물리학 선량법을 이용한 갑상선암의 개인별 최대안전용량 I-131 치료법 개발과 유용성 평가

김정철,윤정한,범희승,제갈영종,송호천,민정준,정환정,김성민,허영준,이명호,박영규,정준기 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.2

목적 : 분화갑상선암 환자에 대한 방사성옥소(I-131) 치료는 재발율과 사망률을 감소시키는 효과적인 치료법이지만, 치료용량을 증가시킴으로써 치료율을 향상시킬 수 있는지에 대해서는 아직 논란이 있다. 본 연구에서는 최대허용선량 치료법의 효용성을 검증하고자 하였다. 대상 및 방법 : 임상적 병기가 제3, 4병기이고, 6개월 이후에 I-131 전신스캔(이하 IWBS)과 혈중 thyroglobulin (이하 Tg), anti-thyroglobulin antibody (이하 ATA), 초음파검사 (이하 US) 및 F-18 FDG PET 등을 통해 치료여부를 확인할 수 있었던 58명(남:여=9:49, 평균연령 50±11세)의 유두상갑상선암 환자를 대상으로 하였다. 이중 11명은 제4병기, 47명은 제3병기였으며, 43명(남:여=4:39), 평균연령 50±11세)은 7.4 GBq 이하의 고식적인 저용량치료법으로 치료하였고, 9.25 GBq 이상의 고용량 치료를 받은 환자는 15명(남:여=5:10, 평균연령 50±12세)으로 고용량군에서 남자가 더 많았으나 연령의 차이는 없었다. 고용량군 환자 모두에서 추적용량의 방사성옥소(평균 77±3 MBq)를 경구 투여한 후 혈중 방사능소실곡선을 통해 최대허용선량(maximum permissible dose, 이하 MPD)을 계산하였으며, 7명에서는 말초혈액림프구의 중기염색체분석법에 의해 생물학적으로 MPD를 계산하였다. 14명에서는 치료용량의 방사성옥소를 투여한 후 혈중 방사능소실곡선을 통해 MPD를 계사하였다. 완전치유(complete response, 이하 CR)는 IWBS에서 병소가 없어지고, 혈중 Tg치가 1 ng/mL 이하로 감소한 경우로 정의하였으며, 부분치유(partial response, 이하 PR)는 IWBS에서 병소가 없어졌더라도 혈중 Tg, ATA치가 높거나, US 또는 PET 검사에서 병소가 남아있는 경우로 정의하였다. 치료후 IWBS에서 병소가 오히려 증가하거나 변함없는 경우는 없었다. 방사성옥소 치료에 의한 부작용은 입원기간 중 타액선이 현저하게 붓고 통증이 있거나, 구토를 심하게 하는 경우, 그리고 퇴원후 1개월째 백혈구수가 20% 이상 감소한 경우로 정의하였다. 결과 : 양 군간에 연속적인 수치변화를 비교하는 경우는 paired t-test를 이용하였으며, 대상군간 치료효과와 부작용의 비교는 chi-square test를 이용하였다. p값 0.05 미만을 통계적으로 유의한 차이로 인정하였다. 고용량군 환자 모두에서 추적용량과 치료용량의 방사성옥소 투여 후 혈액의 피폭선량은 각각 0.012±0.3 Gy, 1.66±25 Gy였으며, 방사성옥소 투여 후 혈액에 전달되는 피폭선량은 추적용량보다 치료용량에서 더 많았고 (1.21: 166 rad, p<0.001), 방사성옥소 1 mCi당 혈액에 전달되는 피폭선량은 차이가 없었다(0.58±0.1 vs. 0.56±0.1 rad/37 MBq, p=0.34). 추적용량 방사성옥소 투여 후 구한 MPD는 평균 13.3±1.9 GBq (9.7 ~ 16 GBq) 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 13.8±2.1 GBq (10.4 ~ 16.3 GBq)로 유의한 차이가 없었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 1.78±0.03 G였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 1.54±0.03 G로 유의하게 낮았으나 (p=0.01), 두 측정치 간에는 유의한 상관관계(r=0.86, p=0.01)가 있었다. 저용량 치료군 43명 중 22명(51.2%)에서 완전치유를 보였고 21명(48.8%)에서는 부분치유를 보인 반면 고용량 치료군 15명 중 12명(80%)에서 완전치유를 보였고 3명(20%)에서만 부분치유를 보여 고용량 치료군에서 유의하게 높은 완전치유를 얻을 수 있었다(p=0.05). 한편 부작용 발생빈도는 저용량 치료군 43명 중 13(30.2%), 고용량 치료군 15명 중 6명(40%)로 양군간에 유의한 차이가 없었다(p=0.46). 임상적인 병기, 연령 및 성별에 따라서는 치유의 차이가 없었다(p>0.05). 결론 : 혈중소실곡선으로부터 MPD를 결정하고 이를 토대로 환자 개개인별로 적절한 선량을 선택하여 치료하는 방법은 부작용을 최소화하면서도 치료효과를 높일 수 있는 매우 유용한 치료법이며, 고위험군 분화갑상선 암 환자에게 가장 적절한 치료법이라고 사료되었다. Purpose: Radioiodine (1-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age 50±11 years) of papillary thyroid cancer. Among them 43 patients were treated with ≤7.4 GBq, while 15 patients with ≥9.25 GBq. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up 1-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were 13.3±1.9 and 13.8±2.1 GBq, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were 1.54±0.03 and 1.78±0.03 Gy (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-does group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose 1-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

