• Radiation Oncology Journal
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• 제20권4호
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• pp.353-358
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• 2002

목적 : 자궁경부 편평상피암의 치료 후 추적조사 시에 시행하는 혈중 Squamous Cell Carcinoma (SCC) 항원 검사가 재발의 조기 발견에 도움이 되는지 알아보고자 하였다. 대상 및 방법 : 1997년 1월부터 1998년 12월까지 자궁경부 편평상피암으로 방사선치료를 받고 완전 관해 되었다가 재발된 환자들 중에서 재발 시에 SCC 항원 검사가 이루어졌던 20명을 대상으로 하였다. SCC 항원은 환자의 혈청으로부터 면역효소법으로 측정되었고, 2 ng/mL 미만을 정상으로 하였다. 진단, 추적조사, 재발 시의 SCC 항원값을 조사하여, SCC 항원 검사의 재발에 대한 민감도, 재발 양상에 따른 차이, 재발에 대한 증가 시기, 종양의 크기 및 병기와의 관계 등을 조사하였다. 결과 : 재발된 환자 20명 중의 17명에서 SCC 항원이 정상보다 증가되어 SCC 항원의 민감도는 $85\%$였고, 평균은 15.2 ng/mL (중앙값 : 9.5 ng/mL)였다. 재발 부위별로는 국소 재발, 원격전이, 동시에 발생한 경우 등으로 나누어서 SCC 항원을 비교하였으나 차이가 없었다. 재발을 진단하기 전 6개월 내에 SCC 항원이 검사되었던 11명에서 재발전 SCC 항원은 평균이 13.6 ng/mL (중앙값 : 3.6 ng/mL)였고, 7명에서 정상 보다 높았으며, 정상 범위였던 4명 중의 3명에서 1.5 ng/mL 이상으로 증가되는 양상이었다. 재발된 환자들 중에서 진단 시에 SCC 항원이 검사되었던 16명의 환자들에서 병기 Ib, IIa이면서 4 cm 미만이었던 환자들에 비하여 병기 Ib, IIa이면서 4 cm 이상이거나 병기 IIb, III이었던 환자들에서 진단 당시의 SCC 항원값이 높았다. 결론 : 자궁경부 편평상피암 환자들에서 추적조사 SCC 항원 검사는 재발의 조기 발견에 유용하고, 향후 효과적인 구제치료법이 개발되면 임상적인 이득이 더욱 증가될 것으로 생각된다.y 미만과 그 이상인 경우가 $5.1\%$ 대 $22.1\%$, 병기 II 이하인 경우와 III 이상인 경우가 $10.5\%$ 대 $31.8\%$였다. 다변량분석에서는 icruCREED 만이 유의하였다(0=0.0432). 등급 1 출혈은 자연적으로 소실되거나(3명) $1\~2$개월의 sucralfate 관장으로 멈추었다. 등급 2의 환자 6명은 $1\~2$개월 동안 sucralfate 관장으로 출혈의 빈도와 양이 줄어들었고 이 중 4명은 전기응고술을 추가로 시행하였다. 다른 9명은 전기응고술을 먼저 시행하였다(4명; sucralfate 관장 병행). 모두 $3\~10$개월 내에 정지되었다. 등급 3의 출혈은 잦은 전기응고술과 수혈을 요하였다. 결론 : 본 연구에서 중등도 이상의 직장출혈빈도가 $8.5\%$로 타 문헌에서 보고된 빈도와 유사한 결과였다. 직장에 조사된 총 생물학적 동등선량이 100 Gy 이상인 경우에 직장출혈이 유의하게 증가하므로, 치료계획시 생물학적 동등선량을 고려함으로써 휴유증 감소에 도움이 될 것으로 생각된다. 직장출혈이 발생한 환자에서 조기에 적극적으로 치료를 시행함으로써 출혈로 인한 불편함을 신속하게 해결하고 이로 인한 심리적 불안감을 해소할 수 있으며 나아가 삶의 질 향상에도 도움을 줄 수 있을 것으로 판단된다.절, 복강림프절 그리고 문합부위 등을 모두 포함하는 좀더 넓은 조사면의 치료가 필요할 것으로 사료된다.장암의 국소제어율을 높일 수 있는 치료방법이 개발되어야 할 것으로 사료된다.어율 모두에 유의한 인자는 방사선치료 후 종양반응과 N 병기였다. 결론 : 조기 병기의 성문상부암에서는 통상적인 방사선단독치료로 후두기능을 보존하면서 수술군과 대등한 종양제어율을 보여주었다. 그러나 진행된 병기의 경우에는 수술과 방사선치료의

