• Title/Summary/Keyword: 표준병원

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Health Promotion Through Healthy People 2010 ("2010년대 건강한 시민" 정책을 통한 미국의 건강증진 방향)

  • Cho, Jung H.
    • Proceedings of The Korean Society of Health Promotion Conference
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    • 2004.10a
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    • pp.17-58
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    • 2004
  • 뉴저지주 보건교육/건강 증진정책을 논하기전에 건강증진과 보건 교육사의 뜻을 먼저 기술하기로 한다. 건강증진이란 일상 사회생활과 행동과학의 응용에서 시작하며 교육의 효율적 작전 및 기술, 질병 역학 조사, 개인 및 가족단위 건강 위해 행위 절감, 사회연관 구축망 조성, 그리고 적게는 이웃, 더 나아가 조직체계 및 지역 사회의 네트웍 실시등을 실시한다. 보건교육 및 건강증진 전문가란 ' 전국 보건교육 인증 위원회(NCHEC) ' 에서 채택된 다음 7개 활동 영역에서 개인적, 그룹, 각주단위, 그리고 범 국가적 조직에서 종사하는자로 한다. 개인 및 지역사회 보건 교육 필요성 분석- 계회, 실행, 효율성 평가, 사업 진행 조정, 자문, 컴뮤니케이션 등의 활동범위를 들 수 있다. 공인 보건 교육사(CHES)란 대학 및 대학원에서 보건 교육학 소정의 필수 과목을 이수하고 학.석사 소지자로서 ' 전국 보건 교육 인증 위원회 ' 에서 그 자격을 인정 받고 공인 자격 시험에 합격한자로 한다. 합격자는 자기 성명뒤에 CHES란 칭호를 부치며 매 5년마다 75단위이상 인정된 전문 직업 보수 교육을 받아야 한다. 보건 교육사 고용 분야는 연방, 주, 지방 정부의 보건 교육사(10-15%) 및 건강 증진 전문가로 종사하며; 이들은 지역 사회 조직화, 프로그람 기획, 공공사업 마켓팅, 메디아, 컴뮤니케이션 자질을 갓추어야 하며; 상해 예방, 학교 보건, 지역 사회 영양 실태 향상, 그 외 모든 건강 증진과 질병 예방에 일익을 담당 하여; 의사, 간호사, 약사, 영양사,환경 위생사드의 전문분야종사자들괴 한팀이 되어 지역 사회 보건 사업에 기여한다. 쥬저지 보건 교육사들은 주법령 8조 '||'&'||' 보건행정 표준 시행령 ' 에 따라 포괄적 보건교육/건강증진 프로그램을 개발하여 총체적으로 조절 관장한다. 특희 ' 미국 학술원 의료 연구원 ' 에서 제정한 ' 10대 필수 공중 보건 사업 ' 에 기준을 두고; 1) 개인 및 지역사회 필수 보건 여건 분석 평가, 2) 보건 교육 이론에 따른 사업 계획 설정, 3) 교육 전략과 보건문제 발굴에 따라 일반 대중 대상 보건 교육 실행 (프로그람 기획, 연수 교육, 미디어 캠페인, 공중보건 향상책 옹호), 4) 사업 진행 과정 정리, 그 결과에 대한 영향력과 결과 평가, 5) 프로그램진행, 인사 및 예산관리 참여, 6) 근무향상을 위한 보수교육 프로그램 개발, 7) 보건 의료 업무 종사자 상호 협조성 향상 훈련, 8) 지역 사회자원 밭굴, 9) 적절한 고객 의뢰 체제 시행, 10) 위기 관리 컴뮤니케이션 체제 개발실시, 11) 일반 대중에게 공중 보건 향상 고취, 12) 각종 협력 지원금 신청서 작성 제출, 13) 문화/인종적으로 적절한 시청각 교재 발굴, 15) 질적 및 양적 보건교육/건겅증진책 연구 실시, 16) 비 보험 가담자, 저 보험자, 빈곤자, 이민자 색출 선도, 17) 관활 구역내 상재하는 각 건강증진 프로그램 밝혀 내서 불필요한 중복 회피등이다. 그 외에도 보건 교육사들은 사회 복지 단체인 미국 암 협회, 미국 심장 협회,미국 폐장 협회 등 각종 사회 복지 비영리단체 와 자선 사업 단체들과 긴밀희 협조하거나 그 단체 임직원으로서 건강 증진 사업에 종사한다. 병원 및 의료기관에선 임직원 보수 교육, 환자의 질병 예방및 건강증진 교육, 그리고 의료 사업장내 건장 증진업무에 종사한다. 건강 유지 의료 기관(HMO)에선 예방주사, 정기검진 촉진등을 통한 입원일수 절감, 응급실 사용도 절감등으로 의료비 감축, 삶의질 향상상에 종사한다. 사업장 보건 교육사는 스트레스 관리, 금연 및 흡연 중단선도, 체중 절감, 종업원 건강증진 생활화참여 유치, 컴뮤니케이션 개발, 마켓팅, 질병 예방등에 그 전문 직업적 노하우를 사업체 건강 증진 프로그램 개발에 접목한다. 뉴저지 2010년대 건강 증진책은 5대 목표 설정하여 현재 시행하고 있다. 특이한점은 2001년 9.11사태 이후 연방정부와 주정부의 상당한 예산 지원을 그랜트 지원금 형식으로 받아 연방, 주정부, 지방 정부, 의료 기관등에서 일사 불란하게 생물/화학/방사성 테러에 대비하는데 보건 교육사들은 시민 인지도 향상과 위기관리 컴뮤니케이션 영역에서 활약한다. 총체적인 보건 교육/건강 증진책은 다음 천년간 뉴저지 건강증진 백서와 미연방 정부 건강증진 2010에 준하여 설립한 뉴저지 건강 증진 2010 에 의한다. 그 모델을 보면; 1) 생활 습관 향상으로 위해 행위 절제; 적절한 영양 섭취 와 과체중화 차단 불필요한 투약 절제와 그 관리 흡연 탐익 절감, 금연, 흡연관련 신체/정신적 피해 관리/치료 습관성 약물 중독 조기발견 예방 낙상 예방 폭력, 의도적/비의도적 상해 예방 2) 심장질환, 암, 뇌졸중, 당뇨, 폐염, 인프루엔자등 주사망원인 질병 조기 발견 예방 책 마련; 독감.폐렴 예방 주사 실시 3) 보건 교육 대상과 표적 설정 특히 보건사업 참여 동반자 발굴하여 그 동참과 책임분담 책려; 주. 지방 정부기관, 의료 종사자, 의료 보험 업자, 대학 등 교육 기관, 연구 기관, 교육자, 지방 보건소, 지역 사회 비 영리단체, 종교 단체 및 교역자 등의 참여 촉구., 지역 사회 비 영리단체, 종교 단체 및 교역자 등의 참여 촉구.

