Clinical Significance of Erosive or Ulcerative Lesions Isolated in Terminal Ileum

( Sun Ok Kwon ),( You Sun Kim ),( Myoung Ki Oh ),( Sun Young Kim ),( In Hye Cha ),( Seong Yeon Jeong ),( Joo Yeon Cho ),( Jin Nam Kim ),( Jeong Seop Moon ) 대한장연구학회 2012 Intestinal Research Vol.10 No.4

Background/Aims: Although terminal ileal erosive or ulcerative lesions are frequently observed on colonoscopic examination, their clinical significance are unclear. We evaluated clinical course and significance of isolated terminal ileal erosive or ulcerative lesions. Methods: We retrospectively analyzed clinical features, number, size and histologic findings of 186 patients with isolated terminal ileal erosive or ulcerative lesions on colonoscopic examination from December 2003 to February 2012. Results: The indications for colonoscopy included screening for colorectal cancer or surveillance in 122 patients (65.6%), evaluations for symptoms in 64 patients (34.4%). Of the 186 patients, 170 underwent biopsy at the terminal ileal lesions. Histologic findings were mostly non-specific chronic inflammation except two cases of Crohn`s disease, one case of cytomegalovirus ileitis, and one case of intestinal tuberculosis. Forty six patients underwent follow-up colonoscopy and the mean duration was 17.8±14.2 months (range, 1-64 months). Of those who showed non-specific ileitis (44 patients), 35 (79.5%) showed resolution of lesions without specific treatment. In the remaining 9 (20.5%) patients, lesions were continued and two patients were diagnosed as Crohn`s disease and Behcet`s ileitis, respectively. There were no significant differences in the duration of follow-up, presence of symptoms, number and size of terminal ileal lesions between the patients who resolved and not resolved. Conclusions: Most isolated terminal ileal erosive or ulcerative lesions reveal non-specific histological findings and have a propensity to resolve without treatment. However, in small portions of patients, isolated terminal ileal lesions need careful attention because it is possible to be early inflammatory bowel diseases. (Intest Res 2012;10:350-356)

말단 회장에 국한된 미란 혹은 궤양 병변의 임상적 의의

권선옥,김유선,오명기,김선영,차인혜,정성연,조주연,김진남,문정섭 대한장연구학회 2012 Intestinal Research Vol.10 No.4

Background/Aims: Although terminal ileal erosive or ulcerative lesions are frequently observed on colonoscopic examination, their clinical significance are unclear. We evaluated clinical course and significance of isolated terminal ileal erosive or ulcerative lesions. Methods: We retrospectively analyzed clinical features, number, size and histologic findings of 186 patients with isolated terminal ileal erosive or ulcerative lesions on colonoscopic examination from December 2003 to February 2012. Results: The indications for colonoscopy included screening for colorectal cancer or surveillance in 122 patients (65.6%), evaluations for symptoms in 64 patients (34.4%). Of the 186 patients, 170 underwent biopsy at the terminal ileal lesions. Histologic findings were mostly non-specific chronic inflammation except two cases of Crohn’s disease, one case of cytomegalovirus ileitis, and one case of intestinal tuberculosis. Forty six patients underwent follow-up colonoscopy and the mean duration was 17.8±14.2 months (range, 1-64 months). Of those who showed non-specific ileitis (44 patients), 35 (79.5%) showed resolution of lesions without specific treatment. In the remaining 9 (20.5%) patients, lesions were continued and two patients were diagnosed as Crohn’s disease and Behcet’s ileitis, respectively. There were no significant differences in the duration of follow-up, presence of symptoms, number and size of terminal ileal lesions between the patients who resolved and not resolved. Conclusions: Most isolated terminal ileal erosive or ulcerative lesions reveal non-specific histological findings and have a propensity to resolve without treatment. However, in small portions of patients, isolated terminal ileal lesions need careful attention because it is possible to be early inflammatory bowel diseases. 목적: 대장내시경검사에서 말단 회장의 미란 또는 궤양 병변이 간혹 발견되나, 그 임상적 의미는 명확하지 않다. 이에 저자들은 말단 회장에국한되어 관찰되는 미란 혹은 궤양 병변의 임상 경과 및 의미에 대하여 알아보고자 하였다. 방법: 2003년 12월부터 2012년 2월까지 시행한 대장내시경검사 중 말단 회장에서만 미란 혹은 궤양 병변이 관찰된 186명을 대상으로 임상양상, 병변의 수, 크기, 조직소견 등을 후향적으로 분석하였다. 결과: 대장내시경검사의 원인으로는 대장암 선별검사인 경우가 122명(65.6%), 증상에 대한 검사인 경우가 64명(34.4%)이었다. 186명 중170명에서 조직검사가 시행되었다. 크론병 2예, 거대세포바이러스 회장염 1예, 장결핵 1예가 진단되었고 그 외 나머지는 모두 비특이적 만성염증 소견을 보였다. 46명이 추적 대장내시경을 시행받았으며 평균기간은 17.8±14.2개월(1-64개월)이었다. 비특이적 회장염을 보인 44명중 35명(79.5%)은 특별한 치료 없이 병변이 호전되었다. 나머지 9명(15.2%)은 미란이 여전히 관찰되었으며, 크론병 1예, 베체트 장염 1예가진단되었다. 호전된 환자군과 호전되지 않은 환자군 간의 추적관찰 기간, 증상의 유무, 말단 회장 병변의 개수, 크기에는 유의한 통계적 차이가 없었다. 결론: 말단 회장에 국한되어 관찰되는 미란 또는 궤양의 대부분은 비특이적인 조직병리 소견을 나타내며, 치료 없이도 호전되는 경향을 보인다. 그러나, 말단 회장에 국한된 병변을 가진 일부 환자에서는 염증성 장질환의 초기 병변일 가능성이 있으므로 주의깊은 관찰이 필요하다.