• 대한한의학방제학회지
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• 제16권1호
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• pp.131-145
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• 2008

With tablets and powder, decoction has been a widely-used method of medicine formula. However, for these formulas have unique bitter tastes and flavors of herbal component materials as it is, the compliance of herbal medicine is severly decreased especially for female and younger patients. Consequently, expected treatment effects can't be acquired completely. If loathsome tastes and flavors of decoction were effectively reduced while pharmacological activity were kept intact, the compliance could be promoted Chong-Myung-Tang has been widely prescribed for student patients with memory This study shows that Chong-Myung-Tang+chocolate have no difference from Chong-Myung-Tang in terms of pharmacological activity. Sensory difference with net chocolate was also surved. In order to observe the difference of Chong-Myung-Tang+chocolate and Chong-Myung-Tang, memory impairment was induced by intraventricular injection of $A{\beta}_{25-35}$ peptides on mice and Chong-Myung-Tang and Chong-Myung-Tang+chocolate were administered orally for 14 days. In water maze task, improvement of learning ability during acquisition period and significant increase of memory score during retention period resulted from the treatment of Chong-Myung-Tang and Chong-Myung-Tang+chocolate with respect to the $A{\beta}-injected$ control animals. Furthermore, the $A{\beta}_{25-35}$ toxicity on the hippocampus was assessed with immunohistochemistry (Bax, TUNEL), and differences in antioxidant activity was observed through TBARS and DPPH test. We employed sensory tests using chocolate flavor, herb flavor, and bitter taste & hardness as standards to show sensory differences with net chocolate. In this study, it is demonstrated that Chong-Myung-Tang+chocolate do not disturb the pharmacological activity of Chong-Myung-Tang, and have no sensory difference with net chocolate. Chong-Myung-Tang+chocolate can be used to enhance the compliance remarkably and thought of as an effective, functional formula to maximize expected treatment.

• 한국병원경영학회지
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• 제8권3호
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• pp.143-160
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• 2003

Due to the dramatic and situational change in medical industry, it has became very important to keep existing patients and to attract new patients by monitoring the medical consumer's expectation and various needs and ensuring the patients' satisfaction. This study regards the patients' satisfaction as the final object of medical service. So the object of this study is to provide useful data for the decision making and medical service marketing by exploring the problems generated by the cognition difference for the medical service between inpatients and outpatients, by responding for the problems and by examining the relationship between the satisfaction with the medical service and revisiting. To achieve the object of this study, literature research and empirical analysis were used. I establish the research model based on the existing service marketing and some hypotheses were chosen for the empirical analysis. As a result of empirical analysis for the five hypotheses, two hypotheses were chosen. First, there was cognition difference about accessibility and convenience between inpatient and outpatient. I guess that the satisfaction degree of inpatient is higher than the outpatient because the inpatient has the reliability for the hospital and determines the hospitalization or emergent coming to hospital. Second, the fifth hypothesis, "the satisfaction of patient will influence the revisiting." was chosen. The hypothesis is not only coincident with existing scholars and studies but also it provides the meaningful points for medical service marketing. The result shows that the parties concerned with hospital management should endeavor for the patient satisfaction in medical service, and that hospital management should be medical consumer centered. To measure the quality of medical service, the cognition differences for accessibility, convenience, physical environment, and human service were evaluated and the result shows that the cognition difference for the accessibility and convenience was outstanding. The analysis shows that there was cognition difference in the four categories among six subcategories in the human service -- the attitude of medical technologist, the attitude of doctor, the length of time for doctor's diagnosis for the patient and doctor's explanation. Therefore, I think that further study is required for the cause analysis for service categories which have cognition difference between inpatient and outpatient. I think the result will be very useful. Through this study, the relationship between patient satisfaction with the medical service and revisiting was verified. And it suggests that, to face the changing medical environment actively and to improve the quality of medical service, marketing strategy should be focused not on medical service providers but on medical service consumers and that the further studies for the medical consumer should be continued.

