.2\%$$19.7\%$, 자궁주위조직에 대한 조사선량 55 Gy 미만과 그 이상인 경우가 $5.1\%$$22.1\%$, 병기 II 이하인 경우와 III 이상인 경우가 $10.5\%$$31.8\%$였다. 다변량분석에서는 icruCREED 만이 유의하였다(0=0.0432). 등급 1 출혈은 자연적으로 소실되거나(3명) $1\~2$개월의 sucralfate 관장으로 멈추었다. 등급 2의 환자 6명은 $1\~2$개월 동안 sucralfate 관장으로 출혈의 빈도와 양이 줄어들었고 이 중 4명은 전기응고술을 추가로 시행하였다. 다른 9명은 전기응고술을 먼저 시행하였다(4명; sucralfate 관장 병행). 모두 $3\~10$개월 내에 정지되었다. 등급 3의 출혈은 잦은 전기응고술과 수혈을 요하였다. 결론 : 본 연구에서 중등도 이상의 직장출혈빈도가 $8.5\%$로 타 문헌에서 보고된 빈도와 유사한 결과였다. 직장에 조사된 총 생물학적 동등선량이 100 Gy 이상인 경우에 직장출혈이 유의하게 증가하므로, 치료계획시 생물학적 동등선량을 고려함으로써 휴유증 감소에 도움이 될 것으로 생각된다. 직장출혈이 발생한 환자에서 조기에 적극적으로 치료를 시행함으로써 출혈로 인한 불편함을 신속하게 해결하고 이로 인한 심리적 불안감을 해소할 수 있으며 나아가 삶의 질 향상에도 도움을 줄 수 있을 것으로 판단된다.

적혈구(赤血球) Protoporphyrin과 철분대사(鐵分代謝)에 관(關)한 연구(硏究) (A Study on Red Cell Protoporphyrin Concentration and Iron Metabolism)