Expression of the C-terminal of 34kDa protein of Mycobacterium paratuberculosis

김두,박형욱,Kim, Doo,Park, Hyung-wook The Korean Society of Veterinary Science 2000 大韓獸醫學會誌 Vol.40 No.1

Paratuberculosis (Johne's disease), a chronic enteritis produced by Mycobacterium paratuberculosis, affects a large proportion of ruminants in all continents and causes important economic losses. The identification of well-characterized and species-specific components of M paratuberculosis would provide the means to improve the specificity and sensitivity of immunodiagnostic assays for Johne's disease. The aims of this study were to express the recombinant C-terminal of 34kDa protein (rC34P) of M paratuberculosis in E coli and to investigate the effectiveness of this protein in detecting antibodies to the native protein in sera from paratuberculosis infected cattle. The C-terminal of the gene encoding the 34kDa protein was amplified by polymerase chain reaction from the chromosomal DNA of M paratuberculosis (ATCC 19698) and cloned into vector pGEX-4T-2. Then, cloned plasmid was transformed into E coli DH5${\alpha}$ and the rC34P was overexpressed. The rC34P was purified by affinity chromatography and gel filtration. The rC34P was examined antigenicity by Western blot. The rC34P was reactive with culture positive bovine serum and hyperimmune rabbit anti-M paratuberculosis serum but was not reactive with culture negative bovine serum and tuberculin positive bovine serum in Western blot. In conclusion, the rC34P produced in this study is expected as a useful candidate for antigen in serological diagnosis of Johne's disease.

Synapses in neurodegenerative diseases

( Jae Ryul Bae ),( Sung Hyun Kim ) 생화학분자생물학회(구 한국생화학분자생물학회) 2017 BMB Reports Vol.50 No.5

Synapse is the basic structural and functional component for neural communication in the brain. The presynaptic terminal is the structural and functionally essential area that initiates communication and maintains the continuous functional neural information flow. It contains synaptic vesicles (SV) filled with neurotransmitters, an active zone for release, and numerous proteins for SV fusion and retrieval. The structural and functional synaptic plasticity is a representative characteristic; however, it is highly vulnerable to various pathological conditions. In fact, synaptic alteration is thought to be central to neural disease processes. In particular, the alteration of the structural and functional phenotype of the presynaptic terminal is a highly significant evidence for neural diseases. In this review, we specifically describe structural and functional alteration of nerve terminals in several neurodegenerative diseases, including Alzheimer`s disease (AD), Parkinson`s disease (PD), Amyotrophic lateral sclerosis (ALS), and Huntington`s disease (HD). [BMB Reports 2017; 50(5): 237-246]

파킨슨병 환자를 대상으로 한 태극권 요법 -임상 연구 경험을 통해 본 문제점과 개선 방안-

황의형,이재혁,이상재,허광호,조현우,Hwang, Eui-Hyoung,Lee, Jae-Hyeok,Lee, Sang-Jae,Heo, Kwang-Ho,Cho, Hyun-Woo 대한예방한의학회 2012 대한예방한의학회지 Vol.16 No.2

