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Continuous Positive Airway Pressure during Bronchoalveolar Lavage in Patients with Severe Hypoxemia (심한 저산소혈증 환자에서 기관지폐포세척술 시 안면마스크를 이용한 지속성 기도양압의 유용성)

  • An, Chang Hyeok;Lim, Sung Yong;Suh, Gee Young;Park, Gye Young;Park, Jung Woong;Jeong, Seong Hwan;Lim, Si Young;Oui, Misook;Koh, Won-Jung;Chung, Man Pyo;Kim, Hojoong;Kwon, O Jung
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.1
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    • pp.71-79
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    • 2003
  • Background : A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. Methods : Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia ($PaO_2/FIO_2$ ratio ${\leq}200$ on oxygen 10 L/min via mask with reservoir bag) were enrolled. The CPAP 5-6 $cmH_2O(F_IO_2\;1.0)$ was delivered through an inflatable face mask using a conventional mechanical ventilator. The CPAP began 10 min before starting the BAL and continued for 30 min after the procedure was completed. A bronchoscope was passed through a T-adapter and advanced through the mouth. BAL was performed using the conventional method. The vital signs, pulse oxymetry values, and arterial blood gases were monitored during the study. Results : (1) Median age was 56 years(male:female=4:3). (2) The baseline $PaO_2$ was $78{\pm}16mmHg$, which increased significantly to $269{\pm}116mmHg$(p=0.018) with CPAP. After the BAL, the $PaO_2$ did not decrease significantly but returned to the baseline level after the CPAP was discontinued. The $SpO_2$ showed a similar trend with the $PaO_2$ and did not decrease to below 90 % during the duration of the study. (3) The $PaCO_2$ increased and the pH decreased significantly after the BAL but returned to the baseline level within 30 min after the BAL. (5) No complications directly related to the BAL procedure were encountered. However, intubation was necessary in 3 patients(43 %) due to the progression of the underlying diseases. Conclusion : In severe hypoxemic patients, CPAP using a face mask and conventional mechanical ventilator during a BAL might allow minimal alterations in oxygenation and prevent subsequent respiratory failure.

Lymphocyte Proportion and Cytokines from the Bone Marrow of Patients with Far-Advanced Pulmonary Tuberculosis with Peripheral Lymphocytopenia (말초혈액의 림프구감소증을 동반한 중증폐결핵 환자들에서 골수 내의 림프구 분획과 사이토카인 소견)

  • An, Chang Hyeok;Kyung, Sun Yong;Lim, Young Hee;Park, Gye Young;Park, Jung Woong;Jeong, Sung Hwan;Ahn, Jeong Yeal
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.5
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    • pp.449-458
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    • 2003
  • Background : The poor prognostic factors of far-advanced pulmonary tuberculosis(FAPTB) are lymphocytopenia in the peripheral blood(PB)(< $1,000/mm^3$) and $T_4$-cell count ${\leq}500/mm^3$. However, the cause of PB lymphocytopenia in FAPTB is unclear. The aim of this study was to analyze the lymphocyte proportion and cytokines of the bone marrow(BM) in FAPTB patients with peripheral lymphocytopenia in order to clarify whether the limiting step of the lymphocytopenia occurs in production, differentiation, or circulation. Methods : This study included patients with FAPTB between August 1999 and August 2002 who visited Gachon Medical School Gil Medical Center. The exclusion criteria were old age(${\geq}65years$), cachexia or a low body weight, shock, hematologic diseases, or BM involvement of tuberculosis. The distributions of cells in PB and BM were analyzed and compared to the control group. The interleukin(IL)-2, IL-7, IL-10, TNF-${\alpha}$, Interferon-${\gamma}$, and TGF-${\beta}$ levels in the BM were measured by ELISA. Result : Thirteen patients(male : female=9:4) were included and the mean age was $42{\pm}12$years. The proportion and count of the lymphocytes in the PB were significantly lower in the FAPTB group ($7.4{\pm}3.0%$, $694{\pm}255/mm^3$ vs. $17.5{\pm}5.8%$, $1,377{\pm}436/mm^3$, each p=0.0001 and 0.002). The proportion of immature lymphocyte in the BM showed a decreasing trend in the FAPTB group($9{\pm}4%$ vs. $12{\pm}3%$, p=0.138). The IL-2($26.0{\pm}29.1$ vs. $112.2{\pm}42.4pg/mL$, p=0.001) and IL-10($3.4{\pm}4.7$ vs. $12.0{\pm}8.0pg/mL$, p=0.031) levels in the BM were significantly lower in the FAPTB group than those in control. The levels of the other cytokines in FAPTB group and control were similar. Conclusion : These results suggest that the cause of lymphocytopenia in PB is associated with a abnormality IL-2 and IL-10 production in the BM. More study will be needed to define the mechanism of a decreased reservoir in BM.