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Evaluation of the LG AdvansureTM Malaria P.f./P.v. real-time QPCR for the Diagnosis of Malaria (LG AdvansureTM Malaria P.f./P.v. real-time QPCR의 말라리아 진단 유용성)

  • Lee, Hye Jin;Kim, Ha Nui;Yoo, Byong Joon;Kim, Jang Su;Kim, Myong Han;Lim, Chae Seung;Lee, Kap No
    • Laboratory Medicine Online
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    • v.1 no.2
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    • pp.100-104
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    • 2011
  • Background: Malaria is a problematic disease in Korea, and microscopic examination of Giemsa-stained blood smear has been used as the gold standard for its diagnosis. However, this technique is time-consuming and has low sensitivity in samples with low numbers of malarial parasites (<20 parasites/μL). Here, we evaluated the performance characteristics of the LG AdvansureTM Malaria P.f./P.v. real-time QPCR (LG life sciences, Korea). Methods: Blood samples from 173 persons who visited Korea University Ansan Hospital were evaluated. QPCR was performed in 73 malaria patients and 100 healthy subjects by using the LG Advansure Malaria P.f./P.v. real-time QPCRR kit, and the results were compared with those of microscopy. The detection limit of this kit was determined by serial dilution of Plasmodium-infected blood with normal blood (blood not infected with Plasmodium). Results: Among the 73 patients that were microscopically confirmed to have malaria (Plasmodium vivax infection, N=70, P. falciparum infection, N=3), 69 patients were diagnosed with P. vivax infection and 3 were diagnosed with P. falciparum infection by LG AdvansureTM Malaria P.f./P.v. realtime QPCR. Both the tests indicated absence of infection in the 100 healthy subjects. The detection limit of LG AdvansureTM Malaria P.f./P.v. real-time QPCR was 0.1 parasite/μL. Conclusions: LG AdvansureTM Malaria P.f./P.v. real-time QPCRis a very sensitive and specific technique and can be used as a confirmatory test for malaria.

