Jee-Hee Kim

TGF-Beta1 Release by Volatile Anesthetics Mediates Protection against Renal Proximal Tubule Cell Necrosis

Background/Aims:We have previously demonstrated that clinically utilized volatile anesthetics protect against renal ischemia reperfusion injury in rats in vivo and reduce necrosis in vitro via activation of ERK and Akt and by upregulating HSP70. In this study, we further deciphered the upstream cellular signaling mechanism(s) of volatile anesthetic-mediated antinecrotic effects in vitro. We hypothesized that volatile anesthetics perturb the structure of the plasma membrane lipid bilayer, causing externalization of phosphatidylserine (PS) to the outer surface on renal tubule cells leading to the increased generation of transforming growth factor-β1 (TGF-β1), a cytokine with antinecrotic properties. Methods and Results: In human proximal tubule (HK-2) cell culture, 16-hour exposure to volatile anesthetics (isoflurane, halothane, sevoflurane) caused membrane externalization of PS detected by positive annexin-V staining and increased the release of TGF-β1 into the cell culture media. Exogenous TGF-β1 induced protection and neutralizing TGF-β1 antibody prevented the cytoprotection by volatile anesthetics against hydrogen peroxide-induced HK-2 cell necrosis. Conclusions: Volatile anesthetics induce a cytoprotective signaling cascade in proximal tubule cells via membrane externalization of PS initiating TGF-β1-mediated cytoprotection.

Endogenous A1 adenosine receptors protect against hepatic ischemia reperfusion injury in mice.

Hepatic ischemia reperfusion (IR) injury is a major clinical problem during the perioperative period and occurs frequently after major hepatic resection or liver transplantation. Exogenous and endogenous A1 adenosine receptor (A1AR) activation protects against renal IR injury. In this study, we questioned whether exogenous and endogenous A1AR activation protects against hepatic IR injury in vivo. A1AR wild‐type (WT) or knockout mice were subjected to 60 minutes of partial hepatic IR. Some animals were treated with a selective A1AR agonist, 2‐chloro‐N6‐cyclopentyladenosine (CCPA; 0.1 mg/kg), or a selective A1AR antagonist, 8‐cyclopentyl‐1,3‐dipropylxanthine (DPCPX; 0.4 mg/kg), 15 minutes before hepatic ischemia. Twenty‐four hours after hepatic IR, the A1 knockout mice and DPCPX‐treated A1 wild‐type (A1WT) mice developed significantly worse liver injury (alanine aminotransferase, liver necrosis, neutrophil infiltration, and apoptosis) compared to A1AR WT mice. However, the selective A1AR agonist CCPA failed to protect against hepatic IR injury in A1WT mice. Our results show that the endogenous A1ARs protect against hepatic IR injury in vivo by primarily reducing apoptosis and necrosis with subsequent reductions in proinflammatory neutrophil infiltration. However, in contrast to the kidneys, in which exogenous A1AR activation protected against IR injury, exogenous A1AR activation failed to protect against liver injury after IR. We conclude that endogenous A1AR activation prevents worsened murine liver IR injury primarily by reducing necrotic and apoptotic cell death. Harnessing the mechanisms of cytoprotection with endogenous A1AR activation may lead to new therapies for perioperative hepatic IR injury. Liver Transpl, 2008.

A Research on the Actual Condition of the Prehospital Emergency Care and Education in 119 Emergency Medical Services

Abstract This is the study of actual condition and improvement on emergency medical treatment by 119 emergency medical service personnel. The subjects in this study were 299 emergency medical service personnel. Data were collected from May 1 to August 31 of 2010, and analyzed by SPSS 12.0 program. The major area of study of them were study of emergency medical services 41.5%, study of nursing 10.0%, fire fighting related studies 15.4%, health related studies 1.0%, and others 32.1%. The certificate of them were 1st class emergency medical technician(EMT) 38.1%, 2nd class EMT 33.8%, nurse 9.4%, first aid education 14.0%, and others 4.7%. Frequency of Prehospital emergency care, oxygen supply(274), splint apply(229), spinal immobilization(229), external bleeding control(223), medication(7), intravenous(4). Professionally trained EMT makes possible to secure high quality emergency medical treatment in the prehospital phase. Therefore, it is essential for the quality improvement of prehospital emergency care that well trained EMT ride on the ambulance together and take the responsibility for the treatment and transferring of emergency patients. In order to improve the proficiency of 119 emergency medical services personnel, it is also necessary to provide continuous job training programs for the prehospital emergency medical treatment.

