• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.846-855
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• 1999

Background : Secondary pulmonary hypertension is an important final endpoint in patients with chronic hypoxic lung disease, accompanied by deterioration of pulmonary hemodynamics. The clinical diagnosis of pulmonary hypertension and/or cor pulmonale could be difficult, and simple noninvasive evaluation of pulmonary artery pressures has been an relevant clinical challenge for many years. Doppler echocardiography might to be a more reliable method for evaluating pulmonary hemodynamics in such patients in terms of the accuracy, reproducibility and easiness for obtaining an appropriate echocardiographic window than M-mode echocardiography. The aim of this study was to assess echocardiographic parameters associated with pulmonary arterial hypertension, defined by increasing right ventricular systolic pressure(RVSP), calculated from trans-tricuspid gradient in patients with chronic hypoxic lungs. Method : We examined 19 patients with chronic hypoxic lung disease, suspected pulmonary hypertension under the clinical guidelines by two dimensional echocardiography via the left parasternal and subcostal approach in a supine position. Doppler echocardiography measured RVSP from tricuspid regurgitant velocity in continuous wave with 2.5MHz transducer and acceleration time(AT) on right ventricular outflow tract in pulsed wave for the estimation of pulmonary arterial pressure. Results : On echocardiography, moderate to severe degree of pulmonary arterial hypertension was defined as RVSP more than 40mmHg, presenting tricuspid regurgitation. Increased right ventricular endsystolic diameter and shortened AT were noted in the increased RVSP group. Increased RVSP was correlated negatively with the shortening of AT. Other clinical data, including pulmonary functional parameters, arterial blood gas analysis and M mode echocardiographic parameters were not changed significantly with the increased RVSP. Conclusion : These findings suggest that shortened AT on pulsed doppler can be useful when quantifying pulmonary arterial pressure with increased RVSP in patients with chronic lung disease with hypoxemia. Doppler echocardiography in pulmonary hypertension of chronic hypoxic lungs is an useful option, based on noninvasiveness under routine clinical practice.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.65-74
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• 1999

Background : Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. Methods: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. Results: Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. The in-hospital mortality after OLB was 5.3%(1/19). Conclusion: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.

• Tuberculosis and Respiratory Diseases
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• v.55 no.5
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• pp.488-498
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• 2003

Background : Activation of the transcription factor NF-${\kappa}B$ has been shown to protect cells from tumor necrosis factor-alpha, chemotherapy, and radiation-induced apoptosis. NF-${\kappa}B$-dependent cIAP expression is a major antiapoptotic mechanism for that. NF-${\kappa}B$ activation and cIAP expression in A549 lung cancer cells which is relatively resistant to radiation-induced cell death were investigated for the mechanism of radioresistance. Materials and methods : We used A549 lung cancer cells and Clinac 1800C linear accelerator for radiation. Cell viability test was done by MTT assay. NF-${\kappa}B$ activation was tested by luciferase reporter gene assay, Western blot for $I{\kappa}B{\alpha}$ degradation, and electromobility shift assay. For blocking ${\kappa}B$, MG132 and transfection of $I{\kappa}B{\alpha}$-superrepressor plasmid construct were used. cIAP expression was analyzed by RT-PCR and cIAP2 promoter activity was performed using luciferase assay system. Results : MTT assay showed that cytotoxicity even 48 hr after radiation in A549 cells were less than 20%. Luciferas assay demonstrated weak NF-${\kappa}B$ activation of $1.6{\pm}0.2$ fold compared to PMA-induced $3.4{\pm}0.9$ fold. Radiation-induced $I{\kappa}B{\alpha}$ degradation was observed in Western blot and NF-${\kappa}B$ DNA binding was confirmed by EMSA. However, blocking NF-${\kappa}B$ using MG132 and $I{\kappa}B{\alpha}$-superrepressor transfection did not show any sensitizing effect for radiation-induced cell death. The result of RT-PCR for cIAP1 & 2 expression was negative induction while TNF-${\alpha}$ showed strong expression for cIAP1 & 2. The cIAP2 promoter activity also did not show any change compared to positive control with TNF-${\alpha}$. Conclusion : We conclude that activation of NF-${\kappa}B$ does not determine the intrinsic radiosensitivity of cancer cells, at least for the cell lines tested in this study.