Isolation of Marine Bacteria Killing Red Tide Microalgae -IV. Characteristics of Algicidal Substances, Produced from Micrococcus sp. LG-5 and the Effects on Marine Organisms- (적조생물 살조세균 탐색 -IV. 살조세균 Micrococcus sp. LG-5가 생산하는 살조물질의 특성과 해양생물에 미치는 영향-)

  • JEONG Seong-Youn;PARK Young-Tae;KIM Mu-Chan;CHOI Seok-Cheol;SEONG Hee-Kyung;KIM Jai-Young;KIM Tae-Un;LEE Won-Jae
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.33 no.4
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    • pp.339-347
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    • 2000
  • An algicidal bacterium, Micrococcus sp. LG-5 against the harmful dinoflagellate, Cochlodinium polykrikoides was isolated. The optimal conditions for the highest algicidal activity of bacterial culture filtrate showed in the range of $20{\~}30^{\circ}C$, at pH 7.0 and $3.0{\%}$ of NaCl concentration. In addition, $IC_(50)(mean of 50{\%} inhibitory concentration)$ of the culture filtrate against C. polykrikoides after incubation of 5 days was $0.482{\%}$. To investigate heat and pH stability of the culture filtrate of Micrococcus sp. LG-5, the culture filtrate ($pore size, 0.1 {\mu}m$) was heated to $121^{\circ}C for 15 min$ and adjusted pH from 2.0 to 10.0. There were no significant changes in algicidal activity by heat treatment and the pH change between pH from 5.0 to 10.0. The algicidal substances produced from Micrococcus sp. LG-5 were mainly detected in the fraction of $10,000{\~}1,000$ MWCO (molecular weight cut-off). The culture filtrate of Micrococous sp. LG-5 showed antimicrobial activity against Enterococcus faecalis, Escheiichia coli, Uebsiella pneunioniae and Vibrio altinolyticus, but did not show against Pseudomonas aeminosa, P. Buorescens, Salmonella typhi, Staphylococcus aureus, V. cholerae and V parahaemolyicus. The culture filtrate of Micrococcus sp. LG-5 was examined against 16 phytoplankton species and showed the algicidal activity against Ajexandzium tuarense, Eutreptiella Drnnastin, Gymnodinium catenatum, G. mikimotoi, G. sanguineum, eyodinium impuaicum, Heterocapsa triquetra, Heterosipa akashiwo, Prorocentrum micans and Pyraminonas sp.. However no algicidal effects of Micrococcus sp. LG-5 were observed against Chlamydomonas sp., Cylindrotheoa closterium, P. mininum, P. triestimum, Pseudonieschia sp. and Sczipuiella trochoidea. On the other hand, algicidal activity on the tested marinelivefood was not detected except for Isochrysis galbana. In addition, physiological responses of cultured olive flounder (Paralichthys oliraceus) exposed to $1 and 10{\%}$ of the culture filtrate of Micrococcus sp. LG-5 were measured. There were no clear changes in AST, GGT, creatinine, urea, total cholesterol, total protein, albumine, $Mg^(+2), Ca^(+2), Na^+, K^+, and Cl^-$. These results indicate that olive flounders were not affected when they were exposed to the culture filtrate of Micrococcus sp. LG-5.

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The Role of Protein Kinase C in Acute Lung Injury Induced by Endotoxin (내독소에 의한 급성폐손상에서 Protein Kinase C의 역할)