Objectives : This study was to analyse the reasons for the early termination of our clinical trials that were to know the influences of Tai-chi on non-motor symptoms of Parkinson's disease. Methods : We stopped the primary study of Tai-chi to observe the changes of non-motor symptoms of Parkinson's disease. So we carried out the survey to our participants of clinical trials. We conducted the survey about the patient's characteristics of usual exercise, experience of Tai-chi, appropriate time allocation, difficulties of proceeding the program and patient's opinion for the improvement of education. And the 4 questions about the contributiveness of Tai-chi for the Parkinson's disease, usability of supplied references, difficulties and time allocation of education were using the questionaries form of 5-point scale(Likert scale). Results : The results of survey showed that the benefits of Tai-chi program for the improvement of symptoms was $3.15{\pm}0.89$ and difficulty of lecture was $3.76{\pm}1.09$. 41% of participants answered that the motions of the Tai-chi is difficult to follow and 17% of participants felt the imbalance during the motion of Tai-chi. Conclusions : Participants replied that the Tai-chi is hard for the patients of Parkinson's disease and the time for the education was too short to keep doing exercise. Thus we have plan to educate the patients of Parkinson's disease with Tai-chi program consists of easier motion by developing ourselves or searching previous studies.

무의미한 연명의료의 중단과 존엄사의 제 문제

문성제 법조협회 2009 法曹 Vol.58 No.6

Modern medicine started from struggles for overcoming a variety of incurable diseases and has made steady and successful efforts to liberate human being from suffering of diseases, but involves unprecedented side effects as well, including those related to holistic medicine primarily for terminal diseases. On the one hand, the advancement of medical science and technologies has its own implications in a sense that it contributed to prolonging the life of patients. On the other hand, physical and mental pain patients feel has robbed terminal patients of even their own dignity. In this context, patients' self-determination right for death of dignity is to give a chance to terminal patients to opt for liberate themselves from overplus of pain. And this study focuses primarily on discussing how to resolve potential conflicts concerned with those issues of life. In order to respect the self-determination of patients, American judicial precedents and legislation has permitted patients' right to deny any medical treatment for prolonging life, i.e. passive euthanasia(easy death) since 1970's, to the certain extent allowable legally. In particular, Oregon Death with Dignity Act has acknowledged that terminal patients may commit physician-assisted suicide. Such a physician-assisted suicide of patients becomes a new way of death which has been never discussed in terms of active euthanasia since 1990's. Unlike passive euthanasia in which physician administers lethal dose of medicine to a patient for the purpose of his death, the active euthanasia is a mean for patients to use such lethal dose of medicine as prescribed by physician at their option for suicide. Crucial difference between active and passive euthanasia can be determined by whether ultimate behavior causing death of a patient is committed by physician or the patient himself. Thus, it is found that active euthanasia has faced relatively low objections against legitimation of physician-assisted suicide of patients in a sense that ultimate behavior to cause death of a patient is attributed to the patient himself, so it is easier for active euthanasia to attribute the death of a patient to his own responsibility than passive euthanasia, and the former also has relatively low risk of misuse or abuse in comparison with the latter. In reality, it is obvious that physician-assisted suicide of patients is an issue unacceptable among the public, since physician's behavior for active euthanasia may face other legal responsibilities such as aiding and abetting suicide as provided in criminal law. However, there have been proposed needs for exemption from any legal responsibility for physician-assisted suicide of terminal patients in respect of their self-determination right, as mentioned above. In order reflect such needs and perspectives on local legislation, the Oregon state(USA) has newly established and enforced the Oregon Death with Dignity Act. The ultimate purpose of this study is to address historical backgrounds concerned with legislation of the Oregon Death with Dignity Act as well as major legal contents in said act to examine the issues about death of dignity, which may be pointed out in terms of hospice medicine in the future, and thereby consider potential problems concerned with death of dignity. 서울서부지방법원 2008가합6977사건 판결에서 무의미한 연명의료장치의 제거를 청구한 원고들의 주장을 받아들임으로써 무의미한 연명의료와 관련된 소극적 안락사에 대한 사회적 논의를 야기하였다. 현대 의료기술의 발전은 치유 불가능한 말기환자들에게 있어 생명연장이 가능하게 되었다는 점에서는 큰 의미를 부여할 수 있으나, 연명만을 위한 무의미한 의료를 통하여 환자들이 받는 육체적·정신적인 고통은 생명연장의 기쁨보다 인간으로서 존엄마저 상실시킬 수 있음이 지적됨에 따라, 환자들에게 스스로 고통으로부터 해방할 수 있는 선택권을 부여해야 한다는 주장이 제기되기에 이르렀는데 이것이 바로 소극적 안락사와 존엄사의 제 문제이다. 제 외국의 경우 치유 불가능한 말기환자에 대하여 치료중단으로 인한 소극적 안락사를 인정하려는 추세이며, 존엄사는 유일하게 미국 오리건 주에서 존엄사법을 제정하여 시행하고 있다. 우리나라 2008가합6977 판결은 무의미하게 연명만을 위한 의료에서 나타나는 문제에 대한 해결의 대한 방향성을 제시하였다는 점에서 매우 의미 있는 판결이다. 그러나 본 판결이 우리 사회에서 보다 설득력을 갖기 위해서는 의료와 환자의 자기결정권의 갈등의 문제를 어떻게 조화시키느냐에 따라 그 방향성이 정해질 것으로 본다. 이 같은 문제의식을 가지고 본 연구는 치유 불가능한 환자와 의료상의 제 문제를 중심으로 무의미한 연명의료장치의 제거와 환자의 자기결정 및 의사표시에 관한 제반문제를 검토하고 미국 오리건 주의 존엄사법의 주요 내용과 그 이후의 동향을 살펴보았다.

