• Journal of Hospice and Palliative Care
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• 제5권2호
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• pp.125-135
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• 2002

목적 : 본 연구는 호스피스 병동에 입원한 말기 암 환자의 통증과 통증에 영향을 미치는 요인인 우울, 불편감, 신체적 간호 시행 횟수, 진통제 사용, 및 영적상태를 평가하기 위한 서술적 조사 연구이다. 대상 : C 대학 3개 부속병원의 호스피스 병동에 새로 입원한 말기 암환자 58명을 대상으로 하였다. 자료수집은 1998년 1월부터 1999년 1월까지 1년간 연구원들의 직접 면접으로 실시하였다. 수집된 자료는 ANOVA, Pearson correlation oefficient, 및 Multivatiate mulitiple regression으로 통계 처리하였다. 결과 : 1) 인구학적 특성:대상자의 나이는 평균 57세 이었고, 60세 이상이 28명(48.3%)으로 가장 많았다. 교육정도는 고등학교 이상 졸업자가 약 53%를 차지하였고, 종교는 가톨릭이 62.1%로 가장 많았다. 결혼 상태는 대부분이 기혼(89.7%)이었고, 가족 수는 2명인 경우가 25.9%, 4명이 19.0%, 없는 경우가 17.2%, 3명이 15.5 % 순이다. 임상적 특성으로 진단명은 위암이 24.1%, 폐암이 17.2%, 직장암이 13.8% 순 이었다. 호스피스 병동에 입원하게된 동기는 통증완화가 67.2%, 영적 간호가 39.7%, 증상완화가 27.6%였다. 수술을 받은 경우는 44.8%, 받지 않은 경우가 55.2%였다. 가족력에 암이 있었던 경우는 27.6%이었고, 일상 수행 정도는 부분적으로 가능한 경우가 65.5%로 가장 많았으며, 전혀 불가능이 22.4%, 그리고 12.1%는 가능하였다. 돌봄과 관련된 특성에서 주 돌봄 제공자가 주로 가족(72.4%)이었으며, 간호 장소는 84.5%가 병원을 선호하였고 그 이유는 통증 조절(51.7%), 언제나 치료가 가능한 점(15.5%), 정서적 안정(15.5%), 그리고 영적 간호(12.1 %) 순으로 나타났다. 대상자 모두는 가정에서의 간호를 염려하고 있었는데 그 이유는 통증 조절이 어렵다는 것(77.6%), 영적 간호 제공자 부재(15.5%), 돌봐줄 사람의 부재(13.8%), 및 가족의 부담감(6.9%)이었다. 통증의 종류를 보면, 대상자의 53.4%가 심부 통증, 20.7%가 복합적인 통증, 17.3%가 내장 통증, 5.2%가 신경성 통증, 3.4%가 표재성 통증을 호소하였다. 마약성 진통제를 사용한 경우는 77.6%였다. 통증 정도는 평균 4.69점이었고, 우울감은 6.13점, 불편감은 4.13점, 그리고 신체간호 시행은 2.59점이였다. 2) 통증과 통증 관련요인과의 상관 관계 :통증과 우울(P<.05), 통증과 신체적 간호(P<.05), 통증과 불편감(P<.05), 우울과 불편감(P<.05)사이에 순 상관 관계를 보여, 우울하고 불편감이 심할 수록 통증이 더 심했으며, 신체 간호 횟수가 많은 경우일수록 통증을 더 느꼈고, 우울할 수록 불편감도 더 심했다. 3) 통증예측 요인 분석: 우울 정도(${\beta}=0.41$, P=0.0049) 와 마약성 진통제 사용 여부(${\beta}=2.11$, P=0.0132)가 환자의 통증 정도($R^2=.46$)에 유의하게 영향을 미쳤다. 결론 : 본 연구의 결과 말기 암환자들 대부분이 입원 당시 중등도 이상의 통증이 있었으며, 통증정도는 우울과 불편감 그리고 신체간호 횟수와 상관관계가 있었고, 우울과 마약성 진통제 사용이 통증 예측인자로 나타났다. 그러므로 말기 암환자의 통증을 완화하기 위해서는 약물요법은 물론 신체적, 심리적, 및 영적 측면과 관련된 총체적인 접근에 의한 다학제간의 중재프로그램이 마련되어야 한다고 본다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6757-6760
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• 2013

