The Crisis of Disintegrated Communities

Arthur Miller was one of the most prominent American Social dramatists and was influenced by the economic depression in the 1930's. This Depression and the hardships he had experienced early in his life, helped him to discover the reality of being a common man. It was on this reality that he based his tragedy. This tragedy dealt mostly with the relationship between man and society. Miller compared the relationship between man and society to that of water and a fish. This meant that like a fish in water, man lives within society. Men have hopes and dreams in this society, which surrounds them. When their surrounding does not materialize these hopes and dreams, man, or 'fish', gets disappointed and frustrated. Miller was very conscious of his strong criticism of society, and of his interest in man's agony and alienation within that society. Miller discovered this systematic relationship between man and society. In 'Death of a Salesman', man endured tragedy because his absolute value was neglected by industrial society. Miller demonstrated in this play that the economic depression not only evolved an entire society into an accelerated industrialization, and forced it to change rapidly and immensely, but also drove the individual into mental depression, forced the traditional society to be disintegrated. According to Miller, there is a big difference concept of &#985168pursued by industrial society when compared to the individual or family member. This difference made all parties concerned misunderstand the social agreement, and this destroyed traditional society. It also affected family values, finally bringing tragedy to the individual and their family. In conclusion, Miller's work teaches us the lesson that man should exist in society, and society should be a part of man. They can not be separate entities. Man shares sincerity and responsibility within society, thus our society respects the value of human beings instead of industrialization.family&#985169Ⅰ. 서론 1 Ⅱ. 전통사회공동체 붕괴 6 Ⅲ. 가족공동체 해체양상 24 1. 사회적 관계로서의 가족공동체 해체위기 26 2. 혈연관계로서의 가족공동체 해체위기 38 Ⅳ. 결 론 50 인용문헌 53 Abstract 5

Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes.

INTRODUCTION: A1chieve® (ClinicalTrials.gov identifier NCT00869908) was a 24-week observational study evaluating certain insulin analogs and not insulin analogs in general in 66,726 people with type 2 diabetes (T2D) in routine clinical care in 28 non-Western countries. This study demonstrated that insulin analogs improved self-management and metabolic control in patients with T2D. We investigated the effectiveness and clinical characteristics of patients with T2D showing better response to basal insulin (BI) (detemir), using data from the A1chieve study performed in Korea. METHODS: Subjects were classified into two groups according to the achievement of target glycated hemoglobin (A1c) level of <7.5%. Multivariate logistic regression analysis was performed to determine the variables independently associated with the achievement of target A1c level. RESULTS: Baseline A1c, postprandial glucose (PPG), difference between PPG and fasting plasma glucose, and duration of diabetes were independently associated with better response to BI after adjusting for other risk factors. Compared to patients with BI use at evening, those who took BI in the morning demonstrated a larger reduction in A1c level. CONCLUSION: Once-daily BI therapy appears to be effective in Korean subjects with type 2 diabetes who had a shorter duration of diabetes and a smaller postprandial glucose excursion. FUNDING: Novo Nordisk Pharma Korea and Novo Nordisk International Operations.ope

Background and data configuration process of a nationwide population-based study using the korean national health insurance system.

BACKGROUND: The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to the databases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history, structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit of Korean researchers. METHODS: The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcare programs of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. The NHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from the four databases of the insured that contain data on health insurance claims, health check-ups and LTCI. RESULTS: Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining. CONCLUSION: The NHIS database represents the entire Korean population and can be used as a population-based database. The integrated information technology of the NHIS database makes it a world-leading population-based epidemiology and disease research platform.ope

Risk of Bladder Cancer among Patients with Diabetes Treated with a 15 mg Pioglitazone Dose in Korea: A Multi-Center Retrospective Cohort Study

It has not yet been determined whether chronic exposure to relatively low doses of pioglitazone increases risk of bladder cancer. We aimed to assess the risk of bladder cancer associated with pioglitazone in Korean patients. This was a retrospective cohort study of diabetic patients who had ≥ 2 clinic visits between November 2005 and June 2011 at one of four tertiary referral hospitals in Korea. A prevalent case-control analysis nested within the cohort was conducted to further adjust confounders. A total of 101,953 control patients and 11,240 pioglitazone-treated patients were included, in which there were 237 and 30 cases of incidental bladder cancer (64.9 and 54.9 per 100,000 person-years; age, sex-adjusted HR 1.135, 95% confidence interval [CI] 0.769-1.677), respectively. In the prevalent case-control analysis nested within the cohort, use of pioglitazone for a duration of > 6 months, but not ever use of pioglitazone, was associated with an increased rate of bladder cancer as compared to never use of pioglitazone. In conclusion, we failed to exclude the possible association between use of pioglitazone for a duration of > 6 months and bladder cancer.ope

The risk of bladder cancer in korean diabetic subjects treated with pioglitazone.