Chitin deacetylase from Absidia coerulea CHK-1 : Mycerial chitin deacetylase of a chitin deacelylase-hyperproducuing fungus, Absidia coerulea CHK-1

Park, Chun,Kim, Jung Ran,Shin, Jae Kyoung,Kim, June Ki,Lee, Tae Kyun,Chung, Ji Chun,Park, Weon Hwan,Park, Sun Dong,Nam, Kyung Soo,Lee, Young Choon,Kim, Cheorl Ho 한국키틴키토산학회 1997 한국키틴키토산학회지 Vol.2 No.2

A mycelial chitin deacetylase has been purified from a chitin deacetylase-hyperproducing fungus, Absidiα coerulea CHK-1. The purified enzyme had a molecular mass of about 62 kDa on denaturated and natural conditions. The pI was 5.5. The chitin deacetylase, when resolved by SDS-PAGE, was positive for Schiff staining, suggesting that the enzyme is a glycoprotein. When O-hydroxylated chitin (glycolchitin) was used as a substrate, the enzyme displayed a temperature optimum of around 50℃ and a pH optimum of around PH 5,5. The enzyme was stable to incubation from pH 3.0 to pH 6.5 at 4℃ for 24 hr. The presence of chitin protected the enzyme from heat inactivation, the extent depending upon the substrate concentration. The activity of the enzyme was stimulated by Mn2+ ion. The enzyme is active on chitooligosaccharides with more than two N-acetylglucosamine residues (M-acetylchitobiose). However, the enzyme is not active on N-acetylglucosamine. The enzyme had an apparent Km of 12.4 mM and Kcat of 32.4 /sec for glycol chitin, respectively.

Contact-adjusted Immunity Levels against SARS-CoV-2 in Korea and Prospects for Achieving Herd Immunity

Chun June Young,Jeong Hwichang,Kim Yongdai 대한의학회 2021 Journal of Korean medical science Vol.36 No.38

The proportion of population vaccinated cannot be directly translated into the herd immunity. We have to account for the age-stratified contact patterns to calculate the population immunity level, since not every individual gathers evenly. Here, we calculated the contact-adjusted population immunity against severe acute respiratory syndrome coronavirus 2 in South Korea using age-specific incidence and vaccine uptake rate. We further explored options to achieve the theoretical herd immunity with age-varying immunity scenarios. As of June 21, 2021, when a quarter of the population received at least one dose of a coronavirus disease 2019 (COVID-19) vaccine, the contact-adjusted immunity level was 12.5% under the social distancing level 1. When 80% of individuals aged 10 years and over gained immunity, we could achieve a 58.2% contact-adjusted immunity level. The pros and cons of vaccinating children should be weighed since the risks of COVID-19 for the young are less than the elderly, and the long-term safety of vaccines is still obscure.

