• Title/Summary/Keyword: Background level

Search Result 4,497, Processing Time 0.045 seconds

Hypoxemia In Liver Cirrhosis And Intrapulmonary Shunt Determination Using Tc-99m-MAA Whole Body Scan (간경화 환자에서의 저산소혈증과 Tc-99m-MAA 주사를 이용한 폐내단락 측정)

  • Lee, Kye-Young;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Kim, Keun-Youl;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
    • /
    • v.41 no.5
    • /
    • pp.504-512
    • /
    • 1994
  • Background: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant cuases of cirrhosis. It is uncertain that the same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia, Method: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. Results: The hypoxemia of $PaO_2$ less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). But there was no patient with significant hypoxemia of $PaO_2$ less than 60 mmHg. $PaO_2$ was significantly decreased in the patients with spider angioma than the pathients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of $11.4{\pm}4.1%$ than normoxemic group of $4.1{\pm}2.0%$ (p<0.05). Conclusions: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to p1ay a major ro1e in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.

  • PDF

Effect of Pressure Rise Time on Tidal Volume and Gas Exchange During Pressure Control Ventilation (압력조절환기법에서 압력상승시간(Pressure Rise Time)이 흡기 일환기량 및 가스교환에 미치는 영향)

  • Jeoung, Byung-O;Koh, Youn-Suck;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Lim, Chae-Man
    • Tuberculosis and Respiratory Diseases
    • /
    • v.48 no.5
    • /
    • pp.766-772
    • /
    • 2000
  • Background : Pressure rise time (PRT) is the time in which the ventilator aclieves the set airway pressure in pressure-targeted modes, such as pressure control ventilation (PCV). With varying PRT, in principle, the peak inspiratory flow rate of the ventilator also varies. And if PRT is set to a shorter duration, the effective duration of target pressure level would be prolonged, which in turn would increase inspiratory tidal volume(Vti) and mean airway pressure (Pmean). We also postulated that the increase in Vti with shortening of PRT may relate inversely to the patients' basal airway resistance. Methods : In 13 paralyzed patients on PCV (pressure control 18$\pm$9.5 cm $H_2O$ $FIO_2\;0.6\pm0.3$, PEEP 5$\pm$3 cm $H_2O$, f 20/min, I : E1 : 2) with Servo 300 (Siemens-Elema, Solna, Sweden) from various causes of respiratory failure, PRT of 10 %, 5 % and 0 % were randomly applied. At 30 min of each PRT trial, peak inspiratory flow (PIF, L/sec), Vti (ml), Pmean (cm $H_2O$) and ABGA were determined. Results : At PRT 10%, 5%, and 0%, PIF were 0.69$\pm$0.13, 0.77$\pm$0.19, 0.83$\pm$0.22, respectively (p<0.001). Vti were 425$\pm$94, 439$\pm$101, 456$\pm$106, respectively (p<0.001), and Pmean were 11.2$\pm$3.7, 12.0$\pm$3.7, 12.5$\pm$3.8, respectively (p<0.001). pH were 7.40$\pm$0.08, 7.40$\pm$0.92, 7.41$\pm$0.96, respectively (p=0.00) ; $PaCO_2$ (mm Hg) were 47.4$\pm$15.8, 47.2 $\pm$15.7, 44.6$\pm$16.2, respectively (p=0.004) ; $PAO_2-PaO_2$ (mm Hg) were 220$\pm$98, 224$\pm$95, 227$\pm$94, respectively (p=0.004) ; and $V_n/V_T$ as determined by ($PaCO_2-P_E-CO_2$)/$PaCO_2$ were 0.67$\pm$0.07, 0.67$\pm$0.08, 0.66$\pm$0.08, respectively (p=0.007). The correlation between airway resistance and change of Vti from PRT 10% to 0% were r= -0.243 (p=0.498). Conclusion : Shortening of pressure rise timee during PCV was associated with increased tidal volume, increased mean airway pressure and lower $PaCO_2$.