• Journal of Hospice and Palliative Care
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• 제11권4호
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• pp.181-187
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• 2008

목적: 말기 암 환자에게 있어서 정확한 여명 예측은 환자의 효율적인 치료 계획을 세우고 환자의 삶의 질을 높이는데 있어서 중요하다. 본 연구에서는 말기 암 환자에서 호중구-림프구 비가 생존기간 예측을 위한 예후 인자로서 유용한가를 알아보고자 한다. 방법: 2004년 1월부터 2007년 6월까지 말기 암 환자로 완화 치료를 목적으로 영동세브란스병원 가정의학과에 입원 혹은 전입되어 치료를 받는 중 사망한 67명의 환자를 대상으로 하였다. 호중구-림프구 비에 따라서 3개의 군으로 나누어 과거 병력, 신체 계측, 임상 증상, 혈액검사 소견, 생존기간을 분석하였다. 결과: 호중구-림프구 비가 가장 높은 군(${\geq}12.5$)에서 환자의 생존기간이 단변량 분석에서 통계적으로 유의하게 짧았으며(hazard ratio (HR)=3.270, P=0.001)), 저하된 활동도, 호흡 곤란 증상을 보정한 다변량 분석에서도 통계적 유의성을 보였다(HR=2.907, P=0.007). 완화 치료를 위해 입원 혹은 전입된 시점에 비하여 사망이 임박한 시점에서 호중구-림프구 비는 의미 있는 증가를 보였다(P=0.001). 결론: 호중구-림프구 비는 말기 암환자에서 생존기간 예측을 위한 독립적인 예후 인자로 확인 되었다.

• IMMUNE NETWORK
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• 제1권2호
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• pp.143-150
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• 2001

Background : Many investigators have found transforming growth factor-${\beta}1$ (TGF-${\beta}1$) to be elevated in tumors. Changes in responsiveness to TGF-${\beta}1$ have been linked to malignant transformation, tumor progression and tumor regression. Many malignant cell lines of epithelial or hematopoietic origin are refractory to the antiproliferative effects of TGF-${\beta}1$. However, a little is known about the association of TGF-${\beta}1$ with progression of malignant tumor. Methods : In this study, we measured the plasma level of TGF-${\beta}1$ in various cancer patients and evaluated the utility of plasma TGF-${\beta}1$ as a possible tumor marker. Plasma TGF-${\beta}1$ levels were measured using enzyme-linked immunosorbent assay in cancer patients and normal controls. Carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) as tumor marker were compared with TGF-${\beta}1$ in the aspects of sensitivity and specificity. Results : The mean of plasma TGF-${\beta}1$ levels was $1.219{\pm}0.834ng/ml$ in normal controls, $5.491{\pm}3.598ng/ml$ in breast cancer, $12.670{\pm}10.386ng/ml$ in lung cancer, $5.747{\pm}3.228ng/ml$ in hepatocellular carcinoma and $10.854{\pm}7.996ng/ml$ in cervical cancer. In comparison with CEA and AFP, TGF-${\beta}1$ is more sensitive. Conclusion : We conclude that the high levels of TGF-${\beta}1$ are common in the plasma of cancer patients. These results suggest that the plasma TGF-${\beta}1$ level can be a potent tumor marker in various cancer patients.

• Clinical and Experimental Reproductive Medicine
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• 제43권1호
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• pp.9-14
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• 2016

