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Studies on the Hemodynamic Changes in Cirrhosis of the Liver (간경변증(肝硬變症)에서의 혈역학적(血力學的) 변화(變化)에 관(關)한 연구(硏究))

  • Kim, Jung-Il;Lee, Jung-Sang;Koh, Chang-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.4 no.2
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    • pp.11-27
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    • 1970
  • Cardiac output, plasma volume and renal plasma flow were determined to evaluate hemodynamic changes in 29 patients with cirrhosis of the liver. The results obtained were as follows. 1. The mean plasma volume was 3793+895ml and it was significantly higher than the normal controls. The mean blood volume ($5266{\pm}1222ml$) and blood volume per kg body weight ($95.7{\pm}23.41ml$) were also increased significantly. The mean plasma volume per kg body weight ($69.1{\pm}19.1ml$) showed increased tendency and the mean difference between blood volume and plasma volume per kg body weight ($26.4{\pm}7.05ml$) was in lower limit of normal range. 2. The mean cardiac output was $7708{\pm}2652ml/min$ and it was significantly increased. The mean cardiac index ($4924{\pm}1998ml/min/M^2$), stroke volume ($96.2{\pm}34.2ml/beat$), stroke index ($62.3{\pm}27.34ml/M^2$) and fractional cardiac index ($1.54{\pm}0.577$) were also increased significantly. The mean total -peripheral resistance was $1664{\pm}753.8\;dynes\;sec\;cm^{-5}M^2$ and it was significantly lower than the normal controls. 3. The mean renal plasma flow was $537{\pm}146.8ml/min/1.73M^2$ and it was normal to decreased tendency. The mean endogenous creatinine clearance ($66.7{\pm}23.0ml/min/1.73M^2$) was significantly decreased. Filtration fraction was variable, but it was slightly lower than normal in most cases. The mean renal fraction of cardiac output ($11.4{\pm}6.27%$) was relatively decreased. 4. Although renal plasma flow was normal or decreased in general, it was definitely diminished in patients with creatinine clearance less than $60ml/min/1.73M^2$, resistant ascites, and signs of azotemia (elevated BUN and serum creatinine). 5. Diminished glomrular filtration rate with low filtration fraction and decreased renal fraction of cardiac output observed strongly supported increased renal afferent arteriolar resistance. 6. Renal circulatory impairment preceded azotemia or oroliguria in cirrhosis. 7. Clinical findigns and liver function were not correlated with hemodynamic changes, except for esophageal varices associated with high cardiac output obsedved. 8. No definite correlation of renal hemodynamics with plasma volume or cardiac output was found.

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Metabolic risk and nutritional state according to breakfast energy level of Korean adults: Using the 2007~2009 Korea National Health and Nutrition Examination Survey (한국 성인의 아침식사 에너지 수준에 따른 대사적 위험과 영양상태: 2007~2009년 국민건강영양조사 자료 이용)

  • Jang, So-Hyoun;Suh, Yoon Suk;Chung, Young-Jin
    • Journal of Nutrition and Health
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    • v.48 no.1
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    • pp.46-57
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    • 2015
  • Purpose: The aim of this study was to determine an appropriate energy level of breakfast with less risk of chronic disease for Korean adults. Methods: Using data from the 2007~2009 Korean National Health & Nutrition Examination Survey, from a total of 12,238 adults aged 19~64, the final 7,769 subjects were analyzed except subjects who were undergoing treatment for cancer or metabolic disorder. According to the percent of breakfast energy intake versus their estimated energy requirement (EER), the subjects were divided into four groups: < 10% (very low, VL), 10~20% (low, L), 20~30% (moderate, M), ${\geq}30%$ (sufficient, S). All data were analyzed on the metabolic risk and nutritional state after application of weighted value and adjustment of sex, age, residential area, income, education, job or jobless, and energy intake using a general linear model or logistic regression. Results: The subjects of group S were 16.9% of total subjects, group M 39.2%, group L 37.6%, and group VL 6.3%. The VL group included more male subjects, younger-aged (19 to 40 years), urban residents, higher income, higher education, and fewer breakfasts eaters together with family members. Among the 4 groups, the VL group showed the highest waist circumference, while the S group showed the lowest waist circumference, body mass index, and serum total cholesterol. The groups of VL and L with lower intake of breakfast energy showed high percent of energy from protein and fat, and low percent of energy from carbohydrate. With the increase of breakfast energy level, intake of energy, most nutrients and food groups increased, and the percentage of subjects consuming nutrients below EAR decreased. The VL group showed relatively higher intake of snacks, sugar, meat and eggs, oil, and seasonings, and the lowest intake of vegetable. Risk of obesity by waist circumference was highest in the VL group by 1.90 times of the S group and the same trend was shown in obesity by BMI. Risk of dyslipidemia by serum total cholesterol was 1.84 times higher in the VL group compared to the S group. Risk of diabetes by Glu-FBS (fasting blood sugar) was 1.57 times higher in the VL group compared to the S group. Conclusion: The results indicate that higher breakfast energy level is positively related to lower metabolic risk and more desirable nutritional state in Korean adults. Therefore, breakfast energy intake more than 30% of their own EER would be highly recommended for Korean adults.