Statistical Analysis on Non-Household Unit Water Use for Business Categories (비가정용수의 업종별 사용량 원단위 및 통계적 특성 분석)

  • Lee, Doojin;Kim, Juwhan;Kim, Hwasoo
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.29 no.4B
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    • pp.385-396
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    • 2009
  • Non-household unit water use for each type of business are estimated in this study. The business types are subdivided into forty based on nine categories by the national industrial standard classification, such as office, commerce, public bathing, public water use etc. Correlation analysis and analysis of variance (ANOVA) are applied to obtain statistical characteristics between industrial water use data, surveyed in six cities including Nonsan, Seosan and the National Statistical Bureau and site area, employees number etc. for each detailed business area. As the proposed non-household unit water uses are compared with five surveyed data in USA, it is shown that almost of water uses per unit area are less than those in USA. Non-household unit water uses of 25% cumulative probability water use recommended as efficiency benchmarks among surveyed data in Korea are also less than those in USA. Especially, in the case of water use in school, the average and the range are similar results showing water use range between 0.4 and 6.2 ($l/m^2/day$) as liter per capita day per an unit area, also water use range between 11.9 to 64.0 (l/student/day) as liter per capita day per a person. From the result of correlation analysis with internal and exogenous affecting factors on non-household water use, it can be concluded that a unit area is most appropriate factor as a standard of non-household unit water use. In case of water use in educational business, the number of students including staffs is more correlated than site ares with water use for the settled water consumption tendency. Although the increase and decrease of educational institutes, retail/wholesale store and restaurants are shown remarkable by the temperature as a representative factor, low correlations are shown in water use fluctuation in lodging house and hospital.

High Grain Quality Mid-late Maturing Rice Cultivar 'Yechan' with Lodging Tolerance and Multiple Disease Resistance (내도복 복합내병 최고품질 중만생 벼 '예찬')

  • Baek, Man-Kee;Park, Hyun-Su;Nam, Jeong-Kwon;Cho, Young-Chan;Kim, Ki-Young;Kim, Jeong-Ju;Kim, Woo-Jae;Shin, Woon-Chul;Jeung, Ji-Ung;Kim, Choon-Song;Jeong, Jong-Min;Lee, Keon-Mi;Park, Seul-Gi;Lee, Chang-Min;Suh, Jung-Pil;Lee, Jeom-Ho
    • Korean Journal of Breeding Science
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    • v.51 no.4
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    • pp.504-514
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    • 2019
  • 'Yechan' is a high grain quality mid-late maturing rice cultivar with lodging tolerance and multiple disease resistance. It was a derived from a cross between 'Hopum' and 'Iksan537' (cultivar name 'Haepum'). 'Hopum' is a high grain quality mid-late maturing rice cultivar with strong lodging tolerance and 'Haepum' is a high grain quality medium maturing rice cultivar with multiple disease resistance. To shorten the breeding period, another culture method was applied to the F1 plants. 'Yechan' was selected through the pedigree method, yield trials, and local adaptability tests, with a high selection pressure for grain quality, lodging, and disease resistance. The heading date of 'Yechan' was August 14, one day later than that of 'Nampyeong'. 'Yechan' is a cultivar tolerant to lodging and it has short culms. It has multiple disease resistance against rice blast, rice stripe virus, and bacterial blight, including the K3a race, the most virulent race in Korea. The yield of 'Yechan' was similar to that of 'Nampyeong'. 'Yechan' showed excellent grain appearance, superior taste when cooked, and enhanced milling performance; thus, we concluded that it could contribute to the improvement of Korean japonica rice cultivar quality. 'Yechan', a high grain quality mid-late maturing rice cultivar with lodging tolerance and multiple disease resistance, would be suitable for cultivation in the southern plain area in Korea and has been utilized in the breeding programs aimed at enhancing the grain quality and stability for the cultivation of Korean japonica rice (Registration No. 7647).

