• 한국발생생물학회지:발생과생식
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• 제4권1호
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• pp.101-108
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• 2000

자궁내막증은 흔한 부인과적 질병이며 여성 불임의 한 원인이 되나 그 발생 원인에 대하여서는 아직 논란의 여지가 많다. 최근 월경혈의 역류에 의하여 자궁내막증이 생긴다는 가설이 가장 유력한데 자궁내막증 환자가 정상여성에서보다 역류되는 월경혈의 양이 많거나 침습성이 강한 것이 자궁내막증의 발생원인이 될 수 있다는 이론들이 소개되었다. Pleitrophin (PTN)이나 midkine(MK)은 성장 및 분화에 관여하는 인자로서 여러 종류의 악성 종양에서 그 발현이 보고되어있으며 종양화 (carcinogenensis), 맥관형성 (angiogenesis), plasminogen activator의 활성화 증가 등에 관여한다고 보고된 바 있다. 이에 자궁내막증 환자의 자궁 내막과 대조군의 자궁내막에서 PTN과 MK mRNA의 발현의 차이를 quantitative competitive RT PCR로 비교하였다. 그 결과 자궁내막증 환자의 황체기 자궁내막에서 대조군의 자궁내막에 비하여 PTN과 MK의 발현이 높게 나타났다. 이러한 PTN과 MK의 발현의 증가로 자궁내막증 환자의 자궁내막이 복강 내에서 더욱 쉽게 맥관형성을 하고 성장이 촉진되어 자궁내막증이 발생될 것으로 생각되어 PTN과 MK가 자궁내막증의 초기 발생과정에 관여할 가능성이 있다.

• 생물정신의학
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• 제6권2호
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• pp.227-234
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• 1999

자살 시도군 231명, 환자 대조군 231명, 정상대조군 231명을 대상으로 혈청 콜레스테롤 농도를 측정하여 다음의 결과를 얻었다. 1) 자살 시도군이 환자대조군 혹은 정상대조군보다 혈청 콜레스테롤 농도의 유의한 저하를 보였다. 2) 진단별로는 우울증과 인격장애에서 자살 시도군이 환자대조군보다 콜레스테롤 농도의 유의한 저하를 보였으나, 정신분열병과 양극성 정동장애 조증형에선 차이가 없었다. 3) 자살 시도군의 남녀별로 비교시, 남자가 여자보다 콜레스테롤 농도의 유의한 저하를 보였으며, 진단별로는 우울증에서만 유의한 차이를 보였다. 4) 자살 시도군에서 낮은 콜레스테롤 농도는 심각한 자살 수행과 연관성이 있었다. 5) 자살 시도군에서 치료전에 비해 치료후 혈청 콜레스테롤 농도의 유의한 증가를 보였다. 본 연구의 결과는 자살 시도의 예측인자로서 혈청 콜레스테롤이 이용될 수 있음을 시사한다. 향후 콜레스테롤 농도에 미치는 변인들을 통제한 전향적 방법을 통해 원인적 측면에서 혈청 콜레스테롤 농도와 세로토닌, 인터루킨-2, 멜라토닌 간의 연관성에 관한 연구가 이루어져야 하겠다.

• 대한한방내과학회지
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• 제26권2호
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• pp.353-359
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• 2005

Objectives: Dysphagia is a common in stroke patients. Dysphagia often affects the rehabilitation of stroke patients by increasing the risk of nutritional deficits and aspiration pneumonia. Despite the proliferation of physical therapies including swallowing training, much controversy remains regarding the application and benefit of them. Therefore, in this study, the clinical effect of moxibustion at Chonjung(CV17, Shanzhong) on post-stroke dysphagia were assessed using Swallowing Provocation Test(SPT). Methods: Dysphagia subjects were selected by Dysphagia Screening Test. Swallowing function was tested by Swallowing Provocation Test(sec). Direct moxibustion was applied to the acupoint, Chonjung, five times and Swallowing Provocation Test was performed before and after 30 minute. The Latency Time of Swallowing Reflex (LTSR) was checked by SPT. To find factors related with improving swallowing function, Cold-Heat and Excess-Deficiency Diagnosis were considered. Results: A total of 42 patient were included, but two of them were excluded due to severe coughing. Overall, the swallowing reflex improved significantly. In subgroup analysis on brain lesion, non-brain stem lesion patients significantly improved. Moxibustion was more effective in the cold group than in the heat group, but there were no differences between the Excess and the Deficiency groups. Conclusions: The result of this clinical study suggest that moxibustion at Chonjung(CV17, Shanzhong) is an effective treatment for the dysphagia patients after stroke, especially in non-brain stem lesion and the cold diagnosed patients.

