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Do-Not-Resuscitate Orders for Terminal Patients with Cancer in Teaching Hospitals of Korea
Kim, Do Yeun,Lee, Kyoung Eun,Nam, Eun Mi,Lee, Hye Ran,Lee, Keun-Wook,Kim, Jee Hyun,Lee, Jong Seok,Lee, Soon Nam Mary Ann Liebert 2007 Journal of palliative medicine Vol.10 No.5
<P>OBJECTIVES: To examine the current practices relating to do-not-resuscitate (DNR) orders for terminal patients with cancer at teaching hospitals in Korea. METHODS: The records of 387 deaths from January 1 to December 31, 2005 at four cancer centers were identified and reviewed to assess the DNR delineation. Basic demographics, circumstances surrounding the establishment of the DNR directive, the percentage of orders for identified populations, and the time interval between DNR consent and death were evaluated. RESULTS: An order of DNR consent was obtained from 296 patients (76%) of a total of 387 patients. All DNR consents were made between the physician and family, without involving the patient. Written preprinted DNR consent forms were used in 169 (57%) cases and 127 patients (43%) had verbal DNR permission. DNR consent was interpreted in two ways: one forbade resuscitation in two hospitals and the other implied limited care in two other hospitals. A unilateral physician decision to withhold cardiopulmonary resuscitation (CPR) was decided for 62 (16%) patients. Terminal CPR was performed on 29 (7%) patients. DNR discussion was made within 7 days of the day of death on 228 (77%) patient among the 296 DNR consenting patients. CONCLUSION: From our teaching-hospital-based analysis of terminal cancer patients in Korea, consent for a DNR order was common. However, DNR order forms were not standardized and lacked room to document patient involvement in the decision. Usually the DNR decision was made within last days of the patient's life. Our results reflect the need for the improvement of end-of-life care decisions in Korea.</P>
An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea
Do Yeun Kim,Sang Min Lee,Kyoung Eun Lee,Hye Ran Lee,김지현,Keun-Wook Lee,Jong Seok Lee,Soon Nam Lee 대한암학회 2006 Cancer Research and Treatment Vol.38 No.4
Purpose: We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not- resuscitate (DNR) consent on the use of intravenous nutrition during the patient’s last week of life and at the time of death.Materials and Methods: The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient’s last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated.Results:In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient’s surrogates did not have any effect on reducing the use of parenteral nutrition.Conclusion: The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care. (Cancer Res Treat. 2006;38:214-217)
Annual Case Volume and One-Year Mortality for Endovascular Treatment in Acute Ischemic Stroke
Kim Jun Yup,Kang Jihoon,Kim Beom Joon,Kim Seong-Eun,Kim Do Yeon,Lee Keon-Joo,Park Hong-Kyun,Cho Yong-Jin,박종무,Lee Kyung Bok,Cha Jae-Kwan,Lee Ji Sung,Lee Juneyoung,Yang Ki Hwa,Hong Ock Ran,Shin Ji Hyeon 대한의학회 2022 Journal of Korean medical science Vol.37 No.36
Background: The association between endovascular treatment (EVT) case volume per hospital and clinical outcomes has been reported, but the exact volume threshold has not been determined. This study aimed to examine the case volume threshold in this context. Methods: National audit data on the quality of acute stroke care in patients admitted via emergency department, within 7 days of onset, in hospitals that treated ≥ 10 stroke cases during the audit period were analyzed. Ischemic stroke cases treated with EVT during the last three audits (2013, 2014, and 2016) were selected for the analysis. Annual EVT case volume per hospital was estimated and analyzed as a continuous and a categorical variable (in quartiles). The primary outcome measure was 1-year mortality as a surrogate of 3-month functional outcome. As post-hoc sensitivity analysis, replication of the study results was examined using the 2018 audit data. Results: We analyzed 1,746 ischemic stroke cases treated with EVT in 120 acute care hospitals. The median annual EVT case volume was 12.0 cases per hospital, and mortality rates at 1 month, 3 months, and 1 year were 12.7%, 16.6%, and 23.3%, respectively. Q3 and Q4 had 33% lower odds of 1-year mortality than Q1. Adjustments were made for predetermined confounders. Annual EVT case volume cut-off value for 1-year mortality was 15 cases per year (P < 0.02). The same cut-off value was replicated in the sensitivity analysis. Conclusion: Annual EVT case volume was associated with 1-year mortality. The volume threshold per hospital was 15 cases per year.