• Tuberculosis and Respiratory Diseases
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• v.63 no.6
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• pp.497-506
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• 2007

Background: The present investigation was performed in rats and isolated human neutrophils in order to confirm the presumptive role of the positive feedback loop of cytosolic phospholipase $A_2$ ($cPLA_2$) activation by plateletactivating factor (PAF). Methods: The possible formation of the positive feedback loop of the $cPLA_2$ activation and neutrophilic respiratory burst was investigated in vivo and in vitro by measurement of the parameters denoting acute lung injury. In addition, morphological examinations and electron microscopic cytochemistry were performed for the detection of free radicals in the lung. Results: Five hours after intratracheal instillation of PAF ($5{\mu}g/rat$), the lung leak index, lung myeloperoxidase (MPO) activity, the number of neutrophils and the concentration of cytokine-induced neutrophil chemoattractant (CINC) in bronchoalveolar lavage fluid were increased by PAF as compared with those of control rats. The NBT assay and cytochrome-c reduction assay revealed an increased neutrophilic respiratory burst in isolated human neutrophils following exposure to PAF. Lung and neutrophilic $cPLA_2$ activity were increased following PAF exposure and exposure to hydrogen peroxide increased $cPLA_2$ activity in the lung. Histologically, inflammatory findings of the lung were observed after PAF treatment. Remarkably, as determined by $CeCl_3$ cytochemical electron microscopy, increased production of hydrogen peroxide was identified in the lung after PAF treatment. Conclusion: PAF mediates acute oxidative lung injury by the activation of $cPLA_2$, which may provoke the generation of free radicals in neutrophils.

• Tuberculosis and Respiratory Diseases
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• v.65 no.4
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• pp.277-284
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• 2008

Background: In principle, cervical tuberculous lymphadenitis (CTBL) is a medical disease that may require surgical treatment, particularly in young women who complain of psychosocial and cosmetic problems. We encountered 13 cases of aggravated CTBL treated surgically despite the appropriate course of antituberculous chemotherapy. We report the clinical characteristis of these cases. Methods: The clinical data of 13 patients with aggravated CTBL requiring surgical treatment from January 2000 to December 2006 at the Department of Chest Medicine, Internal Medicine and Plastic Surgery, National Medical Center was reviewed retrospectively. Results: Twelve of the 13 cases (92%) were female. The most common age was 21~30 years (69%). Multiple nodes were palpated in 11 cases (85%). The supraclavicular lymph nodes were sites the most commonly involved (54%). The other involved sites in the order of decreasing frequency were the jugular chain, posterior cervical, submandibular and infraauricular lymph nodes. A palpable mass was the most commonsymptom. Neck pain was reported in 3 cases (23%). General symptoms such as weight loss, fatigue, anorexia and night sweats were noted in 5 cases (38%). Respiratory symptoms such as cough, sputum, hemoptysis, dyspnea and chest pain were observed in 4 cases (31%). Pulmonary tuberculosis was noted in 11 cases (85%). Other extrapulmonary tuberculosis coexisted in 4 cases (31%). This suggests that surgical CTBLs may be manifestations of a systemic disease and might be difficult to treat. Most cases (92%) were stages 2 and 3 at the initial diagnostic period but all cases fell into stage 4 and 5 when reassesed before surgery. The average duration of anti-TB chemotherapy before and after surgery was 10.2 and 15.2 months, respectively. The 13 patients were followed up until June. 2008. Among them, 2 cases had newly developed CTBL and the other 11cases showed no recurrence. Conclusion: In principle, CTBL is the medical disease. However, despite the appropriate course of anti-TB chemotherapy, CTBL can progress to a more advanced stages and grow rapidly to a large-sized or fistulous mass with a persistent abscess. Surgical treatment may be inevitable for patients with psychosocial and cosmetic problems caused by these masses, particularly in young women.

• Korean Journal of Environment and Ecology
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• v.31 no.5
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• pp.444-454
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• 2017