  • PDF

A Study on the Curriculum for Record Management Science Education - with focus on the Faculty of Cultural Information Resources, Surugadai University; Evolving Program, New Connections (기록관리학의 발전을 위한 교육과정연구 -준하태(駿河台)(스루가다이)대학(大學)의 경우를 중심(中心)으로-)

  • Kim, Yong-Won
    • Journal of Korean Society of Archives and Records Management
    • /
    • v.1 no.1
    • /
    • pp.69-94
    • /
    • 2001
  • The purpose of this paper is to provide an overview of the current status of the records management science education in Japan, and to examine the implications of the rapid growth of this filed while noting some of its significant issues and problems. The goal of records management science education is to improve the quality of information services and to assure an adequate supply of information professionals. Because records management science programs prepare students for a professional career, their curricula must encompass elements of both education and practical training. This is often expressed as a contrast between theory and practice. The confluence of the social, economic and technological realities of the environment where the learning takes place affects both. This paper reviews the historical background and current trends of records management science education in Japan. It also analyzes the various types of curriculum and the teaching staff of these institutions, with focus on the status of the undergraduate program at Surugadai University, the first comprehensive, university level program in Japan. The Faculty of Cultural Information Resources, Surugadai University, a new school toward an integrated information disciplines, was opened in 1994, to explore the theory and practice of the management diverse cultural information resources. Its purpose was to stimulate and promote research in additional fields of information science by offering professional training in archival science, records management, and museum curatorship, as well as librarianship. In 1999, the school introduced a master program, the first in Japan. The Faculty has two departments and each of them has two courses; Department of Sensory Information Resources Management; -Sound and Audiovisual Information Management, -Landscape and Tourism Information Management, Department of Knowledge Information Resources Management; -Library and Information Management, -Records and Archives Management The structure of the entire curriculum is also organized in stages from the time of entrance through basic instruction and onwards. Orientation subjects which a student takes immediately upon entering university is an introduction to specialized education, in which he learns the basic methods of university education and study, During his first and second years, he arranges Basic and Core courses as essential steps towards specialization at university. For this purpose, the courses offer a wide variety of study topics. The number of courses offered, including these, amounts to approximately 150. While from his third year onwards, he begins specific courses that apply to his major field, and in a gradual accumulation of seminar classes and practical training, puts his knowledge grained to practical use. Courses pertaining to these departments are offered to students beginning their second year. However, there is no impenetrable wall between the two departments, and there are only minor differences with regard requirements for graduation. Students may select third or fourth year seminars regardless of the department to which they belong. To be awarded a B.A. in Cultural Information Resources, the student is required to earn 34 credits in Basic Courses(such as, Social History of Cultural Information, Cultural Anthropology, History of Science, Behavioral Sciences, Communication, etc.), 16 credits in Foreign Languages(including 10 in English), 14 credits on Information Processing(including both theory and practice), and 60 credits in the courses for his or her major. Finally, several of the issues and problems currently facing records management science education in Japan are briefly summarized below; -Integration and Incorporation of related areas and similar programs, -Curriculum Improvement, -Insufficient of Textbooks, -Lack of qualified Teachers, -Problems of the employment of Graduates. As we moved toward more sophisticated, integrated, multimedia information services, information professionals will need to work more closely with colleagues in other specialties. It will become essential to the survival of the information professions for librarians to work with archivists, record managers and museum curators. Managing the changes in our increasingly information-intensive society demands strong coalitions among everyone in cultural Institutions. To provide our future colleagues with these competencies will require building and strengthening partnerships within and across the information professions and across national borders.

An Analysis of the Home Economics Education Discipline Items in the Teacher Recruitment Examination for Secondary School (중등교사 신규임용 후보자 선정 경쟁시험 가정과 교과교육학 출제 문항 분석)

