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The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism (중증 폐혈전색전증 환자에서 Urokinase와 Alteplase의 효과 및 출혈 합병증 비교)

  • Yoo, Jung-Wan;Kim, Wongyoung;Choi, Chang Min;Hong, Sang-Bum;Oh, Yeon Mok;Shim, Tae Sun;Lim, Chae-Man;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Koh, Younsuck
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.1
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    • pp.6-12
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    • 2009
  • Background: The efficacy of several thrombolytic agents for treating massive pulmonary thromboembolism (PTE) has been reported to be similar. However, the difference of the bleeding complications caused by two commonly used thrombolytic agents in PTE patients is not well known. The aim of this study was to compare the therapeutic efficacy and the bleeding complications between urokinase and recombinant tissue-type plasminogen activatior (rt-PA, alteplase) in a Korean medical center. Methods: We retrospectively reviewed the clinical data of the patients who were treated with thrombolytic agents (urokinase and alteplase) because of massive PTE. Results: A total of 40 patients were included: 16 (40%) treated with urokinase and 24 (60%) with alteplase. The patients treated with alteplase showed a shorter duration of using vasopressor agents than did the patients who were given urokinase, but the duration of mechanical ventilation, the length of the ICU stay and the hospital stay were not different between the thrombolytic agents. Five patients treated with urokinase and eight patients treated with alteplase died (p=0.565): One patient in the urokinase group and four patients in the alteplase group died due to pulmonary thromboembolism. Bleeding complications after thrombolysis were observed in 3 patients (7.5%) treated with urokinase and in 11 (27.5%) patients treated with alteplase (p=0.079). Major bleeding complication occurred in 2 patients who were treated with alteplase. Conclusion: Urokinase seems to have fewer bleeding complications with an equivalent efficacy, as compared to alteplase, in Korean patients who suffer with massive pulmonary thromboembolism.

Expression of COX-2 and IDO by Uteroglobin Transduction in NSCLC Cell Lines (비소세포폐암 세포주에서 Uteroglobin Transduction이 COX-2 및 IDO의 발현에 미치는 영향)

  • Park, Gun Min;Lee, Sang-Min;Yim, Jae-Joon;Yang, Seok-Chul;Yoo, Chul Gyu;Lee, Choon-Taek;Han, Sung Koo;Sim, Young-Soo;Kim, Young Whan
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.4
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    • pp.274-279
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    • 2009
  • Background: Uteroglobin (UG) is a secretary protein that has strong immunomodulatory properties, and which is synthesized in most epithelia including lung tissue. Overexpression of UG is associated with decreased expression of cyclooxygenase (COX)-2 and suppression of cancer cell growth. Indoleamine 2,3-dioxygenase (IDO) catalyzes tryptophan along the kynurenine pathway, and both the reduction in local tryptophan and the production of tryptophan metabolites contribute to the immunosuppressive effects of IDO. Methods: In this study, we investigated the pattern of expression of COX-2 and IDO, and the effect of UG transduction in the expression of COX-2 and IDO in several non-small cell lung cancer cell lines, especially A549. Results: Both COX-2 and IDO were constitutionally expressed in A549 and H460 cells, and was reduced by UG transduction. In A549 cells, the slightly increased expression of COX-2 and IDO with the instillation of interferon-gamma (IFN-$\gamma$) was reduced by UG transduction. However, the reduced expression of COX-2 and IDO by UG transduction was not increased with IFN-$\gamma$ instillation in A549 cells. In both the A549 COX-2 sense and the A549 COX-2 anti-sense small interfering RNA (siRNA)-transfected cells, IDO was expressed; expression was reduced by UG transduction, irrespective of the expression of COX-2. Conclusion: The results suggest that the anti-proliferative function of UG may be associated with the immune tolerance pathway of IDO, which is independent of the COX-2 pathway.

Particulate Matter 10 from Asian Dust Storms Induces the Expression of Reactive Oxygen Species, NF-κ, TGF-β and Fibronectin in WI-26 VA4 Epithelial Cells (황사의 PM10이 WI-26 VA4 Cells에서 Reactive Oxygen Species, NFκB, TGF-β, Fibronectin의 발현에 미치는 영향)

