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An Epidemiological Investigation on an Outbreak of Shigellosis in a Special School for Handicapped in Yeongcheon-si and in a Rehabilitation Facility in Gyeongsan-si, Korea, 2008 (2008년 영천시 지적장애인 학교와 경산시 재활원에서 발생한 세균성이질에 관한 역학조사)

  • Lee, Hyun-Dong;Lee, Soon-Ok;Lim, Hyun-Sul
    • Journal of agricultural medicine and community health
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    • v.34 no.1
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    • pp.24-33
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    • 2009
  • Objectives: In September 2008, an outbreak of diarrhea occurred among students attending Y school in Yeongcheon-si. Shigella sonnei was cultured from some of the rectal swabs. An epidemiological investigation was carried out to determine the source of the infection and the mode of transmission of the shigellosis outbreak. Methods: The index case lived in the D rehabilitation facility in Gyeongsan-si and an additional epidemiological investigation was carried out there. The cases could not be questioned due to their mental handicaps. The teachers were interviewed instead. A patient case was defined as a resident with diarrhea more than one time a day from September 18 to September 26, 2008 or a resident with confirmed Shigella sonnei at the Y school or the D rehabilitation facility. Results: The attack rate was 1.2% (8 persons) among 659 persons in the Y school and D rehabilitation facility. Five persons were microbiologically confirmed to have the infection and three persons were diagnosed on the basis of symptoms. Shigella sonnei was cultured from five of the 659 rectal swabs. However, 80 environmental specimens including drinking water, preserved foods, and cooking utensils were negative. All eight patients were Y school students and had been living in group boarding and lodging. Six of them lived in the D rehabilitation facility and two lived in the dormitory at the Y school. Five cases showed pulsed-field gel electrophoresis patterns that were identical for Shigella sonnei. Conclusions: The results of this study showed that the infection source of the shigellosis outbreak, in the two places, were identical. It is likely that the infections initially spread from a teacher or volunteer and then among the students.

PRELIMINARY STUDY OF MENTAL REPRESENTATIONS OF PRESCHOOL CHILDREN EXPERIENCING SINGLE, SEVERE TRAUMA (심한 정신적 외상 경험을 한 학령 전기 아동의 정신적 표상에 대한 예비연구)

  • Eon, So-Yong;Song, Won-Woung;Oh, Kyung-Ja;Choi, Eui-Gyum;Shim, Eun-Ji;Shin, Yee-Jin
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.15 no.1
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    • pp.61-74
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    • 2004
  • Objectives:This study was performed to introduce a psychoeducational family therapy model for the families of schizophrenic patient and to investigate the effect of this model on the changes in coping style and depressive symptoms of the family members, and in perception of emotional support by families and depressive symptoms of patients. Methods:Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient at kindergarten, were evaluated for psychological assessments;Intelligence test, MSSB(MacArthur Story-Stem Battery), H-T-P test(House-Tree-Person test). And their parents completed rating scale, KPI-C(Korean Personality Inventory for Children about children’s psychological conditions). Results:With respects to the contents and emotional reactions of MSSB, 9 preschool children showed generally high levels of anxiety, depression, avoidance, aggression, probably related to the traumatic experiences. Even though children couldn't verbally report directly about their traumatic experiences, in both MSSB, structured play narrative assessment tool, and HPT, free drawing and association test, they demonstrated psychiatric problems through reenactment plays, regardless of clinical diagnoses. Conclusion:Present study allowed us the chance to see beyond the outer pathological behaviors of PTSD in preschool children, through deeper evaluations of their mental representation. These preliminary data suggest deep understanding of internal representation would be of help for thorough evaluations and treatment plan for preschool children, experiencing severe trauma.

