• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.595-601
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• 2003

Background: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. Material and Method: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi-fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were intro-duced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. Result: Sympathetic rami were completely blocked in cadaver dissection study Hyper-hidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Com-pensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. Conclusion: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy Operative success rate was similar to the traditional syrnpathicotorny; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.

• Development and Reproduction
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• v.11 no.3
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• pp.235-243
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• 2007

Human umbilical cord blood(HUCB) contains a rich source of hematopoietic stem cells, mesenchymal stem cells and endothelial cell precursors. Mesenchymal stem cells(MSCs) in HUCB are multipotent stem cells, differ from hematopoietic stem cells and can be differentiated into neural cells. We studied on transdifferentiation-promoting conditions in neural cells and cholinergic neuron induction of HUCB-derived MSCs. Neural differentiation was induced by addingdimethyl sulphoxide(DMSO) and butylated hydroxyanisole(BHA) in Dulbeco's Modified Essential Medium(DMEM) and fetal bovine serum(FBS). Differentiation of MSCs to cholinergic neurons was induced by combined treatment with basic fibroblast growth factor(bFGF), retinoic acid(RA) and sonic hedgehog(Shh). MSCs treated with DMSO and BHA rapidly assumed the morphology of multipolar neurons. Both immunocytochemistry and RT-PCR analysis indicated that the expression of a number of neural markers including $\beta$-tubulin III, GFAP and MBP, was markedly elevated during this acute differentiation. The differentiation rate was about $32.3{\pm}2.9%$ for $\beta$-tubulin III-positive cells, $11.0{\pm}0.9%$ for GFAP, and $9.4{\pm}1.0%$ for Gal-C. HUCB-MSCs treated combinatorially with bFGF, RA and Shh were differentiated into cholinergic neurons. After cholinergic neuronal differentiation, the $\beta$-tubulin III-positive cell population of total cells was $31.3{\pm}3.2%$ and of differentiated neuronal population, $70.0{\pm}7.8%$ was ChAT-positive showing 3 folds higher in cholinergic population than neural induction. Conclusively, HUCB-derived MSCs can be differentiated into neural and cholinergic neurons and these findings suggest that HUCB are alternative cell source of treatment for neurodegenerative diseases such as Alzheimer's disease.

• Korean Journal of Ecology and Environment
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• v.41 no.2
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• pp.237-246
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• 2008

Filtration rates and fecal production of freshwater bivalve, Unio douglasiae on two kinds of hibernal diatom communities were measured simultaneously in a laboratory. One community is the Han River (HAN), which dominated by Asterionella Formosa. Stephanodiscus hantzschii (ca. 98% of total phytoplankton). The other community is the Ilgam Lake (IL), which dominated by Synedra ulna, Scenedesmus sp. Microcystis aeruginosa (ca. 82%). The HAN water has higher concentrations of nutrient (TN and TP) and chlorophyll $\alpha$ (Chl-$\alpha$), lower turbidity and conductivity than the IL water. Water sampling for the feeding experiment was conducted in the same day (Jan 15, 2008) and similar time (AM 10:00 for HAN, AM 11:00 for IL). Mussels with the similar size ($0.0{\pm}0.5\;cm$) were collected from the Gunsan and Okgu district (Jeonbuk), and starved in a laboratory for 2 days before the experiment. The experiment comprised CON (no addition of mussel), LOW (addition of mussel at 0.3 indiv. $L^{-1}$), MID (1.0 indiv. $L^{-1}$) and HIGH (2.0 indiv. $L^{-1}$), respectively. With the increment of mussel density and time, the concentration of Chl-$\alpha$ in two diatom communities were clearly decreased; Chl-$\alpha$ of HAN gradually decreased after 1 hour of mussel treatment, while that of IL decreased as soon as mussel introduction. In 7 hours of treatment, the former was removed finally up to about 90% of control, while the later was remained as about 50%. Under the presence of mussel, total phytoplankton density was shifted as the similar patterns to that of Chl-$\alpha$ (r=0.705, P<0.0001), however, there showed the drastic differences following a species. Based on the concentration of Chl-$\alpha$, filtration rate of U. douglasiae averaged 0.266 $L\;g^{-1}\;h^{-1}$ (0.115 to 0.442) on HAN and $0.577\;L\;g^{-1}\;h^{-1}$ (0.146 to 1.428) on IL water, respectively. There were no differences in feces production among the mussel density in the HAH water (ANOVA, P>0.5), while in IL water, including lots of seston, the HIGH mussel produced the higher fecal materials, over one hundred times of LOW. These results suggest that freshwater bivalve Unio douglasiae have the alternative potential, as a filter-feeder of seston in turbid lake, and a biological controller of diatom bloom in cold stream.