  • 조경환;채범석
    • Journal of Nutrition and Health
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    • 제7권3호
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    • pp.1-13
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    • 1974
  • The relative state of human iron storage may be ascertained more reliably through determination of the serum iron, iron binding capacity, transferrin saturation and absorption of radioactive iron in conjunction with studies of red cell morphology than from the study of red cell morphology alone. Recent investigations have shown that there is an increase in red cell protoporphyrin concentration in iron deficiency anemia. The significance of the red cell protoporphyrin has been discussed greatly during the years since its discovery. Two of the main factors which appear to influence the amaunt of protoporphyrin are increased erythropoiesis and factors interfering with the utilization of iron in the synthesis of hemoglobin, and iron deficiency. Recently Heller et al. have described a simplified method for blood protoporphyrin assay and this technique could be used assess nutritional iron status, wherein even minor insufficiencies are detectable as increased protoporphyrin concentrations. Based on the evaluation of the relationship between nutritional iron status and red cell protoporphyrin as an index suitable for the detection of the iron deficiency is described in this paper. RESULTS 1. Hemoglobin Concentrations and Anthropometric Measurements. The mean and standard deviations of the various anthropometric measurements of different age and sex groups are shown in table 1. There measurements have been compared with the Korean Standard. In the absence of local standards for arm circumference and skin-fold thickness over triceps, they have been compared with the standard from Jelliffe. Table 2,3, and 4 give anthropometric measurements and frequency (%) of anemia in children surveyed. The mean height of the children studid was 10 to 20 percent; below the Korean Standard. The distribution of height below 80 percent of the Standard was 21.2 percent, however, among anemic group this percentage was 27.7 percent. In general, the mean weight of the children was 10 to 15 percent below the Korean Standard. The percentage of children with weight less than 80 percent of the Standard was about 35 percent. But in the anemic group of the children, this percentage was 44 percent. The mean arm circumference was about 15 percent lower than the Jelliffe's standard. 61.2 percent of the children had values of arm circumference below 80 percent of the standard. Children with low hemoglobin levels, this percentage was 80 percent. The mean skinfold thickness over the triceps of the children studied was about 25 Percent lower than the Jelliffe's standard and 61.2 percent of the children had the value less than 80 percent of the standard. Among anemic children, this percentage was 70.8%. As may be seen from table 5, the mean hemoglobin concentration of the total group was 11.3g/100ml. Hemoglobin concentration was less than 11.0g/100ml. in 65(36.5%) of the 178 children. The degree of anemia in most of these children was mild with a hemoglobin level of less than 8.0g/100ml. found in only one child. In general, the prevalence of anemia was high in female children than male and decreased its frequency with increasing age. Relatively close relationship was observed between hemoglobin level and anthrophometric measurements especially high between arm circumference and skinfold thickness and hemoglobin but very low in height and low in weight and hemoglobin level, estimated by chi-square value. II. Serum iron, Transferrin saturation (1) Serum iron, and transferrin saturation Serum iron, transferrin saturation and red cell protoporphyrin concentrations were estimated in sub-sample of 84 children from 1 to 6 years and 24 older children between 7 and 13 years of age. The findings are presented in table 6. The mean serum iron concentration of the total group was 59ug/100ml. However, the level incrased with age from 36.6ug/100ml. (1-3years) to 80.8ug/100ml. (7-13 years). 60 percent of these children had a serum iron level less than 50ug/10ml. in the 1-3 years age group and 31.4 percent for 4-6 years group. These contrast with the finding of 12.5 percent anemic children in the 7-13 years age group. The mean transferrin saturation for the total group was 18.1 percent and frequency of anemia by transferrin saturation was observed same pattern as serum iron concentration. (2) Red cell protoporphyrin concentrations. (a) Red cell protoporphrin levels of children: Red cell protoporphyrin and other biochemical data are shown in table 4. The mean concentration in red cell of all children was fround 46.3ug/100ml. RBC. and differences with age groups were observed; in the age group 1-3 years, the mean concentration was $59.5{\pm}32.14$ ug/100ml. RBC; 4-6 years $44.1{\pm}22.57$ ug/100ml. RBC. and 7-13 years, $39.0{\pm}13.56$ ug/100ml. RBC. (b) Normal protoporphyrin values in adults: It was observed that in 10 normal adult males studied here the level of protoporphyrin in red cell ranged from 18 to 54 ug/100ml. RBC. and the mean concentration was $47.5{\sim}14.47$ ug/100ml. RBC. Other biochemical determination made on the same subjects are presented in table 8. (c) Red tell protoporphyrin concentration of occupational blood donors: The results of analyses for red cell protoporphyrin as well as serum iron, transferrin saturation and hemoglobin in the 76 blood donors are presented in table 7 and 8. In this experiment, donors were selected at random, however, most of them bled repeatedly because of poor economic situation, I doubt. Table 9 shows the distribution of red cell protoporphyrin concentration and hemoglobin concentration of occupational donors. The mean hemoglobin value for the total was 11.9 g/100 ml. When iron deficiency anemia is defined as a transferrin saturation below 15%, prevalence of anemia was 47.4 percent and the mean serum iron was 27.1ug/100ml. and red cell protoporphyrin, 168.3ug/100ml. RBC. However, mean serum iron and protoporphyrin concentration of above 15% transferrin saturation were 11.6 ug/100 ml. and 58.8 ug/100 ml. RBC. respectively. The mean Protoporphyrin concentration of non-anemic (above 15% transferrin saturation) donors was slightly higher than the results of normal adult males.

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Tyrosine Hydroxylase 유전자가 주입된 인간 배아줄기세포의 체외 신경세포 분화 (In vitro Neural Cell Differentiation of Genetically Modified Human Embryonic Stem Cells Expressing Tyrosine Hydroxylase)

  • 신현아;김은영;이금실;조황윤;김용식;이원돈;박세필;임진호
    • Clinical and Experimental Reproductive Medicine
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    • 제31권1호
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    • pp.67-74
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    • 2004
  • Objective: This study was to examine in vitro neural cell differentiation pattern of the genetically modified human embryonic stem cells expressing tyrosine hydroxylase (TH). Materials and Methods: Human embryonic stem (hES, MB03) cell was transfected with cDNAs cording for TH. Successful transfection was confirmed by western immunoblotting. Newly transfected cell line (TH#2/MB03) was induced to differentiate by two neurogenic factors retinoic acid (RA) and b-FGF. Exp. I) Upon differentiation using RA, embryoid bodies (EB, for 4 days) derived from TH#2/MB03 cells were exposed to RA ($10^{-6}M$)/AA ($5{\times}10^{-2}mM$) for 4 days, and were allowed to differentiate in N2 medium for 7, 14 or 21 days. Exp. II) When b-FGF was used, neuronal precursor cells were expanded at the presence of b-FGF (10 ng/ml) for 6 days followed by a final differentiation in N2 medium for 7, 14 or 21 days. Neuron differentiation was examined by indirect immunocytochemistry using neuron markers (NF160 & NF200). Results: After 7 days in N2 medium, approximately 80% and 20% of the RA or b-FGF induced Th#2/MB03 cells were immunoreactive to anti-NF160 and anti-NF200 antibodies, respectively. As differentiation continued, NF200 in RA treated cells significantly increased to 73.0% on 14 days compared to that in b-FGF treated cells (53.0%, p<0.05), while the proportion of cells expressing NF160 was similarly decreased between two groups. However, throughout the differentiation, expression of TH was maintained ($\sim$90%). HPLC analyses indicated the increased levels of L-DOPA in RA treated genetically modified hES cells with longer differentiation time. Conclusion: These results suggested that a genetically modified hES cells (TH#2/MB03) could be efficiently differentiated in vitro into mature neurons by RA induction method.