Assessment of Cerebral Hemodynamic Changes in Pediatric Patients with Moyamoya Disease Using Probabilistic Maps on Analysis of Basal/Acetazolamide Stress Brain Perfusion SPECT (소아 모야모야병에서 뇌확률지도를 이용한 수술전후 혈역학적 변화 분석)

  • Lee, Ho-Young;Lee, Jae-Sung;Kim, Seung-Ki;Wang, Kyu-Chang;Cho, Byung-Kyu;Chung, June-Key;Lee, Myung-Chul;Lee, Dong-Soo
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.3
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    • pp.192-200
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    • 2008
  • To evaluate the hemodynamic changes and the predictive factors of the clinical outcome in pediatric patients with moyamoya disease, we analyzed pre/post basal/acetazolamide stress brain perfusion SPECT with automated volume of interest (VOIs) method. Methods: Total fifty six (M:F = 33:24, age $6.7{\pm}3.2$ years) pediatric patients with moyamoya disease, who underwent basal/acetazolamide stress brain perfusion SPECT within 6 before and after revascularization surgery (encephalo-duro-arterio-synangiosis (EDAS) with frontal encephalo-galeo-synangiosis (EGS) and EDAS only followed on contralateral hemisphere), and followed-up more than 6 months after post-operative SPECT, were included. A mean follow-up period after post-operative SPECT was $33{\pm}21$ months. Each patient's SPECT image was spatially normalized to Korean template with the SPM2. For the regional count normalization, the count of pons was used as a reference region. The basal/acetazolamide-stressed cerebral blood flow (CBF), the cerebral vascular reserve index (CVRI), and the extent of area with significantly decreased basal/acetazolamide- stressed rCBF than age-matched normal control were evaluated on both medial frontal, frontal, parietal, occipital lobes, and whole brain in each patient's images. The post-operative clinical outcome was assigned as good, poor according to the presence of transient ischemic attacks and/or fixed neurological deficits by pediatric neurosurgeon. Results: In a paired t-test, basal/acetazolamide-stressed rCBF and the CVRI were significantly improved after revascularization (p<0.05). The significant difference in the pre-operative basal/acetazolamide-stressed rCBF and the CVRI between the hemispheres where EDAS with frontal EGS was performed and their contralateral counterparts where EDAS only was done disappeared after operation (p<0.05). In an independent student t-test, the pre-operative basal rCBF in the medial frontal gyrus, the post-operative CVRI in the frontal lobe and the parietal lobe of the hemispheres with EDAS and frontal EGS, the post-operative CVRI, and ${\Delta}CVRI$ showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the ${\Delta}CVRI$ and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p =0.002, p =0.015), Conclusion: With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes.

A Study on the Determination of Scan Speed in Whole Body Bone Scan Applying Oncoflash (Oncoflash를 적용한 전신 뼈 영상 검사의 스캔 속도 결정에 관한 연구)

