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Thymectomy in Patients with Myasthenia Gravis (흉선절제로 치료한 중증 근무력증)

  • 조광현
    • Journal of Chest Surgery
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    • v.18 no.4
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    • pp.872-880
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    • 1985
  • Myasthenia gravis is a neuromuscular transmission disorder characterized by fatigue and weakness of voluntary muscles. Although the pathogenesis is known as reduction of available acetylcholine receptors at neuromuscular junctions by autoimmune attack, the thymic role in myasthenia gravis is still unclear and under investigation. But thymectomy in the management of myasthenia gravis has become increasingly important since the first successful operation with remission of symptoms in 1939 by Blalock. From January 1983 to June 1985, authors performed 17 thymectomies for patients with myasthenia gravis. Among them, 12 patients were free from thymoma [Croup A] and 5 were coupled with thymoma [Group B]. The results were as follows: 1] Sex distribution was 11 females and 6 males. Mean age of the patients was 32.2 year old. Sex and age distribution by the Group A and B are shown Table 1. 2] Clinical manifestations of ocular symptoms were seen in 5 patients [88.2%], extremity weakness in 13 patients, bulbar weakness in 12 patients and dyspnea in 6 patients. According to the Osserman`s classification, 5 patients were in group IIA, 6 in IIB and 6 in IIC. 3] Pre-operatively, all patients were positive response to the anti-cholinesterase test and 12 patients [92.3%] revealed positive findings in electromyography [EMC] which was done in 13 patients. 4] The postoperative complications were respiratory distress in 3 patients, myasthenic crisis in 2 patients and wound disruption in one patients. 5] Pathologic examination of the thymus showed hyperplasia in 10 patients [90%] and thymoma in 5 patients, of which 4 were mixed type with invasion to the adjacent tissues and one lymphocytic type without invasion. Normal thymus was noticed in only 2 patients. 6] In postoperative evaluations, among the 12 patients c free from thymoma [Group A], complete remission of symptoms was noticed in 3 patients and improvement in 7 patients. But among the 5 patients coupled with thymoma [Group B], only one patients showed improvement [Table 8]. Therefore, remission and clinical improvement were noticed in 11 patients [64.7%] of the all and complete remission was noticed in 3 patients [17.6%].

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A Study on comparison of menstrual pattern according to Mibyeong Index of Korean women in their thirties and forties (30-40대 여성의 미병상태에 따른 월경양상 비교연구)

  • Park, Minyoung;Oh, Hyunjoo;Hwang, Minwoo
    • Journal of Society of Preventive Korean Medicine
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    • v.23 no.1
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    • pp.61-72
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    • 2019
  • Introduction : The aim of this study was to investigate menstrual pattern according to Mibyeong Index(MBI) and compare Mibyeong symptom score according to severity of menstrual pain. Mibyeong Index was designed to measure inconvenience and resilience of subject's complains including four physical symptoms(fatigue, pain, low sleep quality, indigestion) and mental distress including anxiety, anger, depression. Method : We used the clinical data of Korean medicine Date Center(KDC) for subjects who participated in the study of 'Clinical research for collecting of clinical cases based on the personal type of Mibyeng' conducted in Seoul, from June 26, 2015 to June 26, 2017. A total of 566 fertile women aged 30 to 50 who completed the questionnaires were included in this study. In this study, we used items of Mibyeong Index and the menstrual pattern by self-report questionnaires. The date were analyzed through Kruskal Wallis test, Pearson's chi-square test, and one-way ANOVA using SPSS statistics 19.0. Results : Mibyeong status was significantly associated with severity of menstrual pain(p<0.001), worst day of menstrual pain(p<0.05), and type of menstrual pain(low back pain, nausea, depression, and none (respectively, p<0.05)). In addition, The 7-subtype score (fatigue (p<0.001), pain(p<0.001), low sleep quality(p<0.001), indigestion(p<0.001), anxiety(p<0.05), anger(p<0.05) and depression(p<0.05)) of Mibyeong index and total score of Mibyeong Index (p<0.001) showed significant difference for severity of menstrual pain. Conclusion : This result indicates that a close relationship between Mibyeong status and severity of menstrual pain. Further studies are needed but, we hope that this results will be used as the basic data to improve mibyeong status through health care to alleviate dysmenorrhea.