무의미한 연명의료의 중단과 존엄사의 제 문제

문성체 ( Seong Jea Moon ) 법조협회 2009 法曹 Vol.58 No.6

Modern medicine started from struggles for overcoming a variety of incurable diseases and has made steady and successful efforts to liberate human being from suffering of diseases, but involves unprecedented side effects as well, including those related to holistic medicine primarily for terminal diseases. On the one hand, the advancement of medical science and technologies has its own implications in a sense that it contributed to prolonging the life of patients. On the other hand, physical and mental pain patients feel has robbed terminal patients of even their own dignity. In this context, patients` self-determination right for death of dignity is to give a chance to terminal patients to opt for liberate themselves from overplus of pain. And this study focuses primarily on discussing how to resolve potential conflicts concerned with those issues of life. In order to respect the self-determination of patients, American judicial precedents and legislation has permitted patients` right to deny any medical treatment for prolonging life, i.e. passive euthanasia(easy death) since 1970`s, to the certain extent allowable legally. In particular, Oregon Death with Dignity Act has acknowledged that terminal patients may commit physician-assisted suicide. Such a physician-assisted suicide of patients becomes a new way of death which has been never discussed in terms of active euthanasia since 1990`s. Unlike passive euthanasia in which physician administers lethal dose of medicine to a patient for the purpose of his death, the active euthanasia is a mean for patients to use such lethal dose of medicine as prescribed by physician at their option for suicide. Crucial difference between active and passive euthanasia can be determined by whether ultimate behavior causing death of a patient is committed by physician or the patient himself. Thus, it is found that active euthanasia has faced relatively low objections against legitimation of physician-assisted suicide of patients in a sense that ultimate behavior to cause death of a patient is attributed to the patient himself, so it is easier for active euthanasia to attribute the death of a patient to his own responsibility than passive euthanasia, and the former also has relatively low risk of misuse or abuse in comparison with the latter. In reality, it is obvious that physician-assisted suicide of patients is an issue unacceptable among the public, since physician`s behavior for active euthanasia may face other legal responsibilities such as aiding and abetting suicide as provided in criminal law. However, there have been proposed needs for exemption from any legal responsibility for physician-assisted suicide of terminal patients in respect of their self-determination right, as mentioned above. In order reflect such needs and perspectives on local legislation, the Oregon state(USA) has newly established and enforced the Oregon Death with Dignity Act. The ultimate purpose of this study is to address historical backgrounds concerned with legislation of the Oregon Death with Dignity Act as well as major legal contents in said act to examine the issues about death of dignity, which may be pointed out in terms of hospice medicine in the future, and thereby consider potential problems concerned with death of dignity.

End-of-Life Care of Hospitalized Children with Advanced Heart Disease

Joowon Lee,김기범,Mi Kyoung Song,Sang Yun Lee,Min-Sun Kim,Eun Jung Bae 대한의학회 2020 Journal of Korean medical science Vol.35 No.16

Background: Despite improvements in palliative care for critically ill children, the characteristics of end-of-life care for pediatric patients with advanced heart disease are not well-known. We investigated these characteristics among hospitalized children with advanced heart disease in a tertiary referral center in Korea. Methods: We retrospectively reviewed the records of 136 patients with advanced heart disease who died in our pediatric department from January 2006 through December 2013. Results: The median age of patients at death was 10.0 months (range 1 day–28.3 years). The median duration of the final hospitalization was 16.5 days (range 1–690 days). Most patients (94.1%) died in the intensive care unit and had received mechanical ventilation (89.7%) and inotropic agents (91.2%) within 24 hours of death. The parents of 74 patients (54.4%) had an end-of-life care discussion with their physician, and the length of stay of these patients in the intensive care unit and in hospital was longer. Of the 90 patients who had been hospitalized for 7 days or more, the parents of 54 patients (60%) had a documented end-of-life care discussion. The time interval from the end-of-life care discussion to death was 3 days or less for 25 patients. Conclusion: Children dying of advanced heart disease receive intensive treatment at the end of life. Discussions regarding end-of-life issues are often postponed until immediately prior to death. A pediatric palliative care program must be implemented to improve the quality of death in pediatric patients with heart disease.