Objective: Autophagy contributes to the clearance and recycling of macromolecules and organelles in response to stress. We previously reported that vitrified mouse oocytes show acute increases in autophagy during warming. Herein, we investigate the potential role of Atg7 in oocyte vitrification by using an oocyte-specific deletion model of the Atg7 gene, a crucial upstream gene in the autophagic pathway. Methods: Oocyte-specific Atg7 deficient mice were generated by crossing Atg7 floxed mice and Zp3-Cre transgenic mice. The oocytes were vitrified-warmed and then subjected to in vitro fertilization and development. The rates of survival, fertilization, and development were assessed in the Atg7 deficient oocytes in comparison with the wildtype oocytes. Light chain 3 (LC3) immunofluorescence staining was performed to determine whether this method effectively evaluates the autophagy status of oocytes. Results: The survival rate of vitrified-warmed $Atg7^{f/f}$;Zp3-Cre ($Atg7^{d/d}$) metaphase II (MII) oocytes was not significantly different from that of the wildtype ($Atg7^{f/f}$) oocytes. Fertilization and development in the $Atg7^{d/d}$ oocytes were significantly lower than the $Atg7^{f/f}$ oocytes, comparable to the $Atg5^{d/d}$ oocytes previously described. Notably, the developmental rate improved slightly in vitrified-warmed $Atg7^{d/d}$ MII oocytes when compared to fresh $Atg7^{d/d}$ oocytes. LC3 immunofluorescence staining showed that this method can be reliably used to assess autophagic activation in oocytes. Conclusion: We confirmed that the LC3-positive signal is nearly absent in $Atg7^{d/d}$ oocytes. While autophagy is induced during the warming process after vitrification of MII oocytes, the Atg7 gene is not essential for survival of vitrified-warmed oocytes. Thus, induction of autophagy during warming of vitrified MII oocytes seems to be a natural response to manage cold or other cellular stresses.

• Clinical and Experimental Reproductive Medicine
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• 제44권2호
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• pp.96-104
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• 2017

Objective: This study aimed to compare the clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in sibling oocytes. Additionally, we evaluated whether the implementation of split insemination contributed to an increase in the number of ICSI procedures. Methods: A total of 571 cycles in 555 couples undergoing split insemination cycles were included in this study. Among them, 512 cycles (89.7%) were a couple's first IVF cycle. The patients were under 40 years of age and at least 10 oocytes were retrieved in all cycles. Sibling oocytes were randomly allocated to IVF or ICSI. Results: Total fertilization failure was significantly more common in IVF cycles than in ICSI cycles (4.0% vs. 1.4%, p<0.05), but the low fertilization rate among retrieved oocytes (as defined by fertilization rates greater than 0% but < 30%) was significantly higher in ICSI cycles than in IVF cycles (17.2% vs. 11.4%, p<0.05). The fertilization rate of ICSI among injected oocytes was significantly higher than for IVF ($72.3%{\pm}24.3%$ vs. $59.2%{\pm}25.9%$, p<0.001), but the fertilization rate among retrieved oocytes was significantly higher in IVF than in ICSI ($59.2%{\pm}25.9%$ vs. $52.1%{\pm}22.5%$, p<0.001). Embryo quality before embryo transfer was not different between IVF and ICSI. Although the sperm parameters were not different between the first cycle and the second cycle, split insemination or ICSI was performed in 18 of the 95 cycles in which a second IVF cycle was performed. Conclusion: The clinical outcomes did not differ between IVF and ICSI in split insemination cycles. Split insemination can decrease the risk of total fertilization failure. However, unnecessary ICSI is carried out in most split insemination cycles and the use of split insemination might make ICSI more common.

• Clinical and Experimental Reproductive Medicine
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• 제44권2호
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• pp.63-72
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• 2017

Objective: Hyperstimulation methods are broadly used for in vitro fertilization (IVF) in patients with infertility; however, the side effects associated with these therapies, such as ovarian hyperstimulation syndrome (OHSS), have not been well studied. N-glycoproteomes are subproteomes used for the remote sensing of ovarian stimulation in follicular growth. Glycoproteomic variation in human follicular fluid (hFF) has not been evaluated. In this study, we aimed to identify and quantify the glycoproteomes and N-glycoproteins (N-GPs) in natural and stimulated hFF using label-free nano-liquid chromatography/electrospray ionization-quad time-of-flight mass spectrometry. Methods: For profiling of the total proteome and glycoproteome, pooled protein samples from natural and stimulated hFF samples were selectively isolated using hydrazide chemistry to obtain the total proteomes and glycoproteomes. N-GPs were validated by the consensus sequence N-X-S/T (92.2% specificity for the N-glycomotif at p<0.05). All data were compared between natural versus hyperstimulated hFF samples. Results: We detected 41 and 44 N-GPs in the natural and stimulated hFF samples, respectively. Importantly, we identified 11 N-GPs with greater than two-fold upregulation in stimulated hFF samples compared to natural hFF samples. We also validated the novel N-GPs thyroxine-binding globulin, vitamin D-binding protein, and complement proteins C3 and C9. Conclusion: We identified and classified N-GPs in hFF to improve our understanding of follicular physiology in patients requiring assisted reproduction. Our results provided important insights into the prevention of hyperstimulation side effects, such as OHSS.