• 한국콘텐츠학회논문지
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• 제13권8호
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• pp.314-323
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• 2013

본 연구의 목적은 건강보험심사평가원에서 제공한 2009년 환자표본자료를 이용하여 병원의 환자집중도 수준과 분만환자의 평균재원일수와의 관계를 분석하는 것이다. 병원에 내원한 분만환자의 집중도는 DRGs(Diagnosis Related Groups)를 이용하여 생성된 내부허핀달지수를 이용하여 측정하였다. 통계분석에서는 병상 수, 분만환자 수, 100병상 당 의사 수, 100병상 당 간호사 수 같은 병원의 구조변수를 통제변수로 사용하였고, 분만환자의 평균재원일수는 종속변수로 사용하였다. 연구에서 분만환자의 집중화에 따른 재원일수 변이의 분석을 위해 모형 1에서는 병원의 모든 입원환자들 중 분만입원환자의 집중화정도를 분석하였고, 모형 2에서는 모든 산부인과 관련 환자들 중 분만입원환자의 집중화정도를 분석하였다. 분석결과 환자집중도는 두 모형 모두 평균재원일수와 통계적으로 유의하지 않았으며, 분만환자 수와 병상 수에서 통계적으로 유의하였다. 분만환자 수 변수는 평균재원일수와 음의 상관관계를 보였고, 병상 수는 양의 상관관계를 보였다. 연구결과는 병원에 내원한 분만환자의 집중도 지수 보다는 분만환자 수가 평균재원일수에 유의한 영향을 주는 것으로 나타났으며, 환자 수는 병원에서 진료의 효율성을 향상시키는데 기여한다고 볼 수 있다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제4권1호
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• pp.133-141
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• 1993

본 연구에서는 만성 운동성 틱 장애와 뚜레뜨 장애가 같은 원인을 갖는 동일한 스펙트럼상의 장애인지, 아니면 표면적인 증상은 유사하지만 기저의 원인은 다른 별개의 장애인지를 규명하고자, 만성 운동성 틱 장애와 뚜레뜨 장애 집단이 심리검사 반응상에서 서로 구분되는 특성이 있는지를 알아보았다. 서울대학병원 소아정신과를 내원한 6세 이상 13세 이하와 환아들 중에서 소아정신과 의사에 의해 만성 운동성 틱 장애와 뚜레뜨 장애로 진단을 받았던 환아들(틱 집단 : N=29 ; 뚜레뜨 집단, N=10)이 본 연구에서 포함되었다. 두 집단의 심리 검사 반응 특성을 비교한 결과, 뚜레뜨 장애가 만성 운동성 틱 장애보다 더 신경학적인 문제와 관련되어 있는 것으로 나타났으며, 뚜레뜨 장애 아동들이 만성 운동성 틱 장애 아동들보다 사회적 적응에 더 어려움이 있고, 정서적인 영향에 더 취약성이 있는 것으로 나타났다. 이러한 결과는 만성 운동성 틱 장애보다 뚜레뜨 장애에 신경학적 요인, 불안이나 스트레스와 같은 정서적 요인, 그리고 기질적인 요인간의 복잡한 상호작용이 더 관련되어 있을 가능성을 시사한다. 마지막으로 본 연구의 제한점 및 뚜레뜨 장애와 주의력결핍 과잉활동 장애간의 공통병리에 대한 연구의 필요성이 논의되었다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9313-9317
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• 2014

Fragile histidine triad (FHIT) is a suppressor gene related to cervical cancer through CpG island hypermethylation. Folate is a water-soluble B-vitamin and an important cofactor in one-carbon metabolism. It may play an essential role in cervical lesions through effects on DNA methylation. The purpose of this study was to observe effects of folate and FHIT methylation and HPV 16 on cervical cancer progression. In this study, DNA methylation of FHIT, serum folate level and HPV16 status were measured using methylation-specific polymerase chain reaction (MSP), radioimmunoassay (RIA) and polymerase chain reaction (PCR), respectively, in 310 women with a diagnosis of normal cervix (NC, n=109), cervical intraepithelial neoplasia (CIN, n=101) and squamous cell carcinoma of the cervix (SCC, n=101). There were significant differences in HPV16 status (${\chi}^2=36.64$, P<0.001), CpG island methylation of FHIT (${\chi}^2=71.31$, P<0.001) and serum folate level (F=4.57, P=0.011) across the cervical histologic groups. Interaction analysis showed that the ORs only with FHIT methylation (OR=11.47) or only with HPV 16 positive (OR=4.63) or with serum folate level lower than 3.19ng/ml (OR=1.68) in SCC group were all higher than the control status of HPV 16 negative and FHIT unmethylation and serum folate level more than 3.19ng/ml (OR=1). The ORs only with HPV 16 positive (OR=2.58) or with serum folate level lower than 3.19ng/ml (OR=1.28) in CIN group were all higher than the control status, but the OR only with FHIT methylation (OR=0.53) in CIN group was lower than the control status. HPV 16 positivity was associated with a 7.60-fold increased risk of SCC with folate deficiency and with a 1.84-fold increased risk of CIN. The patients with FHIT methylation and folate deficiency or with FHIT methylation and HPV 16 positive were SCC or CIN, and the patients with HPV 16 positive and FHIT methylation and folate deficiency were all SCC. In conclusion, HPV 16 infection, FHIT methylation and folate deficiency might promote cervical cancer progression. This suggests that FHIT may be an effective target for prevention and treatment of cervical cancer.