  • Kim, Yong-Hoon;Moon, Seung-Hyug;Kee, Sin-Young;Ju, Jae-Hak;Park, Tae-Eung;Im, Keon-Il;Cheong, Seung-Whan;Kim, Hyeon-Tae;Park, Choon-Sik;Jin, Byung-Won
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.349-359
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    • 1997
  • Background : The signal pathways and their precise roles for acute respiratory distress syndrome caused by endotoxin (ETX) has not been established. Since there has been several in vitro experiments suggesting that activation of protein kinase C (PKC) pathway may be responsible for endotoxin-induced inflammatory reaction, we performed in vivo experiments in the rats with the hypothesis that PKC-inhibition can effectively prevent endotoxin-induced acute lung injury. Methods : We studied the role of PKC in ETX-induced ALI using PKC inhibitor (staurosporine, STP) in the rat Specific pathogen free male Sprague-Dawley weighted from 165 to 270g were used for the study. Animals were divided into the normal control (NC)-, vehicle control (VC)-, ETX-, PMA (phorbolmyristateacetate)-, STP+PMA-, and STP+ETX-group. PMA (50mg/kg) or ETX (7mg/kg) was instilled through polyethylen catheter after aseptic tracheostomy with and without STP (0.2mg/kg)-pretreatment STP was injected via tail vein 30min before intratracheal injection (IT) of PMA or ETX. Bronchoalveolar lavage (BAL) was done 3-or 6-hrs after IT of PMA or ETX respectively, to measure protein concentration, total and differential cell counts. Results : The results were as follows. The protein concentrations in BALF in the PMA- and ETX-group were very higher than that of VC-group (p<0.001). When animals were pretreated with STP, the %reduction of the protein concentration in BALF was $64.8{\pm}8.5$ and $30.4{\pm}2.5%$ in the STP+PMA- and STP+ETX-group, respectively (p = 0.028). There was no difference in the total cell counts between the PMA-and VC-group (p = 0.26). However the ETX-group showed markedly increased total cell counts as compared to the VC- (p = 0.003) and PMA-group (p = 0.0027), respectively. The total cell counts in BALF were not changed after pretreatment with STP compared to the PMA- (p = 0.22) and ETX-group (p = 0.46). The percentage of PMN, but not alveolar macrophage, was significantly elevated in the PMA-, and ETX-group. Especially in the ETX-group, the percentage of PMN was 17 times higher than that of PMA (p < 0.001). The differential cell counts was not different between the PMA and STP+PMA On the contrary the STP+ETX-group showed decreased percentage of PMN (p = 0.016). There was no significant relationship between the protein concentration and the total or differential cell counts in each group. Conclusion : Pretreatment with PKC-inhibitor (staurosporine) partially but significantly inhibited ETX-induced ALI.

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The Recovery of Left Ventricular Function after Coronary Artery Bypass Grafting in Patients with Severe Ischemic Left Ventricular Dysfunction: Off-pump Versus On-pump (심한 허혈성 좌심실 기능부전 환자에서 관상동맥우회술시 체외순환 여부에 따른 좌심실 기능 회복력 비교)

  • Kim Jae Hyun;Kim Gun Gyk;Baek Man Jong;Oh Sam Sae;Kim Chong Whan;Na Chan-Young
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.116-122
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    • 2005
  • Background: Adverse effects of cardiopulmonary bypass can be avoided by 'Off-pump' coronary artery bypass (OPCAB) surgery. Recent studies have reported that OPCAB had the most beneficial impact on patients at highest risk by reducing bypass-related complications. The purpose of this study is to compare the outcome of OPCAB and conventional coronary artery bypass grafting (CCAB) in patients with poor left ventricular (LV) function. Material and Method: From March 1997 to February 2004, seventy five patients with left ventricular ejection fraction (LVEF) of $35\%$ or less underwent isolated coronary artery bypass grafting at our institute. Of these patients, 33 patients underwent OPCAB and 42 underwent CCAB. Preoperative risk factors, operative and postoperative outcomes, including LV functional change, were compared and analysed. Result: Patients undergoing CCAB were more likely to have unstable angina, three vessel disease and acute myocardial infarction among the preoperative factors. OPCAB group had significantly lower mean operation time, less numbers of total distal anastomoses per patient and less numbers of distal anastomoses per patient in the circumflex territory than the CCAB group. There was no difference between the groups in regard to in-hospital mortality $(OPCAB\; 9.1\%\;(n=3)\;Vs.\;CCAB\;9.5\%\;(n=4)),$ intubation time, the length of stay in intensive care unit and in hospital postoperatively. Postoperative complication occurred more in CCAB group but did not show statistical difference. On follow-up echocardiography, OPCAB group showed $9.1\%$ improvement in mean LVEF, 4.3 mm decrease in mean left ventricular end-diastolic dimension (LVEDD) and 4.2 mm decrease in mean left ventricular end-systolic dimension (LVESD). CCAB group showed $11.0\%$ improvement in mean LVEF, 5.1 mm decrease in mean LVEDD and 5.5 mm decrease in mean LVESD. But there was no statistically significant difference between the two groups. Conclusion: This study showed that LV function improves postoperatively in patients with severe ischemic LV dysfunction, but failed to show any difference in the degree of improvement between OPCAB and CCAB. In terms of operative mortality rate and LV functional recovery, the results of OPCAB were as good as those of CCAB in patients with poor LV function. But, OPCAB procedure was advantageous in shortening of operative time and in decrease of complications. We recommend OPCAB as the first surgical option for patients with severe LV dysfunction.