• Journal of Korean Society of Environmental Engineers
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• v.28 no.10
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• pp.1016-1023
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• 2006

The water content of dewatered cake produced from belt press dewatering equipment was about 75 wt% which was some high to handle it, so the equipment contained a limit at the economical and environmental aspect. The thermal dewatering equipment built as an alternative to overcome several problems was set up at the sludge treatment field and estimated some feasibility as comparison with the dewatering performance of belt press. First, dewatering properties of waterworks sludge was analyzed by monthly. The sludge of a water shortage season contained a high organic content which led to be difficult to dewater the cake, the other side the sludge of rainwater season was ease to dewater because of low organic content. According to the results to analysis the water content of dewatered cake produced from two equipments on the base of the seasonal dewatering properties, the water content of dewatered cake produced from thermal dewatering for sludge of water shortage season was $41.6{\sim}48.3$ wt% and $71{\sim}84$ wt% from belt press. In the case of rainwater season, the water content of dewatered cake produced from thermal dewatering was $34{\sim}37.7$ wt% and $57{\sim}70$ wt% from belt press. It was understood that thereduction of water content of cake by thermal dewatering was larger than belt press. The economical aspect for two equipments was evaluated on considering the reduction of cake treatment amount as the decrease of water content of cake. When putting the cost index of thermal dewatering into 100, belt press was 121. This meant that thermal dewater was more economical than belt press by about 20% in the side of construction and operation. In conclusion, thermal dewatering equipment was estimated by producing the low water content dewatered cake as well as being operated with low coat.

• KSBB Journal
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• v.24 no.4
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• pp.383-392
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• 2009

Xanthii fructus which is well known as "Chang-ihjah" in Korea is the dried fruit of Xanthium strumarium L. (or Xanthium sibiricum PATR. Ex WIDD., Asteraceae. XS). Water extract of this fruit has been used for treatment of various inflammatory diseases such as tympanitis, allergic rhinitis, or ozena as alternative therapy material usually by oral administration in far Eastern countries including Korea. In this study, the effect of XS extract (XS-E) or XS-30% acetone fraction layer (XS-30% AFL) on the differentiation of $CD4^+$ T cells isolated from NC/Nga mouse and the production of IL-17 was investigated. The experimental results showed that $100\;{\mu}g$/mL of XS-E could decrease the production of IL-17 by $CD4^+$ Th17 cells by 2 fold and only $20\;{\mu}g$/mL of XS-30% AFL could inhibit 3.5 fold. The amount of IL-17A and IL-22 mRNA determined by real-time PCR was decreased remarkably when XS-E or XS-30% AFL was treated on $CD4^+$ Th17 cells(p<0.01, p<0.001). The amount of IL-17A protein determined by ELISA was also decreased remarkably(p<0.05, p<0.001). To study the effect of XS-E or XS-30% AFL on the proliferation of Th17 cells, $CD4^+$ T cells of a NC/Nga mouse was firstly differentiated by rIL-6/TGF-$\beta$ and then stimulated by rIL-23. The control group of Th17 cells were doubled every each day, while those of XS-E or XS-30% AFL treated group were shown to be delayed remarkably by these extracts. In conclusion, XS can inhibit the differentiation of Th17 cells of NC/Nga mouse and the production of IL-17 successfully, which may be a beneficial result for the treatment of atopic skin dermatitis.

• Korean Journal of Microbiology
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• v.50 no.4
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• pp.296-301
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• 2014