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Abnormal Fractal Correlation of Heart Rate in Children with Neurocardiogenic Syncope (소아 신경심장성 실신환자에서 비정상적 심박수 프랙탈 상관에 대한 연구)

  • Kim, Keoung-Young;Joo, Eun-Young;Yum, Myung-Kul;Oh, Je-Wen;Kim, Chang-Ryul;Kim, Nam-Su;Lee, Cheol-Beom;Noh, Chung-Ill
    • Clinical and Experimental Pediatrics
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    • v.45 no.9
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    • pp.1114-1119
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    • 2002
  • Purpose : The purposes of this study were to determine short- and long-term fractal correlation behavior of heart rates during daily activity in patients with neurocardiogenic syncope. Methods : Twenty five patients with histories of neurocardiogenic syncope episodes were included. Their analogue 24h ambulatory Holter electrocardiograms were analyzed. The tape was digitized and the digitized electrocardiograms were partioned into sections of one hour. Then their RR intervals were measured and 20,000 points of RRI were used. To quantify the fractal correlation behavior, we employed the detrended fluctuation analysis, and short-term($n{\leq}16$, ${\alpha}_1$) and long-term(n>16, ${\alpha}_2$) fractal scaling exponents were calculated. Results : When compared to control, 24-hour average values of ${\alpha}_1$ and all ${\alpha}_1$ values at quarters of each day were significantly higher in patients with syncope. On the contrary, their 24-hour average value of ${\alpha}_2$ and all ${\alpha}_2$ values at quarters of each day were lower in patients with syncope. However, statistical significances were found in 24-hour average value of ${\alpha}_2$ and in ${\alpha}_2$ value at MN-6AM. Conclusion : In the syncope patients with neurocardiogenic syncope, short-term fractal scaling exponents of RR interval was significantly high throughout the day. Therefore, their RR intervals were smoother in the short term scale and had a tendency to continue in the same direction of increase or decrease, which may contribute to persistent decrease in heart rate during a syncopal attack.

Review on the Justifiable Grounds for Withdrawal of Meaningless Life-sustaining Treatment -Based on a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009)- (무의미한 연명치료 중단 등의 기준에 관한 재고 - 대법원 2009.5.21 선고 2009다17417사건 판결을 중심으로 -)

  • Moon, Seong-Jea
    • The Korean Society of Law and Medicine
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    • v.10 no.2
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    • pp.309-341
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    • 2009
  • According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

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Biochemical Characterizations of Phenylalanine Ammonia-Lyase and its Mutants to Develop an Enzymatic Therapy for Phenylketonuria (페닐케톤뇨증의 효소치료 개발을 위한 phenylalanine ammonia-lyase 및 유전자 변이형의 생화학적 특성)

  • Kim, Woo-Mi
    • Journal of Life Science
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    • v.19 no.9
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    • pp.1226-1231
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    • 2009
  • Enzyme substitution with recombinant phenylalanine ammonia-lyase (PAL, EC 4.3.1.5) is currently being explored for treatment of phenylketonuria (PKU), an autosomal recessive genetic disorder with mutations of the gene encoding phenylalanine-4-hydroxylase (EC 1.14.16.1). However, oral administration of PAL is limited because of proteolytic digestion in the gastrointestinal tract. The aim of this study was to determine the biochemical properties of PAL and delinate the susceptibility of wild-type PAL to pancreatic proteolysis by exploring several mutants, and to develop therapeutic drugs with PAL for PKU. The specific activity of PAL was assayed and its optimal pH, temperature stability, and intestinal protease susceptibility were investigated. Its $V_{max}$ values for phenylalanine and tyrosine were 1.77 and $0.47{\mu}mol$/ min/mg protein, respectively, and its $K_m$ values were $4.77{\times}10^{-4}$ and $4.37{\times}10^{-4}\;M$, respectively. PAL showed an optimal pH at 8.5, corresponding to the average pH range of the small intestine. It showed no loss of activity at $-80^{\circ}C$ for 5 months and possessed 93.4% of its activity under $4^{\circ}C$ for 4 wks. PAL was susceptible to chymotrypsin digestion and, to a lesser extent, to trypsin, elastase, carboxypeptidase A, and B. The trypsin and chymotrypsin cleaving sites were mutated to investigate protection from pancreatic digestion and the specific activities of these mutants were evaluated. The six mutants displayed low specific activities compared to the wild-type, suggesting that the primary trypsin and chymotrypsin cleaving sites may be essential for catalytic reaction. The PAL mutants could therefore be applied as a pretreatment modality without susceptibility to proteolytic attack, however, additional modification for enhancing enzymatic activity is needed to reduce the Phe levels effectively.

