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Current Status of Symptom and Pain Control in Cancer Patients Treated with Chemotherapy (화학요법을 받는 암환자의 증상 및 통증조절 현황)

  • Chung, Young;Na, Duck-Mi;Kim, Jin-Sun;Yang, Kyung-Mi
    • Journal of Hospice and Palliative Care
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    • v.6 no.2
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    • pp.144-151
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    • 2003
  • Purpose : The purpose of this study was to identify the current status of symptom and pain control in cancer patients treated with chemotherapy. Methods : The study population consisted of 66 cancer patients treated with chemotherapy and the data was collected by chart audit and using questionnaire from 19 clinicians in an university hospital during the period of August 7 to 24, 2001. The degree of symptom, analgesics type, dose, administration route, and pain control method of cancer patients treated with chemotherapy was investigated. The collected data were analyzed by frequency, percent, mean, and SD using SPSS $PC^+$ program. Results : The number of cancer patients treated with chemotherapy was 66, male 35 (53.0%), female was 31 (47.0%). The largest of age group was $61{\sim}69$(34.8%) years old. Most frequent cancer site was stomach 19 case (28.8%), cole-rectal 17 case (25.8%), urinary 11 case (16.7%) in the respective order. The most common stage of cancer was stage 3, 14 case (29.2%). The most frequent duration of diagnosis was under 3 month, 25 (37.9%). The frequent symptom of cancer patients treated with chemotherapy was marasmus ($2.4193{\pm}1.2220$), pain ($1.9333{\pm}1.2194$), sleep disorders ($1.7142{\pm}1.0384$), personality change ($1.5806{\pm}0.8971$) in the respective order. 3) The analgesics used for pai control were narcotic analgesics 66.2% and nonnarcotic analgesics 33.8%. Pain control method were regular basis+as needed 47.4%, as needed 31.6%, regular basis 21.0% in order. Administration route were oral 50.7%, injection 41.8%, patch 7.5% in order. Conclusion : The most frequent symptom of cancer patients treated with chemotherapy were marasmus and pain. The frequent analgesics was narcotic analgesics but 21% of the clinician regularly prescribed analgesics for pain control. Thus this prescription was insufficient for pain control. Administration route that were used more oral or injection than patch. Based on this evidence, it seemed that more active practice and education about evaluation and pain control of cancer patients treated with chemotherapy are needed.

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Test Execution Variation in Peritoneal Lavage Cytology Could Be Related to Poor Diagnostic Accuracy and Stage Migration in Patients with Gastric Cancer

  • Ki, Young-Jun;Ji, Sun-Hee;Min, Jae Seok;Jin, Sung-Ho;Park, Sunhoo;Yu, Hang-Jong;Bang, Ho-Yoon;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.13 no.4
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    • pp.214-225
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    • 2013
  • Purpose: Peritoneal lavage cytology is part of the routine staging workup for patients with advanced gastric cancer. However, no quality assurance study has been conducted to show variations or biases in peritoneal lavage cytology results. The aim of this study was to demonstrate a test execution variation in peritoneal lavage cytology between investigating surgeons. Materials and Methods: A prospective cohort study was designed for determination of the positive rate of peritoneal lavage cytology using a liquid-based preparation method in patients with potentially curable advanced gastric cancer (cT2~4/N0~2/M0). One hundred thirty patients were enrolled and underwent laparotomy, peritoneal lavage cytology, and standard gastrectomy, which were performed by 3 investigating surgeons. Data were analyzed using the chi-square test and a logistic regression model. Results: The overall positive peritoneal cytology rate was 10.0%. Subgroup positive rates were 5.3% in pT1 cancer, 2.0% in pT2/3 cancer, 11.1% in pT4a cancer, and 71.4% in pT4b cancer. In univariate analysis, positive peritoneal cytology showed significant correlation with pT stage, lymphatic invasion, vascular invasion, ascites, and the investigating surgeon. We found the positive rate to be 2.1% for surgeon A, 10.2% for surgeon B, and 20.6% for surgeon C (P=0.024). Multivariate analysis identified pT stage, ascites, and the investigating surgeon to be significant risk factors for positive peritoneal cytology. Conclusions: The peritoneal lavage cytology results were significantly affected by the investigating surgeon, providing strong evidence of test execution variation that could be related to poor diagnostic accuracy and stage migration in patients with advanced gastric cancer.