  • Kim, Sung-Sook;Chae, Jung-Hyun
    • Journal of Korean Home Economics Education Association
    • /
    • v.19 no.3
    • /
    • pp.149-168
    • /
    • 2007
  • The purpose of this study was to analyze the home economics education items in the teacher recruitment examination for secondary school. To achieve the purpose, all the home economics education items, which were carried out for seven times from the school year 2001 to the most recent year 2007, were compared and analyzed. The form of items was analyzed by frequency and rate. Behavioral domain of items was analyzed by content analysis. In this study, some recommendations were suggested for the quality of home economics education items through discussion of science education and society education items, which were abstracted from the school year 2001 to the most recent year 2007. The results of this study were as follows. First, the score ratio of home economics education items was fluid as 20-30% from the school year 2001 to 2004 but it fixed as 30-35% since the school year 2005. In subcategory of home economics education, curriculum items accounted for highest ratio(43%). In the next thing, items of teaching-learning method(35%), evaluation(19%) and philosophy(3%) related to home economics education were followed in order. Second, the form of home economics education items was coexistent form of single item and subordinate item from the school year 2001 to 2004. But it was changed into form of single item by 100% since the school year 2005. Third, regarding the content of home economics education items, most of the curriculum items were related to the content of the 7th National Curriculum. Teaching-learning method items were taken mostly from model of teaching-learning. Evaluation items were taken mostly from performance assessment. Philosophy items related to home economics education were taken only from Habermas's three systems of action on the school year 2005. Fourth, about behavioral domain of home economics education items, most of the curriculum items were level of 'simple knowledge or memory'. Therefore, it was suggested that behavioral domain of curriculum items had to be changed into 'complex knowledge or comprehension and application'. The behavioral domain of teaching-learning method items and education evaluation items was mostly 'complex knowledge or comprehension and application'. However, to bettering the items it was suggested that the behavioral domain of them has to be changed 'comprehension' into more 'application'. Fifth, regarding the coverage of home economics education items, curriculum items were limited only superficial content of the 7th National Curriculum. Therefore, it was suggested that coverage of curriculum items had to be extended to theoretical content, which was philosophical background and various principles of curriculum. It was suggested that coverage of teaching-learning method items had to be extended to the content including various teaching-learning theories and the practical reasoning home economics instruction proved effective as home economics instruction recently. Evaluation items were taken mostly from performance assessment. Therefore, it was suggested that coverage of evaluation items had to be extended to analysis of evaluation result, item validity and reliability, and evaluator's philosophical perspective.

  • PDF

The Increased Expression of Gelatinolytic Proteases Due to Cigarette Smoking Exposure in the Lung of Guinea Pig (기니픽에서 흡연 노출에 의한 젤라틴 분해 단백 효소의 발현 양상에 관한 연구)

  • Kang, Min-Jong;Lee, Jae-Ho;Yoo, Chul-Gyu;Lee, Choon-Taek;Chung, Hee-Soon;Seo, Jeong-Wook;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
    • /
    • v.50 no.4
    • /
    • pp.426-436
    • /
    • 2001
  • Background : Chronic obstructive pulmonary disease(COPD) is one of the major contributors to morbidity and mortality among the adult population. Cigarette smoking(CS) is undoubtedly the single most important factor in the pathogenesis of COPD. However, its mechanism is unclear. The current hypothesis regarding the pathogenesis of COPD postulates that an imbalance between proteases and antiproteases leads to the destructive changes in the lung parenchyma. This study had two aims. First, to evaluate the effect of CS exposure on histologic changes of the lung parenchyme, and second, to evaluate the effect of CS exposure on the expression of the gelatinolytic enzymes in BAL fluid cells in guinea pigs. Methods : Two groups of five guinea pigs were exposed to the whole smoke of 20 commercial cigarettes per day, 5 hours/day, 5 days/week, for 6weeks, and 12 weeks, respectively, using a smoking apparatus. Five age-matched guinea pigs exposed to room air were used as controls. Five or more sections were microscopically extamined(${\times}400$) and the number of cellular infiltration of the alveolar wall was measured in order to evaluate the effect of CS exposure on the histologic changes of lung parenchyme. The statistical significance was analyzed by a linear regression method. To evaluate the expression of the gelatinolytic enzymes in intraalveolar cells, BAL fluid was obtained and the intraalveolar cells were separated by centrifugation (500 g for 10 min at $4^{\circ}C$). Two sets of culture plates were loaded with $1{\times}10^6$ intraalveolar cells. One plate, contained O.1mM EDTA, a inhibitor of matrix metalloproteases(MMPs), and the other plate had no EDTA. Both plates were incubated for 48 hours at $37^{\circ}C$. After incubation, gelatinolytic protease expression in the supernatants was analyzed by gelatin zymography. Results : At the end of CS exposure, the level of blood carboxy Hb had increased significantly(4.1g/dl in control group, 24g/dl immediately after CS exposure, 18g/dl 30 min after CS exposure, 15g/dl 1 hour after CS exposure). Alveolar inflammatory cells were identified in the CS exposed guinea pigs. The number of alveolar cellular cells observed in a microscopic field ($400{\times}$) was $121.4{\pm}7.2$, $158.0{\pm}20.2$, $196.8{\pm}32.8$, in the control, the 6 weeks, and the 12 weeks group, respectively. The increased extent of inflammatory cellular infiltration of the lung parenchema showed a statistically significant linear relationship with the duration of CS exposure(p=0.001, $r^2=0.675$). Several types of gelatinolytic enzymes in the intraalveolar cells of CS exposed guinea pigs were expressed, of which some were inhibited by EDT A. However, the gelatinolytic enzymes were not expressed in the control groups. Conclusion : CS exposure increases inflammatory cellular infiltration of the alveolar wall and the expression of gelatinolytic proteases in guinea pigs. EDTA inhibits some of the gelatinolytic proteases. These findings suggest a possibility that CS exposure may increase MMP expression in the lungs of guinea pigs.

