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폐 상피세포에서 Rhinovirus에 의한 Rantes의 생성 기전
신성준 ( Sung Joon Shin ),김상헌 ( Sang Heon Kim ),김태형 ( Tae Hyung Kim ),손장원 ( Jang Won Sohn ),윤호주 ( Ho Joo Yoon ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.1
Background: Rhinovirus (RV) is a well-known cause of upper respiratory tract infections and an important trigger of asthmatic exacerbation. RV can augment tissue eosinophilia when combined with antigen in appropriately sensitized patients. RANTES, a subfamily of chemokines with double cysteine motif, is a potent eosinophil chemoattractant. Objective: This study was designed to investigate RV stimulation of RANTES and NF-κB-dependent transcriptional mechanism in alveolar epithelial cells in vitro. Method: After RV14 infecion on A549 cells, RANTES protein and mRNA were measured using ELISA and RT-PCR. To further understand the transcriptional mechanisms of RANTES production, NF-κB activity was checked with gel shift assay including supershift and competition assay. The mechanism of RANTES promoter activation was analyzed by cis-element assay with mutagenesis experiment. NF-κB activity was inhibited with antioxidant, TLCK, TPCK, and mutant IκBα. Result: RANTES and mRNA levels were increased and peaked at 12 hours after infection with RV14. RV also stimulated NF-κB-DNA binding activity. Supershift assays revealed that this binding was due to p65 and, to a lesser extent, p50 NF-κB subunits. Cis-element analysis of RANTES promoter showed that NF-κB binding site between -50 and -40 was the most important region. A dominant negative mutant of IκBα abrogated RV-induced RANTES promoter activity. Selective antioxidants, N-acetylcysteine, and NF-κ B blockers (TLCK, TPCK) inhibited RV-stimulated RANTES production and promoter activity in alveolar epithelial cells. Conclusion: RV is a potent stimulator of RANTES production in A549 cells in vitro. This inductive effect is, to a great extent, transcriptionally mediated and dependent on NF-κB activation. The most important subuinits of NF-κB are p65/p50, which are interacted with RNATES promoter site between -50 and -40. RANTES production, are inhibited by antioxidant and NF-κB blockers. (Korean J Asthma Allergy Clin Immunol 2006;26:19-26)
임종돌봄에 대한 교육의 필요성: 2개 대학병원의 인턴을 대상으로 예비 분석
김도연,김경지,신성준,권복규,남은미,허대석,이순남,Kim, Do Yeun,Kim, Kyong-Jee,Shin, Sung Joon,Kwon, Ivo,Nam, Eun Mi,Heo, Dae Seog,Lee, Soon Nam 한국호스피스완화의료학회 2017 한국호스피스.완화의료학회지 Vol.20 No.2
목적: 본 연구는 2개 대학병원의 인턴을 대상으로 임종돌봄에 대한 교육 현황을 파악하고자 하였다. 방법: 2개 대학병원의 64명의 인턴들에게 구조화된 설문지를 배포하여 임종돌봄 교과과정의 강의습득 경험과 임상견학 경험 여부를 확인하였다. 또한 임종돌봄 관련 교육이나 진료에 대한 태도를 평가할 수 있는 7개의 자가평가질문을 파악하였다. 결과: 임종돌봄 교과과정 강의 습득과 임상실습 견학 개수의 평균은 각각 5개(총 영역 개수: 9)와 2개(총 영역 개수: 7)였다. 가장 많이 교육받은 항목은 나쁜 소식 전하기(96.9%)였고 임상실습 동안 가장 많이 견학한 항목은 신체증상 조절(56.5%)였다. 그러나 사전연명의료의향서를 포함한 의사소통 영역에 대한 경험은 20% 미만이었다. 임종돌봄 단독 교과목 교육군은 그렇지 않은 군과 비교하여 임종돌봄 교과과정에 대한 만족도, 관심도, 준비됨의 7가지 항목에서 모두 유의하게 긍정적인 답변을 하였다. 결론: 본 연구는 임종돌봄이 필요한 환자를 진료해야 하는 인턴들이 임종돌봄에 대한 교과과정 습득과 임상경험이 매우 부족함을 관찰하였다. 추후 국내 임종돌봄 교육에 대한 의과대학교육의 전체적인 상황을 파악하여 관련된 적절한 지식과 기술을 연마하는 교육체계를 세울 필요가 있다. Purpose: This study was performed to explore the current state of end-of-life (EoL) care education provided to new interns at two university hospitals. Methods: A questionnaire was given to incoming interns (N=64). The levels of acquired knowledge and experience of clinical observation were measured. Seven areas for self-assessment questions were identified and used to analyze the interns' attitudes towards EoL-related education and practice. Results: On average, participants learned five elements (nine in total) from EoL-related classes and two (seven in total) from clinical observation. The most frequently educated element was how to deliver bad news (96.9%) in the classroom setting and how to control physical symptoms (56.5%) in clinical observation. Less than 20% received training on EoL care communication, including discussion of advanced directives. Compared with participants who had no EoL training, those who had EoL training showed positive attitudes in all seven categories regarding overall satisfaction, interest and preparedness in relation to EoL-care classes and practice. Conclusion: Although interns are responsible for caring of dying patients, their EoL training in classroom and clinical settings was very insufficient. Further research should be conducted to establish an education system that provides sufficient knowledge and training on EoL care.