A Study on the substance of Eum-Fire(陰火) in Li Dong-yuan(李東垣)'s Eum-Fire theory (이동원(李東垣)이 논한 음화(陰火)의 실질(實質)에 대한 연구)

  • Eun, Seok-Min
    • Journal of Korean Medical classics
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    • v.25 no.4
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    • pp.5-22
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    • 2012
  • Objective : The concept of Eum-Fire(陰火), which was brought up by Li Dong-yuan(李東垣), is such a very ambiguous thing that many medical scholars had tried to understand its real meaning. Trying to understand the real concept of Eum-Fire, this study goes on based on the view that the concept of Eum-Fire in the medical books of Li Dong-yuan was used as being the same thing with the concept of Xim-Fire(心火) and Premier-Fire (相火), and the substance of this kind of fire is the fire in Ximpo(心包) and Myungmun (命門) which works in the system of Ximgye(心系). To verify this view is the main objective of this study. Method : Inquiring into Li Dong-yuan's medical books, this study investigated examples of the uses of the terms of Eum-Fire, Xim-Fire and Premier-Fire, and analyzed the relation between the meanings of these terms. And as a collateral evidence to the main view of this study, this study notes Wang An-dao(王安道)'s reference about Eum-Fire and inquires into the concept of Premier-Fire that was formed by Liu He-jian(劉河間), who had been referred to in Wang An-dao's argument about Eum-Fire. And this study also presents the Chen Shi-duo(陳士鐸)'s view about Eum-Fire that is expected to show a more concrete concept of Eum-Fire than now and seems to deserve to be compared with that of Li Dong-yuan. Result and Conclusion : It could be understood that the concept of Eum-Fire in Li Dong-yuan's books was used as a thing that owns the same substance as a kind of fire with Xim-Fire and Premier-Fire. In this viewpoint it could also be understood that Li Dong-yuan had attached the concepts like Xim-Fire and Eum-Fire to the concept of Premier-Fire, so terms like these could be understood as such concepts that represented the diverse figures of Premier-Fire. And this study also found that the substance of Xim-Fire as a kind of Premier-Fire means the fire of Ximpo and Myungmun that works in the system of Ximgye, which seems to be formerly introduced as a frame of Premier-Fire by Liu He-jian. This study also found the indirect basis of this viewpoint in the books of Chen Shi-duo, and could get a conclusion that Chen Shi-duo's view about Eum-Fire can be regarded as a thing that could show us more concrete matter of Eum-Fire than now.

The Study of MHC class I Restricted CD8+ T Cell Mediated Immune Responses against Mycobacterium tuberculosis Infection: Evidence of M. tuberculosis S pecific CD8+ T Cells in TB Patients and PPD+ Healthy Individuals (MHC class I 분자들에 의해 제시되는 Epitope을 인지하는 CD8+ T 림프구의 결핵균 감염에 대한 면역반응의 연구: 결핵 환자와 PPD+ 건강개체에 존재하는 결핵균 항원에 특정한 CD8+ T세포)

  • Cho, Jang-Eun;Lee, Kyung Wha;Park, Seung Kyu;Cheon, Seon-Hee;Cho, Sang-Nae;Cho, Sungae
    • IMMUNE NETWORK
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    • v.3 no.3
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    • pp.235-241
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    • 2003
  • Background: The protective immunity against tuberculosis (TB) involves both CD4+ T cells and CD8+ T cells. In our previous study, we defined four Mycobacterium tuberculosis derived peptide epitopes specific for HLA-$A^*0201$ restricted CD8+ T cells ($ThyA_{30-38}$, $RpoB_{127-135}$, $85B_{15-23}$, $PstA1_{75-83}$). In this study, we investigated the immune responses induced by these peptide specific CD8+ T cells in latently and chronically infected people with TB. Methods: We characterized these peptide specific CD8+ T cell population present in PBMC of both TB patients and PPD+healthy people using IFN-${\gamma}$elispot assay, intracellular staining and HLA-A2 dimer staining. Results: The frequency of peptide specific CD8+ T cell was in the range of 1 to 25 in $1.7{\times}10^5$ PBMC based on ex vivo IFN-${\gamma}$ elispot assay, demonstrating that these peptide specific CD8+ T cell responses are induced in both TB patients and PPD+ people. Short term cell lines (STCL) specific for these peptides proliferated in vitro and secreted IFN-${\gamma}$ upon antigenic stimulation in PPD+ donors. Lastly, HLA-$A^*0201$ dimer assays indicated that $PstA1_{75-83}$ specific CD8+ T cell population in PPD+ healthy donors is heterogeneous since approximately 25~33% of $PstA1_{75-83}$ specific CD8+ T cell population in PPD+ healthy donors produced IFN-${\gamma}$ upon peptide stimulation. Conclusion: Our results suggest that MHC class I restricted CD8+ T cell mediated immune responses to M. tuberculosis infection are induced in both TB patients and PPD + people; however, the CD8+ T cell population is functionally heterogeneous.