Gastric cancer is one of the most frequently occurring malignancies in the world. Development of multiple drug resistance (MDR) to chemotherapy is known as the major cause of treatment failure for gastric cancer. Multiple drug resistance 1/P-glycoprotein (MDR1/p-gp) contributes to drug resistance via ATP-dependent drug efflux pumps and is overexpressed in many solid tumors including gastric cancer. To investigate the role of MDR1 knockdown on drug resistance reversal, we knocked down MDR1 expression using shRNA in drug resistant gastric cancer cells and examined the consequences with regard to adriamycin (ADR) accumulation and drug-sensitivity. Two shRNAs efficiently inhibited mRNA and protein expression of MDR1 in SGC7901-MDR1 cells. MDR1 knockdown obviously decreased the ADR accumulation in cells and increased the sensitivity to ADR treatment. Together, our results revealed a crucial role of MDR1 in drug resistance and confirmed that MDR1 knockdown could reverse this phenotype in gastric cancer cells.

• 대한간호학회지
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• 제43권6호
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• pp.781-790
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• 2013

Purpose: The purpose of this study was to further understanding of the experience in acceptance of hospice by patients with terminal cancer and to explore the structure of this experience. Methods: A phenomenological methodology was used for the study. Participants were nine patients who were admitted to the hospice unit of a university hospital. In-depth interviews were done for data collection and the data were analyzed using Colaizzi's method. Results: Four categories, eight theme clusters and 18 themes were identified for the experience in acceptance of hospice by patients with terminal cancer. The three categories were 'Hope for a comfortable death', 'Overcoming barrier of prejudice about hospice', 'Incessant craving for life', 'The last consideration for self and family' Conclusion: While accepting the hospice care, participants experienced inner conflict between giving up medical treatments that prolong life and choosing a comfortable death, and also experienced an incessant craving for life. By accepting hospice care, they showed a human dignity that entails careful concerns for both self and family members.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.3697-3703
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• 2016

Hepatocellular carcinoma (HCC) is the most frequent type of malignant liver tumor and a high impact health problem worldwide. The prevalence of HCC is particularly high in many Asian and African countries. Some HCC patients have no symptoms prior to diagnosis and many of them therefore present at late stage and have a grave prognosis. The well-established causes of HCC are chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection or alcoholic cirrhosis and nonalcoholic steatohepatitis. The Barcelona Clinic Liver Cancer (BCLC) Staging System remains the most widely used for HCC management guidelines. To date, the treatments for HCC are still very challenging for physicians due to limited resources in many parts of the world, but many options of management have been proposed, including hepatic resection, liver transplantation, ablative therapy, chemoembolization, sorafnib and best supportive care. This review article describes the current evidence-based management of HCC with focus on early to advance stages that impact on patient overall survival.

• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6429-6436
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• 2014

