• The Korean Society of Law and Medicine
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• v.19 no.2
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• pp.235-261
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• 2018

The Medical law stipulates regulations about the physician's duty to inform to contribute to patient's self-determination. This law was most recently revised on December 20, 2016, and came into effect on June 21, 2017. There has been much controversy about this, and it has been questioned whether or not it will be effective for physicians to comply with the duty to inform. Therefore, this study investigated perceptions of physicians of whether they observed the duty to inform and their legal judgment about that duty, and analyzed how the revision of the medical law may have affected the legal cognition of physician's duty to inform. This study was conducted through an online questionnaire survey involving 109 physicians over 2 weeks from March 29 to April 12, 2018, and 108 of the collected data were used for analysis. The questionnaire was developed by revising and supplementing the previous research (Lee, 2004). It consisted of 41 items, including 26 items related to the experience of and legal judgment about the duty to inform, 6 items related to awareness of revised medical law, and 9 items on general characteristics. The data were analyzed using SAS 9.4 program and descriptive statistics, Chi-square test, Fisher's exact test and Binary logistic regression were performed. The results are as follows. • Out of eight situations, the median number of situations that did not fulfill the duty to inform was 5 (IQR, 4-6). In addition, 12 respondents (11%) answered that they did not fulfill the duty to inform in all eight cases, while only one (1%) responded that he/she performed explanation obligations in all cases. • The median number of the legal judgment score on the duty to inform was 8 out of 13 (IQR, 7-9), and the scores ranged from a minimum of 4 (4 respondents) to a maximum of 11 (3 respondents). • More than half of the respondents (n=26, 52%) were unaware of the revision of the medical law, 27 (25%) were aware of the fact that the medical law had been revised, 20(18%) had a rough knowledge of the contents of the law, and only 5(5%) said they knew the contents of the law in detail. The level of awareness of the revised medical law was statistically significant difference according to respondents' sex (p<.49), age (p<.0001), career (p<.0001), working type (p<.024), and department (p<.049). • There was no statistically significant relationship between the level of awareness of the revised medical law and the level of legal judgment on the duty to inform. These results suggest that efforts to improve the implementation and cognition of physician's duty to inform are needed, and it is difficult to expect a direct positive effect from the legal regulations per se. Considering the distinct characteristics of medical institutions and hierarchical organizational culture of physicians, it is necessary to develop a credible guideline on the duty to inform within the medical system, and to strengthen the education of physicians about their duty to inform and its purpose.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.1
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• pp.31-38
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• 2006

Purpose: Infantile constipation is one of the most common problems in pediatric gastrointestinal outpatient clinic. We planed to show the clinical feature of infantile constipation and explore the possible relationship between diets and symptoms of constipation. Methods: We analyzed the medical records and telephone questionnaire about infants under 2 years of age with constipation, who visited outpatient clinic of Department of Pediatrics, Ilsan Paik Hospital during the time from March 2002 to February 2005. Data including the symptoms and signs of constipation, diet history, and past-medical history were analyzed. Results: Total 96 infants, 40 male and 56 female, were enrolled in this study. The mean age was 9 months. Twenty-three infants were exclusively breast milk fed (BMF), 20 infants were cow's milk fed (CMF) and 53 infants had a history of mixed feeding with cow's milk and breast milk (MMF). Patients showed painful defecation (95.8%), abdominal distension (53.1%), palpable rectal stool (35.1%), hard stool (30.2%), blood-tinged stool (29.2%) and anal fissure (16.7%). Patients with exclusive cow milk feeding had prominent clinical features, such as anal fissure (p=0.03), hematochezia (p=0.04) and palpable rectal stool (p=0.025). Patients who had a history of larger intake of liquid food had a tendency to get anal skin tag (p<0.05). Conclusion: Exclusive breast milk feeding seemed important to avoid constipation with clinical significance. To educate caregivers in appropriate way of the weaning food may help the infants with constipation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.1
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• pp.23-30
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• 2006