There are many ongoing studies of infectious diseases as the major factor responsible for global declining of the amphibian population. Although some point out the amphibian rearing facilities like frog farms as one of the important sources of harboring and spreading amphibian infectious pathogens in the wild, there have been few related studies in South Korea. In this study, we investigated the bacterial and fungal colonies on the skin and in the internal organs of frogs and tadpoles collected inside and outside of Dybowski's brown frog farms in Inje, Goesan, and Gongju to compare the difference according to the region and between inside and outside the farm. We also intended to classify the bacteria collected from the tadpoles into species by analyzing 16s rDNA gene sequences. The result showed that the number of bacterial colonies found in the skin and gut of frogs and the number of fungal colonies found in the skin and liver of frogs collected in Goesan was significantly greater than those in the frogs in Inje. However, there was no difference between the frogs collected inside and outside of farms in both regions. In the case of tadpoles, the number of fungal colonies in the tadpoles collected from Gongju was greater than that in the tadpoles collected from Inje. The comparison of inside and outside frog farms showed that there were more bacterial colonies on the skin of the tadpoles collected from inside than outside the frog farm in Inje and more bacterial colonies in the organs of the tadpoles collected from outside than inside the farm in Gongju. The frogs with higher condition factor (body weight/snout-vent length*100) showed fewer bacterial colonies on the skin and fewer fungal colonies in the heart, but there were no significant relationships in tadpoles. We identified the total of 15 genera and four phyla of bacteria, but the difference according to regions and between inside and outside farm was not evident. The result of this study indicates that the different conditions according to the locality of farm and between inside and outside farm cause the difference in the population sizes of bacterial and fungal colonies and that it can affect the overall health condition of Dybowski's brown frogs in the farm. Moreover, the result suggests that effective disease control in the facility is greatly necessary to ensure successful operation of amphibian rearing facility and to prevent the possible spread of diseases from the facility to the wild.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.2
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• pp.206-225
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• 2012

General status of pediatric dentistry in Korea is to conduct vigorous academic activities and specialized medical care centering the Korean Association of Pediatric Dentistry (KAPD) that has about 1,000 pediatric dentists as members, pediatric dentistry departments of 11 Colleges of Dentistry, numbers of pediatric dentistry training institutions and private clinics specialized in children. From 1996, the accredited pediatric dentists were produced by the KAPD and from 2008, the state began to produce the accredited pediatric dentists. Since then, doctors with expertise in pediatric care had opened private clinics in addition to the university hospitals, it became the basis of a momentum to deepen the specialty of pediatric dentistry. The Dentistry community of Korea is going through rapid and profound changes recently, and the underlying reasons for such changes can be classified largely into a few categories: (1) Decreasing population and structural changes in population (2) Increase in numbers of dentists, (3) Changes in the pattern of dental diseases and (4) Changes in medical environment. In Korea, the children population in the age range of 0 ~ 14 years old had been decreased by 2 million in 2010 compared to that of 2000 due to reduction of birth rate. The current population of children in the age range of 0 ~ 4 years old in 2010 takes up 16.2% of the total population, but it is estimated that such percentage would decrease to 8.0% by 2050. Such percentage is largely behind the estimated mean global population of 19.6% by 2050. On the other hand, the number of dentists had been largely increased from 18,000 in 2000 to 25,000 in 2010. And it is estimated that the number will be increased to 41,000 by 2030. In addition, the specialized personnel of Pediatric dentistry had been shown as increased by 2.5 times during past 10 years. For the changes in the pattern of dental diseases, including dental caries, each df rate of 5 years old children and 12 years old children had been decreased by 21.9% and 16.7% respectively in 2010 compared to 2000. Each df Index also had been decreased by 2.5 teeth and 1.2 teeth respectively. The medical expenditure of Korea is less than that of OECD and more specifically, the expenditure from the National Health Plan is less than OECD but the expenditure covered by households is larger than OECD. These facts indicate that it is considered as requiring the coverage of the national health plan to be reinforced more in the future and as such reinforcement needs continuous promotion. In medical examination pattern of Pediatric dentistry, the preventive and corrective treatment were increased whereas the restorative treatment was decreased. It is considered that such change is caused from decrease of dental caries from activation of the prevention project at national level. For the restorative treatment, the restorations in use of dental amalgam, pre-existing gold crowning and endodontic treatment had been decreased in their proportion while the restorative treatment in use of composite resin had been increased. It is considered that such changes is caused by the change of demands from patients and family or guardians as they desired more aesthetic improvement along with socio-economic growth of Korean society. Due to such changes in dentistry, the pediatric dentistry in Korea also attempts to have changes in the patterns of medical examination as follows; It tends to implement early stage treatment through early diagnosis utilizing various diagnostic tools such as FOTI or QLF. The early stage dental caries so called white spot had been included in the subjects for dental care or management and in order to do so, the medical care guidelines essentially accompanied with remineralization treatment as well as minimally invasive treatment is being generalized gradually. Also, centering the Pediatric dentists, the importance of caries risk assessment is being recognized, in addition that the management of dental caries is being changed from surgical approach to internal medicinal approach. Recently, efforts began to emerge in order to increase the target patients to be managed by dentists and to expand the application scope of Pediatric dentistry along with through such changes. The interest and activities of Pediatric dentists which had been limited to the medical examination room so far, is now being expanded externally, as they put efforts for participating in the preventive policy making process of the community or the state, and to support the political theories. And also opinions are being collected into the direction that the future- oriented strategic political tasks shall be selected and researches as well as presentations on the theoretical rationale of such tasks at the association level.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.714-722
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• 1998