  • Park, Kyeong Seon;Kim, Yu Jin;Yoon, Jin Young;Kyung, Sun Young;An, Chang Hyeok;Lee, Sang Pyo;Park, Jeong Woong;Jeong, Sung Hwan
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.6
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    • pp.504-511
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    • 2008
  • Background: Particulate matter may be toxic to human tissue. Ambient air particulate matter ${\leq}10{\mu}m$ in aerodynamic size ($PM_{10}$), which changes under different environmental conditions, is a complex mixture of organic and inorganic compounds. The Asian dust event caused by meteorological phenomena can also spread unique particulate matter in affected areas. We evaluated production of ROS, $TGF-{\beta}$, fibronectin, and $NF{\kappa}B$ by exposing normal epithelial cells to Asian dust particulate matter. Methods: Bronchial epithelial cells were exposed to 0, 50, ${\leq}100{\mu}g/ml$ of a suspension of $PM_{10}$ for 24 h. ROS were detected by measurement of DCF release from DCF-DA by FACScan. $TGF-{\beta}$, fibronectin, and $NF{\kappa}B$ were detected by western blotting. Results: $PM_{10}$ exposure increased the expression of $TGF-{\beta}$, fibronectin, and $NF{\kappa}B$. ROS production and $TGF-{\beta}$ levels were significantly higher with 50 or ${\leq}100{\mu}g/ml$ $PM_{10}$. Fibronectin and $NF{\kappa}B$ production were significantly higher after ${\leq}100{\mu}g/ml$ of $PM_{10}$. Conclusion: $PM_{10}$ from Asian dust particles might have fibrotic potential in bronchial epithelial cells via ROS induction after $PM_{10}$ exposure.

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction (중심성 기도 폐쇄를 동반한 폐암에서 냉동치료의 임상적 유용성 및 부작용)

  • Jung, Jin Yong;Lee, Sung Yong;Kim, Dae Hyun;Lee, Kyung Joo;Lee, Eun Joo;Kang, Eun Hae;Jung, Ki Hwan;Kim, Je Hyeong;Shin, Chol;Shim, Jae Jeong;In, Kwang Ho;Kang, Kyung Ho;Yoo, Se Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.4
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    • pp.272-277
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    • 2008
  • Background: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. Methods: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately $-89^{\circ}C$, and the icing time was 5~20 seconds. Results: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications- one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. Conclusion: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Prognostic Value of p53 Overexpression in Patients with Pathologic Stage I Non-small Cell Lung Cancer (제 1기 비소세포폐암 환자에서 p53 과발현과 예후의 관계)

  • Um, Sang-Won;Kim, Hojoong;Kwon, O Jung;Han, Joungho;Shim, Young Mog
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.6
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    • pp.487-494
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    • 2008
  • Background: Chromosome 17p allele losses and mutations of p53 gene are the most common genetic abnormalities in lung cancer. The purposes of this study were to evaluate the factors associated with p53 protein overexpression and to evaluate its prognostic value in patients with pathologic stage I non-small cell lung cancer (NSCLC). Methods: This is a retrospective review for the patients who underwent surgical resection at Samsung Medical Center between Jan 2003 and Jun 2004. Immunohistochemical staining for p53 protein was performed on tumor tissues from patients with lung cancer. The p53 overexpression was evaluated in relation to age, sex, smoking history, histology and pathologic stage by univariate and multivariate analyses. The disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) were analyzed using the Kaplan-Meier methods and the differences in DFS, DSS and OS were assessed by using the log-rank tests. Results: A total of 125 patients were included in the analysis and a median frequency of p53 expression in tumor tissue was 10%. The p53 overexpression (${\geq}10%$) was more common in squamous cell carcinoma (66%) than in adenocarcinoma (38%, p=0.002). The p53 overexpression was more common in pathologic stage IB (59%) than in IA (38%, p=0.002). Patients with p53-overexpressing tumor (27 years) smoked more years compared with those without it (20 years, p=0.032). Smoking history ${\geq}25$ pack-years was more common in patients with p53 overexpression (58%) than in those without it (38%, p=0.024). In the multivariate analysis, only histology was significantly associated with p53 overexpression. However, there were no significant differences of DFS, DSS and OS in relation to p53 status. Conclusion: The p53 overexpression was associated with histology, pathologic stage and smoking history in patients with pathologic stage I NSCLC. However, the p53 overexpression was not associated with patient's survival.

Quantitative Analysis of Amino Acids of Paragonimus Westermani Treated with Praziquantel in Vivo and in Vitro (간흡충(肝吸蟲) 성충(成蟲)에 대한 Praziquantel의 시험관내 살충작용(殺蟲作用)에 의한 유리(遊離) 아미노산(酸)의 정량분석(定量分析))

  • Tak, Byung-Yun;Chung, Myung-Sook;Joo, Kyoung-Hwan;Rim, Han-Jong
    • Journal of agricultural medicine and community health
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    • v.16 no.2
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    • pp.134-140
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    • 1991
  • The amino acid constituents of Paragonimus westermani were very imperfectively known. Lee(1964) detected 9 amino acids in the tissue hydrolysates of P. westermani, and 13 amino acids were detected from the cyst content and body fluid constituents of P. ohirai, But, the quantity of amino acids in P. westermani is still unknown. In the present investigation 18 amino acids, the fundamental constituents of proteins, were quantitatively studied by high performance liquid chromatography. The results obtained were as follows : A total of 18 amino acids were recovered in protein hydrolysates of P. westermani obtained from cat. ; They were cystein, aspartic acid, glutamic acid, serine. glycine, histidine. arginine, threonine, alanine, proline, tyrosine, valine, methionine, isoleucine, leucine, phenylalanine, tryptophan and lysin. Among them, glutamic acid was the most abundant form and tryptophan, cystein, methionine, and histidine constitute minor portion of hydrolysates. Compared to the normal P. westermani, the volume of hydrolysates obtained from the praziquantel(PZQ) treated worm-0.lug PZQ/ml saline for 6 hours incubation, and $3{\times}25$mg/kg bwt${\times}$2days in vivo treatment was generally increased except tryptophan. A total of 17 free amino acids were identified and the volume was 174.18 umol/1 gm wet weight P. westermaini. Among them, glycine and alanine constitute 28% of total volume. No significant differences were observed in the material obtained from worm treated with PZQ. However, slight increase of serine, arginine and the slight diminution of glutamic acid and proline was observed.

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Studies on the Seroepidemiology of Helminthic Diseases in Korea (우리나라의 주요 기생충질환(寄生蟲疾患)에 대한 혈청역학적(血淸疫學的) 조사(調査))

  • Rim, Han-Jong;Lee, Joon-Sang;Joo, Kyoung-Hwan;Chung, Myung-Sook
    • Journal of agricultural medicine and community health
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    • v.16 no.1
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    • pp.48-60
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    • 1991
  • In a seroepidemiological study in several areas of Korea, the ELISA technique was performed to determine prevalence of some important helminthic diseases in our nation during March $15^{th}$ to June $30^{th}$. 1991. In this survey the serum antibody positive rates of anisakiasis, toxocariasis, clonorchiasis, paragonimiasis, cysticercosis, and sparganosis were measured. Among, 6,704 cases examined, 19.7% showed positive antibody titer at least one of the six items studied. Overall positive antibody rate was 8.1% in anisakiasis, 5.6% in toxocariasis, 3.6% in clonorchiasis, 1.7% in paragonimiasis, 4.5% in cysticercosis, and 2.6% in sparganosis respectively. In Pusan port southeastern part of Korea, antibody positive rate of anisakiasis was 2.9%, and clonorchiasis was 2.8% among 450 examine. In TaeJ$\check{o}$n city, central part of Korea. toxocariasis(6.7%) and anisakiasis(3.7%) showed high serologic positive rate. Of the 875 persons in Chunche$\check{o}$n gun(=province), northern central rural area of South Korea, anisakiasis was revealed as 3.4% seropositivity. In Tonghae port, eastern coast of South Korea. 9.9% of population examined showed positive antibody titer in anisakiasis. Of the 1,122 persons examined in Southern part of Cholla-Namdo(Southwestern coastal area of Korea), anisakiasis was 16.9%, cysticerocosis was 12.7% and the paragonimiasis was 3.3% respectively. In some localized area of Cholla-Pukdo, anisakiasis was 9.3% and cysticekosis was 4.3% among 702 cases examined. In some localized area of Kyungsang-Pukdo, anisakiasis was 10.6%. and toxocariasis was 16.1% among 900 cases examined. And finally, in Cheju-do, southern island of Korea, anisakiasis showed high positive rate(6.7%). Because cross reactions between related helminth group may disturb the analysis of these data, use of further developed techniques such as EITB(enzyme-linked immunoelectrotransfer blot) was considered as a essential tools for the study. We thought that probably most of the positive cases of cysticerosis were taeniasis cases. We can't rule out taeniasis even though EITB was employed as far as crude worm extract or cystic fluid of cysticercus was used as antigen. It was well Known that toxocariasis and anisakiasis also showed cross reactivity. However, the data presented here focus on seropositive rate of several helminthic diseases in Korea, not true prevalence rate of helminthiases, and to wait for more expensive purified antigen in sufficient amount for epidemiologic use is not necessary because increased immunologic sensitivity had little effect on epidemiologic sensitivity. We, here, suggest that ELISA should be applied as soon as possible to the evaluation of prevalence of tissue invading parasitic diseases, and a review of the antibody positive rate obtained in this study would be a basic data for controlling program of parasitic diseases in Korea.