The Use of Radioactive $^{51}Cr$ in Measurement of Intestinal Blood Loss ($^{51}Cr$을 사용(使用)한 장관내(賜管內) 출혈량측정법(出血量測定法))

  • Lee, Mun-Ho
    • The Korean Journal of Nuclear Medicine
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    • v.4 no.1
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    • pp.19-26
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    • 1970
  • 1. Sixteen normal healthy subjects free from occult blood in the stool were selected and administered with their $^{51}Cr$ labeled own blood via duodenal tube and the recovery rate of radioactivity in feces and urine was measured. The average fecal recovery rate was 90.7 per cent ($85.7{\sim}97.7%$) of the administered radioactivity, and the average urinary excretion rate was 0.8 per cent ($0.5{\sim}1.5%$) 2. There was a close correlation between the amount of blood administered and the recovery rate from the feces; the more the blood administered, the higher the recovery rate was. It was also found that the administration of the tagged blood in the amount exceeding 15ml was suitable for measuring the radioactivity in the stools. 3. In five normal healthy subjects whose circulating erythrocytes had been tagged with $^{51}Cr$, there was little fecal excretion of radioactivity (average 0.9 ml of blood per day). This excretion is not related to hemorrhage and the main route of excretion of such an negligible radioactivity was postulated as gastric juice and bile. 4. A comparison of the radioactivity in the blood and feces of the patients with $^{51}Cr$ labeled erythrocytes seems to be a valid way of estimating intestinal blood loss.

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Showing Filial Piety: Ancestral Burial Ground on the Inwangsan Mountain at the National Museum of Korea (과시된 효심: 국립중앙박물관 소장 <인왕선영도(仁旺先塋圖)> 연구)

