• 의료법학
• /
• 제20권3호
• /
• pp.235-262
• /
• 2019

전통적으로 인류를 위협해 오던 감염성 질환이 줄어드는 반면, 심뇌혈관 질환을 포함하여 암, 당뇨와 같은 만성질환이 빠른 속도로 퍼져나가고 있다. 오랜 시간에 걸쳐 발병하며 증세가 장기간 지속되지만 치료가 어려운 만성질환의 특성을 반영, 그 위험요인의 관리와 이에 대응하는 건강증진정책의 마련은 세계 각국의 중요 관심사로 부상하게 되었다. 일차 의료 시스템이 점점 더 복잡한 형태로 변화하는 현대사회의 건강요구에 부합, 건강증진 및 질병 예방 정책, 지역사회에 대응 솔루션 등 이른바 환자 중심의 다 부문 접근방식을 제공하면서 변화된 의료 환경에서 일차 의료의 가치는 다시 한 번 부각 되고 있다. 기존의 의료전달체계로는 급속한 고령화 및 질병 패러다임의 변화, 삶의 질 향상을 향한 민중의 욕구를 감당하기 어려워지면서 유럽연합국가들은 지속적이며 포괄적이고 조정된 관리를 제공하는 일차 의료 시스템을 구축, 그 품질 향상을 위하여 다각적인 노력을 기울이고 있다. 본 논문은 우리나라 보건의료 전달체계의 현황 및 문제점 등을 검토하고, 일차 의료 강화와 관련된 유럽연합의 예를 중심으로 그 시사점을 도출, 환자 중심의 미래형 의료전달체계 구축 방안에 관하여 논의하고자 한다.

• Journal of Chest Surgery
• /
• 제17권1호
• /
• pp.157-166
• /
• 1984

These biologic test procedures are designed to test the suitability of P.V.C. made in Korea intended for parenteral preparation, which were based on the U.S. Pharmacopeia XIX "Biologic Test-Plastic Container", Official from July 1, 1975. Healthy adult human blood and rabbits weighing 2\ulcorner.2Kg were used for test materials. Sample P.V.C. were sampled from the medical equipments made in Korea randomly and Control P.V.C. were sampled from the standardized Cobe and Polystan P.V.C. tubes. P.V.C. extract was prepared from a homogeneous P.V.C. samples by incubating 60 square centimeters of the sample per 20 millimeters of sterile pyrogen-free saline at 70\ulcorner for 72 hours or autoclaving at 120\ulcorner for 1 hour. The Implantation Test was designed to evaluate the reaction of living tissue to the plastic by the method of the implantation of the Sample itself into animal tissue. The Systemic Injection Test, the Intracutaneous Test, and the remainders were designed to determine the biological response of animals to plastics by the single-dose injection of specific extracts prepared from a Sample. The results are as follows; 1.Implantation Test - No significant difference for reactions was noted between the Sample treated animal and the Control after 72 hours of implantation. 2.Systemic Toxicity Injection Test - No sign of toxicity and/or death immediately after injection and at 4, 24, 48 hours respectfully after injection. 3.Intracutaneous Test - None of the animals treated with the Sample showed a significantly greater reaction than the observed in the animals treated with Blank. 4.Pyrogen Assay-Only one animal treated with the Sample showed the maximal rise of rectal temperature about 0.2\ulcorner after 3 hours of injection, but remainders showed no change. 5.Hemolytic Index - The positive Control tube of distilled water exhibited complete hemolysis while the negative Control tube and P.V.C. extract were negative demonstrating no hemolysis. 6.Cell Morphology of Erythrocytes and Leukocytes on Stored, Heparinized Human Blood -- There was no significant difference in the morphology of either the Control or Sample extract. 7.Clotting Mechanism of Human Blood in vitro - After allowing to the P.V.C. extract at room temperature for 5 Hours and at 10\ulcorner for 24 hours, there was no appreciable difference in Prothrombin Time under these conditions. 8.Clotting Mechanism of Rabbit in vivo - At the termination of 5 days after intraperitoneal injection of the P.V.C. extract, no significant changes in Clotting Time were observed. According to the above results, it could be concluded that the P.V.C. made in Korea was acceptable for parenteral preparation, especially treated with physiologic saline and/or human blood.man blood.

