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만성 신부전 환자에서 내피전구세포(Endothelial ProgenitorCells)의 감소와 혈관 형성능(Angiogenic Function)의 저하
천일석,김경리,김성해,백경기,장신이,성지동,서원희,변종회,전은석,김범,허우성,오하영,김덕경,최진호 대한심장학회 2004 Korean Circulation Journal Vol.34 No.11
Background and Objectives:The increased risk of cardiovascular disease in patients with chronic renal failure (CRF) has been explained by accelerated atherosclerosis and impaired angiogenesis, where endothelial progenitor cells (EPC) may play key roles. It was hypothesized that:“an altered EPC biology may contribute to the pathophysiology of CRF”. Subjects and Methods:EPC were isolated from CRF patients on maintenance hemodialysis (n=44) and from a normal control group (n=30). After morphological and immunological characterization, the number and in vitro angiogenic function of the EPC were evaluated. Results:CRF patients showed markedly decreased numbers of EPC (44.6%) and colonies (75.3%) compared to the controls (p<0.001). These findings were corroborated by a 30.5% decrease in the migratory function in response to vascular endothelial growth factor (VEGF)(p=0.040) and by a 48.8% decrease in EPC incorporation into human umbilical vein endothelial cells (HUVEC)(p<0.001). In addition, The Framingham’s risk factor scores of both the CRF (r=-0.461, p=0.010) and normal groups (r=-0.367, p=0.016) were significantly correlated with the numbers of EPC. Indeed, under the same burden of risk factors the number of circulating EPC was significantly lower in CRF patients than in the normal group (p<0.001). A significant correlation was also observed between the dialysis dose (Kt/V) and EPC incorporation into the HUVEC (r=0.427, p=0.004). Conclusion:The EPC biology, which is critical for neovascularization and the maintenance of vascular function, was altered in CRF. Our data strongly suggest that dysfunction of circulating EPC has a role in the progression of cardiovascular disease in patients with CRF. 배경 및 목적:이제까지 만성 신부전 환자에서 심혈관 질환의 위험 증가는 동맥경화 진행의 가속과 혈관신생의 저하에 기인한다고 알려져 있다. 이에 저자들은 동맥경화 진행과 혈관신생에 중요한 역할을 하는 내피전구세포의 생물학적 변화가 만성 신부전에서 심혈관 질환의 증가에 기여하리라 가정하였다.방 법:혈액 투석을 받는 만성 신부전 환자들(n=44)과 정상 대조군(n=30)에서 내피전구세포를 분리 후 배양하였다. 내피전구세포의 형태학적 및 면역학적 특성을 확인 후, 각 군에서 내피전구세포의 수 및 혈관신생기능을 평가하였다. 결 과: 만성 신부전 환자들은 정상 대조군에 비해 혈관내피 세포 수(44.6%)와 집락군의 수(75.3%)가 현저히 적었으며(p<0.001), 내피전구세포의 이동능은 30.5% 감소하였고(p=0.040), 혈관내피세포로의 편입능은 48.8% 감소하였다(p<0.001). 만성 신부전군과 정상 대조군에서 Framingham 위험인자 점수로 추정한 관동맥질환의 위험도는 내피전구세포의 수와 유의한 역상관관계를 보였으며(r=-0.461, p=0.010;r=-0.367, p=0.016), 동일한 관동맥질환 위험도 하에서도 내피전구세포의 수는 만성 신부전군에서 정상 대조군 보다 유의하게 적었다(p<0.001). 또한 만성 신부전 환자군에서 투석 용량(Kt/V)과 인간제대정맥내피세포로의 편입 사이에 유의한 상관관계가 있었다(r=0.427, p=0.004). 결 론: 만성 신부전에서 혈관신생과 혈관 기능 유지에 중요한 역할을 하는 내피전구세포가 수적 및 기능적으로 저하되어 있었다. 이는 순환혈액 내 내피전구세포의 수적 및 기능적 저하가 만성 신부전환자에서 촉진되는 심혈관계 질환의 진행에 중요한 역할을 할 것임을 강력히 시사하는 결과이다.
고등학교 교육에 있어서 선택중심 교육과정의 성격 및 교육적 의의 탐색
천일석(Il-Suk Chun) 조선대학교 교과교육연구소 2004 敎科敎育硏究 Vol.25 No.2
This thesis aims at studying on the characteristics and educational meanings of the curriculum made up of optional subjects in academic high schools. The curriculum designed to take optional subjects introduces general and liberal elective-subjects to help the students sound growth by letting them take balanced subjects. Introducing this curriculum, high schools can give the students opportunities to take various subjects they want to help them find and develop their aptitude. Under this curriculum, it is possible for each school to try to reduce the students burdens of studies by limiting the number of subjects within ten. To sum up, the educational meanings of the curriculum composed of optional subjects, each high school can open such subjects as to be suitable for the school and its community. Also this curriculum can motivate the participations of the parents and local residents by adopting subjects peculiar to the community. After all, this curriculum can reflect the students desire and self-determination at school and it can improve the teachers speciality and spontaneity. Therefore by introducing this curriculum, each school can have more possibility to realize the ideal form of education.
Safety of One-Day Admission Transradial Coronary Intervention
오혜림,권현철,이선미,김용훈,천일석,천우정,최진호,이상철,성지동,김준수,전은석,김덕경,이상훈,홍경표,박정의,서정돈 대한심장학회 2004 Korean Circulation Journal Vol.34 No.7
Background:Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention(TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation.The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admissionprogram for PCI. Methods:Total 230 consecutive patients underwent TRI on the day of admission, according topre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical andangiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day andseven days after discharge to assess late complications and the patients' satisfaction. Results:The mean age ofthe subjects was 59±9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) hadunstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients(89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The averagehospital stay for them was 9.4±1.4 hours. Two subjects reported hematoma near the puncture site within 24hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there wereno cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. Nodeaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority ofthe patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. Conclusions:Samedayadmission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients.