• Title/Summary/Keyword: Yang Hwa Gi

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The Literatual Study on the Wea symptom in the View of Western and Oriental Medicine (위증에 대한 동서의학적(東西醫學的) 고찰(考察))

  • Kim, Yong Seong;Kim, Chul Jung
    • Journal of Haehwa Medicine
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    • v.8 no.2
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    • pp.211-243
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    • 2000
  • This study was performed to investigate the cause, symptom, treatment, medicine of Wei symptom through the literature of oriental and western medicine. The results obtained were as follows: 1. Wei symptom is the symptom that reveals muscle relaxation without contraction and muscle relaxation occures in the lower limb or upper limb, in severe case, leads to death. 2. Since the pathology and etiology of Wei symptom was first described as "pe-yeol-yeop-cho"(肺熱葉焦) in Hung Ti Nei Ching(黃帝內經), for generations most doctors had have accepted it. but after Dan Ge(丹溪), it had been classified into seven causes, damp-heat(濕熱), phlegm-damp(濕痰), deficiency of qi(氣虛), deficiency of blood(血虛), deficiency of yin(陰處), stagnant blood(死血), stagnant food(食積). Chang Gyeng Ag(張景岳) added the cause of deficiency of source qi(元氣). 3. The concept of "To treat Yangming, most of all"(獨治陽明) was emphasized in the treatment of Wei symptom and contains nourishment of middle warmer energy(補益中氣), clearance of yangming-damp-heat(淸化陽明濕熱). 4. Since Nei-ching era(內經時代), Wei and Bi symptom(痺症) is differenciated according to the existence of pain. After Ming era(明代) appeared theory of co-existence of Wei symptom and pain or numbness but they were accepted as a sign of Wei symptom caused by the pathological factor phelgm(痰), damp(濕), stagnancy(瘀). 5. In the western medical point of view, Wei symptom is like paraplegia, or tetraplegia. and according to the causative disease, it is accompanied by dysesthesia, paresthsia, pain. thus it is more recommended to use hwal-hyel-hwa-ae(活血化瘀) method considering damp-heat(濕熱), qi deficiency of spleen and stornach(脾胃氣虛) as pathological basis than to simply differenciate Wei and Bi symptom according to the existence of pain. 6. The cause of Gullian-Barre syndrome(GBS) is consist of two factors, internal and external. Internal factors include asthenia of spleen and stomach, and of liver and kidney. External factors include summur-damp(暑濕), damp-heat(濕熱), cold-damp(寒濕) and on the basis of "classification and treatment according to the symptom of Zang-Fu"(臟腑辨證論治), the cause of GBS is classified into injury of body fluid by lung heat(肺熱傷津), infiltration of damp-heat(濕熱浸淫), asthenia of spleen and kidney(脾腎兩虛), asthenia of spleen and stomach(脾胃虛弱), asthenia of liver and kidney (肝腎兩虛). 