• Journal of Chest Surgery
• /
• 제20권1호
• /
• pp.112-127
• /
• 1987

Myasthenia gravis is a neuromuscular transmission function disorder characterized by fatigue and weakness of voluntary muscles. This muscular weakness is intensified by activity and stress, and improved by the use of anticholinesterase compounds. It was initially described by Erb in 1879 and later named myasthenia gravis by Jolly in 1895. Although the pathogenesis is Known to be an autoimmune related reduction in the number of available acetylcholine receptors at neuromuscular junctions, the role of thymus in myasthenia gravis is still unclear and under investigation. Thymectomy in the management of myasthenia gravis has become increasingly important since Dr. Blalock observed in 1939 that some patients with thymic tumors and myasthenia gravis improved following thymectomy. A clinical study of 102 cases of myasthenia gravis was performed at Yonsei University College of Medicine. Seoul, Korea from Jan. 1976 to Jun. 1986. In order to determine which factors are of prognostic significance, attention is focused upon pre-operative patient evaluation, problems in operative and post-operative care, and long-term follow-up observations. The results were as follows: 1. The sex distribution was 67 females and 35 males, the mean age of onset was 28.95*1.69 years, and the maximal incidence occurred between 21 and 40 years of age [56 cases: 54.9%]. 2. Clinical manifestations of ocular symptoms were seen to 70 patients [68.6%] extremities weakness in 33 [32.3%], bulbar weakness in 29 [28.4%], and dyspnea in 13 [12.7%]. 3. Study cases more than two thirds were classified as mild types [MG 1 and MG 11A] and 6 cases as grave [MG 1V] based on the modified Osserman`s classification system, 4. Thymectomy was performed in 19 cases which presented in severe myasthenia symptoms and showed no improvement with cholinergic drugs. Histologic examination of the excised thymus glands revealed no abnormalities in 4 cases, thymic hyperplasia in 5, benign thymoma in 5, and malignant thymoma in 5. 5. Immediate post-operative complications included 2 cases of pneumothorax which were treated by tube thoracostomies, there was no operative mortality. 6. The response to cholinergic drugs in 36 cases younger than 20 years old and in 27 cases older than 40 years was relatively poor, while that in 35 cases between the ages of 21 and 40 years old was good. 7. Thirty of 39 cases in groups IIB, III & IV improved markedly with medical or surgical management while only 16 of 59 cases in the mild groups [I and IIA] improved, almost all surgical cases improved in all categories. 8. There were 5 deaths. occurring between 7 months and 3 years 3 months of treatment of myasthenia gravis. The causes of death were myasthenic crisis in 2 cases, respiratory failure due to candidiasis & radiation pneumonitis in one case, cerebral hemorrhage due to high blood pressure in two case.

• Journal of Preventive Medicine and Public Health
• /
• 제32권2호
• /
• pp.191-199
• /
• 1999

대기오염이 인체에 미치는 영향을 정량적으로 분석하기 위하여 1991년부터 1995년까지의 서울시 사망자료와 대기오염 자료를 general additive Poisson model 을 사용하여 분석하였다. 우리 나라에서도 외국의 연구 결과와 마찬가지로 대기 오염 물질의 증가가 사망자 수의 증가에 유의하게 영향을 미치는 것으로 평가되었다. 특히 본 연구에서 나타난 특성은 일반적으로 많이 알려진 분진에 의한 영향 보다는 오존에 의한 영향이 두드러진다는 것이다. 오존은 100ppb가 증가할 때 마다 사망자 수를 3-10% 증가시키는 것으로 평가되었다. 즉 오존주의보가 발령될 때마다 서울시에서는 많게는 평소보다 10%정도의 추가적인 사망이 발생하는 것으로 추정된다. 이러한 연구결과는 우리 나라의 대기오염 양상이 분진과 $SO_2$ 중심의 '런던스모그'형에서 오존과 $NO_2$ 등에 의한 광화학적 스모그로 바뀌고 있는 사실을 감안할 때 시사하는 바가 매우 크다고 할 수 있다. 따라서 앞으로는 병원입원율, 또는 응급실 내원환자수에 대한 오존의 영향을 평가할 수 있는 연구들이 이어져야 할 것으로 생각되며, 더불어 오존 오염을 감소시킬 수 있는 구체적인 정책들이 시급히 시행되어야 할 것으로 생각된다.

