여러종류의 손상이 신경조직에 미치는 영향에 대한 연구

말초 신경 손상 시 치료의 목표는 운동감각 기능을 회복시키는 것이며 이것이 성공여부는 여러 요인과 관계가 있으나 가장 결정적인 요인은 손상기전이다. 그러므로 말초신경 손상수실 시 관건은 신경의 상태를 정확히 판단하여 초기 혹은 지연봉합을 결정하고, 손상 받은 범위를 적절히 절제하여 긴장없이 봉합 또는 신경이식을 시행하는 것이라 하겠다. 그러나 수술 중 이러한 상황을 정확히 판단하기란 많은 경험을 요하는 일이며 육안적 소견과 실제조직학적 소견이 일치하지 않을 수도 있다. 더구나 손상범위는 시간 경과에 따라 변화하며, 그 변화과정 또한 손상방법에 따라 다양하므로 수술 시 실제 손상정도를 판단하는데 기준이 될 수 있는 자료가 필요하다 하겠다. 이제 저자는 cutting, crushing, sawing, avulsion 등의 4군으로 나누어 손상방법과 시간 경과에 따른 손상정도를 수술 현미경 상에서 관찰하였으며 hematoxylin ? eosin염색하여 반흔 형성의 범위를 계측하였고 Masson’s trichrome염색과 투사 전자현미경으로 손상부위를 관찰한 결과 다음과 같은 결론을 얻었다. 신경손상 후 제 1, 8, 21일째 신경손상정도를 관찰한 결과 avulsion군에서 가장 심한 손상을 보였고 sawing, crushing, cutting군의 순서로 나타났다. 신경손상 1일 후의 소견은 3주후 최종소견과 차이가 있으므로 손상정도를 판단하는데 있어서 좋은 지표가 되지 못하여 cutting과 crushing군은 손상범위를 육안적으로 판단한 후 일차봉합이 가능하나 sawing군의 경우는 시간 경과에 따라 손상범위가 섬유화가 완전히 진행된 후 수술하는 것이 좋으며 avulsion손상의 경우 신경이식을 하는 것이 바람직할 것으로 사료된다. ; The ultimate goal in nerve repair is to restore sensory and motor function of the injury part. The success or failure of this goal depends upon several variables, with the mechanism of injury being one of the more crucial determining factors. At the time of nerve repair, the damaged neural tissue is resected back to what appears to be an uninjured level. However, it is often difficult to determine this level. This study was designed to compare the degree of intraneural scarring over 3-week period in experimental different injuries. The result of this study demonstrated that the degree of injury can very from cutting, crushing, sawing to avulsion, as well as very on period; the first 3 weeks after injury. Therefore, a dynamic pathophysiology is induced by a nerve injury. In this study, the extent of nerve damage was assessed based on histology and intraoperative observations 18 and 21 day after the post-injury. The most severe injury was caused by nerve avulsion, sawing, crushing and cutting mechanisms of injury in order. The most sever injury was caused by nerve avulsion, sawing, crushing and cutting mechanisms of injury in order. The severity of injury within the avulsion group preclude a primary nerve repair, and nerve grafting. The intraoperative observation on the first day does not good predictor of the degree of injury. Especially in case of saw injury, the scope of injury was enlarged in course of time, therefore secondary repair on the nerve would be appropriate when the progress of fibrosis was completed.논문개요 ------------------------------------------------------------- ⅶ Ⅰ. 서론 ------------------------------------------------------------- 1 Ⅱ. 연구대상 및 방법 ------------------------------------------------- 2 A. 연구대상 --------------------------------------------------------- 2 B. 연구방법 --------------------------------------------------------- 2 Ⅲ. 연구결과 --------------------------------------------------------- 4 A. 원인에 따른 신경손상 범위 ---------------------------------------- 4 B. 수술 중 육안적 소견과 조직학적 소견의 상관관계 ------------------- 5 C. 전자현미경 소견 -------------------------------------------------- 7 Ⅳ. 고찰 ------------------------------------------------------------- 8 Ⅴ. 결론 ------------------------------------------------------------- 13 참고문헌 ------------------------------------------------------------- 15 사진부도 및 설명 ----------------------------------------------------- 18 영문초록 ------------------------------------------------------------- 2

Seasonal characteristics of odor and methane mitigation and the bacterial community dynamics in an on-site biocover at a sanitary landfill