7. The cause of GBS is divided by according to the disease developing stage: Early stage include dryness-heat(燥熱), damp(濕邪), phlegm(痰濁), stagnant blood(瘀血), and major treatment is reducing of excess(瀉實). Late stage include deficiency of essence(精虛), deficiency with excess(虛中挾實), and essencial deficiency of liver and kidney(肝腎精不足) is major point of treatment. 8. Following is the herbal medicine of GBS according to the stage. In case of summur-damp(暑濕), chung-seu-iki-tang(淸暑益氣湯) is used which helps cooling and drainage of summer-damp(淸利暑濕), reinforcement of qi and passage of collateral channels(補氣通絡). In case of damp-heat, used kun-bo-hwan(健步丸), In case of cool-damp(寒濕), used 'Mahwang-buja-sesin-tang with sam-chul-tang'(麻黃附子細辛湯合蓼朮湯). In case of asthenia of spleen and kidney, used 'Sam-lyeng-baik-chul san'(蔘笭白朮散), In case of asthenia of liver and kidney, used 'Hojam-hwan'(虎潛丸). 9. Following is the herbal medicine of GBS according to the "classification and treatment according to the symptom of Zang-Fu"(臟腑辨證論治). In the case of injury of body fluid by lung heat(肺熱傷津), 'Chung-jo-gu-pae-tang'(淸燥救肺湯) is used. In case of 'infiltration of damp-heat'(濕熱浸淫), us-ed 'Yi-myo-hwan'(二妙丸), In case of 'infiltration of cool-damp'(寒濕浸淫), us-ed 'Yui-lyung-tang', In case of asthenia of spleen, used 'Sam-lyung-bak-chul-san'. In case of yin-deficiency of liver and kidney(肝腎陰虛), used 'Ji-bak-ji-hwang-hwan'(知柏地黃丸), or 'Ho-jam-hwan'(虎潛丸). 10. Cervical spondylosis with myelopathy is occuered by compression or ischemia of spinal cord. 11. The cause of cervical spondylosis with myelopathy consist of 'flow disturbance of the channel points of tai-yang'(太陽經兪不利), 'stagnancy of cool-damp'(寒濕凝聚), 'congestion of phlegm-damp stagnant substances'(痰濕膠阻), 'impairment of liver and kidney'(肝腎虛損). 12. In treatment of cervical spondylosis with myelopathy, are used 'Ge-ji-ga-gal-geun-tang-gagam'(桂枝加葛根湯加減), 'So-hwal-lack-dan-hap-do-hong-eum-gagam(小活絡丹合桃紅飮加減), 'Sin-tong-chuck-ue-tang-gagam(身痛逐瘀湯加減), 'Do-dam-tang-hap-sa-mul-tang-gagam'(導痰湯合四物湯加減), 'Ik-sin-yang-hyel-guen-bo-tang'(益腎養血健步湯加減), 'Nok-gakyo-hwan-gagam'(鹿角膠丸加減). 13. The cause of muscle dystropy is related with 'the impairement of vital qi'(元氣損傷), and 'impairement of five Zang organ'(五臟敗傷). Symptoms and signs are classified into asthenia of spleen and stomach, deficiency with excess, 'deficiency of liver and kidney'(肝腎不足) infiltration of damp-heat, 'deficiency of qi and blood'(氣血兩虛), 'yang deficiency of spleen and kidney'(脾腎陽虛). 14. 'Bo-jung-ik-gi-tang'(補中益氣湯), 'Gum-gang-hwan'(金剛丸), 'Yi-gong-san-hap-sam-myo-hwan'(異功散合三妙丸), 'Ja-hyel-yang-gun-tang'(滋血養筋湯), 'Ho-jam-hwan'(虎潛丸) are used for muscle dystropy. 15. The causes of myasthenia gravis are classified into 'insufficiency of middle warmer energy'(中氣不足), 'deficiency of qi and yin of spleen and kidney'(脾腎兩處), 'asthenia of qi of spleen'(脾氣虛弱), 'deficiency of qi and blood'(氣血兩虛), 'yang deficiency of spleen and kidney'(脾腎陽虛). 16. 'Bo-jung-ik-gi-tang-gagam'(補中益氣湯加減), 'Sa-gun-ja-tang-hap-gi-guk-yang-hyel-tang'(四君子湯合杞菊地黃湯), 'Sa-gun-ja-tang-hap-u-gyi-eum-gagam'(四君子湯合右歸飮加減), 'Pal-jin-tang'(八珍湯), 'U-gyi-eum'(右歸飮) are used for myasthenia gravis.