Interferon-β alleviates sepsis by SIRT1-mediated blockage of endothelial glycocalyx shedding

  • Suhong Duan;Seung-Gook Kim;Hyung-Jin Lim;Hwa-Ryung Song;Myung-Kwan Han
    • BMB Reports
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    • v.56 no.5
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    • pp.314-319
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    • 2023
  • Sepsis is a life-threatening multi-organ dysfunction with high mortality caused by the body's improper response to microbial infection. No new effective therapy has emerged that can adequately treat patients with sepsis. We previously demonstrated that interferon-β (IFN-β) protects against sepsis via sirtuin 1-(SIRT1)-mediated immunosuppression. Another study also reported its significant protective effect against acute respiratory distress syndrome, a complication of severe sepsis, in human patients. However, the IFN-β effect cannot solely be explained by SIRT1-mediated immunosuppression, since sepsis induces immunosuppression in patients. Here, we show that IFN-β, in combination with nicotinamide riboside (NR), alleviates sepsis by blocking endothelial damage via SIRT1 activation. IFN-β plus NR protected against cecal ligation puncture-(CLP)-induced sepsis in wild-type mice, but not in endothelial cell-specific Sirt1 knockout (EC-Sirt1 KO) mice. IFN-β upregulated SIRT1 protein expression in endothelial cells in a protein synthesis-independent manner. IFN-β plus NR reduced the CLP-induced increase in in vivo endothelial permeability in wild-type, but not EC-Sirt1 KO mice. IFN-β plus NR suppressed lipopolysaccharide-induced up-regulation of heparinase 1, but the effect was abolished by Sirt1 knockdown in endothelial cells. Our results suggest that IFN-β plus NR protects against endothelial damage during sepsis via activation of the SIRT1/heparinase 1 pathway.

The Influence of Emotional Intelligence on Empathy in Medical Students (의과대학생의 정서지능이 공감에 미치는 영향)

  • Kim, Hae Won
    • Anxiety and mood
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    • v.18 no.2
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    • pp.109-115
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    • 2022
  • Objective : The purpose of this study was to examine the influence of subscales of emotional intelligence on empathy in first-year medical students. Methods : A total of 215 first-year medical students were eligible for this study. Demographic factors (age, sex, and medical school entrance type) and measures for emotional intelligence and empathy, such as the Wong and Law Emotional Intelligence Scale and the Interpersonal Reactivity Index, were included in the survey. The relationship between emotional intelligence and empathy was analyzed by multiple linear regression, adjusting for age, sex, and entrance type. Results : The female students' level of emotional intelligence was higher than the male students for the self-emotional appraisal (p=0.029) and others' emotional appraisal (p=0.006) subscales. Meanwhile, the graduate-entry students scored higher for the use of emotion (p<0.001) and regulation of emotion (p=0.010) subscales than the direct-entry students. For empathy, the female students revealed a higher score in empathic concern (p=0.009) than the male students, and graduate-entry students scored higher than the direct-entry students in perspective taking (p=0.004) and empathic concern (p<0.001). The multiple linear regression analysis has identified significant influences of subscales of emotional intelligence on empathy: others' emotional appraisal on perspective taking (p<0.001), self-emotional appraisal (p=0.035) and regulation of emotion (p=0.023) on fantasy, others' emotional appraisal (p<0.001) and use of emotion (p=0.020) on empathic concern, and self-emotional appraisal (p=0.033) and regulation of emotion (p<0.001) on personal distress. Conclusion : This study's findings suggest that emotional intelligence may affect empathy in medical students, which can have implications for developing educational strategies to enhance empathetic attitudes in medical students.

Effect of the Inhibition of PLA2 on Oxidative Lung Injury Induced by $Interleukin-1{\alpha}$