  • Lee, Jaeho
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.123-154
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    • 2019
  • Ancestral Burial Ground on the Inwangsan Mountain is a ten-panel folding screen with images and postscripts. Commissioned by Bak Gyeong-bin (dates unknown), this screen was painted by Jo Jung-muk (1820-after 1894) in 1868. The postscripts were written by Hong Seon-ju (dates unknown). The National Museum of Korea restored this painting, which had been housed in the museum on separate sheets, to its original folding screen format. The museum also opened the screen to the public for the first time at the special exhibition Through the Eyes of Joseon Painters: Real Scenery Landscapes of Korea held from July 23 to September 22, 2019. Ancestral Burial Ground on the Inwangsan Mountain depicts real scenery on the western slopes of Inwangsan Mountain spanning present-day Hongje-dong and Hongeun-dong in Seodaemun-gu, Seoul. In the distance, the Bukhansan Mountain ridges are illustrated. The painting also bears place names, including Inwangsan Mountain, Chumohyeon Hill, Hongjewon Inn, Samgaksan Mountain, Daenammun Gate, and Mireukdang Hall. The names and depictions of these places show similarities to those found on late Joseon maps. Jo Jung-muk is thought to have studied the geographical information marked on maps so as to illustrate a broad landscape in this painting. Field trips to the real scenery depicted in the painting have revealed that Jo exaggerated or omitted natural features and blended and arranged them into a row for the purposes of the horizontal picture plane. Jo Jung-muk was a painter proficient at drawing conventional landscapes in the style of the Southern School of Chinese painting. Details in Ancestral Burial Ground on the Inwangsan Mountain reflect the painting style of the School of Four Wangs. Jo also applied a more decorative style to some areas. The nineteenth-century court painters of the Dohwaseo(Royal Bureau of Painting), including Jo, employed such decorative painting styles by drawing houses based on painting manuals, applying dots formed like sprinkled black pepper to depict mounds of earth and illustrating flowers by dotted thick pigment. Moreover, Ancestral Burial Ground on the Inwangsan Mountain shows the individualistic style of Jeong Seon(1676~1759) in the rocks drawn with sweeping brushstrokes in dark ink, the massiveness of the mountain terrain, and the pine trees simply depicted using horizontal brushstrokes. Jo Jung-muk is presumed to have borrowed the authority and styles of Jeong Seon, who was well-known for his real scenery landscapes of Inwangsan Mountain. Nonetheless, the painting lacks an spontaneous sense of space and fails in conveying an impression of actual sites. Additionally, the excessively grand screen does not allow Jo Jung-muk to fully express his own style. In Ancestral Burial Ground on the Inwangsan Mountain, the texts of the postscripts nicely correspond to the images depicted. Their contents can be divided into six parts: (1) the occupant of the tomb and the reason for its relocation; (2) the location and geomancy of the tomb; (3) memorial services held at the tomb and mysterious responses received during the memorial services; (4) cooperation among villagers to manage the tomb; (5) the filial piety of Bak Gyeong-bin, who commissioned the painting and guarded the tomb; and (6) significance of the postscripts. The second part in particular is faithfully depicted in the painting since it can easily be visualized. According to the fifth part revealing the motive for the production of the painting, the commissioner Bak Gyeongbin was satisfied with the painting, stating that "it appears impeccable and is just as if the tomb were newly built." The composition of the natural features in a row as if explaining each one lacks painterly beauty, but it does succeed in providing information on the geomantic topography of the gravesite. A fair number of the existing depictions of gravesites are woodblock prints of family gravesites produced after the eighteenth century. Most of these are included in genealogical records and anthologies. According to sixteenth- and seventeenth-century historical records, hanging scrolls of family gravesites served as objects of worship. Bowing in front of these paintings was considered a substitute ritual when descendants could not physically be present to maintain their parents' or other ancestors' tombs. Han Hyo-won (1468-1534) and Jo Sil-gul (1591-1658) commissioned the production of family burial ground paintings and asked distinguished figures of the time to write a preface for the paintings, thus showing off their filial piety. Such examples are considered precedents for Ancestral Burial Ground on the Inwangsan Mountain. Hermitage of the Recluse Seokjeong in a private collection and Old Villa in Hwagae County at the National Museum of Korea are not paintings of family gravesites. However, they serve as references for seventeenth-century paintings depicting family gravesites in that they are hanging scrolls in the style of the paintings of literary gatherings and they illustrate geomancy. As an object of worship, Ancestral Burial Ground on the Inwangsan Mountain recalls a portrait. As indicated in the postscripts, the painting made Bak Gyeong-bin "feel like hearing his father's cough and seeing his attitudes and behaviors with my eyes." The fable of Xu Xiaosu, who gazed at the portrait of his father day and night, is reflected in this gravesite painting evoking a deceased parent. It is still unclear why Bak Gyeong-bin commissioned Ancestral Burial Ground on the Inwangsan Mountain to be produced as a real scenery landscape in the folding screen format rather than a hanging scroll or woodblock print, the conventional formats for a family gravesite paintings. In the nineteenth century, commoners came to produce numerous folding screens for use during the four rites of coming of age, marriage, burial, and ancestral rituals. However, they did not always use the screens in accordance with the nature of these rites. In the Ancestral Burial Ground on the Inwangsan Mountain, the real scenery landscape appears to have been emphasized more than the image of the gravesite in order to allow the screen to be applied during different rituals or for use to decorate space. The burial mound, which should be the essence of Ancestral Burial Ground on the Inwangsan Mountain, might have been obscured in order to hide its violation of the prohibition on the construction of tombs on the four mountains around the capital. At the western foot of Inwangsan Mountain, which was illustrated in this painting, the construction of tombs was forbidden. In 1832, a tomb discovered illegally built on the forbidden area was immediately dug up and the related people were severely punished. This indicates that the prohibition was effective until the mid-nineteenth century. The postscripts on the Ancestral Burial Ground on the Inwangsan Mountain document in detail Bak Gyeong-bin's efforts to obtain the land as a burial site. The help and connivance of villagers were necessary to use the burial site, probably because constructing tombs within the prohibited area was a burden on the family and villagers. Seokpajeong Pavilion by Yi Han-cheol (1808~1880), currently housed at the Los Angeles County Museum of Art, is another real scenery landscape in the format of a folding screen that is contemporaneous and comparable with Ancestral Burial Ground on the Inwangsan Mountain. In 1861 when Seokpajeong Pavilion was created, both Yi Han-cheol and Jo Jung-muk participated in the production of a portrait of King Cheoljong. Thus, it is highly probable that Jo Jung-muk may have observed the painting process of Yi's Seokpajeong Pavilion. A few years later, when Jo Jungmuk was commissioned to produce Ancestral Burial Ground on the Inwangsan Mountain, his experience with the impressive real scenery landscape of the Seokpajeong Pavilion screen could have been reflected in his work. The difference in the painting style between these two paintings is presumed to be a result of the tastes and purposes of the commissioners. Since Ancestral Burial Ground on the Inwangsan Mountain contains the multilayered structure of a real scenery landscape and family gravesite, it seems to have been perceived in myriad different ways depending on the viewer's level of knowledge, closeness to the commissioner, or viewing time. In the postscripts to the painting, the name and nickname of the tomb occupant as well as the place of his surname are not recorded. He is simply referred to as "Mister Bak." Biographical information about the commissioner Bak Gyeong-bin is also unavailable. However, given that his family did not enter government service, he is thought to have been a person of low standing who could not become a member of the ruling elite despite financial wherewithal. Moreover, it is hard to perceive Hong Seon-ju, who wrote the postscripts, as a member of the nobility. He might have been a low-level administrative official who belonged to the Gyeongajeon, as documented in the Seungjeongwon ilgi (Daily Records of Royal Secretariat of the Joseon Dynasty). Bak Gyeong-bin is presumed to have moved the tomb of his father to a propitious site and commissioned Ancestral Burial Ground on the Inwangsan Mountain to stress his filial piety, a conservative value, out of his desire to enter the upper class. However, Ancestral Burial Ground on the Inwangsan Mountain failed to live up to its original purpose and ended up as a contradictory image due to its multiple applications and the concern over the exposure of the violation of the prohibition on the construction of tombs on the prohibited area. Forty-seven years after its production, this screen became a part of the collection at the Royal Yi Household Museum with each panel being separated. This suggests that Bak Gyeong-bin's dream of bringing fortune and raising his family's social status by selecting a propitious gravesite did not come true.