  • PDF

The Role of c-Jun N-terminal Kinase in the Radiation-Induced Lung Fibrosis (방사선에 의한 폐 섬유화증에서 c-Jun N-terminal Kinase(JNK)의 역할)

  • Uh, Soo-Taek;Hong, Ki-Young;Lee, Young-Mok;Kim, Ki-Up;Kim, Do-Jin;Moon, Seung-Hyuk;Kim, Yong-Hoon;Park, Choon-Sik;Yeom, Uk;Kim, Eun-Suk;Choi, Doo-Ho
    • Tuberculosis and Respiratory Diseases
    • /
    • v.50 no.4
    • /
    • pp.450-461
    • /
    • 2001
  • Background : The underlying pathogenesis of radiation-induced lung fibrosis (RTLF) has not been very well defined. However, the role of TGF-$\beta$ in the generation of RTLF has been a major focus because there is an increase in the expression of both the TGF-${\beta}m$-RNA and its protein preceding RTLF lesions. The down stream signal after a TGF-$\beta$ stimulated lung fibrosis includes the activation of many mediators such as Smad and c-Jun N-terminal kinase (JNK) through TAK1. It is we hypothesized that JNK activation may play a pivotal role in RTLF pathogenesis through increased transcription of the fibrogenic cytokines. The present study evaluates JNK activity in alveolar macrophages after irradiation and the relationship between JNK activity and the amount of collagen in the lung tissues. Methods : C57BL/6 mice(20-25 gr, males) received chlorotetracycline(2g/L) in their drinking water 1 week prior to irradiation and continuously there after. The mice were irradiated once with 1400 cGy of $60CO{\gamma}$-ray over the whole chest. The cellular composition of the whole lung bronchoalveoalr lavage fluids(BALF), elastin expression in the lung tissues, the level of hydroxyproline in lung tissues, and an in vitro JNK assay was measured before irradiation and one, four, and eight weeks after irradiation (RT). Results : The volumes of BALF retrieved from instilled 4 mL of saline with 2% heparin were 3.7-3.8 mL for each group. The cell numbers were similar before($4.1{\times}10^4{\pm}0.5{\times}10^4/mL$) and 1 week($3.1{\times}10^4{\pm}0.5{\times}10^4/mL$) after RT. At four and eight weeks after RT, the cell number reached to $14.0{\times}10^4{\pm}1.5{\times}10^4mL$ and $10.0{\times}10^4{\pm}1.3{\times}10^4/mL$, respectively. There we no changes in the lymphocytes and neutrophils population observed in the BALF after RT. The H-E stain of the lung tissues did not show any structural and fibrotic change in the lung tissues at 4 and 8 weeks after RT. In addition, the amount of elastin and collagen were not different on Verhoeff staining of the lung tissues before RT to eight weeks after RT. The hydroxyproine content was measured with the left lung dissected from the left main bronchus. The lung were homogenized and hydrolyzed with 6 N Hel for 12 hours at $110^{\circ}C$ then measured as previously described. The content of hydroxyproline, standardized with a lung protein concentration, reached a peak 4 weeks after RT, and thereafter showed a plateau. AnIn vitro JNK assay using c-$Jun_{1-79}$-GST sepharose beads were performed with the alveolar macrophages obtained from the BAL. JNK activity was not detected prior to RT, However, the JNK activity increased from one week after RT and reached a peak four weeks after RT. Conclusion : JNK may be involved in the pathogenesis because the JNK activity showed similar pattern observed with the hydroxyproine content. However, it is necessary to clarify that the JNK increases the transcription of fibrogenic cyiokines through the transcription factor.