  • Lee, Young-Man;Cho, Hyun-Gug;Park, Yoon-Yub;Kim, Jong-Ki;Lee, Yoon-Jeong;Park, Won-Hark;Kim, Teo-An
    • The Korean Journal of Physiology and Pharmacology
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    • v.2 no.5
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    • pp.617-628
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    • 1998
  • In order to understand the pathogenetic mechanism of adult respiratory distress syndrome (ARDS), the role of phospholipase A2 (PLA2) in association with oxidative stress was investigated in rats. $Interleukin-1{\alpha}\;(IL-1,\;50\;{\mu}g/rat)$ was used to induce acute lung injury by neutrophilic respiratory burst. Five hours after IL-1 insufflation into trachea, microvascular integrity was disrupted, and protein leakage into the alveolar lumen was followed. An infiltration of neutrophils was clearly observed after IL-1 treatment. It was the origin of the generation of oxygen radicals causing oxidative stress in the lung. IL-1 increased tumor necrosis factor (TNF) and cytokine-induced neutrophil chemoattractant (CINC) in the bronchoalveolar lavage fluid, but mepacrine, a PLA2 inhibitor, did not change the levels of these cytokines. Although IL-1 increased PLA2 activity time-dependently, mepacrine inhibited the activity almost completely. Activation of PLA2 elevated leukotriene C4 and B4 (LTC4 and LTB4), and 6-keto-prostaglandin $F2{\alpha}\;(6-keto-PGF2{\alpha})$ was consumed completely by respiratory burst induced by IL-1. Mepacrine did not alter these changes in the contents of lipid mediators. To estimate the functional changes of alveolar barrier during the oxidative stress, quantitative changes of pulmonary surfactant, activity of gamma glutamyltransferase (GGT), and ultrastructural changes were examined. IL-1 increased the level of phospholipid in the bronchoalveolar lavage (BAL) fluid, which seemed to be caused by abnormal, pathological release of lamellar bodies into the alveolar lumen. Mepacrine recovered the amount of surfactant up to control level. IL-1 decreased GGT activity, while mepacrine restored it. In ultrastructural study, when treated with IL-1, marked necroses of endothelial cells and type II pneumocytes were observed, while mepacrine inhibited these pathological changes. In histochemical electron microscopy, increased generation of oxidants was identified around neutrophils and in the cytoplasm of type II pneumocytes. Mepacrine reduced the generation of oxidants in the tissue produced by neutrophilic respiratory burst. In immunoelectron microscopic study, PLA2 was identified in the cytoplasm of the type II pneumocytes after IL-1 treatment, but mepacrine diminished PLA2 particles in the cytoplasm of the type II pneumocyte. Based on these experimental results, it is suggested that PLA2 plays a pivotal role in inducing acute lung injury mediated by IL-1 through the oxidative stress by neutrophils. By causing endothelial damage, functional changes of pulmonary surfactant and alveolar type I pneumocyte, oxidative stress disrupts microvascular integrity and alveolar barrier.

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Effect of Betamethasone on Pulmonary Surfactant Activity in Unilateral Pneumonectomized Rabbits (일측폐장절제가토에 있어서 steroid가 제 II 형 폐포세포의 기능에 미치는 영향)

  • Lee, Suck-Kang;Lee, Young-Man
    • Journal of Yeungnam Medical Science
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    • v.1 no.1
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    • pp.59-66
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    • 1984
  • Although it is well established that steroid is effective for treatment of neonatal respiratory distress syndrome (NRDS), the action mechanism of steroid on NRDS is not well known. Several authors have insisted that steroid increases secretion of pulmonary surfactant from type II pneumocyte, but others have insisted that steroid does not affect the secretory function of the type II pneumocyte. And some authors have suggested that steroid may ca use compositional change of pulmonary surfactant phospholipid. From these aspects, it is desirable to confirm the effect of steroid on (he secretory function of the type II pneumocyte. In order to know the effect of steroid on pulmonary surfactant activity, phospholipid phosphorus of lung lavage was measured and composition of pulmonary surfactant phospholipid of lung lavage was analyzed by thin layer chromatography (TLC) in control (C), pneumonectomized (PN), and pneumonectomized with betamethasone treated (PNS) rabbits. And lung weight and lung weight-body weight ratio were measured in each experimental group also. In PN group, right lung pneumonectomy was performed under general anesthesia with pentobarbital sodium (30mg/kg). On the fifth day after the surgery, the left lung was excised and measured above parameters. In PNS group, pneumonectomy was performed as PN group, and one day after the surgery, betamethasone was injected for four days intramusculary (4mg/day) and rabbits were sacrificed. The experiment yielded following results. PNS group's lung weight was significantly (p<0.01) heavier than C group's, but in comparison with PN group's it showed no significant change. PNS group's L/B ratio was significantly (p<0.05) higher than C group's, but compared with PN group's it showed no significant change. The value of phospholipid phosphorus content of PNS group was significantly (p<0.01) higher than that of C group. Even if the value of phospholipid phosphorus content in PNS group was not significantly higher than that of PN group, it showed increasing tendency compared with that of PN group. And in an analysis of the thin layer chromatogram, quantity (${\mu}mol/gm$ of wet weight lung) of phosphatidylcholine in PNS group decreased significantly (p<0.05) compared with C and PN group. From these results, it may be suggested that though steroid inhibits cellular hyperplasia in the compensatory growing lung, it auguments the secretory function of type II pneumocyte and causes compositional change of pulmonary surfactant phospholipid.