의료보험서비스 가격의 적절성에 관한 연구 : 소득계층간 접근형평성 관점에서 (A study on appropriateness of price of medical care service in health insurance)

  • 전기홍;최귀선;강임옥
    • Journal of Preventive Medicine and Public Health
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    • 제31권3호
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    • pp.460-470
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    • 1998
  • By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service ls comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (i) whether there are differences in medical care utilization among different income groups exist, (ii) whether differences in medical care utilization among different income groups exist with the hospital type. (iii) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.

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유상피 육종 (Epithelioid Sarcoma)

  • 조완형;전대근;박종훈;송원석;이수용;고재수;고한상
    • 대한골관절종양학회지
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    • 제12권1호
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    • pp.30-36
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    • 2006
  • 목적: 유상피 육종은 매우 드물며 예후 예측이 힘든 육종이다. 본 연구는 병기, 잔존 종양의 유무, ezrin 발현과 유상피 육종의 임상 양상과의 관계를 분석하였다. 대상 및 방법: 23예를 대상으로 하였다. 전 예에서 수술을 시행하였으며 보조적 치료로 15예는 화학요법을, 6예는 방사선 치료를 하였다. 15예에서 면역조직화학 염색을 하였다. 분석한 인자는 병기, 보조적 요법, 국소 재발, 잔여 종양, 면역조직화학 결과, 절제연이었다. 결과: 15예의 병기 II및 III 환자의 무병 생존율은 129 개월에 47.4%, 8예의 병기 IV환자의 실질 생존율은 80개월에 37.5%였다. 재 절제한 병리 표본에 잔존 종양의 존재 유무가 무병생존에 유의한 인자였다(P=0.03). 보조적 요법의 유무가 치료 결과와 상관은 없었다. 병기 IV와 국소 재발한 예에서 Ezrin 발현이 호발하는 경향이 있었다. 결론: 잔존 종양의 유무가 예후에 중요하였으며 보조적 치료는 결과에 영향을 미치지 못하였다. Ezrin 발현과 예후 사이의 상관 관계를 알기 위해 좀더 많은 증례 분석이 요구된다.

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무혈청배지에 첨가된 성선자극호르몬 및 항산화제가 소 미성숙난자의 체외성숙능에 미치는 영향 (Effects of Addition of Exogenous Gonadotropins and/or an Antioxidant to Serum-Free Medium on in vitro Maturation of Bovine Immature Oocytes)

  • 임정묵;박성은;정형민;이병천;이은송;고정재;박찬;차광렬;황우석
    • 한국수정란이식학회지
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    • 제15권3호
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    • pp.231-236
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    • 2000
  • This study was conducted to examine the effects of exogenous gonadotropins (PMSG+hCG) and an antioxidant (cysteine) on in vitro maturation of bovine follicular oocytes. Cumulus-oocyte complexes (COCs) aspirated from 2 to 5 mm ovarian follicles were cultured for 22 to 24 hours in a modified bovine embryo culture medium (mBECM) supplemented with 3 mg/mL bovine serum albumin, to which PMSG (10 IU/mL) + hCG (10 IU/mL) and/or cysteine (0.6 mM) were added. When examined the expansion of cumulus ce1ls at the end of maturation culture, greater (p<0.05) expansion was found after addition of PMSG+hCG (79 to 96%) to mBECM than after no addition (0%), regardless of the presence or absence of cysteine in the medium. The addition of cysteine did not stimulate cumulus expansion, but a high proportion (92%) of expansion was achieved when COCs were cultured after the addition of PMSG+hCG and cysteine to the medium. No difference in the proportion of oocytes underwent germinal vesicle breakdown (initiation of maturation) was found after the addition of PMSG+hCG and/or cysteine to mBECM. However, nuclear maturation (development to the metaphase-II stage) of oocytes was significantly stimulated by the combined addition of PMSG+hCG and cysteine, compared with no addition. In conclusion, both exogenous gonadotropins and an antioxidant are important for nuclear maturation of bovine immature oocytes and these factors have a cell-specific stimulatory action.

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