An overview of the Publicly Funded Medical Education System in Taiwan

Jen-Hung Yang,Chung-Liang Shih 대한의사협회 의료정책연구소 2020 의료정책포럼 Vol.18 No.3

저자 楊仁宏教授(Jen-Hung Yang, MD, Ph D)는 대만 양명의대 공비생으로 입학하여 피부과 전문의가 되고 이후 대학교수와 타이완 ‘추치(慈濟 Tzu Chi) 의대학장’을 역임하고, 현재 彰化基督教醫院의 교육주임과 카오슝의과대학 교수로 재직하고 있다. 우리나라에서 논의되고 있는 공공의대를 몸소 경험하고 졸업생으로서 공공의대에 대한 의견을 기술하고 있다. 타이완은 1975년 정부 주도로 취약지역과 제대 군인을 위한 ‘원호 의료’ 등을 목적으로 하는 현재 우리나라의 공공의료대학의 설립취지와 동일한 ‘국립양명의대(國立陽明大學)’를 설립하였다. 양명의대는 입학생 모두를 ‘공비(公費) 장학생’으로 선발하였고 등록금과 생활비까지 지원했다. 그럼에도 1988년에 자비로 부담하는 일반 학생의 입학도 허용하기 시작하였고 이후 단독 의과대학에서 여러 보건의료계열을 거느린 국립양명대학교로 지난 1994년에 개편되었다. 저자는 현재까지 3가지 유형의 공비장학생과정에 대한 자세한 설명을 도표와 함께 하고 있다. 그럼에도 공통적인 것은 6년간의 의무기간 중 4년은 전공의교육 그리고 2년이 실제 취약지역, 공중보건, 국제보건 등의 직무를 위한 의무 복무 기간 이었다. 과거 별도로 1년간의 군복무 의무도 부여되었으나 지금은 군복무 기간이 4개월로 줄어들었다고 한다. 2년간의 의무 복무기간 면허는 개인 소유가 아니어서 양명대 학생들은 이에 헌법소원을 제기하였으나 2년간의 의무 복무기간 중 정부 차원의 면허의 관리는 ‘합헌’으로 판정받기도 하였다. 과거 장학금에 대한 1:1 배상을 하면 의무복무도 면제되었으나 최근 2016부터 자신이 공비(公費)로 받은 금액의 4배를 배상하여야 해제된다고 한다. 이것은 2016년부터 속칭 비인기과 전공을 지원하는 정책으로 입학전형이 바뀌었기 때문이다. 공비 장학생은 점차 줄기 시작하여 2009년에 와서는 소수 몇 명의 도서지방 출신 학생을 제외하고 학생 전원 자비 교육생으로 바뀌었다고 한다. 34년간의 공비학생제도가 자비학생으로 전환되었던 이유는 2년의 의무 복무로 더 이상 졸업생들을 보낼 지역이 없었다는 점이다. 지난 1982년~2017년 사이 양명대 졸업생 4,111명을 대상으로 한 취업 현황 파악을 살펴보면, 약 31.7%는 의료원에서, 38.5%는 지역병원, 29.8%는 1차(기층) 진료에 종사하고 있는 것으로 분석됐다. 총 6,557명의 졸업생 중 84%는 도시에 남았고, 전체 16%만이 취약지에 남았다. 양 교수는 도시와 시골간의 불균형은 공공의대로 해결할 수 없는 문제라고 지적하고 있다. 보다 더 정교한 공공성이 강화된 의학교육제도의 구축과 혁신이 필요함을 주장하고 있다. We briefly review the origin, planning, development, and outcome of the publicly funded medical education program (PFMP) in Taiwan. The general PFMP was launched in National Yang-Ming University School of Medicine in 1975. Approximately 6,600 PFMP graduates filled the gap of medical needs at that time, and at least a part (16%) of graduates still served at medically underserved areas. We demonstrated the contributions of the PFMPs to improve the healthcare in medically underserved areas and our public health system. We recognize that PFMP alone cannot overhaul the inadequacy of healthcare resources and physician supplies between the urban and rural underserved areas. We need more efforts and innovations to construct a more sophisticated public-funded medical education system to achieve an even and fair distribution of good healthcare resources.