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Effect of Compaction Method on Induced Earth Pressure Using Dynamic Compaction Roller (진동롤러에 의한 다짐방법이 인접구조물의 다짐토압에 미치는 영향)

  • Roh, Han-Sung
    • International Journal of Highway Engineering
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    • v.3 no.4 s.10
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    • pp.127-136
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    • 2001
  • To increase the structural integrity of concrete box culvert good compaction by the dynamic compaction roller with bi9 capacity is as effective as good backfill materials. It is needed for effective compaction that a compaction roller closes to concrete structure with high frequency. However structural distress of the culvert could be occur due to the excessive earth pressure by great dynamic compaction load. To investigate the characteristics of Induced stress by compaction, a box culvert was constructed with changing cushion materials and compaction methods. Two types of cushion material such as tire rubber chip and EPS(Expanded Polystyrene) were used as cushion panels and they are set on the culverts before backfill construction. Laboratory test result of cushion material says that the value of dynamic elastic modulus of rubber is lesser than that of EPS. On the other hand, material damping of rubber material is greater than that of EPS. In most case, dynamic compaction rollers with 10.5 ton weights were used and vibration frequency was applied 30Hz for the great compaction energy. This paper presents the main results on the characteristics of dynamic earth pressures during compaction. The amounts of induced dynamic pressures$(\Delta\sigma\;h)$ by compaction are affected with construction condition such as compaction frequency, depth of pressure cell, distance between roller and the wall of culvert and roller direction. Based on the measured values dynamic lateral pressure on the culverts, it could be said that orthogonal direction of roller to the length of culvert is more effective to compaction efficiency than parallel direction.

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COVID-19 in a 16-Year-Old Adolescent With Mucopolysaccharidosis Type II: Case Report and Review of Literature

  • Park, So Yun;Kim, Heung Sik;Chu, Mi Ae;Chung, Myeong-Hee;Kang, Seokjin
    • Pediatric Infection and Vaccine
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    • v.29 no.2
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    • pp.70-76
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    • 2022
  • Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient's clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.

Distribution of Pattern Identification According to BMI in Functional Dyspepsia Patients and Analysis of Frequently Used Herbal Medicines: A Retrospective Chart Review (기능성소화불량 환자의 BMI에 따른 변증 유형 분포 및 다빈도 처방 분석 : 후향적 차트 리뷰)

  • Chae-Rim Yoon;Chang-Yul Keum;Aram Han;Su-Hyun Choi;Su-Hyun Choi;Dahee Jeong;Hae-in Jeong;Na-Yeon Ha;Jinsung Kim
    • The Journal of Internal Korean Medicine
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    • v.44 no.4
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    • pp.645-660
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    • 2023
  • Objectives: This study analyzed the clinical characteristics of patients with functional dyspepsia (FD) who received Korean medicine treatment. Methods: A retrospective chart review was conducted to investigate sociodemographic characteristics, clinical characteristics, and prescribed treatments. The clinical records of 192 patients who visited Kyung Hee University Korean Medicine Hospital for FD from May 1, 2022, to May 31, 2023, were analyzed. In addition, the distribution of pattern identification and symptom type according to body mass index (BMI), as well as prescription history, were analyzed. Results: As the degree of obesity increased, the proportion of Spleen-Qi deficiency pattern patients decreased (p=0.012), and the proportion of damp-phlegm pattern patients increased (p=0.000). Additionally, as the degree of obesity increased, the proportion of patients with excess differentiation increased (p=0.002). The PDS (Postprandial distress syndrome) symptom type was significantly more frequent in the underweight and normal groups than in the overweight and obese groups, and the EPS (Epigastric pain syndrome) symptom type was more frequent in the overweight and obese groups. Regardless of the type of pattern identification, the most frequently used prescriptions were Naesowhajung-tang, Hanshin Naeso-san, and Sojeokgunbi-hwan granule. Conclusion: This study analyzed the medical records of patients with FD to elucidate the use of Korean medicine treatments. Our study is meaningful in that we found that the distribution of pattern identification and symptom patterns are linked to the degree of obesity in FD patients and identified the tendency for herbal medicine treatments to be prescribed in clinical practice.