Rotavirus is a major cause of acute gastroenteritis in young children in developed and developing countries. The use of probiotics for the treatment of gastrointestinal diseases is both safe and easily accessible. In this study, we evaluated the anti-rotaviral activities of probiotic mixtures in a Sprague-Dawley rat. 24 litters with their dams were randomly assigned to four groups; placebo, phosphate buffered saline (PBS), and two probiotic mixture (PRO-1 and PRO-2) groups. All rats were inoculated with rotavirus at dose of 8 log plaque forming units per rat at 5 days old. Animals in the PRO-1 and PRO-2 groups were orally administered probiotic mixtures 1 or 2, respectively, at a dose of 8 log colony forming units daily during 4 days. For control purposes, placebo and PBS groups were orally administered the same amount of placebo (containing maltose and polydextrose) or PBS once daily for 4 days, respectively. Antiviral analysis was performed by real-time quantitative PCR (RT-qPCR) and observing intestinal villi. As a result, weights of small intestines were greater in the PRO-1, PRO-2 groups than in control groups. Villi were short and villous epithelial necrosis was exhibited in control groups, but these morphological changes were not observed in PRO-1, PRO-2 treated rats. RT-qPCR analysis showed that VP7 gene level of rotavirus in fecal samples and small intestinal epithelial cells were lower in the PRO-1 and PRO-2 groups. These findings suggest that probiotic mixtures may be useful probiotics for the treatment of or as alternative therapies for rotaviral gastroenteritis.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.55-84
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• 2015

The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.

• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.285-293
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• 2000

Purpose: A prospective comparison was made between imaging with Tc-99m pertechnetate (Tc-99m) and Ioine-131 (I-131) for the detection of residual and metastatic tissue after total thyroidectomy in patients with well-differentiated thyroid carcinoma. Materials and Methods: Initially our patients had imaging with Tc-99m, followed by I-131 within 3 days. The study included 21 patients who had ablation with high dose of I-131 ranging from 100 mCi to 150 mCi. Planar and pinhole images were acquired for both Tc-99m and I-131. Diagnostic images of Tc-99m and I-131 were compared with post-therapy images. Degree of uptake on Tc-99m and I-131 images was scored by four point scale and compared. Results: The results of the Tc-99m study were: 16 of 19 studies (84%) were positive on simple planar images, but 19 of 20 studies (95%) were positive on pinhole images. Conventional I-131 diagnostic imaging on the other hand showed that all studies (100%) were positive on both planar and pinhole images. There was a significant difference in degree of uptake between Tc-99m and I-131 planar images (p<0.05). Only one case of Tc-99m scintigraphy was negative on both planar and pinhole studies (false negative). There was no distant metastasis on the therapeutic I-131 images. Conclusion: Tc-99m scan using pinhole in certain clinical situations is an alternative to the I-131 scan in detecting thyroid or lymph node metastasis prior to the first ablative treatment after thyroidectomy for well-differentiated thyroid carcinoma.

• Korean Journal of Ecology and Environment
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• v.37 no.3 s.108
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• pp.344-354
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• 2004

A pilot study was performed from September 2000 to April 2004 to examine the feasibility of the wetland-pond system for the agricultural reuse of reclaimed water. The wetland system was a subsurface flow type, with a hydraulic residence time of 3.5 days, and the subsequent pond was 8 $m^3$ in volume (2 m ${\times}$ 2 m ${\times}$ 2 m) and operated with intermittent-discharge and continuous flow types. The wetland system was effective in treating the sewage; median removal efficiencies of $BOD_5$ and TSS were above 70.0%, with mean effluent concentrations of 27.1 and 16.8 mg $L^{-1}$, respectively, for these constituents. However, they did often exceed the effluent water quality standards of 20 mg $L^{-1}$. Removal of T-N and T-P was relatively less effective and mean effluent concentrations were approximately 103.2 and 7.2 mg $L^{-1}$, respectively. The wetland system demonstrated high removal rate (92 ${\sim}$ 90%) of microorganisms, but effluent concentrations were in the range of 300 ${\sim}$ 16,000 MPN 100 $mL^{-1}$ which is still high for agricultural reuse. The subsequent pond system provided further treatment of the wetland effluent, and especially additional microorganisms removal in addition to wetland-pond system could reduce the mean concentration to 1,000 MPN 100 $mL^{-1}$ from about $10^5$ MPN 100 $mL^{-1}$ of wetland influent. Other parameters in the pond system showed seasonal variation, and the upper layer of the pond water column became remarkably clear immediately after ice melt. Overall, the wetland system was found to be adequate for treating sewage with stable removal efficiency, and the subsequent pond was effective for further polishing. This study concerned agricultural reuse of reclaimed water using natural systems. Considering stable performance and effective removal of bacterial indicators as well as other water quality parameters, low maintenance, and cost-effectiveness, wetland- pond system was thought to be an effective and feasible alternative for agricultural reuse of reclaimed water in rural area.