Antiproliferative and Antitumorigenic Activity of Toona sinensis Leaf Extracts in Lung Adenocarcinoma

Chih-Jen Yang,Yu-Jung Huang,Cheng-Yuan Wang,Chuan-Sheng Wang,Pei-Hui Wang,Jen-Yu Hung,Tung-Heng Wang,Hseng-Kuang Hsu,Hurng-Wern Huang,S.P. Anand Kumar,Ming-Shyan Huang,Ching-Feng Weng 한국식품영양과학회 2010 Journal of medicinal food Vol.13 No.1

Toona sinensis is a traditional Chinese herb, and the extracts of T. sinensis leaf possess a variety of biological functions. This study attempted to test the antiproliferative effect of TSL-1 (a bioactive fraction of T. sinensis) in H441 cells (lung adenocarcinoma). The data showed that the antiproliferative effect of TSL-1 on H441 cells is prominent using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. TSL-1-induced apoptosis was confirmed by cell morphology, sub-G1 peak accumulation, cleavage of poly(ADP)-ribose polymerase, and propidium iodide-annexin V double staining. Furthermore, decreased Bcl-2 accompanied by increased Bax (in western blotting) was found with TSL-1 treatment of H441 cells. TSL-1 treatment-induced G1 arrest was concurrent with the down-regulation of protein levels of cyclin D1 and cyclin-dependent kinase 4 in H441 cells. Peroral and intraperitoneal administrations of TSL-1 were performed to evaluate the therapeutic efficacy, and peroral administration of TSL-1 was also used to elucidate the therapeutic efficacy in the H441 cell xenograft model in vivo. The data revealed that TSL-1 treatment inhibited H441 tumor growth in both therapeutic and preventive experiments. Taken together, these results demonstrate that TSL-1 possesses the capability of preventing and alleviating lung cancer proliferation in vitro and in vivo with proven nephrological and hepatic safety and has the potential to be developed as an anti–lung cancer drug.

An IoT based Temperature Control System for Honey Bee Colony Winter Loss Prevention

( Sheng-hao Chen ),( Hung-jen Lin ),( Yu-cheng Yang ),( En-cheng Yang ),( Joe-air Jiang ) 한국농업기계학회 2018 한국농업기계학회 학술발표논문집 Vol.23 No.1

Honey bees are the most important plant pollinators in nature. Currently, about one-third of human food comes from flowering plants. About 80% of the plants need honey bees for pollination. However, extreme weather increases the possibility of honey bees being exposed to the threat of winter losses, as global climate change intensifies. To protect honey bee colonies, in this study, a heating system is proposed to maintain the temperature of a beehive during the winter. The heating system contains a beecounter, a monitoring system built for beehives, to automatically record the data of temperature and relative humidity both inside and outside the beehives and monitor honey bees’ behavior of coming in and going out of the beehives. When the beecounter detects that the temperature inside the beehive is below a certain threshold, the heating system will be activated to increase the temperature of the beehive. And, all environmental parameters and data are transmitted through a Wi-Fi module and sent to a cloud. With the IoT technology, the temperature inside the beehive will be precisely controlled to increase the survival rate of colonies during the winter. Finally, image processing techniques are used to calculate the honey bee eclosion rates to verify the effectiveness of the proposed system, and the results show that the proposed system can successfully maintain the temperature of the beehive and increase the numbers of the bees entering and leaving the beehive.

Synthesis of ginsenoside Rb₁-imprinted magnetic polymer nanoparticles for the extraction and cellular delivery of therapeutic ginsenosides

Liu, Kai-Hsi,Lin, Hung-Yin,Thomas, James L.,Shih, Yuan-Pin,Yang, Zhuan-Yi,Chen, Jen-Tsung,Lee, Mei-Hwa The Korean Society of Ginseng 2022 Journal of Ginseng Research Vol.46 No.5