A Systematic Review and Meta-analysis of Sensory Integration Intervention Studies in Children with Cerebral Palsy (뇌성마비 아동의 감각통합 중재 연구에 대한 체계적 고찰과 메타분석)

  • Kim, Eun-Joo;Choi, Yoo-Im
    • Journal of Digital Convergence
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    • v.11 no.4
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    • pp.383-389
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    • 2013
  • The purpose of this study was to investigate evidence-based practice (EBP) for sensory integration (SI) intervention in children with cerebral palsy (CP) through a systematic review and meta analysis. The screening strategy was performed to select studies for analysis after that, a meta-analysis was implemented for calculating the effect size (ES) in group studies. Twenty-four studies were included for a systematic review and included seven case reports, three single-subject designs, and fourteen group experimental design studies(three randomized controlled trials, three two groups nonrandomized studies, and six one group nonrandomized studies). The ES of the experimental group studies was moderate size of 0.272. The results of the ES according to the dependent variables, the ES was the largest in the fine motor development. The effect size of the published papers was greater than the unpublished paper's and two groups nonrandomized studies' size effect was the largest in the design. The ES of the infants was larger than the children. The ES for a period of 8 weeks, the number of five times a week, and time in 90 minutes showed the biggest in SI program. Although the ES of SI intervention in children with CP showed moderate effect, accumulation of research well be needed.

The Equality of Keywords of Journal of KAPD with Medical Subject Headings (대한소아치과학회지의 주요어와 의학주제표목의 일치도)

  • Kim, Eunhee;Kim, Ahhyeon;Shim, Younsoo;Ahn, Eunsuk;Jeon, Eunyoung;An, Soyoun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.43 no.2
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    • pp.123-128
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    • 2016
  • The purpose of this study is to analyze the equality between keywords used in the Journal of the Korean Academy of Pediatric Dentistry and medical subject headings (MeSH). A total of 4,353 English keywords in 1,165 papers from 1998 to 2014 were eligible for this study. We classified them according to equality to MeSH. We assayed patterns of errors in using MeSH, and reviewed frequently used non-MeSH terms. 24.9% of total keywords were completely coincident with MeSH terms, 75.1% were not MeSH terms. The results show that the accordance rate of keywords with MeSH terms in the Journal of the Korean Pediatric Dentistry is at a low level. Therefore, there is a need for authors to understand MeSH more specifically and accurately. Use of proper keywords aligned with the international standards such as MeSH is important to be properly cited. Authors should pay attention and be educated on the correct use of MeSH as keywords.

Mineral Imbalance: Bone Decalcification and Soft Tissue Calcification (무기질 불균형: 골 탈석회화와 연조직 석회화)

  • Jeong, Dae-Won;Lim, Hyun-Sook;Kang, Young-Hee
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.38 no.12
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    • pp.1815-1819
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    • 2009
  • Based on the soft and rigid extents, tissues are mainly divided into two groups in mammals, soft tissues including heart, lung, kidney and brain, and hard tissues including tendon, cartilage, teeth and bone. Among various tissues, bone, a dynamic rigid organ, is continuously remodeled by the opposing functional activity between bone formation by osteoblasts and bone destruction by osteoclasts. Bone protects the soft tissues and provides mineral reservoirs, which can supply the mineral needs of other soft tissues to normally maintain cellular function. While calcification in bone is an important action to fundamentally support the body and protect the soft tissues, calcification in soft tissues, including the heart, aorta, kidney, lung and spleen, results in severe organ damages, eventually causing sudden death. A growing body of evidence indicates that the osteoporotic patient who are aging, post-menopausal, diabetes and chronic kidney disease simultaneously represent a high clinical incidence of soft tissue calcification, illustrating a link between soft tissue calcification and bone decalcification (osteoporosis). This study will review what is currently known about the connection between bone decalcification and soft tissue calcification.