Purpose: The estimation of fluid deficit is crucial to the proper management of dehydrated children. Without well-documented serial weights on the same scale, the estimation of any given child's fluid deficit is imprecise and dependent largely on subjective clinical criteria. Despite the abundance of literature on clinical and laboratory evaluation of dehydration, few studies have focused on serum uric acid. So, we examined the usefulness of scrum uric acid in gastroenteritis patients with dehydration. Methods: Medical records of 90 gastroenteritis patients were retrospectively reviewed. By the body weight loss, we classified patients with mild, moderate, and severe dehydration groups. We studied the relevance of laboratory data (BUN, creatinine, serum bicarbonate, glucose, urine specific gravity, and uric acid) with dehydration. Results: 54 children (60%) were dehydrated mildly, 24 (26%) dehydrated and moderately, and 12 (14%) dehydrated severely. Statistically significant differences in BUN, creatinine, serum bicarbonate, glucose, and urine specific gravity could not be observed. But there was significant relationship between uric acid and the degree of dehydration. Data analysis suggested that the level of 7.0 mg/dL is the best cut-off value for predicting the development of moderate or severe dehydration. At this cut-off value, the sensitivity and specificity were 66.6% and 87.1%. Conclusion: Our study supports that the measurement of serum uric acid with traditional scale is useful for predicting the development of dehydration. But, in order 10 be used as the indicator for proper treatment at an earlier stage, further validation about serum uric acid is necessary.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.143-149
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• 2002

Purpose: The following study was performed to reveal the relationship between Clostridium difficile colitis in childhood and associated antibiotics. Methods: From January 2000 to June 2002 at Seoul National University Children's Hospital, 85 symptomatic pediatric patients who showed positive stool culture for Clostridium difficile were included. The implicated antibiotics within 2 months before stool culture were analyzed. Of the 85 patients, there were 50 males and 35 females, and their average age was 2.5 years. Results: There was a history of implicated antibiotics within 2 months in 55 cases (67%). Forty-three patients (78%) of them showed Clostridium difficile in stool culture during antibiotics treatment. The time interval between the initiation of antibiotics and stool culture ranged from one day to 7 weeks (mean 10 days) in these patients. In the remaining 12 patients, Clostridium difficile was detected after the discontinuation of antibiotics. The time interval between the discontinuation and stool culture ranged from one day to 7 weeks (mean 12 days). The associated antibiotics were cefotaxime (20 cases), amikacin(15 cases), ampicillin (13 cases), cefazolin (8 cases), vancomycin (8 cases), etc. In 31 cases, more than one antibiotics were prescribed. Conclusion: When diarrhea occurred in young children during antibiotic usage or with a past history of recent antibiotic usage, Clostridium difficile should be investigated as a cause of diarrhea for proper management.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.11-18
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• 2002

Purpose: It is known that lactoferrin serves as a source of iron for H. pylori in gastric mucosa. This study was undertaken to investigate the relationship between lactoferrin and H. pylori infection coexistent with iron-deficiency anemia by determining the lactoferrin levels in gastric biopsy specimens, and by locating the major sites of lactoferrin expression, according to the presence or absence of iron-deficiency anemia. Methods: Fifty-five adolescents that underwent gastroduodenoscopy were divided into three groups: NL (n=19) for normal controls, HP (n=15) for patients with H. pylori, and IDA (n=21) for patients with H. pylori gastritis and coexisting iron-deficiency anemia. Histopathologic features were graded from to marked on the basis of the Updated Sydney System. The gastric mucosal levels of lactoferrin were measured by immunoassay. Immunohistochemical technique was used to allow identification of the location and quantification of the lactoferrin expression. Results: Lactoferrin levels in the antrum increased significantly, in proportion to, H. pylori density, polymorphonuclear cell infiltration, and chronic inflammation in the histologic specimens. Patients in the HP and IDA groups showed significantly increased mucosal levels of lactoferrin compared with that observed in the normal group (p=0.0001). The lactoferrin level in IDA group tended to be higher than that in the HP group (p=0.2614). The major sites of lactoferrin expression by immunohistochemistry were in glands and neutrophils within epithelium. Lactoferrin was stained weakly in NL, and strongly in HP and IDA. Conclusion: The lactoferrin sequestration in the gastric mucosa of IDA was remarkable, and this finding seems to give a clue that leads to the clarification of the mechanism by which H. pylori infection contributes to iron-deficiency anemia.

• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.294-302
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• 2000