  • PDF

Effect of FK506 and Cyclosporin A on $I{\kappa}B{\alpha}$ Degradation and $IKK{\alpha}$ Pathway in Bronchial Epithelial Cells, Monocytes, Lymphocytes and Alveolar Macrophages (FK506과 cyclosporin A가 기관지상피세포, 단핵구, 림프구 및 폐포대식세포에서 $I{\kappa}B{\alpha}$ 분해 및 $IKK{\alpha}$ 활성에 미치는 효과)

  • Yoon, Ho Il;Lee, Chang-Hoon;Lee, Hee-Seok;Lee, Choon-Taek;Kim, Young Whan;Han, Sung Koo;Shim, Young-Soo;Yoo, Chul-Gyu
    • Tuberculosis and Respiratory Diseases
    • /
    • v.54 no.4
    • /
    • pp.449-458
    • /
    • 2003
  • Background : Cyclosporin A(CsA) and tacrolimus(FK506) have been widely used as immunosuppressants. The effects of CsA, or FK506, on the $I{\kappa}B/NF-{\kappa}B$ pathway have been shown to vary according to the cell type. However, their effects on the $I{\kappa}B/NF-{\kappa}B$ pathway have not been reported in bronchial epithelial cells. In this study, the effects of CsA and FK506 on the $I{\kappa}B/NF-{\kappa}B$ pathway in bronchial epithelial cells, monocytes, lymphocytes and alveolar macrophages were evaluated. The relationship between their effects on the $I{\kappa}B/NF-{\kappa}B$ pathway and $I{\kappa}B$ kinase(IKK) activity was also investigated. Methods : BEAS-2B and A549 cells, pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes were used. The cells were pre-treated with CsA, or FK506, for various time periods, followed by stimulation with TNF-${\alpha}$, LPS or IL-$1{\beta}$. The $I{\kappa}B{\alpha}$ expressions were assayed by Western blot analyses. The IKK activity was evaluated by an in vitro immune complex kinase assay, using GST-$I{\kappa}B{\alpha}$ as the substrate. Results : Neither CsA nor FK506 affected the level of $I{\kappa}B{\alpha}$ expression in any of the cell types used in this study. CsA pre-treatment inhibited the TNF ${\alpha}$-induced $I{\kappa}B{\alpha}$ degradation in bronchial epithelial cells. In contrast, the TNF ${\alpha}$-induced $I{\kappa}B{\alpha}$ degradation was not affected by FK506 pre-treatment. However, FK506 suppressed the cytokine-induced $I{\kappa}B{\alpha}$ degradation in the pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes. The inhibitory effect of CsA, or FK506, on $I{\kappa}B{\alpha}$ degradation was not related to IKK. Conclusions : CsA and FK506 suppressed the $I{\kappa}B{\alpha}$ degradation in bronchial epithelial cells, monocytes, lymphocytes and alveolar macrophages, so this may not be mediated through IKK.

Clinical Course of Usual Interstitial Pneumonia (통상성 간질성 폐섬유증의 임상경과)

  • Park, Joo-Hun;Kitaichi, M.;Yum, Ho-Kee;Shim, Tae-Sun;Lim, Chae-Man;Koh, Youn-Suck;Lee, Sang-Do;Kim, Woo-Sung;Kim, Won-Dong;Kim, Dong-Soon
    • Tuberculosis and Respiratory Diseases
    • /
    • v.49 no.5
    • /
    • pp.601-613
    • /
    • 2000
  • Background : Idiopathic pulmonary fibrosis (IPF) is a fatal progressive fibrous disease of the lung of unknown etiology. Recently it has been classified into several distinct entities on the basis of pathologic and clinical characteristics, ie : usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), acute interstitial pneumonia (AIP), bronchiolitis obliterans with organizing pneumonia (BOOP), and nonspecific interstitial pneumonia (NSIP). IPF is now applied only for UIP, which has the worst prognosis. The previous reports of 3-5 year median survival appears to be overoptimistic because other types with better prognosis like NSIP or BOOP might have been included. Therefore, this study was performed to determine the clinical course and the prognostic factors of UIP as diagnosed by surgical lung biopsy. Methods : The subjects were 72 UIP patients (age $58.2{\pm}11.6$ years, M : F=45 : 27, median follow up period : 18.1 months (0.7-103.6) diagnosed by surgical lung biopsy at the Asan Medical Center (68 patients) and the Paik Hospital in Seoul (4 patients). Clinical scores (level of dyspnea : 1-20 points), radiologic score (honeycombing : HC score 0-5 points, ground glass : GG score 0-5 points), and physiologic scores (FVC : 1-12 points, $FEV_1$ : 0-3 points, TLC : 0-10 points, $D_{LCO)$ : 0-5 points, $AaDO_2$ : 0-10 points) were summed into a total CRP score. Results : 1) The one year survival rate was 78.3%, while the rate for three year survival was 58.1%, and the median survival period was 42.5months. 2) Short term (1 year) prognosis : The patients who died within one year of diagnosis (14 patients) had the higher initial total CRP score ($28.6{\pm}8.3$ vs. $16.6{\pm}9.7$) than those who lived longer than one year (46 patients). The difference in the total CRP score was attributed to the symptom score ($8.4{\pm}2.1$ vs. $5.7{\pm}3.9$) and the physiologic score ($15.7{\pm}7.1$ vs. $6.7{\pm}5.7$) including FVC, $D_{LCO)$ and $AaDO_2$. 3) Long-term (3year) prognosis : The total CRP score ($12.2{\pm}6.7$ vs. $28.7{\pm}7.9$ : including symptom score, FVC, $D_{LCO)$ and $AaDO_2$) at the time of diagnosis were also different for the long-term survivors and those who lived less than 3 years. 4) Cox regression analysis showed $D_{LCO)$ (${\geq}$60%) (Hazard ratio : 4.56, 95% CI : 2.30-16.04) was the independent prognostic factors of UIP (P<0.05). Conclusion : These results suggest that $D_{LCO)$ at the time of diagnosis seem to be a prognostic markers of biopsy-proven UIP.