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A pilot study on increased blood lead concentration of some foreign workers in lead refining industry (일부 납 제련업 종사 외국인 근로자의 납 노출 실태)

  • Yang, Jeong Sun;Kim, Tae Kyun;Park, In-Jeong;Kim, Min Gi;Lee, Sun Wung;Heo, Kyung-Hwa;Kang, Seong-Kyu
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.18 no.3
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    • pp.248-251
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    • 2008
  • During survey of blood lead concentration of workers who worked in lead refining industry, we found that some foreign workers showed increased blood lead level compared with that of domestic workers. The mean concentration of lead in blood for foreign workers (15%, 13 workers, mean age: 29) was 55.8 ug/dL which was over biological exposure index, while that of Korean workers (85%, 76 workers, mean age: 42) was 28.9 ug/dL. Some other biological markers of lead exposure such as ZPP and ${\delta}-ALA$ also showed elevated levels. Most of foreign workers stayed in dormitories near or in the factories that may cause to let them under the condition of 24 hours exposure of lead. The lack of safety manual on proper prevention of lead exposure in their own language for effective communication may be one of reasons of elevated blood lead concentration of foreign workers.

The study of comparison of Eastern-Western Medicine on the pathological concept of the Pung(風) and the cause and therapy of Jung Pung(中風) showed the following results. (풍(風)의 병리적(病理的) 의미규명(意味糾明)과 중풍(中風)의 원인(原因) 및 치료(治療)에 대한 동서의학적(東西醫學的) 비교(比較).)

  • Kim, Sae-Gil
    • The Journal of Korean Medicine
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    • v.16 no.1 s.29
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    • pp.96-117
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    • 1995
  • 1. The Pung(風) is the necessary power for growth and maintenance of life. 2. The characteristics of the Pung(風) is the Yang evil, the features for opening and excretion, mobility and rapid change. That is the major cause of all diseases, and its mobility is the main character. 3. Jung Pung(中風) is the same concept of apoplexy in Western medicine. 4. Jung Pung(中風) is classified on the basis of pathology, anatomy, and histology in Western Medicine, but In Oriental Medicine that is classified on the basis of symptom and severity of disease. 5. In Western Medicine, Jung Pung(中風) was regarded as the local cause of disease, but in Oriental Medicine regarded as the physiological changes caused by the weakness of the whole body. 6. In the emergency care, the method of GaeKeum is compared to Levin tubing, the method of to the use of urokinase for the promotion of cerebrovascular circulatio, and the method of To(吐法) to suction for the elimination of Dam(痰), the method of Hun(熏法) to the use of solution for the improvement of circulation. 7. With the comparison of the cause and diagnosis, the hemorrhagic disease and infarction were regarded as the major agents in Western Medicine and the symptom appeared in the patient was the standard of diagnosis and therapy in Oriental Medicine. 8. In the Western therapy of cerebral hemorrhage, the method of coagulation and hemostasis was used for the elimination of hematoma and cerebral edema, but in Oriental Medicine, the method of YanghaelGiHael(凉血止血) was used for descending the PungHwa(風火) and hemostasis. 9. In the period of recovering injury, the physical therapy was underlined for the recovering of partial function in Western Medicine, the method of accupuncture and drug therapy was adapted for the normal function of the whole body.

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Establishment and Selection of Indicator Materials for Cervi Parvum Cornu Pharmacopuncture

  • Yang, Kyu-Jin;Lee, Ki-Beom;Kim, No-Hyeon;Kim, Tae-Gyu;Gi, Yu-Mi;Joo, Hwan-Soo;Suh, Chang-Yong;Lee, In-Hee;Chung, Hwa-Jin;Ha, In-Hyuk;Lee, Jae-Woong
    • Journal of Acupuncture Research
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    • v.34 no.4
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    • pp.180-184
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    • 2017
  • Background: Recently, Cervi Parvum Cornu pharmacopuncture has been widely used. But no studies on the indicator materials for Cervi Parvum Cornu pharmacopuncture have been conducted. The aim of this study was to select indicator materials that would aid in the uniform preparation of standardized Cervi Parvum Cornu pharmacopuncture. Methods: Three lots of Cervi Parvum Cornu pharmacopuncture were analysed. Each lot was prepared using the same methods and materials. Chondroitin sulfate, alanine, and leucine were selected as the indicator materials for Cervi Parvum Cornu. For standardization, chondroitin sulfate analysis was performed using the colorimetric method, while alanine and leucine were analyzed using liquid chromatography-mass spectrometry (LC-MS). Results: Analysis of the three lots of Cervi Parvum Cornu pharmacopuncture found chondroitin sulfate levels of $108.9{\pm}17.3ug/ml$, $118.8{\pm}5.0ug/ml$ and $112.3{\pm}11.9ug/ml$. Alanine levels were $44.9{\pm}2.8ug/ml$, $44.6{\pm}0.3ug/ml$, and $43.9{\pm}0.2ug/ml$. Leucine levels were $29.6{\pm}0.7ug/ml$, $29.0{\pm}0.1ug/ml$, and $29.4{\pm}0.1ug/ml$. Conclusion: These results suggest that chondroitin sulfate, alanine, and leucine may be useful for the standardization of Cervi Parvum Cornu pharmacopuncture.