• 감성과학
• /
• 제14권2호
• /
• pp.269-278
• /
• 2011

본 연구에서는 집중력 시에 통상적인 방법으로 사용되는 EEG 선호의 theta/alpha 값과 심박변이도(HRV) 변수들의 상관관계를 분석하기 위함이다. 각 주파수 대역에 따른 EEG 선호의 파행과 자율신경계 변화를 연구한 논문들을 바탕으로, 본 연구에서는 집중상태에 따른 theta파의 변화와 alpha파의 신호를 분석하여 theta/alpha 값으로 중추신경계 변화를 평가하였다. 또한 자율신경계에서 생리학적 변화는 HRV 변수들(beat interval, SDNN, RMSSD, NN50, LF, HF, LF/HF)로 평가/해석하였다. 실험방법은 신경 인지 검사 프로그램인 CNT 4.0을 이용하여 21 명의 건강한 피험자들의 청각 집중력 테스트를 수행하였고, EEG 신호와 PPG 신호를 분석하였다. EEG로부터 추출한 theta/alpha값과 PPG로부터 추출한 HRV변수들은 중다회귀분석을 이용하여 각각의 조합에 따른 두 지표간의 상관관계를 평가하였다. theta/alpha와 심혈관계의 변수들의 상호연관성은 {SDNN(2), HF(6)} 변수가 포함된 3차원 이상의 조합에서 상대적으로 유효하게 나타났다. 결과적으로 고차원 HRV 변수 조합이 저차원 조합보다 theta/alpha 와 상대적으로 높은 상관관계($R^2=0.253$; 7차원)를 나타내었고, 통계적 유의성(p<0.05)을 만족하였다.

• The Korean Journal of Physiology and Pharmacology
• /
• 제14권3호
• /
• pp.139-144
• /
• 2010

In this study, we evaluated the role of apurinic/apyrimidinic endonuclease1/redox factor-1 (Ref-1) on the tumor necrosis factor-$\alpha$ (TNF-$\alpha$) induced cyclooxygenase-2 (COX-2) expression using A549 lung adenocarcinoma cells. TNF-$\alpha$ induced the expression of COX-2 in A549 cells, but did not induce BEAS-2B expression. The expression of COX-2 in A549 cells was TNF-$\alpha$ dose-dependent (5~100 ng/ml). TNF-$\alpha$-stimulated A549 cells evidenced increased Ref-1 expression in a dose-dependent manner. The adenoviral transfection of cells with AdRef-1 inhibited TNF-$\alpha$-induced COX-2 expression relative to that seen in the control cells ($Ad{\beta}gal$). Pretreatment with $10\;{\mu}M$ of SB203580 suppressed TNF-$\alpha$-induced COX-2 expression, thereby suggesting that p38 MAPK might be involved in COX-2 expression in A549 cells. The phosphorylation of p38 MAPK was increased significantly after 5 minutes of treatment with TNF-$\alpha$, reaching a maximum level at 10 min which persisted for up to 60 min. However, p38MAPK phosphorylation was markedly suppressed in the Ref-1-overexpressed A549 cells. Taken together, our results appear to indicate that Ref-1 negatively regulates COX-2 expression in response to cytokine stimulation via the inhibition of p38 MAPK phosphorylation. In the lung cancer cell lines, Ref-1 may be involved as an important negative regulator of inflammatory gene expression.