A Comparison of Tiotropium 18㎍, Once Daily and Ipratropium 40㎍, 4 Times Daily in a Double-Blind, Double-Dummy, Efficacy and Safety Study in Adults with Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환 환자에서 Tiotropium 1일 1회, 1회 18㎍ 요법과 Ipratropium 1일 4회, 1회 40㎍ 요법의 치료효과 및 안전성 비교)

  • Kim, Seung Joon;Kim, Myung Sook;Lee, Sang Haak;Kim, Young Kyoon;Moon, Hwa Sik;Park, Sung Hak;Lee, Sang Yeub;In, Kwang Ho;Lee, Chang Youl;Kim, Young Sam;Kim, Hyung Jung;Ahn, Chul Min;Kim, Sung Kyu;Kim, Kyung Rok;Cha, Seung Ick;Jung, Tae Hoon;Kim, Mi Ok;Park, Sung Soo;Choi, Cheon Woong;Yoo, Jee Hong;Kang, Hong Mo;Koh, Won Jung;Ham, Hyoung Suk;Kang, Eun Hae;Kwon, O Jung;Lee, Yang Deok;Lee, Heung Bum;Lee, Yong Chul;Rhee, Yang Keun;Shin, Won Hyuk;Kwon, Sung Yeon;Kim, Woo Jin;Yoo, Chul Gyu;Kim, Young Whan;Shim, Young Soo;Han, Sung Koo;Park, Hye Kyung;Kim, Yun Seong;Lee, Min Ki;Park, Soon Kew;Kim, Mi Hye;Lee, Won Yeon;Yong, Suk Joong;Shin, Kye Chul;Choi, Byoung Whui;Oh, Yeon Mok;Lim, Chae Man;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Jung, Sung Soo;Kim, Ju Ock;Ko, Young Chun
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.5
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    • pp.498-506
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    • 2005
  • Background : This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules ($18{\mu}g$ once daily) with a ipratropium metered dose inhaler (2 puffs of $20{\mu}g$ q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). Method : After the initial screening assessment and a two-week run-in period, patients received either tiotropium $18{\mu}g$ once daily or ipratropium $40{\mu}g$ four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second ($FEV_1$) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. Result : In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted $FEV_1$ of 42 (12)% were analyzed. The trough $FEV_1$ response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. Conclusion : This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.

Time Course Change of Phagocytes and Proinflammatory Activities in BALF in Endotoxin-induced Acute Lung Injury (시간별 내독소 정맥주입으로 유발된 급성폐손상의 변화양상에 대한 고찰)