The Prediction of Export Credit Guarantee Accident using Machine Learning (기계학습을 이용한 수출신용보증 사고예측)

  • Cho, Jaeyoung;Joo, Jihwan;Han, Ingoo
    • Journal of Intelligence and Information Systems
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    • v.27 no.1
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    • pp.83-102
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    • 2021
  • The government recently announced various policies for developing big-data and artificial intelligence fields to provide a great opportunity to the public with respect to disclosure of high-quality data within public institutions. KSURE(Korea Trade Insurance Corporation) is a major public institution for financial policy in Korea, and thus the company is strongly committed to backing export companies with various systems. Nevertheless, there are still fewer cases of realized business model based on big-data analyses. In this situation, this paper aims to develop a new business model which can be applied to an ex-ante prediction for the likelihood of the insurance accident of credit guarantee. We utilize internal data from KSURE which supports export companies in Korea and apply machine learning models. Then, we conduct performance comparison among the predictive models including Logistic Regression, Random Forest, XGBoost, LightGBM, and DNN(Deep Neural Network). For decades, many researchers have tried to find better models which can help to predict bankruptcy since the ex-ante prediction is crucial for corporate managers, investors, creditors, and other stakeholders. The development of the prediction for financial distress or bankruptcy was originated from Smith(1930), Fitzpatrick(1932), or Merwin(1942). One of the most famous models is the Altman's Z-score model(Altman, 1968) which was based on the multiple discriminant analysis. This model is widely used in both research and practice by this time. The author suggests the score model that utilizes five key financial ratios to predict the probability of bankruptcy in the next two years. Ohlson(1980) introduces logit model to complement some limitations of previous models. Furthermore, Elmer and Borowski(1988) develop and examine a rule-based, automated system which conducts the financial analysis of savings and loans. Since the 1980s, researchers in Korea have started to examine analyses on the prediction of financial distress or bankruptcy. Kim(1987) analyzes financial ratios and develops the prediction model. Also, Han et al.(1995, 1996, 1997, 2003, 2005, 2006) construct the prediction model using various techniques including artificial neural network. Yang(1996) introduces multiple discriminant analysis and logit model. Besides, Kim and Kim(2001) utilize artificial neural network techniques for ex-ante prediction of insolvent enterprises. After that, many scholars have been trying to predict financial distress or bankruptcy more precisely based on diverse models such as Random Forest or SVM. One major distinction of our research from the previous research is that we focus on examining the predicted probability of default for each sample case, not only on investigating the classification accuracy of each model for the entire sample. Most predictive models in this paper show that the level of the accuracy of classification is about 70% based on the entire sample. To be specific, LightGBM model shows the highest accuracy of 71.1% and Logit model indicates the lowest accuracy of 69%. However, we confirm that there are open to multiple interpretations. In the context of the business, we have to put more emphasis on efforts to minimize type 2 error which causes more harmful operating losses for the guaranty company. Thus, we also compare the classification accuracy by splitting predicted probability of the default into ten equal intervals. When we examine the classification accuracy for each interval, Logit model has the highest accuracy of 100% for 0~10% of the predicted probability of the default, however, Logit model has a relatively lower accuracy of 61.5% for 90~100% of the predicted probability of the default. On the other hand, Random Forest, XGBoost, LightGBM, and DNN indicate more desirable results since they indicate a higher level of accuracy for both 0~10% and 90~100% of the predicted probability of the default but have a lower level of accuracy around 50% of the predicted probability of the default. When it comes to the distribution of samples for each predicted probability of the default, both LightGBM and XGBoost models have a relatively large number of samples for both 0~10% and 90~100% of the predicted probability of the default. Although Random Forest model has an advantage with regard to the perspective of classification accuracy with small number of cases, LightGBM or XGBoost could become a more desirable model since they classify large number of cases into the two extreme intervals of the predicted probability of the default, even allowing for their relatively low classification accuracy. Considering the importance of type 2 error and total prediction accuracy, XGBoost and DNN show superior performance. Next, Random Forest and LightGBM show good results, but logistic regression shows the worst performance. However, each predictive model has a comparative advantage in terms of various evaluation standards. For instance, Random Forest model shows almost 100% accuracy for samples which are expected to have a high level of the probability of default. Collectively, we can construct more comprehensive ensemble models which contain multiple classification machine learning models and conduct majority voting for maximizing its overall performance.