• The Korean Journal of Physiology and Pharmacology
• /
• 제21권1호
• /
• pp.37-44
• /
• 2017

Regulation of vascular smooth muscle cell (VSMC) phenotype plays an essential role in many cardiovascular diseases. In the present study, we provide evidence that $kr{\ddot{u}}ppel$-like factor 8 (KLF8) is essential for tumor necrosis factor ${\alpha}$ ($TNF{\alpha}$)-induced phenotypic conversion of VSMC obtained from thoracic aorta from 4-week-old SD rats. Stimulation of the contractile phenotype of VSMCs with $TNF{\alpha}$ significantly reduced the VSMC marker gene expression and KLF8. The gene expression of KLF8 was blocked by $TNF{\alpha}$ stimulation in an ERK-dependent manner. The promoter region of KLF8 contained putative Sp1, KLF4, and $NF{\kappa}B$ binding sites. Myocardin significantly enhanced the promoter activity of KLF4 and KLF8. The ectopic expression of KLF4 strongly enhanced the promoter activity of KLF8. Moreover, silencing of Akt1 significantly attenuated the promoter activity of KLF8; conversely, the overexpression of Akt1 significantly enhanced the promoter activity of KLF8. The promoter activity of SMA, $SM22{\alpha}$, and KLF8 was significantly elevated in the contractile phenotype of VSMCs. The ectopic expression of KLF8 markedly enhanced the expression of SMA and $SM22{\alpha}$ concomitant with morphological changes. The overexpression of KLF8 stimulated the promoter activity of SMA. Stimulation of VSMCs with $TNF{\alpha}$ enhanced the expression of KLF5, and the promoter activity of KLF5 was markedly suppressed by KLF8 ectopic expression. Finally, the overexpression of KLF5 suppressed the promoter activity of SMA and $SM22{\alpha}$, thereby reduced the contractility in response to the stimulation of angiotensin II. These results suggest that cross-regulation of KLF family of transcription factors plays an essential role in the VSMC phenotype.

• The Korean Journal of Physiology and Pharmacology
• /
• 제17권4호
• /
• pp.291-297
• /
• 2013

Notch1 has been reported to be highly expressed in triple-negative and other subtypes of breast cancer. Mutant p53 (R280K) is overexpressed in MDA-MB-231 triple-negative human breast cancer cells. The present study aimed to determine whether the mutant p53 can be a potent transcriptional activator of the Notch1 in MDA-MB-231 cells, and explore the role of this mutant p53-Notch1 axis in curcumin-induced apoptosis. We found that curcumin treatment resulted in an induction of apoptosis in MDA-MB-231 cells, together with downregulation of Notch1 and its downstream target, Hes1. This reduction in Notch1 expression was determined to be due to the decreased activity of endogenous mutant p53. We confirmed the suppressive effect of curcumin on Notch1 transcription by performing a Notch1 promoter-driven reporter assay and identified a putative p53-binding site in the Notch1 promoter by EMSA and chromatin immunoprecipitation analysis. Overexpression of mutant p53 increased Notch1 promoter activity, whereas knockdown of mutant p53 by small interfering RNA suppressed Notch1 expression, leading to the induction of cellular apoptosis. Moreover, curcumin-induced apoptosis was further enhanced by the knockdown of Notch1 or mutant p53, but it was decreased by the overexpression of active Notch1. Taken together, our results demonstrate, for the first time, that Notch1 is a transcriptional target of mutant p53 in breast cancer cells and suggest that the targeting of mutant p53 and/or Notch1 may be combined with a chemotherapeutic strategy to improve the response of breast cancer cells to curcumin.