Landfills are key anthropogenic emission sources for odors and methane. For simultaneous mitigation of odors and methane emitted from landfills, a pilot-scale biocover (soil:perlite:earthworm cast:compost, 6:2:1:1, v/v) was constructed at a sanitary landfill in South Korea, and the biocover performance and its bacterial community dynamics were monitored for 240 days. The removal efficiencies of odor and methane were evaluated to compare the odor dilution ratios or methane concentrations at the biocover surface and landfill soil cover surface where the biocover was not installed. The odor removal efficiency was maintained above 85% in all seasons. The odor dilution ratios ranged from 300 to 3000 at the biocover surface, but they were 6694-20,801 at the landfill soil cover surface. Additionally, the methane removal efficiency was influenced by the ambient temperature; the methane removal efficiency in winter was 35-43%, while the methane removability was enhanced to 85%, 86%, and 96% in spring, early summer, and late summer, respectively. The ratio of methanotrophs to total bacterial community increased with increasing ambient temperature from 5.4% (in winter) to 12.8-14.8% (in summer). In winter, non-methanotrophs, such as Acinetobacter (8.8%), Rhodanobacter (7.5%), Pedobacter (7.5%), and Arthrobacter (5.7%), were abundant. However, in late summer, Methylobacter (8.8%), Methylocaldum (3.4%), Mycobacterium (1.1%), and Desuiviicoccus (0.9%) were the dominant bacteria. Methylobacter was the dominant methanotroph in all seasons. These seasonal characteristics of the on-site biocover performance and its bacterial community are useful for designing a full-scale biocover for the simultaneous mitigation of odors and methane at landfills. (C) 2017 Elsevier Ltd. All rights reserved

(The) differences in behaviors of utilization on western and oriental medical care in Korea

