Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

박진,김정아 대한의학회 2020 Journal of Korean medical science Vol.35 No.13

Background: In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation. Methods: This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018. Results: The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain- death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended. Conclusion: Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

DACUM기법을 활용한 브레인트레이너(Brain-Trainer) 직무 분석

신재한(Jae-Han Shin) 한국청소년상담학회 2022 청소년상담학회지 Vol.3 No.2

본 연구에서는 건강, 교육, 문화 등 다양한 두뇌산업 현장에서 ‘브레인트레이너(Brain-Trainer)'가 수행해야 할 직무를 DACUM 기법을 활용하여 분석함으로써 ‘브레인트레이너(Brain-Trainer)'의 직무와 과업을 규명하고 직무 모형을 제안하는데 그 목적이 있다. ‘브레인트레이너(Brain-Trainer)'의 직무를 분석하기 위해서 두뇌 관련 전문가 10명을 대상으로 DACUM 위원회를 구성하여 2013년 3월 12일과 13일에 걸쳐 2일간 운영하였다. 본 연구의 결론을 제시하면 다음과 같다. 첫째, ‘브레인트레이너(Brain-Trainer)'의 직무를 효과적으로 수행하기 위해서 교육훈련 프로그램이나 교육과정을 설계하고 개발할 필요가 있다. 둘째, 두뇌산업 현장에서 ‘브레인트레이너(Brain-Trainer)'가 실제 활동한 결과를 토대로 재교육 및 보수교육을 실시할 필요가 있다. 셋째, ‘브레인트레이너(Brain-Trainer)'의 역량을 강화하기 위한 이론교육은 물론, 실제 임상경험을 할 수 있는 교육 실습을 병행해야 한다. 본 연구를 통해서 ‘브레인트레이너(Brain-Trainer)' 관련 새로운 직업군이 창출되고 두뇌훈련 분야가 확대되기를 기대할 수 있다. In this study, the tasks to be performed by a 'Brain-Trainer' in various brain industries such as health, education, and culture were analyzed using the DACUM technique. The purpose is to identify the duties and tasks of a 'Brain-Trainer' and to suggest a job model. To analyze the job of 'Brain-Trainer', the DACUM committee was formed for 10 brain-related experts and operated for 2 days on March 12 and 13, 2013. The conclusion of this study is presented as follows. First, it is necessary to design and develop a training program or curriculum in order to effectively perform the duties of a 'Brain-Trainer'. Second, it is necessary to carry out re-education and refresher training based on the results of actual activities of 'Brain-Trainers' in the field of brain industry. Third, theoretical education to strengthen the competency of a 'Brain-Trainer', as well as education and practice for actual clinical experience should be provided. Through this study, it can be expected that a new job group related to 'Brain-Trainer' will be created and the field of brain training will be expanded.

Temperature Difference between Brain and Axilla according to Body Temperature in the Patient with Brain Injury

오종양,조광욱,주원일,유도성,박해관 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Objective: Commonly, brain temperature is estimated from measurements of bodytemperature. However, temperature difference between brain and body is still controversy. The objective of this study is to know temperature gradient between the brain and axillaaccording to body temperature in the patient with brain injury. Methods: A total of 135 patients who had undergone cranial operation and had the thermaldiffusion flow meter (TDF) insert were included in this analysis. The brain and axillatemperatures were measured simultaneously every 2 hours with TDF (2 kinds of devices:SABER 2000 and Hemedex) and a mercury thermometer. Saved data were divided into 3 groupsaccording to axillary temperature. Three groups are hypothermia group (less than 36.4°C),normothermia group (between 36.5°C and 37.5°C), and hyperthermia group (more than 37.6°C). Results: The temperature difference between brain temperature and axillary temperaturewas 0.93±0.50°C in all data pairs, whereas it was 1.28±0.56°C in hypothermia, 0.87±0.43°Cin normothermia, and 0.71±0.41°C in hyperthermia. The temperature difference wasstatistically signifcant between the hypothermia and normothermia groups (p=0.000), butnot between the normothermia and hyperthermia group (p=0.201). Conclusion: This study show that brain temperature is signifcantly higher than the axillarytemperature and hypothermia therapy is associated with large brain-axilla temperaturegradients. If you do not have a special brain temperature measuring device, the results of thisstudy will help predict brain temperature by measuring axillary temperature.