Improved Acroparesthesia During Enzyme Replacement Therapy in a Patient Lately Diagnosed with Fabry Disease (진단이 지연된 Fabry 병 환자에서 효소대체요법을 통한 사지 말단 동통의 호전을 보인 1례)

  • Yang, Aram;Kim, Jinsup;Cho, Sung Yoon;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.3
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    • pp.92-95
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    • 2017
  • Fabry disease (FD) is an X-linked lysosomal storage disorder caused by an ${\alpha}$-galactosidase A (GLA, MIM 300644) enzyme deficiency due to pathogenic variants in the ${\alpha}$-galactosidase A gene (GLA). The disease leads to accumulation of globotriaosylceramide (Gb3) and related glycophospholipids affecting nearly all major organ systems, with the primary sites damaged by Gb3 including renal glomeruli, myocardium, neurons of the dorsal ganglion and autonomic nervous system, and vascular endothelial and smooth muscle. Progressive deposition in these organ systems present with various clinical manifestations including acroparesthesia, renal failure and heart failure. Here, we report a Chinese male diagnosed with Fabry disease in his late $4^{th}$ decades showing improvement of acroparesthesia during enzyme replacement therapy (ERT). A 48-year-old Chinese man who presented with chronic recurrent severe burning pain in his fingers and toes since the age of 10, with worse involvement of the former visited to our clinic for further evaluation. His medical history included a transient ischemic attack aged 40 and diagnosed with stage 4-5 chronic kidney disease aged 47. In the family history, the patient's brother was found to be have Fabry disease 1 month before his visit. Except for his brother, all other members of the family are healthy. Based on his medical history and family history, he was strongly suspicious for Fabry disease. He was found to have a galactose-alpha-1,3-galactose level 4.96 (Reference range, 42.5-67.9) suggestive of Fabry disease. The followed sequencing of GLA coding region in our patient revealed hemizyosity for the mutation c.988C>T (Q330X) in Exon 7. Since ERT start, he showed significant improvement in his symptoms of burning sensation of fingers and toes. On the contrary, due to deteriorating kidney function even with ERT, he is considered for kidney transplantation. Despite of diagnostic delay until late 4th decades, ERT showed a potential improvement of acroparesthesia in our patient. However, late start of ERT can lead to poor outcome in multiorgan function. Therefore, early diagnosis with high index of suspicion followed by continuous ERT with regular monitoring have an impact on quality of life in Fabry disease.

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Influence of Korean Red Ginseng Water Extract on Recovery of Hepatic Function in Hypercholesterolemic Mice Fed High Cholesterol Diet (홍삼물추출물이 고콜레스테롤 식이로 유도된 고콜레스테롤 혈증에서 간 기능 회복에 미치는 영향)

  • Song, Yong-Bum;Kyung, Jong-Soo;Park, Sung-Bum;Wee, Jae-Joon;Do, Jae-Ho;Kim, Young-Sook
    • Journal of Ginseng Research
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    • v.32 no.4
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    • pp.283-290
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    • 2008
  • Hypercholesterolemia is associated with many pathological states such as fat deposit in the tendon and skin, hepatomegaly, pancreatitis and heart attack. The present study was focused on the effect of Korean red ginseng water extract (RGWE) on the recovery of hepatic function that was deteriorated in high-cholesterol diet fed mice. Mice were divided into 6 groups ; normal diet group (AIN-2WK), 4 week-high-cholesterol diet group (CHOL-4WK), 2 week-high-cholesterol + 2 week-normal diet group (CHOL-2WK), 2 week-high-cholesterol + 2 week-normal diet + RGWE treated group (R100, R300, R500). RGWE treated group received normal diet and RGWE at daily doses of 100, 300, 500 mg/kg b.w. for 2 weeks after the 2 weeks feeding of high-cholesterol diet. The results are as follows : 1. The hepatic weight and total hepatic lipid weight were markedly lower in RGWE treated group than those in the CHOL-4WK or CHOL-2WK group, indicating that ginseng inhibited hepatic hypertrophy. 2. Total hepatic cholesterol and HDL-cholesterol in normal diet conversion group (CHOL-2WK) were significantly reduced compared with the high cholesterol group (CHOL-4WK). The lowering effect was significantly reinforced by RGWE administration. 3. Hepatic triglyceride level of CHOL-4WK group was markedly lower than that of the normal group (AIN-2WK). However, the level was significantly increased in CHOL-2WK and RGWE treated group. The result indicated that ginseng administration and diet conversion exert normalizing effects of hepatic function. 4. The lipid peroxide levels in RGWE treated groups were markedly lower than CHOL-2WK group. These results suggest that Korean red ginseng water extract can be useful as a dietary supplement for the treatment of obesity or hypercholesterolemia by improving lipid metabolism and hepatic function.