Diagnosis of Obstructive Sleep Apnea Syndrome Using Overnight Oximetry Measurement (혈중산소포화도검사를 이용한 폐쇄성 수면무호흡증의 흡증의 진단)

  • Youn, Tak;Park, Doo-Heum;Choi, Kwang-Ho;Kim, Yong-Sik;Woo, Jong-Inn;Kwon, Jun-Soo;Ha, Kyoo-Seob;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.9 no.1
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    • pp.34-40
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    • 2002
  • Objectives: The gold standard for diagnosing obstructive sleep apnea syndrome (OSAS) is nocturnal polysomnography (NPSG). This is rather expensive and somewhat inconvenient, however, and consequently simpler and cheaper alternatives to NPSG have been proposed. Oximetry is appealing because of its widespread availability and ease of application. In this study, we have evaluated whether oximetry alone can be used to diagnose or screen OSAS. The diagnostic performance of an analysis algorithm using arterial oxygen saturation ($SaO_2$) base on 'dip index', mean of $SaO_2$, and CT90 (the percentage of time spent at $SaO_2$<90%) was compared with that of NPSG. Methods: Fifty-six patients referred for NPSG to the Division of Sleep Studies at Seoul National University Hospital, were randomly selected. For each patient, NPSG with oximetry was carried out. We obtained three variables from the oximetry data such as the dip index most linearly correlated with respiratory disturbance index (RDI) from NPSG, mean $SaO_2$, and CT90 with diagnosis from NPSG. In each case, sensitivity, specificity and positive and negative predictive values of oximetry data were calculated. Results: Thirty-nine patients out of fifty-six patients were diagnosed as OSAS with NPSG. Mean RDI was 17.5, mean $SaO_2$ was 94.9%, and mean CT90 was 5.1%. The dip index [4%-4sec] was most linearly correlated with RDI (r=0.861). With dip index [4%-4sec]${\geq}2$ as diagnostic criteria, we obtained sensitivity of 0.95, specificity of 0.71, positive predictive value of 0.88, and negative predictive value of 0.86. Using mean $SaO_2{\leq}97%$, we obtained sensitivity of 0.95, specificity of 0.41, positive predictive value of 0.79, and negative predictive value of 0.78. Using $CT90{\geq}5%$, we obtained sensitivity of 0.28, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.38. Conclusions: The dip index [4%-4sec] and mean $SaO_2{\leq}97%$ obtained from nocturnal oximetry data are helpful in diagnosis of OSAS. CT90${\leq}$5% can be also used in excluding OSAS.

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CLINICAL STUDY OF THE ABUSE IN PSYCHIATRICALLY HOSPITALIZED CHILDREN AND ADOLESCENTS (소아청소년 정신과병동 입원아동의 학대에 대한 임상 연구)