  • Moon, Seung-Hyug;Oh, Je-Ho;Park, Sung-Woo;NamGung, Eun-Kyung;Ki, Shin-Young;Im, Gun-Il;Jung, Sung-Whan;Kim, Hyeon-Tae;Uh, Soo-Tack;Kim, Yong-Hoon;Park, Choon-Sik;Jin, Byeng-Weon
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.360-378
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    • 1997
  • Background : Severe acute lung injury(ALI), also known as the adult respiratory distress syndrome(ARDS), is a heterogenous nature of dynamic and explosive clinical synrome that exacts a mortality of approximately 50%. Endotoxin(ETX) is an abundant component of the outer membrane of gram-negative bacteria capable of inducing severe lung injury in gram-negative sepsis and gram-negative bacterial pneumonia, which are among the most common predisposing causes of ARDS. The influx of PMNs into airway tissue is a pathological hallmark of LPS-induced lung injury. And there is a substantial evidence suggesting that cytokines are important mediators of lung injury in gram-negative sepsis. However, the kinetics of phagocytes and cytokines by an exact time sequence and their respective pathogenic importance remain to be elucidated. This study was performed to investigate the role of phagocytes and proinflammatory cytokines in ETX-induced ALI through a time course of changes in the concentration of protein, $TNF{\alpha}$ and IL-6, and counts of total and its differential cells in BALF. The consecutive histologic findings were also evaluated. Method : The experimental animals, healthy male Sprague-Dawley, weighted $200{\pm}50g$, were divided into control- and ALI- group. ALI was induced by an intravenous administration of ETX, 5mg/kg. Above mentioned all parameters were examined at 0(control), 3, 6, 24, 72 h after administration of ETX. $TNF{\alpha}$ and IL-6 cone. in BALF were measured by a bioassay. Results : The protein concentration and total leukocyte count(TC) in BALF was significantly increased at 3h compared to controls(p < 0.05). The protein conc. was significantly elavated during observation period, but TC was significantly decreased at 72h(p < 0.05 vs. 24h). There was a close relationship between TC and protein cone. in BALF(r = 0.65, p < 0.001). The PMN and monocyte count was well correlated with TC in BALF, and the correlation of PMN(r = 0.97, p < 0.001) appeared to be more meaningful than that of monocyte(r = 0.61, p < 0.001). There was also a significant correlation between protein cone. and PMN or monocyte count in BALF(PMN vs. monocyte : r = 0.55, p < 0.005 vs. r = 0.64, p < 0.001). The count of monocyte was significantly elavated during observation period though a meaningful reduction of PMN count in BALF at 72h, this observation suggested that monocyte may, at least, partipate in the process of lung injury steadly. In this study, there was no relationship between IL-6 and $TNF{\alpha}$ cone., and $TNF{\alpha}$ but not IL-6 was correlated with TC(r = 0.61, p < 0.05) and monocyte(r = 0.67, p < 0.05) in BALF only at 3, 6h after ETX introduced. In particular, the IL-6 cone. increased earlier and rapidly peaked than $TNF{\alpha}$ cone. in BALF. In histologic findings, the cell counts of lung slices were increased from 3 to 72h(p < 0.001 vs. NC). Alveolar wall-thickness was increased from 6 to 24h(p < 0.001 vs. NC). There was a significant correlation between the cell counts of lung slices and alveolar wall-thickness(r= 0.61, p < 0.001). This result suggested that the cellular infiltrations might be followed by the alterations of interstitium, and the edematous change of alveolar wall might be most rapidly recovered to its normal condition in the process of repair. Conclusion : We concluded that although the role of PMN is partly certain in ETX-induced ALI, it is somewhat inadequate to its known major impact on ALL Alveolar macrophage and/or non-immune cells such as pulmonary endothelial or epithelial cells, may be more importantly contributed to the initiation and perpetual progression of ETX-induced ALI. The IL-6 in ETX-induced ALI was independent to $TNF{\alpha}$, measured by a bioassay in BALF. The early rise in IL-6 in BALF implies multiple origins of the IL-6.

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The Impact of Justice of Layoff on Management Trust, Job Satisfaction and Organizational Commitment in the Hotel Corporations (호텔기업에 있어 구조조정상의 공정성 지각이 경영진의 신뢰, 직무만족 및 조직몰입에 미치는 영향)