A Survey on the Level of $NO_2$ Inside and Outside Urban Homes by Palmes Tube (Palmes tube를 이용한 도시 주택의 옥내외 $NO_2$ 농도에 관한 조사연구)

  • Kim, Yong-Won;Pae, Ki-Taek;Kim, Sung-Chun;Moon, Duck-Hwan;Lee, Jong-Tae;Kim, Joon-Youn
    • Journal of Preventive Medicine and Public Health
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    • v.19 no.1 s.19
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    • pp.31-44
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    • 1986
  • For many years, $NO_2$ has been regarded as one of the elements among indoor air pollutants of urban homes, leading to increased public concerns on this gas. For the purpose of preparing the fundamental data for the evaluation and control of health effect relevant to $NO_2$ levels, authors measured the indoor (kitchen, living room, bed room) and outdoor $NO_2$ levels categorized by the type of house(apartment, detached dwelling) and cooking fuel(L.P.G., briquette) in the winter and summer, and surveyed the variables(kitchen ventilation, family size, parental smoking) may effect the indoor $NO_2$ levels. The level of $NO_2$ was measured by Palmes tube, and this survey was carried out at 110 homes in the Pusan area from October 1984 to September 1985. The obtained results were as follows: 1) The mean indoor and outdoor $NO_2$ level in winter and summer, respectively, was $0.029{\pm}0.012$ ppm and $0.022{\pm}0.012$ ppm in the kitchen, $0.022{\pm}0.009$ ppm and $0.018{\pm}0.010$ ppm in the living room, $0.017{\pm}0.008$ ppm and $0.016{\pm}0.010$ ppm in the bed room, and $0.021{\pm}0.007$ ppm and $0.016{\pm}0.007$ ppm outdoors. 2) In the category of the type of house and cooking fuel, the highest mean indoor and outdoor $NO_2$ level in the winter was in apartments using briquettes, and in the summer. the highest level was in apartments using L.P.G. 3) In the category of the type of house, the mean indoor and outdoor $NO_2$ level in the winter and summer was higher in the apartment group compared to detached dwelling. 4) In the category of the type of cooking fuel, the mean indoor and outdoor $NO_2$ level in the winter was higher in the briquette group, and in the summer, the L.P.G. group was higher. 5) In the category of the kitchen ventilation, family size, parental smoking and asthma attack history of children, there was an insignificant difference in the indoor $NO_2$ levels.

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Interpretation of the Umbrella Clause in Investment Treaties (국제투자조약상 포괄적 보호조항(Umbrella Clauses)의 해석에 관한 연구)