보건행정학과/박사[한글]누가, 언제, 어디서, 어떤 의료서비스를, 어떻게 이용하는가? 이는 매우 복잡하고 어려운 문제이다. 의료이용은 단일차원이 아닌, 사회인구학적 특성, 사회심리적 요인, 문화 및 경제적 요인, 그리고 지역내 의료자원의 양, 자원의 분포 등 다양한 요인들이 상호작용을 함으로써 결정되며, 양방의료와 한방의료의 이용행태에 영향을 미치는 요인간에는 차이를 보인다. 이 연구에서는 양·한방의료이용 행태의 차이를 다음과 같이 구명하고자 하였다; 양·한방의료 선택에 영향을 미치는 요인; 양·한방 의료이용 여부와 양·한방 의료이용량에 영향을 미치는 요인의 차이; 양·한방의료이용 만족도에 영향을 미치는 요인의 차이; 그리고 양·한방의료의 대체관계 구명. 이 연구의 원자료는 한국보건사회연구원의 1998년 국민건강조사 자료이며, 대상자수는 비혈연가구를 제외한 39,060명이다. 가설을 검증하기 위해 이 연구에서는 지금까지 수 십년 동안 의료이용 연구에서 많이 이용된 바 있는 Andersen모형을 기본 모형으로 하여 내용에 따라 로지스틱 회귀분석, 다항 로짓회귀분석, 위계적 다중회귀분석 등을 실시하였다. 이 연구의 결과를 요약하면 다음과 같다. 첫째, 상용치료원을 양방병의원으로 가지고 있는 경우 상용치료원이 없는 경우보다 양방의료이용 확률이 1.8배정도 증가하는 것에 비해, 상용치료원을 한방병의원으로 가지고 있는 경우 상용치료원이 없는 경우보다 한방의료이용 확률이 무려 6.7배나 증가하였다. 둘째, 양·한방의료 선택요인에 관한 다항 로짓회귀분석 결과, 양방의료에 비해 한방의료를 선택할 확률은 교육수준이 높을수록, 상용치료원을 한방병의원으로 가지고 있을수록, 인구 10만명당 한의사수가 많을수록, 근골격계질환에 이환될수록, 순환기계질환에 이환될수록, 사고 및 후유증에 이환될수록 증가하였다. 셋째, 위계적 다중회귀분석 결과, 양방의료기관 방문회수에는 의료필요요인이 가장 큰 영향을 미치는 반면, 한방의료기관 방문회수에는 의료필요요인과 의료가능요인이 비슷한 설명력을 나타내었다. 특히, 개별 독립변수중 양방의료이용량에 가장 큰 영향을 미치는 변수는 이환일수인 반면, 한방의료이용량에 가장 큰 영향을 미치는 변수는 한방의료서비스 가격으로 두드러진 차이를 보였다. 넷째, 양방의료이용 만족도에 영향을 미치는 요인중 가장 큰 영향을 미치는 변수는 친절인식도였으며, 비용인식도, 연령, 대기시간의 순으로 영향력을 나타내었고, 한방의료이용 만족도에 가장 큰 영향을 미치는 변수 역시 친절인식도였으며, 그 외 비용인식도와 대기시간이 부의 영향력을 나타내었다. 특히, 두드러진 차이를 보인 것은 비용인식도의 경우 양방의료이용 만족도보다 한방의료이용 만족도에 더 큰 영향력을 보였다. 다섯째, 한방의료가 양방의료의 대체재로 이용되고 있는지 또는 보완재로 이용되고 있는지를 구명하기 위해 한방의료이용회수를 종속변수로 하여 다중회귀분석을 실시한 결과, 한방의료는 양방의료의 대체재로 이용되고 있는 것으로 밝혀졌다. 결론적으로 양·한방 의료를 이용하는 행태에는 몇가지 측면에서 차이를 보였는데, 이를 토대로 다음과 같은 정책을 제언해 볼 수 있겠다. 첫째, 양·한방의료를 선택하는데 있어서 상용치료원의 종류와 같이 평소 의료를 이용하던 습관이 중요한 영향을 미쳤다. 따라서 한방의료이용을 제고시키기 위한 정책을 시행하고자 한다면, 한방의료의 과학화와 더불어 소비자에게 한방의료에 대한 긍정적 이미지를 인식시키기 위한 전략이 필요할 것이다. 둘째, 질병의 종류가 양·한방 의료를 선택하는데 상당한 영향을 미치고 있었고, 제한적으로나마 양방의료가 한방의료로 대체될 수 있음이 증명된 점을 고려할 때, 한방, 양방, 그리고 양·한방 협진으로 치료효과가 높은 질병에 대한 연구를 통해 양·한방 중복의료 이용행태를 감소시킴으로써 소비자 측면에서는 의료비 부담을 감소시키고, 국가적 측면에서는 자원의 낭비를 막고 효율적인 자원활용을 꾀해야 할 것이다. 셋째, 양방의료이용에는 질병의 경중도가 가장 중요한 영향을 미치고 있는 반면, 한방의료이용에 있어서는 의료서비스의 가격이 가장 중요한 영향을 미치고 있는 점을 감안 할 때, 한방의료서비스에 대한 접근성을 제고시키기 위해서는 의료보험의 한방급여를 개선하여 본인부담을 감소시켜 주는 것이 시급한 과제라 하겠다. [영문]Korea is unique in that the status of oriental medicine is equal to that of western medicine, socially and politically. Until now, there has been no study on the separate analysis of western and oriental medical care. The objectives of this study were to examine the differences in behaviors of utilization and satisfaction on western and oriental medical care, to identify different motivation of choice for western and oriental medical care, and to see if there is a substitution of oriental medical care for western medical care. The data came from a national health survey of noninstitutionalized Koreans conducted in 1998. The data were collected by the Korea Institute for Health and Social Affairs and a total number of 12,283 Korean households with 39,060 household members took part in the 「1998 National Health and Nutrition Survey」. The Andersen model of health behavior was employed to guide the analysis and the development of hypotheses. The major statistical methods used for the analysis were multiple logistic regression analysis, hierarchical regression analysis, and polychotomous logistic regression analysis. The major findings are as follows; 1. The choice of oriental medical care is related with high educational level, regular source of oriental medical care, number of oriental physicians, musculoskeletal system disease, and circulatory system disease. 2. Most of the explained variance in the number of western medical care visits are accounted for by need characteristics with minimal contribution from the predisposing and enabling components. But most of the explained variance in the number of oriental medical care visits are accounted for by need and enabling characteristics with minimal contribution from the predisposing components. The number of illness days is the most important variable contributing to the explanation of the number of western medical care visits, while the costs per visit is the most important variable contributing to the explanation of the number of oriental medical care visits. 3. The level of satisfaction with western medical care is affected by kind, perception of high price for western medical care, age, and waiting time. The level of satisfaction with oriental medical care is affected by kind, perception of high price for western medical care, and waiting time. 4. There is a substitution between oriental medical care and western medical care. The findings show that it is critical to focus on the reduction of cost sharing to access oriental medical care. Other policies for the improvement of western and oriental medical care delivery system include the method of prevention for hospital shopping behavior and improvement of quality of oriental medicine.ope

Characterization of Bacterial Community Dynamics during the Decomposition of Pig Carcasses in Simulated Soil Burial and Composting Systems