Do-Hyoung Kim,Mi-Ran Han,Gyunghee Lee,Sangsoo Lee,Young-Joon Kim,Michael E. Adams 한국응용곤충학회 2015 한국응용곤충학회 학술대회논문집 Vol.2015 No.10
The ecdysis behavioral sequence in insects is a classic fixed action pattern (FAP) initiated by hormonal signaling. Ecdysis triggering hormones (ETHs) release the FAP through direct actions on the CNS. Here we present evidence implicating two groups of central ETH receptor (ETHR) neurons in scheduling the first two steps of the FAP: kinin (aka drosokinin, leucokinin) neurons regulate pre-ecdysis behavior and CAMB neurons (CCAP, AstCC, MIP, and Bursicon) initiate the switch to ecdysis behavior. Ablation of kinin neurons or altering levels of ETH receptor (ETHR) expression in these neurons modifies timing and intensity of pre-ecdysis behavior. Cell ablation or ETHR knockdown in CAMB neurons delays the switch to ecdysis, whereas overexpression of ETHR or expression of pertussis toxin in these neurons accelerates timing of the switch. Calcium dynamics in kinin neurons are temporally aligned with pre-ecdysis behavior, whereas activity of CAMB neurons coincides with the switch from pre-ecdysis to ecdysis. Activation of CCAP or CAMB neurons through temperature-sensitive TRPM8 gating is both necessary and sufficient to trigger ecdysis behavior. Our findings demonstrate that kinin and CAMB neurons are direct targets of ETH and play critical roles in scheduling successive behavioral steps in the ecdysis FAP. Furthermore, temporal organization of the FAP is likely a function of ETH receptor density in target neurons.
IGSF4 is a novel TCR ζ-chain–interacting protein that enhances TCR-mediated signaling
Kim, Hye-Ran,Jeon, Byeong-Hun,Lee, Hyun-Su,Im, Sin-Hyeog,Araki, Masatake,Araki, Kimi,Yamamura, Ken-ichi,Choi, Suck-Chei,Park, Do-Sim,Jun, Chang-Duk The Rockefeller University Press 2011 The Journal of experimental medicine Vol.208 No.12
<P>Immunoglobulin superfamily member 4 (IGSF4) is a known ligand of CRTAM, a receptor expressed in activated NKT and CD8<SUP>+</SUP> T cells, but its function in T cell immunity has not been elucidated. In this study, we show that IGSF4 directly interacts with the T cell receptor (TCR) ζ-chain and enhances TCR signaling by enhancing ζ-chain phosphorylation. Ectopic overexpression of <I>IGSF4</I> enhances TCR-mediated T cell activation. In contrast, <I>IGSF4</I> knockdown shows a dramatic decrease in markers associated with T cell activation compared with those in control small interfering RNA. The transmembrane domain is essential for TCR ζ-chain association and clustering to the immunological synapse, and the ectodomain is associated with T cell interaction with antigen-presenting cells (APCs). <I>IGSF4</I>-deficient mice have impaired TCR-mediated thymocyte selection and maturation. Furthermore, these mice reveal attenuated effector T cell functions accompanied by defective TCR signaling. Collectively, the results indicate that IGSF4 plays a central role in T cell functioning by dual independent mechanisms, control of TCR signaling and control of T cell–APC interaction.</P>
Do Hang,Hye-Sook Choi,Se-Chan Kang,Kyung-Ran Kim,Eun-Soo Sohn,Mi-Hyun Kim,Suhkneung Pyo,Eunwha Son 한국식품영양과학회 2005 Preventive Nutrition and Food Science Vol.10 No.4
Fucoidans, high-molecular-weight sulfated polysaccharides extracted from brown seaweeds, have various biological activities. Here we examined whether fucoidan could increase the immunomodulation and proliferation capacity of cells in vitro. When peritoneal macrophages were treated with various concentrations of fucoidan (1~100 μg/mL) for 24 hours, NO production was significantly increased. In addition, exposure of macrophages to 10 μg/mL of fucoidan induced a phagocytic activity. Treatment of neuroblastoma cells (SK-N-SH) with fucoidan enhanced cell proliferation and NO production in a concentration-dependent manner. These results indicate that fucoidan has both immunomodulatory and cell proliferative properties, and may thus be a a candidate for development as an immunomodulating agent.