How to Measure the User Experience? (사용자 경험 측면에서 제품을 평가하는 방법 : 심층 인터뷰, 설문 방법론을 이용한 새로운 평가 방법론)

  • Lee, Ki-Ho;Lee, In-Seong;Jun, Suk-Won;Yang, Seung-Hwa;Choi, Gi-Woong;Kim, Jin-Woo;Park, Seung-Yong;Han, Myung-Hee
    • 한국HCI학회:학술대회논문집
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    • 2008.02b
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    • pp.1-6
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    • 2008
  • 최근 제품이나 서비스를 기획할 때, 사용자 경험 (User Experience)의 측면에 대한 고려를 해야 한다는 이야기가 많아지고 있다. 이는 기능이나 성능을 결정할 때 기능 추가, 몇 %의 성능 상승같이 좁은 방법으로 제품이나 서비스의 기획의 방향을 결정하는 것이 아니라, 사용자가 그 기능이나 성능에서 대해서 어떻게 느끼고, 기능이나 성능을 통해서 어떤 경험을 했는지에 대한 전반적인 고려가 필요하다는 것을 여러 분야에서 공감하고 있다는 증거라 하겠다. 그러나 사용자 경험이라는 개념이 명확하게 정의되어 있지 않고, 그에 대한 실증적인 연구가 부족하여, 더 나은 사용자 경험을 제공하기 위해서 어떤 노력이 필요한지에 대해서 명확하고 쉽게 파악하기 어려운 실정이다. 기존의 HCI 분야에서는 제품이나 서비스를 평가할 때 사용성 (Usability)에 초점을 맞추어서 사용성 평가 (Usability Testing)를 통해서 정량적으로 문제점을 조사하는 방법론에 대한 연구가 많이 이루어졌다. 그러나 이러한 사용성 평가 는 사용자들의 과업 수행 시간, 과업 수행 여부 등 사용자들이 제품이나 서비스를 통해서 진행하는 결과에 대한 성능 (Performance)에 주목하고 있어서 전반적인 사용자 경험을 중요시하는 현재 HCI 가 가야 할 방향과 현업의 필요와는 부합하지 않는다고 할 수 있다. 본 논문에서는 심층 인터뷰를 통해서 사용자에게 제품 경험에 있어서 중요한 요소를 찾아내고, 각 요소를 이용하여 제품에 대한 사용자의 전반적인 경험을 설문으로 물어본 후 구조방정식 모형분석을 통하여 각 경험 요소의 가중치를 도출하였다. 또한 이러한 가중치를 바탕으로 핸드폰, MP3 플레이어, LCD TV, 냉장고의 실제 제품 평가에 적용하여 사용자 경험을 바탕으로 한 제품 평가를 진행하였다. 또한 이러한 방법론을 한국뿐만 아니라 러시아, 독일, 인도의 사용자들에게도 같은 방식으로 진행하여 실증적으로 본 연구에서 개발된 방법론이 가능한지 여부를 확인하였다.

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Clinical Study of Oriental Medical Treatment 1 Case of Patient with Oral Dyskinesia (토농설(吐弄舌) 환자(患者) 1례(例)에 대한 임상적(臨床的) 고찰(考察))

  • Hwang, Kyu-Jeong;Yang, Gi-Young;Jang, Suk-Gun;Kim, Young-Hwa;Hong, Kwon-Eui;Lee, Hyun;Lee, Byung-Ryul
    • Journal of Acupuncture Research
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    • v.19 no.1
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    • pp.262-269
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    • 2002
  • By process of trearment for case diagnosed as Oral Dyskinesia and admitted from the 3lth, July, 2001 to the 1st, September, 2001, the results are as follows. Method and Results : This patient was diagnosed as Oral Dyskinesia of Shaoyang disease with interior syndrome that was based by disorder of hepatic qi, medicated shihogayonggolmoreutang(shihujiayonggumolie-tang), gamisoyo-san(jiaweishaoyao-san) and acupun - cturetherapy was taken on proximal and disital acupoints including Yingu(B10, 陰谷), Zulingyi(G41, 足臨泣), Jianshi(P5, 間使), Shenmen(H6, 神門), Sanyinjiao(Sp6, 三陰交), Yi - ntang(Extra point, 印堂), Lianquan(CV23, 康泉), Qihai(CV6, 氣海) and Danhange(Damhangyuk, 膽寒格), Ganjeongge(ganjeonggyuk, 肝正格), Pizhengge(Bijeonggyuk, 脾正格) of Shayen - zhenfa(Shayamchimbeop, 舍岩鍼法). Conclusion : I consider that psychosomatic tremer disease including Oral Dyskinesia can improved by Oriental medical treatment and continuous research must be accumulated subsequently.