  • Yang, Gwang-Gil;Jung, Woo-Young
    • The Korean Journal of Nuclear Medicine Technology
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    • v.13 no.3
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    • pp.56-60
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    • 2009
  • Purpose: The various studies and efforts to develop program are in progress in the field of nuclear medicine for the purpose of reducing scan time. The Oncoflash is one of the programs used in whole body bone scan which allows to maintain the image quality while to reduce scan time. When Those applications are used in clinical setting, both the image quality and reduction of scan time should be considered, therefore, the purpose of this study was to determine the criteria for proper scan speed. Materials and Methods: The subjects of this study were the patients who underwent whole body bone scan at the departments of nuclear medicine in the Asan Medical Center located in Seoul from 1st to 10th, July, 2008. The whole body bone images obtained in the scan speed of 30cm/min were classified by the total counts into under 800 K, and over 800 K, 900 K, 1,000 K, 1,500 K, and 2,000 K. The image quality were assessed qualitatively and the percentages of those of 1,000K and under of total counts were calculated. The FWHM before and after applying the Oncoflash were analyzed using images obtained in $^{99m}Tc$ Flood and 4-Quadrant bar phantom in order to compare the resolution according to the amount of total counts by the application of the Oncoflash. Considering the counts of the whole body bone scan, the dosed 2~5 mCi were used. 152 patients underwent the measurement in which the counts of Patient Postioning Monitor (PPM) were measured with including head and the parts of chest which the starting point of whole body bone scan from 7th to 26th, August, 2008. The correlations with total counts obtained in the scan speed of 30cm/min among them were analyzed (The exclusion criteria were after over six hours of applying isotopes or low amount of doses). Results: The percentage of the whole body bone image which has the geometric average of total counts of under 1,000K among them obtained in the scan speed of 30cm/min were 17.6%(n=58) of 329 patients. The qualitative analysis of the image groups according to the whole body counts showed that the images of under 1,000K were assessed to have coarse particles and increased noises. The analysis on the FWHM of the images before and after applying the Oncoflash showed that, in the case of PPM counts of under 3.6 K, FWHM values after applying the Oncoflash were higher than that before applying the Oncoflash, whereas, in the case of that of over 3.6 K, the FWHM after applying the Oncoflash were not higher than that before applying the Oncoflash. The average of total counts at 2.5~3.0 K, 3.1~3.5 K, 3.6~4.0 k, 4.1~4.5 K, 4.6~5.0 K, 5.1~6.0 K, 6.1~7.0 K, and 7.1 K over (in PPM) were $965{\pm}173\;K$, $1084{\pm}154\;K$, $1242{\pm}186\;K$, $1359{\pm}170\;K$, $1405{\pm}184\;K$, $1640{\pm}376\;K$, $1,771{\pm}324\;K$, and $1,972{\pm}385\;K$, respectively and the correlations between the counts in PPM and the total counts of image obtained in the scan speed of 30 cm/min demonstrated strong correlation (r=.775, p<.01). Conclusions: In the case of PPM coefficient over 3.6 K, the image quality obtained in the scan speed of 30cm/min and after applying the Oncoflash was similar to that obtained in the scan speed of 15 cm/min. In the case of total counts over 1,000 K, it is expected to reduce scan time without any damage on the image quality. In the case of total counts under 1,000 K, however, the image quality were decreased even though the Oncoflash is applied, so it is recommended to perform the re-image in the scan speed of 15 cm/min.

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EVALUATION OF SERUM LEVELS OF SYSTEMIC STATUS IN ORAL AND MAXILLOFACIAL SURGERY PATIENTS (구강악안면 수술을 받은 환자들에서의 전신영양평가)