Background: Rifampicin (RFP) is a key component of the antituberculous short-course chemotherapy and the RFP resistance is a marker of multi-drug resistant (MDR) tuberculosis. RPoB gene encodes the $\beta$-subunit of RNA polymerase of M. tuberculosis which is the target of RFP. And the mutations of rpoB gene have been found in about 96% of rifampicin resistant clinical isolates of M. tuberculosis. So in order to find a rapid and clinically useful diagnostic method in identifying the RFP resistance, we compared the PCR -line probe method with PCR-SSCP for the detection of the rpoB gene mutation in cultured M. tuberculosis. Methods: 45 clinical isolates were collected from patients who visited Sung Kyun Kwan University Hospital. The RFP susceptibility test was referred to the referral laboratory of the Korean Tuberculosis Institute. 33 were rifampicin resistant and 12 were rifampicin susceptible. The susceptibility results were compared with the results of the PCR-BSCP and PCR-line probe method. Results: We could find rpoB mutations in 27/33(81.8%) RFP-resistant strains by PCR-line probe method, and in 23/33 (69.7%) by PCR-SSCP and there was no significant difference between two methods. There was no mutation in rifampicinn susceptible strains by both methods. Conclusion: PCR-line probe method would be a rapid, sensitive and specific method for the detection of rifampicin resistant Mycobacterium tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.395-403
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• 1993

Background: The cell cycle is composed of a series of steps which can be negatively or positively regulated by various factors. Alteration or inactivation of p53 by mutations, or by its interactions with oncogene products of DNA tumor viruses, can lead to cancer. Mutations of the p53 gene occur frequently in human primary lung cancers and the wild-type p 53 allele is often concomitantly deleted. These suggest that deprivation of suppressive role of the wild-type p53 may ensure tumor cell growth presumable by the mutant p53 gene. Methods: In an attempt to investigate this hypothesis, a mutant p53 gene was immunohistochemically demonstrated in the formalin-fixed paraffin-embedded tissue sections of lung cancers by using a monoclonal antibody p53 (Ab-3 and clone DO7). Results: The expression of p53 (DO7) was found in all four normal lung tissues, four small cell carcinomas, and four non small cell carcinomas in histologic types of lung cancer. In the six normal lung tissues the expressions of p53 (Ab-3) were not found. Contrarily, the expression of p53 (Ab-3) was found in the nuclei of lung cancers among fifteen (46.9%) of thirty-two cases studied. The expression of p53 (Ab-3) was disclosed in three case (37.5%) of eight small cell carcinomas and twelve cases (50.0%) of twenty-four non small cell carcinomas in histologic types of lung cancer. Conclusion: These findings suggest that expression of the mutant p53 is related to the one of events in the pathogenesis of human lung cancer and the role of the other oncogenes might be also related to the development of lung cancers.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.377-387
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• 1996

Background : In 1980, WHO made a definition in which the term "impairment" as applied to the respiratory system is used to describe loss of lung function, "disability" the resulting diminution in exercise capacity. The measurement of pulmonary function during exercise would give us information about overall functional capacity and respiratory performance that would be lacking in tests performed at rest. We conducted this study to investigate the role of resting pulmonary function test and exercise test for assessing impairment/disability in patients with chronic airflow obstruction(CAO). Method : We studied 19 patients with CAO. The spirometry and body plethysmograph were performed in stable condition. And then patients performed a progressive incremental exercise test to a symptom-limited maximum using cycle ergometer. Patients were divided in two groups, severe and non-severe impairment, according to the resting PFTs and compaired each other. A patient was considered to be severely impaired if FVC < 50 %, FEV1 < 40 % or FEV1/FVC < 40 %. Results : 1) The airway obstruction and hypoxemia of severe impairment group were more severe and exercise performance was markedly reduced compairing to non-severe impairment group. 2) The severe impairment group showed ventilatory limitation during exercise test and the limiting symptomes ware dyspnea in 9/10 patients. 3) The impairment and disability of the patients with tuberculous destructed lung were most marked in patients with CAO. 4) The FEV1 was the most prevalent criterion for the determination of severe impairment based on resting PFTs and was the valuable best correlated to V02max(r=0.81, p < 0.001). 5) The sensitivity of exercise limits for predicting severe disability according to resting PFTs was 80 % and specificity 89 %. Conclusion : In patients with severe CAO, FEV1 is a good predictive of exercise performance and impairment measured by resting PFTs can predict a disability by exercise test.