  • Jo, Hee-Moon
    • Journal of Arbitration Studies
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    • v.19 no.2
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    • pp.95-126
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    • 2009
  • One of the controversial issues in investor-state investment arbitration is the interpretation of "umbrella clause" that is found in most BIT and FTAs. This treaty clause requires on Contracting State of treaty to observe all investment obligations entered into with foreign investors from the other Contracting State. This clause did not receive in-depth attention until SGS v. Pakistan and SGS v. Philippines cases produced starkly different conclusions on the relations about treaty-based jurisdiction and contract-based jurisdiction. More recent decisions by other arbitral tribunals continue to show different approaches in their interpretation of umbrella clauses. Following the SGS v. Philippines decision, some recent decisions understand that all contracts are covered by umbrella clause, for example, in Siemens A.G. v. Argentina, LG&E Energy Corp. v. Argentina, Sempra Energy Int'l v. Argentina and Enron Corp. V. Argentina. However, other recent decisions have found a different approach that only certain kinds of public contracts are covered by umbrella clauses, for example, in El Paso Energy Int'l Co. v. Argentina, Pan American Energy LLC v. Argentina and CMS Gas Transmission Co. v. Argentina. With relation to the exhaustion of domestic remedies, most of tribunals have the position that the contractual remedy should not affect the jurisdiction of BIT tribunal. Even some tribunals considered that there is no need to exhaust contract remedies before bringing BIT arbitration, provoking suspicion of the validity of sanctity of contract in front of treaty obligation. The decision of the Annulment Committee In CMS case in 2007 was an extraordinarily surprising one and poured oil on the debate. The Committee composed of the three respected international lawyers, Gilbert Guillaume and Nabil Elaraby, both from the ICJ, and professor James Crawford, the Rapportuer of the International Law Commission on the Draft Articles on the Responsibility of States for Internationally Wrongful Acts, observed that the arbitral tribunal made critical errors of law, however, noting that it has limited power to review and overturn the award. The position of the Committee was a direct attack on ICSID system showing as an internal recognition of ICSID itself that the current system of investor-state arbitration is problematic. States are coming to limit the scope of umbrella clauses. For example, the 2004 U.S. Model BIT detailed definition of the type of contracts for which breach of contract claims may be submitted to arbitration, to increase certainty and predictability. Latin American countries, in particular, Argentina, are feeling collectively victims of these pro-investor interpretations of the ICSID tribunals. In fact, BIT between developed and developing countries are negotiated to protect foreign investment from developing countries. This general characteristic of BIT reflects naturally on the provisions making them extremely protective for foreign investors. Naturally, developing countries seek to interpret restrictively BIT provisions, whereas developed countries try to interpret more expansively. As most of cases arising out of alleged violation of BIT are administered in the ICSID, a forum under the auspices of the World Bank, these Latin American countries have been raising the legitimacy deficit of the ICSID. The Argentine cases have been provoking many legal issues of international law, predicting crisis almost coming in actual investor-state arbitration system. Some Latin American countries, such as Bolivia, Venezuela, Ecuador, Argentina, already showed their dissatisfaction with the ICSID system considering withdrawing from it to minimize the eventual investor-state dispute. Thus the disagreement over umbrella clauses in their interpretation is becoming interpreted as an historical reflection on the continued tension between developing and developed countries on foreign investment. There is an academic and political discussion on the possible return of the Calvo Doctrine in Latin America. The paper will comment on these problems related to the interpretation of umbrella clause. The paper analyses ICSID cases involving principally Latin American countries to identify the critical legal issues arising between developing and developed countries. And the paper discusses alternatives in improving actual investor-State investment arbitration; inter alia, the introduction of an appellate system and treaty interpretation rules.

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Experimental Evaluation of Bi-directionally Unbonded Prestressed Concrete Panel Impact-Resistance Behavior under Impact Loading (충돌하중을 받는 이방향 비부착 프리스트레스트 콘크리트 패널부재의 충돌저항성능에 대한 실험적 거동 평가)

  • Yi, Na-Hyun;Lee, Sang-Won;Lee, Seung-Jae;Kim, Jang-Ho Jay
    • Journal of the Korea Concrete Institute
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    • v.25 no.5
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    • pp.485-496
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    • 2013
  • In recent years, frequent terror or military attacks by explosion or impact accidents have occurred. Examplary case of these attacks were World Trade Center collapse and US Department of Defense Pentagon attack on Sept. 11 of 2001. These attacks of the civil infrastructure have induced numerous casualties and property damage, which raised public concerns and anxiety of potential terrorist attacks. However, a existing design procedure for civil infrastructures do not consider a protective design for extreme loading scenario. Also, the extreme loading researches of prestressed concrete (PSC) member, which widely used for nuclear containment vessel, gas tank, bridges, and tunnel, are insufficient due to experimental limitations of loading characteristics. To protect concrete structures against extreme loading such as explosion and impact with high strain rate, understanding of the effect, characteristic, and propagation mechanism of extreme loadings on structures is needed. Therefore, in this paper, to evaluate the impact resistance capacity and its protective performance of bi-directional unbonded prestressed concrete member, impact tests were carried out on $1400mm{\times}1000mm{\times}300mm$ for reinforced concrete (RC), prestressed concrete without rebar (PS), prestressed concrete with rebar (PSR, general PSC) specimens. According to test site conditions, impact tests were performed with 14 kN impactor with drop height of 10 m, 5 m, 4 m for preliminary tests and 3.5 m for main tests. Also, in this study, the procedure, layout, and measurement system of impact tests were established. The impact resistance capacity was measured using crack patterns, damage rates, measuring value such as displacement, acceleration, and residual structural strength. The results can be used as basic research references for related research areas, which include protective design and impact numerical simulation under impact loading.