  • Lee, Soo-Kyung;Hong, Kang-E
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.10 no.2
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    • pp.145-157
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    • 1999
  • This study was performed by the children and adolescents who were abused or neglected physically, emotionally that were selected in child & adolescents psychiatric ward. We investigated the number of these case in admitted children & adolescents, and also observed characteristics of symptoms, developmental history, characteristics of abuse style, characteristics of abusers, family dynamics and psychopathology. We hypothesized that all kinds of abuse will influnced to emotional, behavioral problems, developmental courses on victims, interactive effects on family dynamics and psychopathology. That subjects were 22 persons of victims who be determined by clinical observation and clinical note. The results of the study were as follows:1) Demographic characteristics of victims:ratio of sex was 1:6.3(male:female), mean age was $11.1{\pm}2.5$. According to birth order, lst was 12(54.5%), 2nd was 5(23%), 3rd was 2(9%) and only child was 3(13.5%). 2) Characteristics of family:According to socioeconomic status, middle to high class was 3(13.5%), middle one was 9(41.% ), middle to low one was 9(41%), low one was 1(0.5%). according to number of family, under the 3 person was 3(13.5%), 4-5 was 17(77.5%), 6-7 was 2(9%). according to marital status of parents, divorce or seperation were 5(23%), remarriage 2(9%), severe marital discord was 19(86.5%). In father, antisocial behavior was 7(32%), alcohol dependence was 10(45.5%). In mother, alcohol abuse was 5(23%), depression was 17(77.3%), history of psychiatric management was 6(27%). 3) Characteristics of abuse:Physical abuse was 18(81.8%), physical and emotional abuse and neglect were 4(18.2%). according to onset of abuse, before 3 years was 15(54.5%), 3-6 years was 5(27.5%), schooler was 1(15%). Only father offender was 2(19%), only mother offender was 8(35.4%), both offender was 8(35.4%), accompaning with spouse abuse was 7(27%), and accompaning with other sibling abuse was 4(18.2%). 4) General characteristics and developmental history of victims:Unwanted baby was 12(54.5%), developmental delay before abuse was9(41%), comorbid developmental disorder was 15(68%). there were 6(27.5%) who didn‘t show definite sign of developmental delay before abuse. 5) Main diagnosis and comorbid diagnosis:According to main diagnosis, conduct disorder 6(27.3%), borderline child 5(23%), depression4(18%), attention deficit hyperactivity disorder(ADHD) 4(18%), pervasive developmental disorder not otherwise specified 2(9%), selective mutism 1(5%). According to comorbid diagnosis, ADHD, borderline intelligence, mental retardation, learning disorder, developmental language disorder, oppositional defiant disorder, chronic tic disorder, functional enuresis and encoporesis, anxiety disorder, dissociative disorder, personality disorder due to medical condition. 5) Course of treatment:A mean duration of admission was $2.4{\pm}1.5$ months. 11(15%) showed improvement of symtoms, however 11(50%) was not changed of symtoms.

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Diagnostic Value of ADA Multiplied by Lymphocyte to Neutrophil Ratio in Tuberculous Pleurisy (결핵성 흉막염에서 ADA 활성도와 림프구/중성구 비의 곱의 진단적 유용성)