Purpose: To investigate the mechanisms related to F-18-FDG uptake by tumors, F-18-FDG accumulation was compared with glucose transporter-1 (Glut-1) expression and hexokinase activity in various human cancer cell lines. Materials and Methods: Human colon cancer (SNU-C2A, SNU-C4, SNU-C5), hepatocellular carcinoma (SNU-387, SNU-423, SNU-449), lung cancer (NCI-H522, NCI-H358, NCI-H1299), uterine cervical cancer (HeLa, HeLa 229, HeLa S3) and brain tumor (A172, Hs 683) cell lines were used. After 24 hr incubation of $5{\times}10^5$ cells, 37 kBq F-18-FDG was added and the uptake by cells at 10 min was measured using a gamma counter. Hexokinase activity was measured by continuous spectrophotometric rate determination. To measure mitochondrial hexokinase activity, mitochondrial fraction was separated by a high speed centrifuge. Immunohistochemical staining of Glut-1 was performed, and graded as 0, 1, 2, or 3 according to expression. Results: There was difference among F-18-FDG uptake, total and mitochondrial hexokinase activity, and Glut-1 expression with different cancer cell lines. The correlations of F-18-FDG with total hexokinase and mitochondrial hexokinase activity were low (r=0.27 and 0.26, respectively). Glut-1 expression showed a good correlation with F-18-FDG uptake (p=0.81, p=0.0015). Previously, we reported no correlation of F-18-FDG uptake with hexokinase activity in colon cancer cell lines. Thus, when colon cancer cells were excluded, F-18-FDG uptake showed higher correlation with total hexokinase and mitochondrial hexokinase activity (r=0.81, p=0.0027 and r=0.81, p=0.0049, respectively). Conclusion: Both Glut-1 expression and hexokinase activity were contributing factors related to F-18-FDG accumulation in human cancer cell lines. The relative contribution of Glut-1 expression and hexokinase activity, however, was different among different cancer cell types.

• Korean Journal of Organic Agriculture
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• v.25 no.1
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• pp.135-148
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• 2017

Response Surface Methodology (RSM), which is combining with Plackett-Burman design and Box-Behnken experimental design, was applied to optimize the ratios of the nutrient components for carotenoid production by Rhodobacter sphaeroides PS-24 in liquid state fermentation. Nine nutrient ingredients containing yeast extract, sodium acetate, NaCl, $K_2HPO_4$, $MgSO_4$, mono-sodium glutamate, $Na_2CO_3$, $NH_4Cl$ and $CaCl_2$ were finally selected for optimizing the medium composition based on their statistical significance and positive effects on carotenoid yield. Box-Behnken design was employed for further optimization of the selected nutrient components in order to increase carotenoid production. Based on the Box-Behnken assay data, the secondary order coefficient model was set up to investigate the relationship between the carotenoid productivity and nutrient ingredients. The important factors having influence on optimal medium constituents for carotenoid production by Rhodobacter sphaeroides PS-24 were determined as follows: yeast extract 1.23 g, sodium acetate 1 g, $NH_4Cl$ 1.75 g, NaCl 2.5 g, $K_2HPO_4$ 2 g, $MgSO_4$ 1.0 g, mono-sodium glutamate 7.5 g, $Na_2CO_3$ 3.71 g, $NH_4Cl$ 3.5g, $CaCl_2$ 0.01 g, per liter. Maximum carotenoid yield of 18.11 mg/L was measured by confirmatory experiment in liquid culture using 500 L fermenter.

• The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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• v.8 no.2
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• pp.78-93
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• 2003

To investigate seasonal variation and structure of the microbial community in Kyeonggi Bay, abundance and carbon biomass of nano-and micrzooplankton were evaluated in relation to size fractionated chlorophyll-a concentration, through the monthly interval sampling from December 1997 to November 1998. Communities of nano-and microzooplankton were classified into 4 groups such as heterotrophic nanoflagellate(HNF), ciliates, heterotrophic dinoflagellates(HDF) and zooplankton nauplii. Abundance and carbon biomass of HNF ranged from 380 to 4,370 cells ml-1(average 1,340$\pm$130 cells ml-1) and from 0.63 to 12.4 $\mu\textrm{g}$C 1-1(average 4.35$\pm$0.58 $\mu\textrm{g}$C 1-1), respectively. Abundance and carbon biomass of ciliates ranged from 331 to 44,571 cells ml-1(average 3,526$\pm$544 cells ml-1) and from 1.3 to 119.7 $\mu\textrm{g}$C 1-1(average 13.7$\pm$3.0 $\mu\textrm{g}$C 1-1), respectively. Abundance and carbon biomass of HDF ranged from 88 to 48,461 cells 1-1(average 9,034$\pm$2,347 cells 1-1) and from 0.05 to 54.05 $\mu\textrm{g}$C 1-1(average 6.9$\pm$2.4 $\mu\textrm{g}$C 1-1), respectively. Abundance and carbon biomass of zooplankton nauplii ranged from 5 to 546 indiv. 1-1(average 83$\pm$15 indiv. 1-1) and from 0.17 to 43.2 $\mu\textrm{g}$C 1-1(average 6.3$\pm$1.2 $\mu\textrm{g}$C 1-1), respectively. Eash component of microbial biomass was not different from tidal cycle except tintinnids group. Depth integrated nano-and microzooplankton biomass ranged from 124 to 1,635 mgC m-2(average 585$\pm$110 mgC m-2) and was highest in March and May. The relative contribution of each component to the nano-and microzooplankton showed difference according to seasons. Community structure of nano-and microzooplankton was dominated by planktonic ciliate group. During the study period, carbon biomass of nano-and microzooplankton was strongly positively correlated with size fractionated chlorophylla-a. It implied that prey-predator relationship between microzooplankton and phytoplankton was important in the pelagic ecosystem of Kyeonggi Bay.