BACKGROUND: There is growing concern regarding the increased incidence of bladder cancer in diabetic patients using pioglitazone. This study aimed to investigate the association between bladder cancer and the use of pioglitazone in Korean diabetics. METHODS: This retrospective, matched case-control study included a case group (n=329) of diabetic patients with bladder cancer who presented at the Severance Hospital from November 2005 to June 2011. The control group consisted of patients without bladder cancer (1:2 ratio matching for sex and age, n=658) who were listed on the Severance Hospital diabetes registry. RESULTS: The percentage of subjects who had ever used pioglitazone was significantly lower in the case group than in the control group (6.4% vs. 15.0%, P<0.001). Multivariate conditional logistic analysis revealed that independent factors affecting bladder cancer were smoking (odds ratio [OR], 11.64; 95% confidence interval [CI], 6.56 to 20.66; P<0.001), coexisting cancer (OR, 6.11; 95% CI, 2.25 to 16.63; P<0.001), and hemoglobin levels (OR, 0.78; 95% CI, 0.69 to 0.88; P<0.001). The OR of the history of pioglitazone use was 2.09 and was not significantly different between the two groups (95% CI, 0.26 to 16.81; P=0.488). CONCLUSION: A relationship between pioglitazone use and incidence of bladder cancer was not observed in Korean diabetic patients. This suggests that the risk for bladder cancer in Korean diabetic subjects treated with pioglitazone might be different from that of Caucasian populations. Large-scale, well-designed and multi-center studies are needed to further evaluate this relationship.ope

Dimethyl sulfoxide reduces hepatocellular lipid accumulation through autophagy induction

Induction of autophagy is known not only to regulate cellular homeostasis but also to decrease triglyceride accumulation in hepatocytes. The aim of this study is to investigate whether DMSO (dimethyl sulfoxide) has a beneficial role in free fatty acid-induced hepatic fat accumulation. In HepG2 cells, treatment with 0.5 mM palmitate for six hours significantly increased lipid and triglyceride (TG) accumulation, assessed by Oil-red O staining and TG quantification assay. Treatment with 0.01% DMSO for 16 h statistically reduced palmitate-induced TG contents. Pretreatment of 10 mM 3-methyladenine (3MA) for 2 h restored hepatocellular lipid contents, which were attenuated by treatment with DMSO. DMSO increased LC3-II conversion and decreased SQSTM1/p62 expression in a time and dose-dependent manner. In addition, the number of autophagosomes and autolysosomes, as seen under an electron microscopy, as well as the percentage of RFP-LAMP1 colocalized with GFP-LC3 dots in cells transfected with both GFP-LC3 and RFP-LAMP1, as seen under a fluorescent microscopy, also increased in DMSO-treated HepG2 cells. DMSO also suppressed p-eIF2α/p-EIF2S1, ATF4, p-AKT1, p-MTOR and p-p70s6k/p-RPS6KB2 expression as assessed by western blotting. Knockdown of ATF4 expression using siRNA suppressed ATF4 expression and phosphorylation of AKT1, MTOR and RPS6KB2, but increased LC3-II conversion. DMSO reduced not only soluble but also insoluble mtHTT (mutant huntingtin aggregates) expressions, which were masked in the presence of autophagy inhibitor. DMSO, a kind of chemical chaperone, activated autophagy by suppressing ATF4 expression and might play a protective role in the development of fatty acid-induced hepatosteatosis.ope

Pentoxifylline attenuates methionine- and choline-deficient-diet-induced steatohepatitis by suppressing TNF-α expression and endoplasmic reticulum stress.