  • Jeon, Eun Ju;Kwak, Hee Won;Song, Ju Han;Lee, Young Woo;Jeong, Jae Woo;Choi, Jae Cheol;Shin, Jong Wook;Kim, Jae Yeol;Park, In Won;Choi, Byoung Whui
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.1
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    • pp.17-23
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    • 2007
  • Background: Many diagnostic approaches for defining the definitive cause of pleurisy should be included due to the large variety of diseases resulting in pleural effusion. Although ADA is a useful diagnostic tool for making a differential diagnosis of pleural effusion, particularly for tuberculous pleural effusion, a definitive diagnostic cut-off value remains problematic in Korea. It was hypothesized that ADA multiplied by the Lymphocyte/Neutrophil ratio(L/N ratio) might be more powerful for making a differential diagnosis of pleural effusion. Methods: One hundred and ninety patients, who underwent thoracentesis and treatment in Chung-Ang University Hospital from January, 2005 through to February 2006, were evaluated. The clinical characteristics, radiologic data and the examination of the pleural effusion were analyzed retrospectively. Results: 1. Among the 190 patients, 59 patients (31.1%) were diagnosed with tuberculous pleurisy, 45 patients(23.7%) with parapneumonic effusion, 42 patients(22.1%) with malignant effusions, 36 patients(18.9%) with transudate, and 8 patients(4.2%) with empyema. One hundred and twenty one patients were found to have an ADA activity of 1 to 39 IU/L(63.7%). Twenty-nine were found to have an ADA activity of 40 to 75 IU/L(15.3%) and 40 were found to have an ADA activity of 75 IU/L or greater(21.0%). 2. Among the patients with tuberculous pleurisy, 5(8%), 18(30%) and 36 patients(60%) had an ADA activity ranging from 1 to 39 IU/L, 40 to 75 IU/L, and 75 IU/L or greater, respectively. In those with an ADA activitiy 40 to 75 IU/L, 18 patients(62%) had tuberculous pleurisy, 9(31%) had parapneumonic effusion and empyema, and 1(3.4%) had a malignant effusion. 3. In those with an ADA activity of 40 to 75 IU/L, there was no significant difference between tuberculous pleurisy and non-tuberculous pleural effusion(tuberculous pleurisy : 61.3 ${\pm}$ 9.2 IU/L, non-tuberculous pleural effusion : 53.3${\pm}$10.5 IU/L). 4. The mean L/N ratio of those with tuberculous pleurisy was 39.1 ${\pm}$ 44.6, which was significantly higher than nontuberculous pleural effusion patients (p<0.05). The mean ADA x L/N ratio of the tuberculous pleurisy patients was 2,445.7 ${\pm}$ 2,818.5, which was significantly higher than the non-tuberculous pleural effusion patients (level p<0.05). 5. ROC analysis showed that the ADA x L/N ratio had a higher diagnostic value than the ADA alone in the group with an ADA between 40-75 IU/L. Conclusion: The ADA multiplied by the lymphocyte-to-neutrophil ratio might provide a more definitive diagnosis of tuberculous pleurisy.

The Classification System and Information Service for Establishing a National Collaborative R&D Strategy in Infectious Diseases: Focusing on the Classification Model for Overseas Coronavirus R&D Projects (국가 감염병 공동R&D전략 수립을 위한 분류체계 및 정보서비스에 대한 연구: 해외 코로나바이러스 R&D과제의 분류모델을 중심으로)

  • Lee, Doyeon;Lee, Jae-Seong;Jun, Seung-pyo;Kim, Keun-Hwan
    • Journal of Intelligence and Information Systems
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    • v.26 no.3
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    • pp.127-147
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    • 2020
  • The world is suffering from numerous human and economic losses due to the novel coronavirus infection (COVID-19). The Korean government established a strategy to overcome the national infectious disease crisis through research and development. It is difficult to find distinctive features and changes in a specific R&D field when using the existing technical classification or science and technology standard classification. Recently, a few studies have been conducted to establish a classification system to provide information about the investment research areas of infectious diseases in Korea through a comparative analysis of Korea government-funded research projects. However, these studies did not provide the necessary information for establishing cooperative research strategies among countries in the infectious diseases, which is required as an execution plan to achieve the goals of national health security and fostering new growth industries. Therefore, it is inevitable to study information services based on the classification system and classification model for establishing a national collaborative R&D strategy. Seven classification - Diagnosis_biomarker, Drug_discovery, Epidemiology, Evaluation_validation, Mechanism_signaling pathway, Prediction, and Vaccine_therapeutic antibody - systems were derived through reviewing infectious diseases-related national-funded research projects of South Korea. A classification system model was trained by combining Scopus data with a bidirectional RNN model. The classification performance of the final model secured robustness with an accuracy of over 90%. In order to conduct the empirical study, an infectious disease classification system was applied to the coronavirus-related research and development projects of major countries such as the STAR Metrics (National Institutes of Health) and NSF (National Science Foundation) of the United States(US), the CORDIS (Community Research & Development Information Service)of the European Union(EU), and the KAKEN (Database of Grants-in-Aid for Scientific Research) of Japan. It can be seen that the research and development trends of infectious diseases (coronavirus) in major countries are mostly concentrated in the prediction that deals with predicting success for clinical trials at the new drug development stage or predicting toxicity that causes side effects. The intriguing result is that for all of these nations, the portion of national investment in the vaccine_therapeutic antibody, which is recognized as an area of research and development aimed at the development of vaccines and treatments, was also very small (5.1%). It indirectly explained the reason of the poor development of vaccines and treatments. Based on the result of examining the investment status of coronavirus-related research projects through comparative analysis by country, it was found that the US and Japan are relatively evenly investing in all infectious diseases-related research areas, while Europe has relatively large investments in specific research areas such as diagnosis_biomarker. Moreover, the information on major coronavirus-related research organizations in major countries was provided by the classification system, thereby allowing establishing an international collaborative R&D projects.