뇌 기반 과학 영재 교육에 대한 교사들의 인식 조사

이미숙,권영식,이길재 韓國生物敎育學會 2010 생물교육 Vol.38 No.2

The purpose of this study was to examine the science teachers' perceptions related to Brain-Based Learning and to find ways to apply Brain-Based Learning to science class for science gifted students. For this purpose, 33 questions were surveyed to 144 science teachers. Among them, 73 science teachers are in charge of teaching gifted students. The results of this study were as follows: 1) Over 50% of teachers' brain style was left-brain type in self-test and most of the teachers had never seen any instruction related to Whole-brain learning or Brain-Based Learning. Also, most of them had never conducted brain style test to their students. There is no significant difference in perceptions between the group of general science teachers and the group of gifted education teachers. 2) Most of them had positive perception that science gifted students have unique brain and they need special instruction based on their characteristic brain. The group of gifted education teachers were more active in taking charge of Brain-Based Learning for those students. 3) Among the nine Brain-Based educational principles, the principle of creating a state of relaxed alertness, which is an atmosphere that is high in challenge, was the most important to group of gifted education teachers. On the other hand, the importance of the principle using music, art and moving of body in science class was higher to general teacher group than others. 4) Most of teachers wanted to take a training program for Brain-Based Learning and informations related to brain and learning.

초등과학교육에의 적용을 위한 뇌-기 반 학습 연구의 교육적 의미 분석

최혜영 ( Hye Young Choi ),신동훈 ( Dong Hoon Shin ) 한국초등과학교육학회 2014 초등과학교육 Vol.33 No.1

The purpose of this study was to analyze 181 papers about brain-based learning appeared in domestic scientific journals from 1989 to May of 2012 and suggest application conditions in elementary science education. The results of this study summarizes as follows; First, learning activity suggested by brain-based learning study is mainly explained by working of brain function. Learning activity explained by brain-based learning study are divided into ‘learning according to specialized brain function, learning according to brain function integration and learning beyond specialization and integration of hemispheres’. Second, it searched how increased knowledge of brain structure and function affects learning. Analysis from this point of view suggests that brain-based learning study affects learning in many ways especially emotion, creativity and learning motivation. Third, brain-based learning study suggests various possibilities of learning activity reflecting brain plasticity. Plasticity which is one of most important characteristics of brain supports the validity of learning activity as learning disorder treatment and explains the possibility of selective increment of brain function by leaning activity and the need of whole-brain approach to learning activity. Fourth, brain-based learning brought paradigm shifts in education field. It supports learning sophistication on the understanding of student`s learning activity, guides learning method that reflects the characteristics of subject and demands reconstruction of curriculum. Fifth, there are many conditions to apply brain-based learning in elementary science education field, learning environment that fits brain-based learning, change of perspectives on teaching and learning of science educators and development of brain-based learning curriculum are needed.