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The Literature Study on Correlation between Wushijiuyu(五十九兪) and Fangfengtongshengsan(防風通聖散) for the Treatment of Fever Disease ($\ll$황제내경(黃帝內經)$\gg$의 열병(熱病) 치료혈(治療穴)과 방풍통성산(防風通聖散)의 이론적 상관성에 관한 연구)

  • Jung, Mi-Kyung;Yun, Jong-Hwa;Park, Hyun-Guk;Kim, Gi-Wook;Jang, Min-Gee;Lee, Seung-Deok;Kim, Kap-Sung
    • Journal of Acupuncture Research
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    • v.25 no.5
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    • pp.1-16
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    • 2008
  • Backgrounds : There have not been so many studies about the correlation of logical background between acupuncture and herbal medicine. Objectives : This study was aimed to find out the logical relationship between acupuncture points of Wushijiuyu(五十九兪) and Fangfengtongshengsan(防風通聖散) for the treatment of fever disease. Methods : I investigated the background of rationale of Wushijiuyu(五十九兪) and Fangfengtongshengsan(防風通聖散) through survey of classical text include Yellow Emperor's Classic of Medicine(.帝.經內經, Hwang Di Nei Jing), Liujing(類經), Zhenjiujiayijing(鍼灸甲乙經) and Huangdisuwenxuanmingfanglun(黃帝素問宣明方論). Results & Conclusions : The words "Wushijiuyu(五十九兪) and Wushijiuci(五十九刺)" are founded in the Yellow Emperor's Classic of Medicine(黃帝內經) are either prescription of the acupuncture points for the treatment of fever disease. However, acupuncture points of two methods are not same. According to Liujing(類經), Wushijiuyu(五十九兪) have used acupuncture points located in head, upper and lower extremities, trunk, and back. However Wushijiuci(五十九刺) just select acupuncture points of head and extremities without those of trunk and back. Acupuncture points located in yang meridian(45points) and Dumai(督脈, 5points) are significantly used more than those of yin meridian(8 points) and Renmai(任脈, 2points) in Wushijiuyu(五十九兪) and Wushijiuci(五十九刺). The distribution of acupuncture points used Wushijiuyu(五十九兪) have closer correlation with Fangfengtongshengsan(防風通聖散) than Wushijiuci(五十九刺) in the prescription.

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A high response to controlled ovarian stimulation induces premature luteinization with a negative impact on pregnancy outcomes in a gonadotropin-releasing hormone antagonist cycle

  • Koo, Hwa Seon;Cha, Sun Hwa;Kim, Hye Ok;Song, In Ok;Min, Eung Gi;Yang, Kwang Moon;Park, Chan Woo
    • Clinical and Experimental Reproductive Medicine
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    • v.42 no.4
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    • pp.149-155
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    • 2015
  • Objective: The goal of this study was to investigate the relationship between serum progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration and the pregnancy rate among women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) using a flexible antagonist protocol. Methods: This prospective study included 200 IVF and ICSI-ET cycles in which a flexible antagonist protocol was used. The patients were divided into five distinct groups according to their serum P4 levels at the time of hCG administration (0.80, 0.85, 0.90, 0.95, and 1.00 ng/mL). The clinical pregnancy rate (CPR) was calculated for each P4 interval. Statistically significant differences were observed at a serum P4 level of 0.9 ng/mL. These data suggest that a serum P4 concentration of 0.9 ng/mL may represent the optimal threshold level for defining premature luteinization (PL) based on the presence of a significant negative impact on the CPR. Results: The CPR for each round of ET was significantly lower in the PL group defined using this threshold (25.8% vs. 41.8%; p=0.019), and the number of oocytes retrieved was significantly higher than in the non-PL group ($17.3{\pm}7.2$ vs. $11.0{\pm}7.2$; p=0.001). Elevated serum P4 levels on the day of hCG administration were associated with a reduced CPR, despite the retrieval of many oocytes. Conclusion: Measuring serum P4 values at the time of hCG administration is necessary in order to determine the optimal strategy for embryo transfer.