Background: Panax ginseng (ginseng) is a traditional medicine that is reported to have cardioprotective effects; ginsenosides are the major bioactive compounds in the ginseng root. Methods: Magnetic molecularly imprinted polymer (MMIP) nanoparticles might be useful for both the extraction of the targeted (imprinted) molecules, and for the delivery of those molecules to cells. In this work, plant growth regulators were used to enhance the adventitious rooting of ginseng root callus; imprinted polymeric particles were synthesized for the extraction of ginsenoside Rb₁ from root extracts, and then employed for subsequent particle-mediated delivery to cardiomyocytes to mitigate hypoxia/reoxygenation injury. Results: These synthesized composite nanoparticles were first characterized by their specific surface area, adsorption capacity, and magnetization, and then used for the extraction of ginsenoside Rb₁ from a crude extract of ginseng roots. The ginsenoside-loaded MMIPs were then shown to have protective effects on mitochondrial membrane potential and cellular viability for H9c2 cells treated with CoCl₂ to mimic hypoxia injury. The protective effect of the ginsenosides was assessed by staining with JC-1 dye to monitor the mitochondrial membrane potential. Conclusion: MMIPs can play a dual role in both the extraction and cellular delivery of therapeutic ginsenosides.

Admission policies and methods at crossroads: a review of medical school admission policies and methods in seven Asian countries

Diantha Soemantri,Indika Karunathilake,Jen-Hung Yang,Shan-Chwen Chang,Chyi-Her Lin,Vishna D,Nadarajah,Hiroshi Nishigori,Dujeepa D,Samarasekera,Shuh Shing Lee,Lilybeth R,Tanchoco,Gominda Ponnamperuma 한국의학교육학회 2020 Korean journal of medical education Vol.32 No.3

Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas

Lan Ting-Yuan,Lin Yen-Chun,Tseng Tai-Chung,Yang Hung-Chih,Kao Jui-Hung,Cheng Chiao-Feng,Lee Tai-Ju,Huang Shang-Chin,Lu Cheng-Hsun,Li Ko-Jen,Hsieh Song-Chou 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.2

Background/Aims: Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. Methods: From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. Results: After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). Conclusions: In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAgnegative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Clinical and Histologic Features of Patients with Biopsy-Proven Metabolic Dysfunction-Associated Fatty Liver Disease

( Shang-chin Huang ),( Hau-jyun Su ),( Jia-horng Kao ),( Tai-chung Tseng ),( Hung-chih Yang ),( Tung-hung Su ),( Pei-jer Chen ),( Chun-jen Liu ) 대한간학회 2021 Gut and Liver Vol.15 No.3

Background/Aims: Fatty liver disease is defined as a cluster of diseases with heterogeneous etiologies, and its definition continues to evolve. The novel conceptional criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) were proposed in 2020 to avoid the exclusion of a certain subpopulation, but their evaluations have been limited. We aimed to examine and compare the clinical as well as histologic features of MAFLD versus nonalcoholic fatty liver disease (NAFLD) in patients with biopsy-proven hepatic steatosis. Methods: From January 2009 to December 2019, 175 patients with histology-proven hepatic steatosis and 10 with cryptogenic cirrhosis who were treated at National Taiwan University Hospital, Taipei, Taiwan, were enrolled. Patients were classified into different groups according to the diagnostic criteria of MAFLD and NAFLD. The clinical and histologic features were then analyzed and compared. Results: In total, 76 patients (41.1%) were diagnosed with both MAFLD and NAFLD, 81 patients (43.8%) were diagnosed with MAFLD alone, nine patients (4.9%) were diagnosed with NAFLD alone, and 19 patients (10.3%) were diagnosed with neither. Those with MAFLD alone exhibited a higher degree of disease severity regarding histology and laboratory data than those with NAFLD alone. Advanced fibrosis was associated with the presences of hepatitis B virus infection and metabolic diseases. Conclusions: The novel diagnostic criteria for MAFLD include an additional 38.9% of patients with hepatic steatosis and can better help identify those with a high degree of disease severity for early intervention than can the previous NAFLD criteria. (Gut Liver 2021;15:451-458)

Special Lecture : TANDEM DUPLICATIONS AND DELETIONS IN MITOCHONDRIAL DNA ARE EARLY MOLECULAR EVENTS OF HUMAN AGEING PROCESS

Yau Huei Wei,Hsin Chen Lee,Cheng Yoong Pang,Jen Hung Yang,Shu Huei Kao 생화학분자생물학회(구 한국생화학분자생물학회) 1994 추계학술대회집 Vol.- No.-