• 의료법학
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• 제13권2호
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• pp.11-38
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• 2012

The Supreme Court stand in the position in specific lawsuit that it doesn't allow the discretionary not covered service, but recently in revocation suit of fine disposal that is imposed on medical fee of leukemia patient, it altered the existing adjudgement and admitted the discretionary not covered service exceptionally. It put forward the allowable condition roughly in that case. According as this alteration, it has become more important to embody the allowance conditions of exceptions. The Supreme Court presented three things, which are procedural condition, medical condition and subscriber's agreement. Concerning procedural condition, several present conciliation procedures are as follows: medical care benefit arret request, relative value conciliation etc, prior request on anti-cancer drug among chemicals which exceed acceptance criteria, request of non benefit object on common drugs. To be granted the existence of those system, there should be no obstacle to use that. Even if it were so, we should take circumstances into consideration; individual situation is unescapable concerning substance and urgency of the discretionary not covered service, process of the procedure, time required etc. Regarding medical condition, safety and effectiveness will be verified through evaluation procedures of new medical skill. About the necessity, the Supreme Court made clear through a sentence that it allow the discretionary not covered service, in case that needs to treat a patient out of the standard of medical benefit. Strict interpretation is right and it answer the purpose of the sentence that the supreme court permit the discretionary not covered service, exceptionally. We need to differentiate medical necessity and medical validity. Subscriber's agreement should holds true if it entails full explanation, and if it is preliminary, explicit and individual. On this account, it should be difficult to admit that someone agree effectively when he call for the affirmation that he is recipient of medical care. Reasonable expense needs to be a part of review whether the agreement is valid. Meanwhile If we adjust system of medical expense and eventually reorganize a fee for consultation payment system (Fee-for-service controlled by item to DRG (Diagnosis Related Groups)), controversial area of the discretionary not covered service will be decreased and that will guarantee the discretion of the doctor.

• 보건행정학회지
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• 제13권1호
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.

• 기본간호학회지
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• 제6권3호
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• pp.493-506
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• 1999

The purpose of the study is to evaluate the effectiveness and competence level of trainees of Cardiopulmonary resuscitation training targeted for nursing students. 70 nursing students of Y nursing college are recruited as subjects from Dec. 1st, 1998 through Dec. 8th. 1998. For the pre-test. demographic data related to CPR and knowledge of CPR were evaluated. For the post-test, the next week of pre-test, three difference groups of subjects were tested their knowledge of CPR. CPR training was designed by two components which were 90 mins lecture and demonstration by one professor and individual practice using two educational models with two professors. As the tool of measurement estimating pre or post knowledge of CPR. questionnaires were developed based on self-diagnosis questionnaires of American Heart Association(AHA). The questionnaires were multiple choices (50 questions) and open end questions regarding CPR process. Each multiple choices questions valued 2 points (Score varied min. 0 point to max 100 points.). Collected data were computerized and analyzed by SPSS-WIN. Frequency and percentage of each questions analyzed. The differences of the knowledge and competency level of subjects between pre and post test was analyses by paired t-test. The followings are research outcome. 1. In the pre-test, 95% of subjects answered that they already knew what CPR was. but only 82% described correctly what CPR was. 49% learned CPR before, and 80s5 of them learned at high school. 2. 37 questions scores increases, and 10 questions scores decreased. 3 questions didnt change their score. After getting training, ratio of 80% correct score significantly increased 4 times. 3. In post-test. knowledge level of trainees increased compared to that of pre-test. (t=-15.075, p=.000) 4. Competence level also increased (t=-14.86, p=.00). In result, after getting CPR training, most CPR knowledge increased except open the air tract, toddler CPR, and alternative behavior when the air tract is blocked. CPR training needs to extend the educational scope not only CPR lecture but also psychomotor skill practice. CPR trainees are in need of appropriate feedback as well as enough opportunities of skill practice.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6163-6166
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• 2015

Objective: To analyze the relationship between a prethrombotic state and the occurrence of thrombosis, as well as survival time for patients with cervical cancer. Methods: Patients with first diagnosis of cervical cancer were subgrouped according to FIGO staging, and two D-dimer levels were assessed. According to the results, patients are divided into an observation group (abnormal) and control group (normal). Results: For 106 patients with cervical cancer, 38 with abnormal D-dimer, the abnormal rate is 35.9%, of which stage I accounted for 6.5%, stage II 38.5%, stage III 50%, and stage IV 61.1% (p=0.013); The level of D-dimers in stageI wass $0.87{\pm}0.68ug/ml$, while in stage II it was $1.50{\pm}1.35ug/ml$, stage III $2.60{\pm}1.86ug/ml$ and stage IV $18.6{\pm}53.4ug/ml$ (P=0.031); after follow-up of patients for 2-30 months, the mortality of observation group is 21.1%, while for control group it was 2.94% (p <0.01). In the observation group, survival time was $15.1{\pm}5.8$ months, while for control group it was $21.0{\pm}5.4$ months, the difference between two groups being highly significant (p=0.000). Conclusion: There is a direct correlation between prethrombotic state and the grade malignancy of cervical cancer. The level is positively correlated with clinical stage, and is inversely related to survival time, so that a prethrombotic state could be used to predict the prognosis for patients with cervical cancer.