미숙아에서 뇌 MRI와 뇌 초음파 검사의 결과 비교

이승현,이주영,손진아,이진아,최창원,김이경,김한석,최중환,김병일 대한신생아학회 2012 Neonatal medicine Vol.19 No.1

Purpose : Brain magnetic resonance imaging (MRI) scans have become increasingly popular as a predictive tool for neurodevelopmental outcome in preterm infants, while serial brain ultrasonograms remain as a standard evaluation modality for neonatal brain. The aim of this study was to determine whether brain MRI taken at term-equivalent age could give us further information over serial brain ultrasonograms taken during admission. Methods : We analyzed 225 preterm infant (<32 weeks gestational age) who were admitted to NICU at Seoul National University Bundang Hospital from January 2006 to June 2011. The 28 infants with chromosomal abnormalities or major congenital anomalies were excluded. We compared abnormal findings between brain MRI scan taken at term-equivalent age and serial brain ultrasonograms taken during admission in 197 preterm infants. Results : The brain MRI scans taken at term-equivalent age showed normal findings in 142 out of 197 (72%) infants and abnormal findings in 55 out of 197 (28%) infants. The brain ultrasonograms during admission revealed 82 intraventricular hemorrhages, 90periventricular leukomalacias, 7 brain parenchymal lesions, 3 ischemic lesions. Brain MRI scans discovered 30 intraventricular hemorrhages, 10 periventricular leukomalacias, 12 brain parenchymal lesions, 3 ischemic lesions. Ventriculomegaly was discovered only by the brain ultrasonography. Five brain parenchymal lesions and 9 cerebellar lesions were appeared only on the brain MRI scans. Brain MRI scans taken at term-equivalent age detected grade 1 or 2 intraventricular hemorrhages which were not discovered by last brain ultrasonograms. Conclusion : In compare to the serial brain ultrasonograms, the brain MRI scan taken at term-equivalent age is advantageous in discovering brain parenchymal lesions and cerebellar lesions and precise grading of intraventricular hemorrhage in preterm infants. 목적: 미숙아에서 뇌 자기공명영상(magnetic resonance imaging,MRI) 검사는 신경발달의 결과를 예측하는 방법으로서 점차 많이사용되고 있지만, 정기적 뇌 초음파 검사는 여전히 신생아 뇌 검사방법의 기준으로 남아있다. 미숙아에서 퇴원 무렵에 시행된 뇌 자기공명영상과 입원기간 중 연속적으로 시행된 뇌 초음파영상을 비교하여 뇌 자기공명영상이 추가적인 정보를 줄 수 있는지 알아보았다. 방법: 2006년 1월부터 2011년 6월까지 임신나이 32주 미만의 미숙아로 분당 서울대병원 신생아 중환자실에 입원한 환아들 중 퇴원무렵에 뇌 MRI 검사를 받은 225명을 대상으로 하였으며, 이들 환아중 염색체 이상 또는 중추신경계 기형이 있는 28명 환아를 제외한197명의 뇌 MRI와 입원기간 중 뇌 초음파 소견을 비교하였다. 결과: 대상 환아들 중 퇴원 무렵 뇌 MRI 검사 결과가 정상인 환아는 142명(124/197, 72%) 이었고, 양성 소견(positive finding)을 보인환아는 55명(55/197, 28%) 이었다. 뇌 초음파에서 미숙아의 주요 뇌병변에 대해 기술된 경우는 뇌실 내 출혈 82명, 뇌실 주위 백질연화증 90명, 뇌실질의 출혈 7명 및 허혈성 병변 3명 이였고, 뇌 MRI에서는 각 질환 별로 30명, 10명, 12명, 3명 이었다. 뇌실 확장은 주로 뇌 초음파에서 발견되었고, 뇌 초음파에서 발견되지 않았던 뇌실 내 출혈5건, 뇌실 주변 백질연화증 1건, 뇌실질 출혈 11명, 소뇌 병변 9명은뇌 MRI에서만 발견되었다. 교정나이 만삭아 시기에 촬영한 뇌 MRI 에서 입원기간 마지막으로 시행한 뇌 초음파에서 발견되지 않았던뇌실 내 출혈(Grade 1 or 2)이 발견되기도 하였다. 결론: 뇌 초음파 검사와 비교할 때, 미숙아들에게 퇴원 전 뇌 MRI 검사는 뇌 초음파 검사에서 발견하기 어려운 뇌 실질의 출혈, 소뇌병변의 발견 및 뇌실 내 출혈 정도를 명확히 확인하는 데 있어서도도움이 될 것으로 생각된다

Brain Inflammation and Microglia: Facts and Misconceptions

정혜경,지경민,민경진,조은혜 한국뇌신경과학회 2013 Experimental Neurobiology Vol.22 No.2

The inflammation that accompanies acute injury has dual functions: bactericidal action and repair. Bactericidal functions protect damaged tissue from infection, and repair functions are initiated to aid in the recovery of damaged tissue. Brain injury is somewhat different from injuries in other tissues in two respects. First, many cases of brain injury are not accompanied by infection: there is no chance of pathogens to enter in ischemia or even in traumatic injury if the skull is intact. Second, neurons are rarely regenerated once damaged. This raises the question of whether bactericidal inflammation really occurs in the injured brain; if so, how is this type of inflammation controlled? Many brain inflammation studies have been conducted using cultured microglia (brain macrophages). Even where animal models have been used, the behavior of microglia and neurons has typically been analyzed at or after the time of neuronal death, a time window that excludes the inflammatory response, which begins immediately after the injury. Therefore, to understand the patterns and roles of brain inflammation in the injured brain, it is necessary to analyze the behavior of all cell types in the injured brain immediately after the onset of injury. Based on our experience with both in vitro and in vivo experimental models of brain inflammation, we concluded that not only microglia, but also astrocytes, blood inflammatory cells, and even neurons participate and/or regulate brain inflammation in the injured brain. Furthermore, brain inflammation played by these cells protects neurons and repairs damaged microenvironment but not induces neuronal damage.

Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation?

Hong, Jong Won,Chung, Soon Won,Ahn, Sung Jae,Lee, Won Jai,Lew, Dae Hyun,Kim, Yong Oock Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.5

Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (${\pm}15.3$). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (${\pm}14hours$ 50 minutes) and 22 hours 57 minutes (${\pm}16hours$ 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.

불교 명상을 통한 심신치유의 뇌과학적 이해

김종욱(Kim, Jong Wook),안지영(An, Ji Young) 韓國佛敎硏究院 2014 불교연구 Vol.41 No.-

오늘날 명상이 스트레스나 우울증 등 심신 관련 질환을 치료하는데 매우 유용하게 활용될 수 있다는 사실들이 속속 알려지고 있다. 그런데 불교의 명상 관련 기존의 논문들은 명상 수행이 어떤 치유효과를 가져 오는가를 증명하는데 주안점을 두었을 뿐, 그런 치유효과가 과연 어디에 기반을 두고 이루어지는가에 대해서는 큰 관심이 없었다. 본 논문은 불교 명상을 통한 심신치유의 효과가 뇌의 가소성에 기반하여 이루진다는 점을 보여 주기 위해 작성되었다. 뇌가 생각과 활동 혹은 경험과 훈련을 통해서 스스로의 기능과 구조를 변경할 수 있는 것을 일러 가소성이라 한다. 뇌의 가소성은 뇌가 마음을 일으키고 형성하지만, 마음이 변화하면 뇌 역시도 변화한다는 것을 함축한다. 명상은 이런 마음의 변화를 통해 뇌파의 변화와 뇌구조의 변화를 가져온다. 지속적인 명상의 수행은 통찰이나 직관적 깨달음에서 나타나는 세타파와 명료한 생각이나 사랑·공감에서 일어나는 감마파의 발생을 활성화한다. 또한 명상을 하면 긍정적 정서와 관련된 좌측 전전두피질 부위가 강화되며, 기억을 담당하는 해마와 감정 조절을 담당하는 안와전두피질 등의 크기가 보통 사람보다 더 커지고, 흥분이나 긴장과 관련된 교감신경계의 반응성은 낮아지면서 억제나 이완작용을 하는 부교감신경계는 활성화된다. 이뿐만 아니라 뇌 속 스트레스 호르몬인 아드레날린이나 노르에프네프린 또는 코티솔 같은 신경전달물질은 감소하는 대신, 일종의 평화의 호르몬인 도파민과 엔도르핀 그리고 행복의 감정을 전달하는 세로토닌 등의 신경전달물질 분비는 촉진된다. 명상을 통한 마음의 변화가 이처럼 뇌파와 뇌구조와 신경전달시스템의 변화를 가져온다는 것은 뇌가 그만큼 유연하고도 개방적인 체계라는 것에 대한 증거이며, 뇌가 가소성을 지닌 체계라는 것에 기반하여 이루어지는 현상이다. 뇌가 마음을 형성하지만, 마음은 뇌를 변화시킨다는 것을 함축하는 뇌의 가소성이야말로 불교의 명상을 통해 스트레스나 우울증이나 강박장애 같은 질환을 치유할 수 있는 근거가 된다. 명상은 마음을 변화시키고, 마음의 변화는 가소적인 뇌를 변화시켜, 심신을 치유하고 삶을 바람직한 방향으로 변화시킨다. These days the meditation is broadly utilized for the purpose of curing the mental disease like the stress, hypochondria and obsessive compulsive disorder. In this article I explicate that the mental and physical healing by the Buddhist meditation is founded on the brain plasticity. The brain plasticity means that the brain can make alterations in its structure and function through the experience and practice or the thinking and acting by itself. This concept implies that the brain raises and forms the mind, but the change of mind causes the change of brain. Through the meditation the change of mind lead to the change of the brain waves and brain structure. The continuant practice of meditation activates the occurrence of the theta waves and gamma waves. The theta waves appear in the state of insight and intuitional awareness, and gamma waves come out in the state of clear thought and sympathy. The meditation practice strengthens the left prefrontal lobe part related to the positive feeling, and enlarges the hippocampus and orbitofrontalcortex related to the memory and emotion control, and activates the parasympathetic nervous system related to the inhibitory and relaxant action. In the state of meditation the stress hormones like adrenaline, norepinephrine and cortisol neurotransmitter decrease, but a kind of happiness hormones like dopamine, endorphin and serotonin neurotransmitter increase. The fact that the change of mind by meditation causes the change of brain waves and brain structure and neurotransmitter system is the evidence of the flexibility and openness in the brain system, and is foundeded on the brain plasticity. The brain plasticity is the basis of cure of the mental disease like the stress, hypochondria and obsessive compulsive disorder through the Buddhist meditation. The meditation changes the mind, and the change of mind causes the change of the plastic brain. And so this change heals the mind and body in the desirable direction of life.