Using morphometrics to unravel species relationships and delimitations in Sorbus pohuashanensis in the Korean peninsula (한반도내 당마가목의 실체와 근연종과의 관계-전형질분석을 중심으로)

  • Park, Soo-Kyung;Gil, Hee-Young;Kim, Hui;Chang, Chin-Sung
    • Korean Journal of Plant Taxonomy
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    • v.43 no.4
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    • pp.300-311
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    • 2013
  • Subalpine species, Sorbus pohuashanensis in the Korean peninsula, which is assumed to be evolved from hybridization between S. commixta and an unknown species based on the flavonoids data. Morphometric analysis was conducted on the basis of 19 leaf and flower (or fruit) characters. A total of 721 samples in 13 populations of Sorbus pohuashanensis and S. commixta from Korea and additional specimens of S. commixta, S. pohuashanensis, and S. wilsoniana from Japan and China were examined to reveal the hybridization patterns and morphological differences. We found a preliminary evidence where Korean mountain rowan is more related to a Chinese inland taxon, S. wilsoniana, rather than Northeastern Chinese S. pohuashanensis in terms of flavonoids. The current morphological structure of the Korean mountaion rowan, however, which is more similar to S. commixta, was neither associated with that of S. wilsoniana nor that of S. pohuashanensis. This indicates that this morphological variation represents an intermediate of S. commixta and S. wilsoniana via a more ancient hybridization event in terms of qualitative characters, such as stipules, buds, and carpels. These morphometric differences together with other distinguishing characteristics suggest that the Korean mountain rowan should be considered as a conspecific species of S. commixta, although this demonstration of hybridization with the current phenetic species concept contradicts longstanding historical species concept.

Chinese Patients with Gastric Cancer Need Targeted Adjuvant Chemotherapy Schemes

  • Shi, Wen-Tao;Wei, Lei;Xiang, Jin;Su, Ke;Ding, Qiong;Tang, Meng-Jie;Li, Ji-Qiang;Guo, Yi;Wang, Pu;Zhang, Jing-Wei
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.10
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    • pp.5263-5272
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    • 2012
  • Background: Gastric cancer (GC) is one of the most common cancers in China. Adjuvant chemotherapy (AC) is a routine auxiliary treatment for GC recommended by the guidelines issued in 2011 by the Ministry of Health of the People's Republic of China, but the relevant credible consequences in China have been insufficient because of China's late start and ethical concerns. Methods: A series of databases, including Cochrane Library, MEDLINE, EMBASE, the Chinese database of the National Knowledge Infrastructure and the VIP database, were searched by 2 reviewers independently for studies investigating AC for GC through March 2012. The retrieved literature was screened according to the eligibility criteria. Results: A total of 35 randomized control trials (RCTs) were subjected to the final analysis, including 4,043 patients in treatment group and 3,884 in the control group, as well as 4 clinical-control trials (CCTs), which accessed the final analysis with 238 and 252 patients, respectively. AC reduced the risk of death as a protective treatment with statistical significance (HR=0.91, 95%CI: [0.85, 0.97], P=0.002), and it seemed more effective for Asian than non-Asian patients. The effects of AC were not influenced by the starting time (P>0.05). D2 lymphadenectomy-based chemotherapy was effective (HR=0.89, 95%CI: [0.80, 0.99], P=0.04). Oral S-1 40 mg/m2 after D2 lymphadenectomy might be a better choice for Asians with advanced GC and might result in a greater reduction of adverse events than in non-Asian patients. GRADE quality assessment determined that the strength of the evidence from foreign studies from Europe, the United States and Asian countries other than China was high, while it was moderate for Chinese studies. Conclusion: AC was effective or even curative in Chinese patients in general, although it is still necessary to optimize a targeted AC scheme for Chinese patients with GC.