A Case Report of ROSC for Out-of Hospital Cardiopulmonary Resuscitation: Based on one Area Heart Saver

이 연구는 병원 전 심정지 환자에게 심폐소생술과 후 72시간 이상 자발순환이 회복된 환자 8례를 대상으로 하였다.분석 결과 심정지 원인으로는 심장질환이 3례, 응급상황으로 인해 병력을 구하지 못한 경우가 5례를 보였다. 심정지 환자의 6례가 가정에서 발생하였고, 가족이나 동료에 의해 심정지가 목격된 경우가 8례였으며, 가족이나 동료 등 목격자의의해 시행된 심폐소생술은 5례였다. 구급대원 도착 후 임종 호흡을 보인 환자가 3례로 확인되었다. 심정지 환자의 최초초기리듬은 심실세동 7례, 무맥성전기활동 1례를 보였다. 출동에서 현장 도착까지 소요시간은 6.1분(±2.7), 출동에서 병원 도착까지 소요시간은 23.0분(±8.8), 자발순환이 회복되기까지 심폐소생술 지속 시간은 8.7분(±3.4)이 소요되었다. 출동한 구급대원의 자격은 1급응급구조사 6례, 2급응급구조사 2례였으며, 3명 출동이 7례를 보였다. 병원 전 심정지 환자의소생률 향상을 위해서는 무엇보다도 목격자에 의한 심폐소생술이 필요하며, 이를 위해서는 일반인 심폐소생술 교육을 지속적으로 진행하여야 한다.ABSTRACTThis study was to investigate the cardiopulmonary resuscitation (CPR) outcomes and the clinical characteristics of out-of-hospital cardiac arrest (OHCA) by analyzing date in one region. A total 8 patients, survived over 72 hours after ROSC.The cardiac arrest were caused by unknown (5 cases), cardiac disease (3 cases). The most common place of cardiac arrestwas in the home (6 cases), witnessed cardiac arrest (8 cases), cardiopulmonary resuscitation by bystander was performed(4 cases), agonal respiration (3 cases). The initial electrocardiogram (ECG) showed ventricular fibrillation (VF) in 7 cases,pulseless electrical activity (PEA) other rhythms in 1 cases. Average time from call to scene arrival 6.1 minutes, call tohospital arrival 23.0 minutes, duration of total CPR was 8.7 minutes. The certificate of them were level 1 emergency med-ical technician (EMT) 6 cases, level 2 EMT 3 cases, total 3 members 7 cases. To improve the rate of survival for out-of-hospital cardiac arrest victims, development of continuous CPR educational program for lay rescue.

Study on Subjectivity of Fire Fighter

Abstract This study was carried out by practical method in a subjectivity study accessible in-depth, in sloughing off old habit of functional quantity analysis about a subjectivity of fire-public servant in nation. The perception pattern come out in this study were divided into four types in Q-methodology. The result is as follows ; it is divided into 1[(N=26) : Occupational Type], 2[(N=11) : Experience Type], 3[(N=1) : Human Type], 4[(N=2) : Justice Type]. There are four types of fire fighter images. In conclusion, this study is to ascertain acceptance behavior about Reception Type on a subjectivity of fire-public servant in nation ; to offer a developmental suggestion about it. Key Words : Fire fighter, Q-Methodology, Subjectivity study * 교신저자 : 이제영(jylee1231@empas.com)접수일 11년 08월 26일 수정일 11년 09월 22일 게재확정일 11년 10월 06일 1. 서론 화재를 예방하고 불이 났을 때 불을 꺼주며 , 소방시설을 관리하고 긴급한 사태에 대비해 119구조 운영과 관리를 주로 하는 소방공무원(消防公務員)은 국민의 생명, 신체, 재산을 보호하는 것을 직무로 하고 있다[1]. 특히, 이러한 소방관들은 화재를 예방·경계하거나 진압하고 화재, 재난 ·재해 그 밖의 위급한 상황에서의 구조 구급활동 등을 통하여 국민의 생명·신체 및 재산을 보호함으로써 공공의 안녕질서 유지와 복리증진에 이바지함을 목적으로

The Current Status of Bioterrorism Education in Health-related Colleges -In the Professors of the Health-related Colleges-

A bioterrorism attack(BT) attack is the deliberate release of viruses, bacteria, fungi, and toxins used to cause illness or death in people, animal, and plants. Therefore, the healthcare workers are those who will take the main role in BT outbreak situations. The purpose of this study is to investigate current status of education for BT preparedness and response in health-related colleges. It is important to provide the BT preparedness and response to the health-allied students in case of unexpected BT outbreak. The questionnaires were collected from March 10 to June 10 in 2007 via mai l. Approximately 97.6% of the health-related professors answered that they had no experience of bioterrorism education. The contents of the bioterrorism curricula should contain the followings : definition and characteristics of the emergency and disaster, definition of bioterrorism, history of bioterrorism, general characteristics of bioterrorism, etiological agents of bioterrorism, bioterrorism response, systematic response, and medical response. Through these data, we will develop the disaster and bioterrorism preparedness curricula.