• Korean Journal of Ecology and Environment
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• v.35 no.3 s.99
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• pp.145-151
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• 2002

The effect of low pH on physiological changes was studied with the acidophilic green alga, Clamydomonas acidophila, UTCC 122. The growthrates (${\mu}$) were identical, $0.5{\sim}0.7\;day^{-1}$, at pH 3.7${\sim}$6.7 and no significantly different (ANOVA, p =0.134), showing cell volume reduced gradually as they were growing, whereas that at pH 2.7 was falling to zero and cell volume increased dramatically. Chlorophyll a concentration of the cultures incubated for one day was $191{\sim}255\;pg\;cell^{-1}$, after then it declined from $60{\sim}103\;pg\;cell^{-1}$ at pH 3.7${\sim}$6.7 except $210\;pg\;cell^{-1}$ at pH 2.7, which was directly related with cell volume. External carbonic anhydrase (CA) activity was varied from1.1 to$3.7{\times}10^{-4}\;E.U.\;mm^{-2}$, showing the gradualincrease during culture, except at 2.7 and pH 5.7. However there was not found any relationship among the pH gradient cultures. CA molecular mass of C. acidophila was 29 kBa, and concentration of that was identical in all cultures. The proteins of 41 kDa and 63 were not or very　faintly expressed in low pH cultures, in contrast that of 17 kDa more expressed. In this work, we found that C. acidophila could live optimally within a wide range of acidic pH, and 17 kDa of unidentified protein might be concerned with tolerating in low acid environment.

• Korean Journal of Ecology and Environment
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• v.42 no.2
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• pp.260-269
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• 2009

Hwabuk Dam has been under construction to reduce flood damage in Nakdong River watershed and to supply stable water for middle area of Gyeongbuk Province. Therefore, fish investigation in up and downstream of the dam was conducted from 2004 to 2008 in order to determine any negative effect on fish community due to dam construction and to use as fundamental data for conserving species diversity and maintaining stream health. According to data analysis on water quality, temperature, dissolved oxygen, pH, suspended solids, and total E-coli had seasonal variation, but they did not significantly differ in sites. However, biological and chemical oxygen demand, chlorophyll-a, nitrogen, and phosphorus representing organic matter and nutrient concentration were higher in upper site and decreased to lower site so that they differed by site. Concentration of arsenic among the heavy metals was less than 0.05 mg $L^{-1}$, which is regulated for protection of human health in water quality standard, except for 0.092 mg $L^{-1}$ in June 2005. During the study period, the total number of fish caught from the 6 sites was 10,263 representing 7 families 19 species. Among them, dominant and subdominant species were Korean chub (Zacco koreanus, 62.5%) and Chinese minnow (Rhynchocypris oxycephalus, 10.6%) which inhabit mostly in mid and upper streams, Korea. Among the 19 species, Korean endemic species were 9 species (47.4%) including Korean slender gudgeon (Squalidus gracilis majimae), Korean dark sleeper (Odontobutis platycephala), and Korean shiner (Coreoleuciscus splendidus). There was several individuals of the $1^{st}$-class endangered species, Naktong nose loach (Koreocobitis nahtongensis), caught in 2005${\sim}$2007, and no introduced species of fish was found in entire sampling period. According to result of community analysis, dominance index decreased toward lower site, but diversity and richness indices increased toward lower site. The equation of length-weight relationship on the dominant species was TW=0.000003$(TL)^{3.2603}$. The parameter b in the equation was greater than 3.0 indicating good nutritional condition in the populations. Compared to populations of Korean chub in other streams, the population in Hwabuk Dam watershed had higher mean of condition factor by size indicating better growth rate. With fish fauna and multi-metric health assessment model in each sampling attempt, index of biotic integrity (IBI) was evaluated and it resulted mostly in good (26${\sim}$35) and excellent (36${\sim}$40) condition in all sites, and the mean of IBI was the highest in site 5. The results indicate that it is very important to study not only environmental impact assessment with fish composition but also stream health assessment in order to conserve healthy aquatic ecosystem.