  • Kim, Uk-Kyu;Kim, Yong-Deok;Byun, June-Ho;Shin, Sang-Hun;Chung, In-Kyo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.29 no.5
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    • pp.301-314
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    • 2003
  • The purposes of this retrospective study were to assess the change of serum parameters in oral and maxillofacial surgery patients after operation and to determine what laboratory parameters on treatment periods were associated with the recovery of systemic condition. For purposes of assessing systemic nutritional status, several serum parameters were chosen. The sample patients were randomsubjects extracted from three category patient groups- oral cancer, odontogenic abscess, facial bone fracture based on treated patients at department of oral and maxillofacial surgery in Pusan National University Hospital from September 1, 1998, to September 1, 2002. Each groups were consisted with 10 patients. Each patient chart was examined and blood sample parameters were reviewed with clinical signs, symptoms and vital sign at preoperative day, postoperative 1 day, postoperative 1 week. Several parameters were analyzed statistically for extraction of mean values and differences between the periods groups. The findings of serum parameters of cancer, abscess and fracture groups were as follows: 1. In cancer patients, Hb, MCV, albumin, cholesterol, LDH, AST, ALT, neutrophil, platelet, leukocyte, Na, K, Cl, BUN, creatinine were analyzed. Values of Hb, albumin, AST, neutrophil, leukocyte, Cl showed significantly differences according to periods. 2. In abscess patients, CRP, ESR, leukocyte, body temperature, neutrophil were analyzed. Values of CRP, leukocyte, body temperature, neutrophil showed significanlty differences according to periods. 3. In fracture patients, same parameters with cancer patient's were chosen. Values of platelet, Cl only showed significantly differences according to periods. 4. In cancer patients, data regarding correlation was analyzed statistically as Pearson's value. A positive correlation was found between Hb and albumin, K, Na(P<0.05). A positive correlation was also found between neutrophil and leukocyte(P<0.05). Positive correlations were found between cholesterol and ALT, LDH and platelet, creatinine both, Platelet and BUN, Na and K(P<0.01). 5. In abscess patients, Peason's correlation values were analyzed on parameters. A positive correlation was found only between CRP and neutrophil(P<0.05). 6. In fracture patients, The correlations of parameters also were statistically analyzed. Positive correlations were found between MCV and K, albumin and LDH, AST and three parameters of creatinine, Na, Cl, K and neutrophil, neutrophil and three parameters of leukocyte, BUN, K(P<0.05). Positive correlations were found between LDH and AST, ALT and AST, creatinine both(P<0.01). This retrospective clinical study showed the CRP levels only on abscess patients may be useful in determination of clinical infected status, but the levels of other parameters on cancer, fracture patients did not showed significant values as diagnostic aids for clinical status.

Clinical Convergence Angle of Prepared Tooth for full Veneer Crowns (전부 피개관의 치아 형성 시 축면 경사각에 대한 조사)

  • Kim, Sung-Jin;Pae, Ah-Ran;Woo, Yi-Hyung;Kim, Hyeong-Seob
    • Journal of Dental Rehabilitation and Applied Science
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    • v.26 no.1
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    • pp.21-32
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    • 2010
  • The convergence angle of a prepared tooth is a very important factor in the retention and resistance of a crown restoration. But various intraoral environments and clinician's techniques make it difficult to obtain the ideal inclination. Therefore, in this study, clinical convergence angle of a prepared tooth was investigated. The data was collected from the patient models of prosthodontic residents and the patient models of general practitioners. The images of mesiodistal and buccolingual surfaces were taken with a digital camera to evaluate the convergence angle on 'ImageJ' program. The images were classified according to the criteria (1. Clinician group, 2. Position in the dental arch, 3. The purpose of abutment preparation)and then analyzed. The mean convergence angle of a prepared tooth for Korean clinicians was $15.02^{\circ}$ (${\pm}10.13^{\circ}$). 1. It was significant in the convergence angle between the general practitioner group and the prosthodontic resident group(p<0.05). 2. It was significant between the mesiodistal and buccolingual surface in the the prosthodontic resident group(p<0.05). 3. For the general practitioner group, it was significant when anteriors and premolars were compared with molars(p<0.05). For the prosthodontic resident group, it was significant when anteriors and premolars were compared with molars (p<0.05). 4. When divided into upper and lower arches, for the general practitioner group, it showed significant difference in the buccolingual aspect(p<0.05). Also in the prosthodontic resident group, it showed significant difference in the buccolingual aspect(p<0.05). 5. Dividing left and right sides of the arches, there was no significant difference in the general practitioner group and the prosthodontic resident group(p>0.05). 6. In the general practitioner group, it was significant in the mesiodistal axial convergence angle of single crown abutment and 3 unit bridge abutment(p<0.05). In the prosthodontic resident group, it was significant in the mesiodistal and overall axial convergence angle of single crown abutment and 3 unit bridge abutment(p<0.05). Clinical convergence angle of prepared tooth in Korea was included in agreement with other studies investigating convergence angle that ranged from 10 to 22 degrees, achieved in clinical practice.