BACKGROUND: Pentoxifylline (PTX) anti-TNF properties are known to exert hepatoprotective effects in various liver injury models. The aim of this study was to investigate whether PTX has beneficial roles in the development of methionine- and choline-deficient-(MCD-) diet-induced NAFLD SD rats in vivo and TNF-α-induced Hep3B cells in vitro. METHODS: SD Rats were classified according to diet (chow or MCD diet) and treatment (normal saline or PTX injection) over a period of 4 weeks: group I (chow + saline, n = 4), group II (chow + PTX), group III (MCD + saline), and group IV (MCD + PTX). Hep3B cells were treated with 100 ng/ml TNF-α (24 h) in the absence or presence of PTX (1 mM). RESULTS: PTX attenuated MCD-diet-induced serum ALT levels and hepatic steatosis. In real-time PCR and western blotting analysis, PTX decreased MCD-diet-induced TNF-alpha mRNA expression and proapoptotic unfolded protein response by ER stress (GRP78, p-eIF2, ATF4, IRE1α, CHOP, and p-JNK activation) in vivo. PTX (1 mM) reduced TNF-α-induced activation of GRP78, p-eIF2, ATF4, IRE1α, and CHOP in vitro. CONCLUSION: PTX has beneficial roles in the development of MCD-diet-induced steatohepatitis through partial suppression of TNF-α and ER stress.ope

Glycemic Effectiveness of Metformin-Based Dual-Combination Therapies with Sulphonylurea, Pioglitazone, or DPP4-Inhibitor in Drug-Naïve Korean Type 2 Diabetic Patients

BACKGROUND: This study compared the glycemic effectiveness of three metformin-based dual therapies according to baseline hemoglobin A1c (HbA1c) to evaluate the appropriateness of the guideline enforced by the National Health Insurance Corporation of Korea for initial medication of type 2 diabetes (T2D). METHODS: This prospective observational study was conducted across 24 weeks for drug-naïve Korean T2D patients with HbA1c greater than 7.5%. Subjects were first divided into three groups based on the agent combined with metformin (group 1, gliclazide-modified release or glimepiride; group 2, pioglitazone; group 3, sitagliptin). Subjects were also classified into three categories according to baseline HbA1c (category I, 7.5%≤HbA1c<9.0%; category II, 9.0%≤HbA1c<11.0%; category III, 11.0%≤HbA1c). RESULTS: Among 116 subjects, 99 subjects completed the study, with 88 subjects maintaining the initial medication. While each of the metformin-based dual therapies showed a significant decrease in HbA1c (group 1, 8.9% to 6.4%; group 2, 9.0% to 6.6%; group 3, 9.3% to 6.3%; P<0.001 for each), there was no significant difference in the magnitude of HbA1c change among the groups. While the three HbA1c categories showed significantly different baseline HbA1c levels (8.2% vs. 9.9% vs. 11.9%; P<0.001), endpoint HbA1c was not different (6.4% vs. 6.6% vs. 6.0%; P=0.051). CONCLUSION: The three dual therapies using a combination of metformin and either sulfonylurea, pioglitazone, or sitagliptin showed similar glycemic effectiveness among drug-naïve Korean T2D patients. In addition, these regimens were similarly effective across a wide range of baseline HbA1c levels.ope

당화 알부민이 췌도세포 독성에 미치는 기전 규명

Dept. of Medicine/박사The purpose of this study was to investigate whether glycated albumin (GA), an early precursor of Advanced Glycation End-product (AGEs), would induce dysfunction in pancreatic ß-cells and to determine which kinds of cellular mechanisms are activated in GA-induced-cell apoptosis. Decreased viability and increased apoptosis were induced in INS-1 cells treated with 2.5 mg/mL GA under 16.7 mM high-glucose conditions. Insulin content and glucose-stimulated secretion from isolated rat islets were reduced in 2.5 mg/mL GA-treated cells. In response to 2.5 mg/mL GA in INS-1 cells, autophagy induction and flux decreased as assessed by green fluorescent protein– microtubule-associated protein 1 light chain 3 dots, microtubule - associated protein 1 light chain 3-II conversion, and sequestosome1(SQSTM1)/p62 in the presence and absence of bafilomycin A1. Accumulated SQSTM1/p62 through deficient autophagy activated the nuclear factor-B (p65)-inducible nitric oxide synthase(NOS)-caspase-3 cascade, which was restored by treatment with small interfering RNA against p62. Small interfering RNA treatment against autophagy-related protein 5 significantly inhibited the autophagy machinery resulting in a significant increase in iNOS-cleaved caspase-3 expression. Treatment with 500 μM 4-phenyl butyric acid significantly alleviated the expression of endoplasmic reticulum stress markers and iNOS in parallel with upregulated autophagy induction. However, in the presence of bafilomycin A1, the decreased viability of INS-1 cells was not recovered. Glycated albumin, an early precursor of AGE, caused pancreatic-ß cell death by inhibiting autophagy induction and flux, resulting in nuclear factor-B (p65)-iNOS-caspase-3 cascade activation as well as by increasing susceptibility to endoplasmic reticulum stress and oxidative stress.ope