Poly-ADP-ribosylation (PAR) is a post-translational modification of mainly chromosomal proteins. It is known to be strongly involved in several molecular events, including nucleosome-remodelling and carcinogenesis. In this investigation, it was attempted to evaluate PAR level as a reliable biomarker for early detection of cancer in blood lymphocyte histones. PAR of isolated histone proteins was monitored in normal and dimethylnitrosamine (DMN)-exposed mice tissues using a novel ELISA-based immuno-probe assay developed in our laboratory. An inverse relationship was found between the level of PAR and period of DMN exposure in various histone proteins of blood lymphocytes and spleen cells. With the increase in the DMN exposure period, there was reduction in the PAR level of individual histones in both cases. It was also observed that the decrease in the level of PAR of histones resulted in progressive relaxation of genomic DNA, perhaps triggering activation of genes that are involved in initiation of transformation. The observed effect of carcinogen on the PAR of blood lymphocyte histones provided us with a handy tool for monitoring biochemical or physiological status of individuals exposed to carcinogens without obtaining biopsies of cancerous tissues, which involves several medical and ethical issues. Obtaining blood from any patient and separating blood lymphocytes are routine medical practices involving virtually no medical intervention, post-procedure medical care or trauma to a patient. Moreover, the immuno-probe assay is very simple, sensitive, reliable and cost-effective. Therefore, combined with the ease of preparation of blood lymphocytes and the simplicity of the technique, immuno-probe assay of PAR has the potential to be applied for mass screening of cancer. It appears to be a promising step in the ultimate goal of making cancer detection simple, sensitive and reliable in the near future.

• Asian Pacific Journal of Cancer Prevention
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• 제13권7호
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• pp.3275-3279
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• 2012

Recently, population-based studies of type 2 diabetes patients have provided evidence that metformin treatment is associated with a reduced cancer incidence and mortality, but its mode of action remains unclear. Here we report effects of metformin on hepatocellular carcinoma (HCC) Hep-G2 cells and details of molecular mechanisms of metformin activity. Our research indicates that metformin displays anticancer activity against HCC through inhibition of the mTOR translational pathway in an AMPK-independent manner, leading to G1 arrest in the cell-cycle and subsequent cell apoptosis through the mitochondrion-dependent pathway. Furthermore, we showed that metformin strongly attenuated colony formation and dramatically inhibited Hep-G2 tumor growth in vivo. In conclusion, our studies suggested that metformin might have potential as a cytotoxic drug in the prevention and treatment of HCC.

• 호스피스학술지
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• 제7권2호
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• pp.6-14
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• 2007

Purpose: Hepatocellular carcinoma is the 3rd leading cause of cancer death in Korea and its prognosis is very poor. We aimed to investigate the clinical characteristics of terminal patients with hepatocellular carcinoma on admission into a hospice unit, and to know if they had received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 62 patients with hepatocellular carcinoma who had admitted, received palliative care, and died in a hospice unit between January 2003 and December 2005. Results: The median age of patients was 56.5 years with 50 men(80.65%) and 12 women(19.35%) and gender ratio(male to female) was 417. Child-Pugh class A, B, and C were 6(9.68%), 22(35.38%), and 34(58.84%) respectively. We divided the patients into two groups and compared, the terminal HCC patients with class C as group I and those with class A & B as group 2. The median time from hospice referral to death was significantly short in group 1 with 15.5 days compared to group 2 with 53 days. Statistically more prevalent symptoms in group I were ascites, dyspnea, peripheral edema, and hepatic encephalopathy with abnormal laboratory findings (jaundice, hypoalbuminemia, or renal insufficiency). There, however, was no significant difference in complications and managements during admission between group 1 and 2. Conclusion: Most terminal HCC patients were often accompanied with chronic liver disease. The length of hospice and palliative care for above patients was not enough to attend them. Therefore, we suggest that proper education and information should be provided to physicians, patients, and their family members for effective hospice and palliative care.

• Journal of Hospice and Palliative Care
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• 제19권3호
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• pp.249-255
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• 2016