• 대한의생명과학회지
• /
• 제12권3호
• /
• pp.289-301
• /
• 2006

Cardiopulmonary bypass (CPB) for cardiac surgery triggers the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that leads to postoperative major organ dysfunction. Traditionally, corticosteroids (steroid) have been administered to patients undergoing cardiac surgery to ward off these detrimental physiologic alterations. However, the majority of the studies have been performed on adult patients with high-dose steroid. We carried out a randomized, prospective, double-blind study to compare the efficacy of low-dose steroid with that of high-dose steroid and to determine the adequate dose of pretreated-steroid for prophylactic effects in pediatric cardiac surgery. Thirty pediatric patients scheduled for elective cardiac surgery were randomly assigned to two groups; fifteen patients received low-dose methylprednisolone (10mg/kg intravenously, n=15, low-dose group) and the others received high-dose methylprednisolone (30mg/kg intravenously, n=15, high-dose group) 1 hour prior to CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after start of CPB (CPB-10), and immediately after CPB-end (CPB-OFF) for measuring total leukocyte counts (T-WBC) and diff-counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), total antioxidant (TAO), neuron-specific enolase (NSE), troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and blood urea nitrogen (BUN) levels. Other parameters such as volumes of urine output, pulmonary index $(PI,\;PaO_2/FiO_2)$, mechanical ventilating period, intensive care unit (ICU)-staying period, postoperative complications (fever, wound problem), postoperative 24 hrs and total volumes in blood loss, and hospitalized days were also assessed. All parameters were compared between two groups. There were no significant differences in T-WBC counts, monocyte fraction, platelet counts, TA levels, NSE levels, creatinine levels, BUN levels, the volumes of total urine output, PI, the incidences of fever and wound problem, postoperative 24hrs- and total-blood loss volumes and ICU-staying period between two groups (P>0.05). At CPB-OFF, neutrophil fraction, MPO level, TNI level, and AST level were higher in the high-dose group than in the low-dose group (P<0.05). IL-6 level at CPB-10 was higher in the high dose-group than in the low-dose group (P<0.05). Furthermore, mechanical ventilating periods and hospitalized days of the high-dose group were significantly longer than those of low-dose group (P<0.05). The high-dose group had significantly low lymphocyte fi-action at CPB-OFF compared with the low-dose group (P<0.001). These findings suggest that pretreatment of high-dose steroid is not superior to that of low-dose steroid regrading its potential benefits in pediatric cardiac surgery. Therefore, the conventional strategy of steroid treatment, high-dose pretreatment, should be modified in the cardiac surgery with CPB. However, further studies must be performed on the larger number of patients in as much as small number of patients in this study.

• Journal of Chest Surgery
• /
• 제34권7호
• /
• pp.515-523
• /
• 2001

배경: 당뇨병 환자에서 사망률과 이환률의 원인은 70%이상 혈관계의 합병증에 기인한다. 이러한 합병증은 혈관 내피세포 이완 작용 이상과 연관되어 있으며 이는 oxygen free radical의 직접적인 독성으로 추정되어 본 연구는 당뇨를 유발시킨 백서 복부 대동맥 운동성에 대한 Vit C의 보호효과를 연구 목적으로 한다. 대상 및 방법: 백서 60마리를 실험군(n=33)과 대조군(n=27)으로 나누고 실험 군은 streptozotocin을 투여하여 당뇨를 유발시켰다. 각각 실험 군과 대조군을 ascorbic acid를 투여한 군과 투여하지 않은 군으로 세분한 후 ascorbic acid투여 직후, 6주, 9주, 12주후의 복부 대동맥 혈관근육의 운동성을 측정하였다. 결과: 대조군의 경우 6주째 복부 대동맥 절편에서 acetylcholine투여 후 정상적인 이완반응이 나타났으나 실험군의 경우 현저히 저하됨이 관찰되었다. 9, 12주 째 절편에서는 실험군 중 ascorbic acid투여군에서 acetylcholine에 의한 이완반응이 거의 대조군에서의 결과와 일치할 정도로 회복되었다. 결론: 이상의 결과로 당뇨병을 유발한 백서에서 내피세포 의존적인 장애가 나타남을 확인할 수 있었으며 이러한 장애는 ascorbic acid의 투여로 회복됨을 알 수 있었으며 그 효과는 항산화 작용에서 비롯된 것으로 생각되므로 ascorbic acid가 당뇨환자의 혈관성 질환에 대해 보호적 효과를 보일 수 있을 것으로 사료된다.