기능적-자기공명촬영장치를 이용한 저작시 두뇌활성화부위

이병황,유태민,이종헌,박경주 대한구강악안면병리학회 2014 대한구강악안면병리학회지 Vol.38 No.2

This study were to perform for verifying the activation areas in the human's brain during mastication by using functional-MRI (f-MRI)device on the basis of hypothesis regarding anatomical-physiological parts of brain processing the information of motor and sensoryfunction, and to perform further more for a providing basic provisional foundation about diagnosis, treatment and prognosis of abnormalocclusion as applying functional MRI. Generally healthy 10 volunteers who have a normal occlusion were selected. The half of membersof volunteers was female. Age distributions were approximately alike. Before taking a f-MRI, sufficient practice was carried out asstrict standards and made volunteers be not sensible to sweet taste of gum through chewing gum for 30 minutes before taking af-MRI. Functional images for all volunteers were firstly obtained, and then anatomical images were next. The functional images consistedof echo-planar image volumes which were sensitive to BOLD (blood oxygenation level-dependent) contrast in axial orientation. Thevolume covered the whole brain with a 64×64 matrix and 42 slices. Images with 64 volumes were acquired under periodic mastication. The orofacial sensorimotor cortex was primary responsible cerebral part during mastication and insula. And also supplementary motorarea and cerebellum in brain were intimately connected with mastication. Other numerous anatomical parts of brain were activatedin each volunteer during mastication, but there was no statistical significance in this experiment. Differences according to gender andage were no significance in this study. The f-MRI device showed the accurate and detailed image in activation area of brain throughvaluable device. It suggested that f-MRI might be helpful to establish the basis of funtional standard occlusion depend on activationarea of brain. This study were to perform for verifying the activation areas in the human's brain during mastication by using functional-MRI (f-MRI)device on the basis of hypothesis regarding anatomical-physiological parts of brain processing the information of motor and sensoryfunction, and to perform further more for a providing basic provisional foundation about diagnosis, treatment and prognosis of abnormal occlusion as applying functional MRI. Generally healthy 10 volunteers who have a normal occlusion were selected. The half of members of volunteers was female. Age distributions were approximately alike. Before taking a f-MRI, sufficient practice was carried out as strict standards and made volunteers be not sensible to sweet taste of gum through chewing gum for 30 minutes before taking a f-MRI. Functional images for all volunteers were firstly obtained, and then anatomical images were next. The functional images consisted of echo-planar image volumes which were sensitive to BOLD (blood oxygenation level-dependent) contrast in axial orientation. The volume covered the whole brain with a 64×64 matrix and 42 slices. Images with 64 volumes were acquired under periodic mastication. The orofacial sensorimotor cortex was primary responsible cerebral part during mastication and insula. And also supplementary motor area and cerebellum in brain were intimately connected with mastication. Other numerous anatomical parts of brain were activated in each volunteer during mastication, but there was no statistical significance in this experiment. Differences according to gender and age were no significance in this study. The f-MRI device showed the accurate and detailed image in activation area of brain through valuable device. It suggested that f-MRI might be helpful to establish the basis of funtional standard occlusion depend on activation area of brain.