• Radiation Oncology Journal
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• 제33권3호
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• pp.198-206
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• 2015

Purpose: We evaluated the prognostic factors and clinical outcomes of 56 patients with vulvar cancer treated with curative radiotherapy (RT) or concurrent chemoradiotherapy. Materials and Methods: Overall survival (OS) and disease-free survival (DFS) were assessed retrospectively. Prognostic factors evaluated included age, International Federation of Gynecology and Obstetrics (FIGO) stage, TNM classification, tumor size, treatment modality, RT duration, and RT field. The association between the tumor human papillomavirus (HPV) status and survival was analyzed in 35 patients. Results: During the median follow-up of 2.8 years (range, 0.3 to 18.9 years), 21 patients (37.5%) experienced treatment failure. Fifteen patients (27%) had local failure: nine (16%) local failure only, three (5%) locoregional failure, two (4%) local and distant failure, and one (2%) locoregional and distant failure. Of 56 patients, seven (13%) had persistent disease at the first follow-up at 2 months and all but one died within a year after completing RT. The 5-year OS and DFS were 51.6% and 44.0%, respectively. In multivariate analysis, clinical size ${\geq}3$ cm predicted a poor prognostic factor for DFS (p = 0.040) and age (${\geq}70years$) was poor prognostic for DFS (p = 0.032) and OS (p = 0.048). Patients with HPV-positive tumors tended to have better 5-year OS and DFS, but the differences were not significant statistically. Conclusion: Clinical size ${\geq}3$ cm was a significant prognostic factor for DFS. However, age was the most important prognostic factor for DFS and OS in patients treated with curative RT. Further studies are needed to determine which treatment should be considered for old age ${\geq}70years$.

• Clinical and Experimental Reproductive Medicine
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• 제28권3호
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• pp.191-198
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• 2001

Objective : This study was conducted to examine the effect of vitrification on the survival and in vitro development of mice 1-cell zygotes. Method: Effects of exposure to vitrification solution and vitrification, with different concentrations of the cryoprotectant solution, were examined. The 1-cell zygotes were also subjected to a slow freezing-thawing method to compare with vitrification method. Solution composed of ethylene glycol (6.0 M, 5.0 M, 4.0 M) and sucrose (1.0 M) were used as cryopropectant. The experiments employed the method loading the embryos on electron microscope grids. Results: I. The effects of exposure in vitrification solution. 1-cell zygotes were non-toxic at all concentrations of the vitrification solution showing the survival rate between 88.1% and 97.5%. Development into 2-cell was more successful in the higher concentrations of the vitrification solution. Therefore, higher concentrations of the vitirification solution do not seem to cause any problems in vitrification procedure. II. The effects of vitrification method. 1-cell zygotes showed the survival rate between 78.8% and 92.4%. The lowest and the highest survival rate was observed in the 6.0 M and 4.0 M vitrification solution, respectively. 2-cell development rates varied from 77.6% to 91.3%. Blastocyst development rate was shown highest in 5.0 M and the lowest in 4.0 M solution. Therefore, the highest 2-cell and blastocyst development rate was observed in 5.0 M solution. III. Comparison of vitrification and slow freezing-thawing method on 1-cell zygotes. This experiment showed that 1-cell zygotes had the highest survival and development rates in 5.0 M vitrification solution. Vitrified group of 1-cell zygotes, in the 5.0 M vitrification solution, were compared with the group processed in slow freezing-thawing method. The development rate into 2-cell and blastocyst as well as the survival rate were higher in the vitrified group than in the slowly freezed group. Conclusion: 1. The results demonstrate that the best cryoprotectant is a 5.0 M vitrification solution for 1-cell zygotes. 2. Vitrification method significantly increases the survival rate of the 1-cell zygote and its development into 2-cell and blastocyst. Equilibration and exposure time during the vitrification was remarkerbly short in this experiment. Total time, from the exposure to vitirification solution to storage in the liquid nitrogen, was taken only 90 seconds. In contrast, the slow freezing-thawing method have taken more than four hours. Taken together, we presume that the overall time used for the procedure contributes to the results as an important parameter. 3. The loading of 1-cell zygotes on the EM grid is technically more simple and takes less time than the straw or cryo vial method.