Deep Learning-based Professional Image Interpretation Using Expertise Transplant (전문성 이식을 통한 딥러닝 기반 전문 이미지 해석 방법론)

  • Kim, Taejin;Kim, Namgyu
    • Journal of Intelligence and Information Systems
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    • v.26 no.2
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    • pp.79-104
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    • 2020
  • Recently, as deep learning has attracted attention, the use of deep learning is being considered as a method for solving problems in various fields. In particular, deep learning is known to have excellent performance when applied to applying unstructured data such as text, sound and images, and many studies have proven its effectiveness. Owing to the remarkable development of text and image deep learning technology, interests in image captioning technology and its application is rapidly increasing. Image captioning is a technique that automatically generates relevant captions for a given image by handling both image comprehension and text generation simultaneously. In spite of the high entry barrier of image captioning that analysts should be able to process both image and text data, image captioning has established itself as one of the key fields in the A.I. research owing to its various applicability. In addition, many researches have been conducted to improve the performance of image captioning in various aspects. Recent researches attempt to create advanced captions that can not only describe an image accurately, but also convey the information contained in the image more sophisticatedly. Despite many recent efforts to improve the performance of image captioning, it is difficult to find any researches to interpret images from the perspective of domain experts in each field not from the perspective of the general public. Even for the same image, the part of interests may differ according to the professional field of the person who has encountered the image. Moreover, the way of interpreting and expressing the image also differs according to the level of expertise. The public tends to recognize the image from a holistic and general perspective, that is, from the perspective of identifying the image's constituent objects and their relationships. On the contrary, the domain experts tend to recognize the image by focusing on some specific elements necessary to interpret the given image based on their expertise. It implies that meaningful parts of an image are mutually different depending on viewers' perspective even for the same image. So, image captioning needs to implement this phenomenon. Therefore, in this study, we propose a method to generate captions specialized in each domain for the image by utilizing the expertise of experts in the corresponding domain. Specifically, after performing pre-training on a large amount of general data, the expertise in the field is transplanted through transfer-learning with a small amount of expertise data. However, simple adaption of transfer learning using expertise data may invoke another type of problems. Simultaneous learning with captions of various characteristics may invoke so-called 'inter-observation interference' problem, which make it difficult to perform pure learning of each characteristic point of view. For learning with vast amount of data, most of this interference is self-purified and has little impact on learning results. On the contrary, in the case of fine-tuning where learning is performed on a small amount of data, the impact of such interference on learning can be relatively large. To solve this problem, therefore, we propose a novel 'Character-Independent Transfer-learning' that performs transfer learning independently for each character. In order to confirm the feasibility of the proposed methodology, we performed experiments utilizing the results of pre-training on MSCOCO dataset which is comprised of 120,000 images and about 600,000 general captions. Additionally, according to the advice of an art therapist, about 300 pairs of 'image / expertise captions' were created, and the data was used for the experiments of expertise transplantation. As a result of the experiment, it was confirmed that the caption generated according to the proposed methodology generates captions from the perspective of implanted expertise whereas the caption generated through learning on general data contains a number of contents irrelevant to expertise interpretation. In this paper, we propose a novel approach of specialized image interpretation. To achieve this goal, we present a method to use transfer learning and generate captions specialized in the specific domain. In the future, by applying the proposed methodology to expertise transplant in various fields, we expected that many researches will be actively conducted to solve the problem of lack of expertise data and to improve performance of image captioning.

The Location of Medical Facilities and Its Inhabitants' Efficient Utilization in Kwangju City (광주시(光州市) 의료시설(醫療施設)의 입지(立地)와 주민(住民)의 효율적(效率的) 이용(利用))

  • Jeon, Kyung-Sook
    • Journal of the Korean association of regional geographers
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    • v.3 no.2
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    • pp.163-193
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    • 1997
  • Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.