  • PDF

The Influences of Maintenance Hemodialysis on Sleep Architecture and Sleep Apnea in the Patients with Chronic Renal Failure (만성신부전 환자에서 혈액투석 유지요법이 수면구조 및 수면 무호흡에 미치는 영향)

  • Park, Yong-Geun;Lee, Sang-Haak;Choi, Young-Mee;Ahn, Seok-Joo;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Song, Jeong-Sup;Park, Sung-Hak;Moon, Hwa-Sik
    • Tuberculosis and Respiratory Diseases
    • /
    • v.47 no.6
    • /
    • pp.824-835
    • /
    • 1999
  • Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

  • PDF

Chemokine Secretion From Alveolar Macrophages in Patients with Diffuse Interstitial Lung Diseases(DILD) (미만성 간질성 폐질환 환자들의 폐포대식세포의 chemokine(MIP-1, IL-8) 분비능에 관한 연구)

  • Kim, Dong Soon;Paik, Sang Hoon;Lim, Chae Man;Lee, Sang Do;Koh, Younsuck;Kim, Woo Sung;Kim, Won Dong
    • Tuberculosis and Respiratory Diseases
    • /
    • v.43 no.6
    • /
    • pp.954-964
    • /
    • 1996
  • Background : The type of the infiltrating cells in al veolitis may be determined by the chemokines in the lesion. MIP-1 ${\alpha}$, a C-C type chemokine, stimulates proliferation and cytokine secretion from macrophages and induces early neutrophilic and later monocytic inflammation in vi vo. IL-8, a C-X-C type chemokine is known to attract neutrophils and T-lymphocytes. This study is performed to find out the relative role of two different chemokines in diffuse interstitial lung disease. Subject and Method : We measured the secretion of MIP- 1 ${\alpha}$ and IL-8 from alveolar macrophages(AM), and their level in BAL fluid of 26 patients with DILD (10 IPF, 4 collagen disease, 10 sarcoidosis, and 2 hypersensitivity pneumonitis) and 7 normal control. Result: IL-8 secretion was significantly increased in patients with DILD ($8.15{\pm}4.58$ ng/ml) than in normal ($1.10{\pm}0.93$ ng/ml, p=0.0003). Significant correlation was found between IL-8 secretion and total cell number in BAL fluid (r=0.484, p=0.0068), %(r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte, and % of AM (r=-0.505, 0.0032). MIP- 1 ${\alpha}$ secretion was also increased in DILD ($2.41{\pm}1.45$ ng/ml) compared to control ($0.63{\pm}0.30$ ng/ml, p=0.0031), and showed a tendency of correlation with total cell number (r=0.368, p=0.0456) and No. of alveolar macrophages (r=0.356, p=0.0579) in BAL fluid. The concentration of IL-8 in BAL fluid was significantly increased in the patients with DILD ($40.4{\pm}34.5$ pg/ml) compared to control ($3.90{\pm}2.47$ pg/ml, p=0.0094) and it showed a significant correlation with the total cell number (r=0.484, p=0.0068), %(r=-0.505, p=0.0032) of AM, and % (r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte in BAL fluid. But there was a no significant difference in MIP- 1 ${\alpha}$ concentration in BAL fluid between normal control group and the patients with DILD. Conclusion : From the above results, we concluded that AM of DILD releases increased amount of both IL-8 and MIP- 1 ${\alpha}$ but IL-8 has better correlation with the type of alveolitis.

  • PDF