Response Activities for Tar Ball Pollution from the 'Hebei Spirit' Oil Spill in the Southwestern Sea of Korea (서남해역에서 허베이스피리트호 원유유출 사고에 의해 생성된 타르볼 방제작업)

  • Cho, Hyun-Jin;Kim, Jeong-Yeop;Yang, Mun-Chul;Seo, Kang-Ryul;Min, Nam-Gi;Im, Sung-Huk;Jeon, Sung-Gun;Kim, Hee-Sik;Kim, Young-Hwa;Kim, Gi-Hun;Chang, Sun-Hee
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.12 no.4
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    • pp.279-283
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    • 2009
  • Approximately 12,547 kL of oil from the tanker 'Hebei Spirit' released into the western sea of Korea, which subsequently reached and covered extensive areas of the western coastlines of Korea. In the following days great numbers of tar balls hit the southwestern coast. Three different cleanup methods were used to mediate the southwestern coastline tar ball pollution by Korea Coast Guard (KCG) net setting, manual pick up, and sweeping them up. Net setting was useful in protecting coastlines from being hit by tar balls. The cold weather in winter conditions helped the tar ball response efforts because it caused them to harden, allowing them to be swept up from beaches and to be gathered up by hand.

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Periodontal pathogens and the association between periodontitis and rheumatoid arthritis in Korean adults

  • Kim, Jin-Hee;Choi, In Ah;Lee, Joo Youn;Kim, Kyoung-Hwa;Kim, Sungtae;Koo, Ki-Tae;Kim, Tae-Il;Seol, Yang-Jo;Ku, Young;Rhyu, In-Chul;Song, Yeong Wook;Lee, Yong-Moo
    • Journal of Periodontal and Implant Science
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    • v.48 no.6
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    • pp.347-359
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    • 2018
  • Purpose: Periodontitis and rheumatoid arthritis (RA) share a similar inflammatory pathogenesis. Porphyromonas gingivalis (Pg) can induce anticyclic-citrullinated peptide autoantibodies (anti-CCP antibodies), a key factor in the development of RA. This study aimed at evaluating the relationships between the 2 diseases and identifying the clinical implications thereof, with a focus on periodontal pathogens in Korean adults. Methods: A total of 260 RA patients and 86 age- and sex-matched control patients without arthritis were enrolled in this prospective cross-sectional study. Periodontal indices and the prevalence and amount of periodontal pathogens were compared between the groups. Correlations between periodontal and RA indices were examined, as were correlations between 9 periodontal pathogens and RA indices. Results: The RA group had significantly higher values than the control group for all investigated periodontal indices (P<0.05) except the number of teeth. The gingival index (GI) was correlated with the disease activity score 28 (DAS28) (r=0.125, P=0.049), RA disease duration (r=0.253, P<0.001), erythrocyte sedimentation rate (ESR) (r=0.162, P=0.010), and anti-CCP antibody titer (r=0.205, P=0.004). Probing pocket depth (PPD) was correlated with ESR (r=0.139, P=0.027) and anti-Pg antibody titer (r=0.203, P=0.001). Bleeding on probing (BOP) was correlated with DAS28 (r=0.137, P=0.030), RA disease duration (r=0.202, P=0.001), ESR (r=0.136, P=0.030), anti-Pg antibody titer (r=0.177, P=0.005), and anti-CCP antibody titer (r=0.188, P=0.007). Clinical attachment level (CAL) and periodontitis severity were correlated with anti-Pg antibody titer (the former r=0.201, P=0.002; the latter r=0.175, P=0.006). The quantity of Pg was positively correlated with the serum anti-Pg antibody titer (r=0.148, P=0.020). Conclusions: The GI, BOP, and PPD showed positive relationships with several RA indices. The anti-Pg antibody titer had positive relationships with PPD, BOP, CAL, and periodontitis severity. Thus, increasing values of periodontal indices could be used as a risk indicator of disease development in RA patients, and an increasing anti-Pg antibody titer could be considered as a warning sign in RA patients suffering with periodontitis.