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The Effect of Nitric Oxide Donor or Nitric Oxide Synthase Inhibitor on Oxidant Injury to Cultured Rat Lung Microvascular Endothelial Cells (산화질소 공여물과 산화질소 합성효소 길항제가 백서 폐미세혈관 내피세포 산화제 손상에 미치는 영향)

  • Chang, Joon;Michael, John R.;Kim, Se-Kyu;Kim, Sung-Kyu;Lee, Won-Young;Kang, Kyung-Ho;Yoo, Se-Hwa;Chae, Yang-Seok
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1265-1276
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    • 1998
  • Background : Nitric oxide(NO) is an endogenously produced free radical that plays an important role in regulating vascular tone, inhibition of platelet aggregation and white blood cell adhesion to endothelial cells, and host defense against infection. The highly reactive nature of NO with oxygen radicals suggests that it may either promote or reduce oxidant-induced cell injury in several biological pathways. Oxidant injury and interactions between pulmonary vascular endothelium and leukocytes are important in the pathogenesis of acute lung injury, including acute respiratory distress syndrome(ARDS). In ARDS, therapeutic administration of NO is a clinical condition providing exogenous NO in oxidant-induced endothelial injury. The role of exogenous NO from NO donor or the suppression of endogenous NO production was evaluated in oxidant-induced endothelial injury. Method : The oxidant injury in cultured rat lung microvascular endothelial cells(RLMVC) was induced by hydrogen peroxide generated from glucose oxidase(GO). Cell injury was evaluated by $^{51}$chromium($^{51}Cr$) release technique. NO donor, such as S-nitroso-N-acetylpenicillamine(SNAP) or sodium nitroprusside(SNP), was added to the endothelial cells as a source of exogenous NO. Endogenous production of NO was suppressed with N-monomethyl-L-arginine(L-NMMA) which is an NO synthase inhibitor. L-NMMA was also used in increased endogenous NO production induced by combined stimulation with interferon-$\gamma$(INF-$\gamma$), tumor necrosis factor-$\alpha$(TNF-$\alpha$), and lipopolysaccharide(LPS). NO generation from NO donor or from the endothelial cells was evaluated by measuring nitrite concentration. Result : $^{51}Cr$ release was $8.7{\pm}0.5%$ in GO 5 mU/ml, $14.4{\pm}2.9%$ in GO 10 mU/ml, $32.3{\pm}2.9%$ in GO 15 mU/ml, $55.5{\pm}0.3%$ in GO 20 mU/ml and $67.8{\pm}0.9%$ in GO 30 mU/ml ; it was significantly increased in GO 15 mU/ml or higher concentrations when compared with $9.6{\pm}0.7%$ in control(p < 0.05; n=6). L-NMMA(0.5 mM) did not affect the $^{51}Cr$ release by GO. Nitrite concentration was increased to $3.9{\pm}0.3\;{\mu}M$ in culture media of RLMVC treated with INF-$\gamma$ (500 U/ml), TNF-$\alpha$(150 U/ml) and LPS($1\;{\mu}g/ml$) for 24 hours ; it was significantly suppressed by the addition of L-NMMA. The presence of L-NMMA did not affect $^{51}Cr$ release induced by GO in RLMVC pretreated with INF-$\gamma$, TNF-$\alpha$ and LPS. The increase of $^{51}Cr$ release with GO(20 mU/ml) was prevented completely by adding 100 ${\mu}M$ SNAP. But the add of SNP, potassium ferrocyanate or potassium ferricyanate did not protect the oxidant injury. Nitrite accumulation was $23{\pm}1.0\;{\mu}M$ from 100 ${\mu}M$ SNAP at 4 hours in phenol red free Hanks' balanced salt solution. But nitrite was not detectable from SNP upto 1 mM The presence of SNAP did not affect the time dependent generation of hydrogen peroxide by GO in phenol red free Hanks' balanced salt solution. Conclusion : Hydrogen peroxide generated by GO causes oxidant injury in RLMVC. Exogenous NO from NO donor prevents oxidant injury, and the protective effect may be related to the ability to release NO. These results suggest that the exogenous NO may be protective on oxidant injury to the endothelium.

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