목적: 췌장암 환자의 90% 이상이 신경성 통증을 앓는 것으로 알려져 있으며 말기 췌장암 환자에서는 통증조절이 매우 중요한 목적 중 하나이다. 케타민은 NMDA 수용체 길항제로서 신경통에 효과가 있는 것으로 알려져 있으며 마약성 진통제의 요구를 감소시켜주는 효과에 대한 연구들이 앞서 진행된 바 있는 약물이다. 본 연구에서는 완화병동에 입원한 췌장암 환자들을 대상으로 케타민의 사용과 관련된 항목들을 알아보고 마약성 진통제를 줄여주는 효과를 나타내는지에 대해 진행한 연구이다. 방법: 2013년 1월부터 2014년 12월까지 서울성모병원완화의학과에 입원한 췌장암 환자 111명에 대한 의무기록을 통하여 케타민을 사용한 그룹(34명)과 사용하지 않은 그룹(77명)에 대해 케타민 사용과 관련된 요인 및 사용 후 모르핀을 포함한 마약성 진통제의 용량 변화를 분석하였다. 결과: 케타민을 사용한 군에서 사용하지 않은 군에 비하여 총 기본 마약성 진통제 사용량(P value 0.001), 하루에 사용한 마약성 진통제의 용량(P value<0.001), 평균 구제 약물의 용량(P value 0.001), 하루 평균 구제 약물 사용 횟수(P value 0.001), 하루 평균 구제 약물을 용량(P value<0.001)이 더 높게 나타났다. 케타민 사용 전후를 비교한 결과 마약성 진통제는 케타민 사용 전(76.1 (${\pm}64.5$))에 비하여 후(89.6 (${\pm}80.9$))에 유의하게 증가한 것으로 확인되었다. 결론: 후향적으로 의무기록 분석을 통해 이루어진 본 연구에서는 더 많은 용량의 마약성 진통제를 요한 환자들이 케타민을 사용한 경향이 확인되었다. 이와 더불어 케타민을 사용함으로 인해 마약성 진통제 요구량이 감소하는 경향은 확인할 수 없었다. 차후 더 많은 환자들과 다양한 종류의 암성 통증을 대상으로 한 완화의료적 목적의 케타민 사용에 대한 연구가 요할 것으로 생각되며 케타민의 사용에 관련된 가이드라인에 대한 논의가 요할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3903-3907
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• 2013

Background: Patients with colorectal cancer are usually treated with chemotherapy, which reduces the number of blood cells, especially white blood cells, and consequently increases the risk of infections. Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by, for example, increasing the numbers of natural killer cells and peripheral blood lymphocytes. However, there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer. The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer, who have received chemotherapy, can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects. Materials and Methods: Sixty-six patients with colorectal cancer in Phichit Hospital, Thailand, were enrolled in a single-blind, randomised-controlled trial. The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period. The control group received standard supportive care only. Assessments were conducted at pre-assessment and at the end of one week of massage or standard care. Changes from pre-assessment to the end of treatment were measured in terms of white blood cells, neutrophils, lymphocytes, CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores. Results: The main finding was that after adjusting for pre-assessment values the mean lymphocyte count at the post-assessment was significantly higher (P=0.04) in the treatment group than in the controls. The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11%. The secondary outcomes were that at the post assessment the symptom severity scores for fatigue, presenting symptom, pain and stress were significantly lower in the massage group than in the standard care controls. Conclusions: Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9853-9857
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• 2014

Background: The morbidity and mortality rate of liver cancer continues to rise in China and advanced cases respond poorly to chemotherapy. Ribosomal protein L24 has been reported to be a potential therapeutic target whose depletion or acetylation inhibits polysome assembly and cell growth of cancer. Materials and Methods: Total RNA of cultured amycin-resistant and susceptible HepG2 cells was isolated, and real time quantitative RT-PCR were used to indicate differences between amycin-resistant and susceptible strains of HepG2 cells. Viability assays were used to determine amycin resistance in RPL24 transfected and control vector and null-transfected HepG2 cell lines. Results: The ribosomal protein L24 transcription level was 7.7 times higher in the drug-resistant HepG2 cells as compared to susceptible cells on quantitative RT-PCR analysis. This was associated with enhanced drug resistance as determined by methyl tritiated thymidine (3H-TdR) incorporation. Conclusions: The ribosomal protein L24 gene may have effects on drug resistance mechanisms in hepatocellular carcinoma HepG2 cells.