The comparison of predicted adult height change and height gain after gonadotropin-releasing hormone agonist and combined growth hormone treatment in girls with idiopathic central precocious puberty (진성 성조숙증으로 진단 받은 여아에서 gonadotropin-releasing hormone agonist 단독치료 및 growth hormone의 병합치료 시 예측 성인키의 변화 및 성장 획득의 비교)

  • Seo, Ji-Young;Yoon, In-Suk;Shin, Choong-Ho;Yang, Sei-Won
    • Clinical and Experimental Pediatrics
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    • v.49 no.3
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    • pp.305-311
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    • 2006
  • Purpose : GnRH analogues(GnRHa) are used to treat central precocious puberty(CPP). However, in some patients, the GV decrease is so remarkable that it impairs predicted adult height(PAH); and there fore, the addition of growth hormone(GH) is suggested. We analysed the growth changes during two years and final adult height(FAH) in girls with idiopathic CPP treated with combined therapy, compared with those of girls treated with GnRHa alone. Methods : For the analysis, we classified the patients, who was treated for longer than two years, into three groups depending on the initial PAH and combination of GH; PAH_L, treated with GnRHa and PAH less than midparental height(MPH) - 5 cm. PAH_H, treated with GnRHa and PAH greater than MPH - 5 cm. GnRHa+GH, combined GH treatment, regardless of PAH before treatment. We analysed the GV and PAH change during the first two years and FAH. Results : In PAH_L, the PAH(SDS) at first year of therapy was significantly increased to $153.5{\pm}6.5cm(-1.4{\pm}1.3)$ from $149.7{\pm}6.4cm(-2.1{\pm}1.3)$ before treatment(P=0.004). In PAH_H, there was no significant increase in PAH during the two years of treatment. During the first year of combination of GH and GnRHa, GV and PAH increased significantly. We observed significant increases in FAH, comparing to the initial PAH in the PAH_L and GnRHa+GH groups. The height gains(FAH - initial PAH) were significantly higher in the PAH_L and GnRHa+GH groups than that in the PAH_H group. Conclusion : This study suggests the FAH and height gains are improved in patients, whose predicted adult height before treatment was shorter than those with higher predicted adult height, with the treatment of GnRHa alone or in combination with GH. GH could not improve the final adult height, but compensated the growth in patients whose growth velocity was decelerated by GnRHa alone.

Function of the Neuronal $M_2$ Muscarinic Receptor in Asthmatic Patients (천식 환자에서 $M_2$ 무스카린성 수용체 기능에 관한 연구)

  • Kwon, Young-Hwan;Lee, Sang-Yeup;Bak, Sang-Myeon;Lee, Sin-Hyung;Shin, Chol;Cho, Jae-Youn;Shim, Jae-Jeong;Kang, Kyung-Ho;Yoo, Se-Hwa;In, Kwang-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.4
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    • pp.486-494
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    • 2000
  • Background : The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to $M_3$ muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal $M_2$ muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these $M_2$, muscarinic receptors act as autoreceptors. Loss of function of these $M_2$ receptors, as it occurs in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of $M_2$ muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. Method : We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test ($PC_{20}$<16mg/ml). Methacholine provocation tests were performed twice on separate days allowing for an interval of one week. In the second test, pretreatment with the $M_2$ muscarinic receptor agonist pilocarpine($180{\mu}g$) through inhalation was performed be fore the routine procedures. Results : Eleven subjects with mild asthma and eight subjects with moderate asthma showed significant increase of $PC_{20}$ from 5.30$\pm$5.23mg/ml(mean$\pm$SD) to 20.82$\pm$22.56mg/ml(p=0.004) and from 2.79$\pm$1.51mg/ml to 4.67$\pm$3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of $PC_{20}$ from l.76$\pm$1.50mg/ml to 3.18$\pm$4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. Conclusion : In subjects with mild and moderate asthma, function of $M_2$ muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. ηlese results suggest that function of $M_2$ muscarinic receptors is different according to severity of asthma.

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