  • Kim, Young-Soon;Ahn, Dae-Hee
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.1
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    • pp.115-139
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    • 2008
  • Since financial crisis of IMF resulted in intensive competitiveness and adverse management environment, many hotel industries have responded it with restructuring. Since this restructuring is accompanied by reduction of employees, hence comes the recognition of justice in the procedure of restructuring. When the surviving employees in the restructuring process recognize unfairness in the procedure and practical operations, organization effectiveness can not be maintained due to losing trust of their employers. In this paper I will examine the relationship between validity of restructuring and compensatory programs for layoffs and surviving employees' trust of the employers. Also I will find out the relationship between remaining employees' trust of the employers and their job satisfaction and organization commitment. Through this relationship, we can prepare an alternative to reduce negative effect of restructuring. The hypotheses of this study are proposed as follows: H1: The higher surviving employees' recognition of procedural justice in restructuring process is, the higher their trust with a manager of the company is. H2: The higher surviving employees' recognition of distributive justice in restructuring process is, the higher their trust with a manager of the company is. H3: The higher surviving employees' recognition of procedural justice in restructuring process is, the higher their job satisfaction is. H4: The higher surviving employees' recognition of distributive justice in restructuring process is, the higher their job satisfaction is. H5: The higher surviving employees' recognition of procedural justice in restructuring process is, the higher their organization commitment is. H6: The higher surviving employees' recognition of distributive justice in restructuring process is, the higher their organization commitment is. H7: The higher surviving employees' trust with a manager of the company in restructuring process is, the higher their job satisfaction is. H8: The higher surviving employees' trust with a manager of the company in restructuring process is, the higher their organization commitment is. For the purposes of this study, employees working in luxury hotels located in Seoul were targeted. Self-administered questionnaires were distributed to those who consented with the investigation after explaining the purpose of the survey. A total of 500 questionnaires were distributed and 450 questionnaire were returned to the researcher for analysis. 430 of the returned questionnaires were used for analysis. As for the education for this survey, 250 junior college graduates or under (58.1%), 143 college graduates (33.3%) and 37 graduate school graduates (8.6%). As for the marital status, 315 persons (73.3%) are single and 115 are married (26.7%). As for the monthly income, 49 people (11.48%) are less than 2 million won, 148 (34.4%) are between 2 million and less than 2.5 million won, 153 (35.6%) are between 2.5 million to less than 3 million won, 80 (18.6%) are more than 3 million won. As for the workplace, 293 people (68.1%) work for the F&B department, 73 (17.0%) for rooms department, 41 (9.5%) for operation/ marketing department, 23 (5.3%) for account/ general affair department. As for the period of employment, 85 people (19.8%) are less than 5 years, 150 (34.9%) are between 6 to 9 years, 143 (33.3%) are between 10 to 14 years. and 52 (3.%) are more than 15 years. An exploratory factor analysis was used to survey validity and reliability of calculating tool on perceived values. This study used correlation between individual items and whole items and Cronbach's alpha value of multiple-item scale which is usually used to assess scale and reliability. Reliability of conceptual sub-dimension was assessed by basing on repeated procedure of correlation between individual items and whole items and factor loading. 1. Verification of correlation between validity of restructuring and trust This research showed that procedural and distributive justice of restructuring affects trust positively. The path coefficient between procedural justice of restructuring and trust is 0.719(t=10.135, p=0.000), and thereby the higher procedural justice results in higher trust. The path coefficient between distributive justice of restructuring and trust is 0.160(t=3.291, p=0.001), and thereby the higher distributive justice results in higher trust. Hence H1 and H2 are accepted. 2. Verification of correlation between validity of restructuring and job satisfaction The path coefficient between procedural justice of restructuring and job satisfaction is 0.179(t=2.202, p=0.028), and thereby the higher procedural justice results in higher job satisfaction. The path coefficient between distributive justice of restructuring and job satisfaction is 0.074(t=1.620, p=0.105), and thereby distributive justice of restructuring has no relationship with job satisfaction. Hence H3 is accepted, but H4 is removed. 3. Verification of correlation between validity of restructuring and organization commitment The path coefficient between procedural justice of restructuring and organization commitment is 0.188(t=2.466, p=0.014), and thereby the higher procedural justice results in higher organization commitment. The path coefficient between distributive justice of restructuring and organization commitment is 0.118(t=2.720, p=0.007), and thereby the higher distributive justice results in higher organization commitment. Hence H5 and H6 are accepted. 4. Verification of correlation between trust and job satisfaction The path coefficient between trust and job satisfaction is 0.610(t=6.736, p=0.000), and thereby the correlation has a meaningful result. Since the higher trust of the employer results in higher job satisfaction, H7 is accepted. 5. Verification of correlation between trust and organization commitment The path coefficient between procedural justice of restructuring and job satisfaction is 0.446(t=5.547 p=0.000), and thereby the higher trust of the employer results in higher organization commitment. Hence H8 is accepted. This research aimed to help the employers of hotel industries by analyzing the effects of validity of restructuring on employees' trust, job satisfaction and organization commitment. The research found that employer's validity of restructuring has significant affects on the degree of employee's trust with a manager, thereby reducing the negative effects of restructuring and enhancing organization commitment and job satisfaction. The principal purpose of this research is to confirm the correlation between employees' perceived validity of restructuring and their trust with a manager. Also whether this correlation results in competitive edge of the company is also investigated. It is also pointed out that employees had to participated the procedure of restructuring, sharing the philosophy and reason of restructuring. This participation and furthermore compensatory methods can reduce employees' anxiety of organization operations. Variable of trust appeared to have impact on intermediation effect between perceived variable of validity and job satisfaction, organization commitment, so that increase of trust with a manager plays an crucial role in increasing organization effectiveness. Since this research did not cover whole hotel industries which underwent restructuring, it showed a limit. Unlike previous studies which dealt with validity and trust of superior bosses, this research focussed on employers. Also the organization citizenship which is not considered in this study will be dealt with in the future study.

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