Soil burial is the most widely used disposal method for infected pig carcasses, but composting has gained attention as an alternative disposal method because pig carcasses can be decomposed rapidly and safely by composting. To understand the pig carcass decomposition process in soil burial and by composting, pilot-scale test systems that simulated soil burial and composting were designed and constructed in the field. The envelope material samples were collected using special sampling devices without disturbance, and bacterial community dynamics were analyzed by high-throughput pyrosequencing for 340 days. Based on the odor gas intensity profiles, it was estimated that the active and advanced decay stages were reached earlier by composting than by soil burial. The dominant bacterial communities in the soil were aerobic and/or facultatively anaerobic gram-negative bacteria such as Pseudomonas, Gelidibacter, Mucilaginibacter, and Brevundimonas. However, the dominant bacteria in the composting system were anaerobic, thermophilic, endospore-forming, and/or halophilic gram-positive bacteria such as Pelotomaculum, Lentibacillus, Clostridium, and Caldicoprobacter. Different dominant bacteria played important roles in the decomposition of pig carcasses in the soil and compost. This study provides useful comparative date for the degradation of pig carcasses in the soil burial and composting systems

Leaching characteristics of heavy metals from sewage sludge by Acidithiobacillus thiooxidans MET

An acidophilic, sulfur-oxidizing Acidithiobacillus thiooxidans MET bacterium was isolated from anaerobically digested, dewatered sewage sludge. This bacterium showed sulfur-oxidizing ability at both acidic and neutral conditions, and allowed metal leaching even at a high (130 g L-1) sludge solids concentration. We found that low metal leaching efficiency at high solids concentration was mainly due to an increase in buffering capacity resulting in retardation of pH reduction. Therefore, metal leaching was mainly influenced not by sludge solids concentration, but by the pH (or sulfate concentration per unit sludge mass) of the sludge solutions. The relationship between the pH of the sludge solution and the efficiency of metal leaching was obtained by quantitatively investigating the effect of pH reduction or the amount of sulfate produced per unit sludge mass on leaching of each metal. Furthermore, the relationship between total metal content in the sludge and metal leached to the solution was obtained for each metal. Such a relationship allowed estimation of leachable metal at various amounts of total metal content in sludge

Isolation and characterization of a diesel-degrading bacterium, Gordonia sp. SD8

A diesel-degrading bacterium, Gordonia sp. SD8, was isolated from soil contaminated with petroleum, and its diesel degradation was characterized in a soil as well as a liquid culture system. SD8 could grow in the mineral salt medium supplemented with diesel as a sole carbon and energy source. The maximum specific growth rate (0.67±0.05 d -1) and diesel degradation rate (1,727±145 mg-TPH L -1 d -1) of SD8 showed at 20,000 mg-TPH L -1 and 30°C, and then this bacterium could degrade high strength of diesel of 40,000 mg-TPH L -1. The residual diesel concentration in the inoculated soil with SD8 was 3,724 mg-TPH kg-dry soil -1 after 17 days, whereas the diesel concentration in the non-inoculated soil was 8,150±755 mg-TPH kg-dry soil -1. These results indicate that Gordonia sp. SD8 can serve as a promising microbial resource for the bioremediaion of contaminated soil with petroleum hydrocarbons including diesel

Styrene degradation in a polyurethane biofilter inoculated with Pseudomonas sp. IS-3

In a search for bacteria capable of degrading styrene better than previously isolated strains, bacterium IS-3 was isolated from activated sludge and found to be most closely related to Pseudomonas sp. Styrene degradation by this strain was tested in liquid cultures and polyurethane-packed biofilters. In liquid cultures, the rate of styrene degradation by this bacterium increased from 24.93 to 76.53 μmol g-1 DCW h-1 for an initial mass range from 8.7 to 34.8 μmol. The maximum styrene elimination capacity was 580-635 g/m3·h at a space velocity (SV) of 50-200/h. The critical elimination capacities guaranteeing 95% removal of the input styrene were determined to be 635, 170, and 38 g/ m3·h, respectively, at SVs of 50, 100, and 200/h. Kinetic analysis revealed that the maximum styrene elimination velocity (Vm) for this biofilter was 1,000 g/m·h, and the saturation constant (Km) was 454 ppmv. Together, these results suggest that a polyurethane biofilter containing Pseudomonas sp. IS-3 could have potential practical applications for the effective removal of styrene gas. © The Korean Society for Microbiology and Biotechnology