인삼 및 은행잎성분에 의한 재조합 사람 아밀로이드 C-단 단백의 세포독성억제 효과

최웅 충북대학교 의과대학 충북대학교 의학연구소 1999 忠北醫大學術誌 Vol.9 No.1

연구목적: 알쯔하이머 병(Alzheimer's disease, AD)의 병변을 구성하는 물질은 세포독성을 나타내는 베타 아밀로이드 펩티드 (Aβ, β-amyloid peptide)이다. Aβ의 전구단백의 대사물중 Aβ를 포함하는 C-단 105 아미노산 절편(carboxy terminal 105 amino acid fragment, CT-105)도 역시 세포독성을 나타내는 것으로 알려져 있는데, 본 연구에서는 천연물로부터 뇌보호 또는 뇌기능 개선기능이 있는 물질을 검색하고자 하였다. 재료 및 방법: 인삼성분과 Egb761을 이용하여 PC12 cell에 대한 CT-105의 세포독성에 대한 억제효과를 살펴보았다. 세포독성은 MTS assay를 이용하여 ELISA reader로 흡광도를 측정하였다. 결과: PC12 cell에 0.1 ∼1.0 mg/ml의 농도로 인삼성분과 Egb761을 전처리하고 나서, CT-105 노출 후 72시간 뒤에 관찰할 결과, 인삼성분은 CT-105의 세포독성을 억제하지 못하였으나, Egb761은 억제하였다. PC12 cell이 CT-105에 노출 되고나서 2시간 뒤에 Egb761를 처리하여도, CT-105의 세포독성을 억제하였다. 결론: Egb761은 PC12 cell에 대한 CT-105의 세포독성을 억제하며, 그 기전은 Egb761의 기존의 알려진 세포보호 효과와는 다를 것으로 추정되었다. Purpose: Amyloid beta-peptide (Aβ) is the main component of the brain pathology of Alzheimer's disease. C-terminal 105 amino acid fragment (CT-105) of amyloid precursor peptide, which contains Aβ domain, is known to be also cytotoxic. We screened the compounds which have the effects of brain protection and/or brain function improvement. Materials and Methods: The effects of ginsenosides and Egb761 was examined on the cytotoxicity of CT-105 to PC12 cells. Cytotoxicity was measured by MTS assay and absorbance reading with ELISA reader. Results: Ginsenosides and Egb761 was pretreated at the final concentration of 0.1 ∼ 1.0 mg/ml, and PC12 cells were examined 72 hours after CT-105 exposure. Ginsenoside could not protect PC12 cells, however, Egb761 could protect PC12 cells even when it is added to the cells 2 hours after CT-105 exposure. Conclusion: Egb761 can protect PC12 cells from CT-105 cytotoxicity, and the mechanism of action might be different from those reported previously for its brain protection effect.

Z-DNA–Containing Long Terminal Repeats of Human Endogenous Retrovirus Families Provide Alternative Promoters for Human Functional Genes

Du Hyeong Lee,배우현,하홍석,박은경,이윤주,김우령,김희수 한국분자세포생물학회 2022 Molecules and cells Vol.45 No.8

Transposable elements (TEs) account for approximately 45% of the human genome. TEs have proliferated randomly and integrated into functional genes during hominoid radiation. They appear as right-handed B-DNA double helices and slightly elongated left-handed Z-DNAs. Human endogenous retrovirus (HERV) families are widely distributed in human chromosomes at a ratio of 8%. They contain a 5′-long terminal repeat (LTR)-gag-pol-env-3′-LTR structure. LTRs contain the U3 enhancer and promoter region, transcribed R region, and U5 region. LTRs can influence host gene expression by acting as regulatory elements. In this review, we describe the alternative promoters derived from LTR elements that overlap Z-DNA by comparing Z-hunt and DeepZ data for human functional genes. We also present evidence showing the regulatory activity of LTR elements containing Z-DNA in GSDML. Taken together, the regulatory activity of LTR elements with Z-DNA allows us to understand gene function in relation to various human diseases.