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Contents of Total and Organic Mercury in Bone, Muscle and Fin of Carassius carassius Middle Steam of Nakdong River, Korea (낙동강 본류에 서식하는 붕어에서의 총수은 및 유기수은 함량)

  • Choi, Young;Kim, Doo-Hie
    • Journal of agricultural medicine and community health
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    • v.18 no.2
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    • pp.131-140
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    • 1993
  • This study was conducted to examine the levels of mercury in tissue of Carassius carassius collected at five areas(Andong, Sangju, Waekwan, Gangjung and Gaejin) in Nakdong river from February to March, 1993. The contents of total and organic mercury were determined by methods of Gold amalgam and Selective atomic absorption with mercury analyzer(Model SP-3A). The total mercury contents in muscle were $0.148{\pm}0.0646$ ppm by the Gold amalgam, and $0.113{\pm}0.0345$ ppm by the Selective atomic absorption, but in all parts of Carassius carassius were $0.342{\pm}0.4235$ ppm and $0.240{\pm}0.2974$ ppm respectively. These two methods were extremely high correlated(r=0.9812, p<0.001). The mean value of total and organic mercury by the two methods was high in the order of bone>fin>muscle, respectively, and the proportion of organic mercury to the total was 69.0%. Mean value of total and organic mercury in the muscle was the highest at Wakeman located in middle basin of Nakdong river, and in the bone and fin was the highest at Andong dam located in upper basin. According to sizes and parts of fish, the concentration of mercury was the highest in the muscle of 15-19 cm group, the highest in the bone of 10-14 cm group and in the fin of 20-24 cm group.

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The influence of Collar design on peri-implant marginal bone tissue (Collar design이 임플랜트 주위 변연골 흡수에 미치는 영향)

  • Kim, Jee-Hwan;Jung, Moon-Kyou;Moon, Hong-Suk;Han, Dong-Hoo
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.1
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    • pp.53-64
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    • 2008
  • Statement of problem: Peri-implant marginal bone loss is an important factor that affects the success of implants in esthetics and function. Various efforts have been made to reduce this bone loss by improving implant design and surface texture. Previous studies have shown that early marginal bone loss is affected by implant neck designs. Purpose: The purpose of this study was to examine the influence of laser microtexturing of implant collar on peri-implant marginal bone loss. Materials and methods: Radiographical marginal bone loss was examined in patients treated with implant-supported fixed partial dentures. Marginal bone level was examined with 101 implant fixtures installed in 53 patients at three periods(at the time of implantation, prosthetic treatment and 6-month after loading). Four types of implants were examined. The differences of bone loss between implants(ITI standard) with enough biologic width and implants(ITI esthetic plus, Silhouette IC, Silhouette IC Laser-$Lok^{TM}$) with insufficient biologic width have been compared. Resorption angles were examined at the time of prosthetic delivery and 6-month after loading. Results and Conclusion: Within the limitation of this study, the following results were drawn. 1. The marginal bone loss of ITI standard and Silhouette IC Laser-$Lok^{TM}$ was less than that of ITI esthetic plus and Silhouette IC(P<0.05). The marginal bone loss between ITI standard and Silhouette IC Laser-$Lok^{TM}$ had no significant statistical difference(P>0.05). There was no significant statistical difference between marginal bone loss of ITI esthetic plus and Silhouette IC(P>0.05). 2. There was no significant difference in marginal bone loss between maxilla and mandible(P>0.05). 3. There was no significant difference in resorption angle among four types of implants(P>0.05). The marginal bone of implants with supracrestal collar design of less than that of biologic width had resorbed more than those with sufficient collar length. The roughness and laser microtexturing of implant neck seem to affect these results. If an implant with collar length of biologic width, exposure of fixture is a possible complication especially in the anterior regions of dentition that demand high esthetics. Short smooth neck implant are often recommended in these areas which may lack the distance between microgap and the marginal bone level. In these cases, the preservation of marginal bone must be put into consideration. From the result of this study, it may be concluded that laser microtexturing of implant neck is helpful in the preservation of marginal bone.

Clinical Trial of Nasal Flumazenil Administration (플루마제닐의 경비 투여)

  • Hong, Soo-Jin;Kim, Hyun-Jung;Yum, Kwang-Won
    • Journal of the korean academy of Pediatric Dentistry
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    • v.28 no.3
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    • pp.441-446
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    • 2001
  • Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

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