영국의 중의학: 의사, 의사가 아닌 시술자, 중국인 시술자

  • Stollberg, Gunnar
    • Journal of Pharmacopuncture
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    • v.6 no.1
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    • pp.14-15
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    • 2003
  • 중의학은 서양의 의료 다원주의의 한 부분이 되었다. 특히 침과 같이 서양의 개념과는 분명히 다른 의료 기법에 있어서는 두드러진다. 그밖에 뜸, 안마, 기공, 중약 및 복합 처방들도 있다. 서양에서 전문직업인화는 보건의료 관련분야에서 중심적인 인력양성 방법이 되었다. 이는 대학이 기반을 다진 중세까지 거슬러 올라가는데, 19세기에는 법인들이 전문직업인 모임으로 바뀌어 가면서 개인적 환경을 변화시키고 직업의 체계를 개발하였다. 변호사, 교사, 사제, 의사가 그 예이다. 의료에 있어서 학교교육을 통해 수련된 의사들이 조산사나 안마사들을 지배하게 되었는데 이런 경향은 1950-60년대에 극에 달한다. 그러다가 이들의 지배는 대중매체, 환자, 다른 주변 의료 보조인력들에 의해 도전을 받는다. 이와 비슷한 양상을 이단적인 의료에서도 관찰할 수 있다. 전문직업인의 우세와 시점이 비슷한 생물의학의 우월적 지배는 많은 다양한 의료에 의해 도전을 받는다. 그러나 생물의학의 우월함의 약세가 시술자들의 전문직업인화 까지를 포함하지는 않았다. 실제로 침술과 같은 치료술들을 전문직업인인 의사나 의사가 아닌 시술자들이 함께 쓰고 있기 때문이다. 이는 직능간의 분쟁을 야기할 가능성이 높다. 이단적 개념을 기존 의료계로 통합하는 것이 전문직업인들인 의사들의 노력으로 이해되었다. 이 견해는 두 가지 문제를 내포하고 있는데, 첫째 의사들을 단일한 속성으로 보고 있다는 것인데, 실제로 현대의학을 배우고 가르치는 나라들 사이에도 매우 다양한 차이가 있음을 간과하고 있다. 둘째로 의료인이 아닌 시술자들도 다양한 분야로 통합되었는데, 통합은 어쩌면 하급의 전문인들의 노력의 결과로 설명되어야 하는 것이 더 알맞을 수 있다. 그러나 이들도 전문직업인의 조직구조를 가져야 만 하고, 그렇지 않으면 파편으로 남을 것이다. 전문직업인주의는 언제나 과학과 연계하고 있는데, 독일 정부와 직업인 조직은 의료과학 집단에게 이단적 시술들의 임상효과를 검증하게 하였다. 이것은 이단 의료계에 우호적인 단체나 적대적인 단체 모두에게 적용되었다. 매우 강한 힘을 가진 냉소적인 조직 가운데 하나는 National Committee of SHI-Physicians and Sickness Funds(Bundesausschuss der Arzte und Krankenkassen).2 인데, 2001년에, 이 단체에서 출판한 자료에는 침의 효용성은 침을 시술하는 사람에 달린 것 일뿐 시술자의 수련이나 침 시술의 배경 개념에 달려있는 것이 아니다. 그러므로 침은 무작위 표본추출 대조군 실험을 통해 효과를 검증받지 못한 다른 치료법들의 범주에 머물러 있다.(cf. Bundesausschuss 2001: 8). 1990년대, 무작위 표본추출 대조군 실험은 생물의학이 아닌 의료의 효과를 검증하는데 알맞지 않고 비윤리적이라고 강한 비판을 받았다. 한편 1995년에 WHO는 침의 유효성 평가를 위해 이 실험기법을 추천하며, 이어 2001년에, the International Council of Medical Acupuncture and Related Techniques(ICMART)는 침연구와 시술을 위한 헌장(Acupuncture Charter Berlin an Evidence Based Medicine (EBM)3 for acupuncture)을 채택 공표한다. 독일 보험 회사들도 침의 효과와 효율성을 검증하기 위해 대규모 실험을 시작했다. 100,000 명이 넘는 환자들이 무작위 표본추출 대조군 실험을 통해 평가되고 있는데 이 실험은 병원이나 일차의료기관의 외래에서 진행되고 있다. 영국에서는 이 분야의 유력한 Edzard Ernst가 위의 개념과 비슷한 구도를 설정 공표하는데 보완의학 분야의 많은 다른 전문가들의 견해를 무릎 쓰고, 그는 증거기반 의학에 대한 그의 신념을 표방한다. "무작위 표본추출 대조군 실험이 보환의학 분야의 시술을 검증하기 위한 알맞은 방법이 아니라고 끝없이 주장하지만 우리는 거의 모든 치료법을 포괄하는 분야에 이들 실험을 발견하였으니, 이는 보완의학도 엄정한 방법으로 검증할 수 있다는 것을 보여준다고 할 수 있다."(Ernst et al. 2001: xiii). 적어도 독일에서 진행중인 효과 검증 연구가 향후 아시아 의학의 기반 마련에 중요한 역할을 하게 될 것이다. 영국에서는 이에 대한 정치적 수렴이 전문 직업인화에 달려 있을 것이다. 여기에서 나는 아시아에서 유래한 의료의 서양에서 어떻게 사회학적 관찰의 대상으로 분류되고 정의되는지 소개하고자 한다.