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임상 연구 : 만성신질환 환자에서 레닌-안지오텐신 차단제와 efonidipine 병합요법이 단백뇨에 미치는 효과에 대한 다기관 관찰 연구
위정국 ( Jung Kook Wi ),정경환 ( Kyung Whan Jeong ),이태원 ( Tae Won Lee ),이상호 ( Sang Ho Lee ),문주영 ( Ju Young Moon ),차대룡 ( Dae Ryong Cha ),하성규 ( Sung Kyu Ha ),김순배 ( Soon Bae Kim ),곽임수 ( Ihm Soo Kwak ),임천규 ( Ch 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.3
목 적: 기존의 L형 CCB에 비해 L/T형 CCB는 사구체 내압의 감소 및 알도스테론 차단 효과가 더 우수하여 단백뇨 감소 및 신기능의 보존의 측면에서 유용할 것으로 제시되고 있다. 연구자들은 ACE 차단제 또는 ARB 제제와 amlodipine을 사용하고 있는 만성신질환 환자에서 efonidipine으로의 교체 투여가 혈압, 요단백량에 미치는 영향을 조사하고자 하였다. 방법: ACE 억제제 또는 ARB 제제와 amlodipine을 사용 중 단회뇨 단백/크레아티닌비 0.5 이상의 단백뇨를 보이는 만성신질환 2-4단계 환자 41명을 대상으로 amlodipine 5 mg을 efonidine 40 mg으로 교체투여하고 교체 전과 3개월 후의 혈압과 요단백량을 비교, 분석하였다. 결과: 단백뇨성 만성신질환 환자에서 amlodipine 5 mg을 eponidifine 40 mg으로 변경하였을 때 1) 수축기 및 확장기 혈압, 혈청 크레아티닌에는 유의한 변화를 보이지 않았다. 2) 단회뇨 단백/크레아티닌비는 유의한 감소를 보였다 (교체 전 2.9±2.6, 교체 후 2.3±1.9). 3) 성별 및 원인질환에 따른 요단백량의 감소량은 차이가 없었다. 4) 만성신질환 2,3기 환자에서 4기 환자에 비해 유의한 요단백량 감소가 관찰되었다. 5) 요단백/크레아티닌비 3.0 이상의 환자에서 단백뇨 감소효과가 더 우수하였다. 결론: 본 관찰 연구는 ACE 억제제 또는 ARB 제제를 투여 중인 단백뇨성 만성신질환 환자에서 L/T형 칼슘통로차단제와의 병합투여는 L형 차단제와의 병합투여에 비해 우수한 단백뇨 감소 효과를 가지고 있음을 시사한다. 향후 L/T형 칼슘통로차단제의 항단백뇨 및 신기능 보존 효과에 대한 대규모 전향적 연구가 필요할 것이다. Purpose: Efonidipine, which inhibits both T- and L-type calcium channels, has been shown to be effective in reducing proteinuria and preserve renal function. This study was conducted to compare the effects of efonidipine versus amlodipine on the management of hypertension and proteinuria in patients with chronic kidney disease (CKD) receiving ACE inhibitors or ARB. Methods: This study included 41 CKD patients who were at stages 2-4 and had a urine spot protein/ creatinine ratio of >0.5. Patients were administered amlodipine (5 mg/day) and efonidipine (40 mg/ day) for 3 months in a cross-over design. Blood pressure and spot urine protein/creatinine ratio were compared before and after the cross-over treatment. Results: There were 24 male patients and 17 female patients. The mean age of the patients was 55.9±12.9 years. When the patients` medication was changed to eponidifine, we obtained the following results. First, there were no significant changes in blood pressure and serum creatinine. Second, the urine spot protein/creatinine ratio was significantly decreased (before the cross-over, 2.9±2.6; after the cross-over, 2.3±1.9 g/g; p=0.02). Finally, the reduction rate of proteinuria was significantly higher in patients with CKD at stages 2-3 than in those with CKD at stage 4 after the cross-over (stage 2, - 26.1%; stage 3, -17%; stage 4, +12.8%; p=0.03). Conclusion: It is concluded that efonidipine may significantly decrease proteinuria compared with amlodipine in CKD patients receiving ACE inhibitors or ARB. Further double-blind clinical trials with a larger sample size are needed to confirm our results.
Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections
Chi Hyuk Oh,이준규,Tae Jun Song,Jin-Seok Park,Jae Min Lee,Jun Hyuk Son,Dong Kee Jang,Miyoung Choi,Jeong-Sik Byeon,In Seok Lee,Soo Teik Lee,Ho Soon Choi,Ho Gak Kim,Hoon Jai Chun,Chan Guk Park,Joo Young Ch 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections(PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use ofendoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of GastrointestinalEndoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelinesdevelopment prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched,and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines weresystematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discussesendoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations,optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metalstents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed byexternal experts and suggests best practices recommended based on the evidence available at the time of preparation. This will berevised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.
Cho, Hee Jun,Baek, Kyoung Eun,Kim, In-Kyu,Park, Sun-Mi,Choi, Yeong-Lim,Nam, In-Koo,Park, Seung-Ho,Im, Min-Ju,Yoo, Jong-Min,Ryu, Ki-Jun,Oh, YoungTaek,Hong, Soon-Chan,Kwon, Oh-Hyung,Kim, Jae Won,Lee, Ch American ChemicalSociety 2012 JOURNAL OF PROTEOME RESEARCH Vol.11 No.4
<P>Rho GDP dissociation inhibitor 2 (RhoGDI2) was initiallyidentifiedas a regulator of the Rho family of GTPases. Our recent works suggestthat RhoGDI2 promotes tumor growth and malignant progression, as wellas enhances chemoresistance in gastric cancer. Here, we delineatethe mechanism by which RhoGDI2 promotes gastric cancer cell invasionand chemoresistance using two-dimensional gel electrophoresis (2-DE)on proteins derived from a RhoGDI2-overexpressing SNU-484 human gastriccancer cell line and control cells. Differentially expressed proteinswere identified using matrix-assisted laser desorption ionization-time-of-flightmass spectrometry (MALDI-TOF-MS). In total, 47 differential proteinspots were identified; 33 were upregulated, and 14 were downregulatedby RhoGDI2 overexpression. Upregulation of SAE1, Cathepsin D, Cofilin1,CIAPIN1, and PAK2 proteins was validated by Western blot analysis.Loss-of-function analysis using small interference RNA (siRNA) directedagainst candidate genes reveals the need for CIAPIN1 and PAK2 in RhoGDI2-inducedcancer cell invasion and Cathepsin D and PAK2 in RhoGDI2-mediatedchemoresistance in gastric cancer cells. These data extend our understandingof the genes that act downstream of RhoGDI2 during the progressionof gastric cancer and the acquisition of chemoresistance.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jprobs/2012/jprobs.2012.11.issue-4/pr2011186/production/images/medium/pr-2011-011186_0005.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/pr2011186'>ACS Electronic Supporting Info</A></P>
실험적 신질환 : Cyclosporine에 의해 유도된 췌장손상 시 sriolimus로 대체 투여하였을 때 Srolimus가 당뇨에 미치는 영향
송현국 ( Hyun Kuk Song ),기정연 ( Jung Yeon Ghee ),한동하 ( Dong He Han ),윤혜은 ( Hye Eun Yoon ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),김용수 ( Yong Soo Kim ),방병기 ( Byung Kee Bang ),윤권호 ( Kun Ho Yoon ),양철우 ( Ch 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1
Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections
( Chi Hyuk Oh ),( Tae Jun Song ),( Jun Kyu Lee ),( Jin-seok Park ),( Jae Min Lee ),( Jun Hyuk Son ),( Dong Kee Jang ),( Miyoung Choi ),( Jeong-sik Byeon ),( In Seok Lee ),( Soo Teik Lee ),( Ho Soon Ch 대한소화기학회 2021 Gut and Liver Vol.15 No.5
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. (Gut Liver 2021;15:677-693)