Gemcitabine-induced myositis in a diabetes mellitus patient on hemodialysis

( June Young Chun ),( Jae Myung Lee ),( Dong Won Ahn ),( Jee Won Chai ),( Young A Kim ),( Kichul Shin ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.5

Poster Session : PS 0755 ; Rheumatology ; A Case of Gemcitabine-Induced Vasculitis Mimicking Diabetic Muscle Infarction

( June Young Chun ),( Jae Myung Lee ),( Dong Won Ahn ),( Jee Won Chai ),( Young A Kim ),( Kichul Shin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Myopathy or myositis in cancer patients can be related with a number of etiologies and infi ammatory myositis is the primary disease entity of concern. There have also been rare cases of muscle injury caused by cytotoxic agents used in cancer treatment. Methods: Here we report a case of a 64-year-old male with pancreatic adenocarcinoma and diabetes mellitus on hemodialysis presenting with swelling of his face and right arm. He had been treated with gemcitabine monotherapy for the previous 6 months. Results: Forearm MRI revealed diffuse swelling of muscles of his right forearm and fi ngers. Muscle biopsy showed marked necrosis of muscle fi bers with infi ammatory cell infi ltration and fi brinoid necrosis in the vascular walls. With discontinuation of gemcitabine, musculoskeletal symptoms resolved spontaneously. Conclusions: This case advocates that gemcitabine-related musculoskeletal complications are in need to be carefully monitored during its use, especially in patients with underlying small vessel disease or atherosclerosis.

Case Reports : Primary granulocytic sarcoma of ovary

( Jee Young Jung ),( Min Jung Jung ),( Jee Young Oh ),( Mi Hyang Kim ),( Hang Goo Yun ),( Young Lim Oh ),( Tae Hwa Lee ),( Chun June Lee ),( Won Gyu Kim ) 대한산부인과학회 2010 Journal of Womens Medicine Vol.3 No.2

Primary granulocytic sarcoma of ovary is extremely rare presentation of acute non-lymphatic leukemia. Absence of high suspicion, it is often misdiagnosed with other ovarian malignancies. We describe a case of 37-years-old woman with ovarian mass who is identified as primary granulocytic sarcoma of ovary without any coexisting hematologic disorders.

다양한 요오드화 조영제에 아나필락시스 반응을 보인 환자에서 성공적인 조영증강 전산화 단층촬영 사례 1예

전준영 ( June Young Chun ),최승진 ( Seong Jin Choi ),김률 ( Ryul Kim ),김건우 ( Gun Woo Kim ),김주영 ( Ju Young Kim ),최영훈 ( Young Hun Choi ),강혜련 ( Hye Ryun Kang ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Although hypersensitivity reactions to iodinated contrast media (ICM) are uncommon, their clinical impacts are considerable because of their wide use and potential fatality. The best way to prevent ICM-induced hypersensitivity is to avoid re-exposure to the ICM. However, ICM use is inevitable in the evaluation of many diseases. A 64-year-old male with renal cell carcinoma presented with anaphylaxis after computed tomography (CT) using iohexol. Intradermal test results were positive to iohexol, iomeprol, and ioversol. The following 3 CT scans using the test-negative agents iopromide, iopamidol, and iobitridol still provoked hypersensitivity reactions despite premedication using intravenous antihistamine and corticosteroid. For the next step, iodixanol, a nonionic iso-osmolar dimer, was tested by intravenous graded challenges in addition to the intradermal skin test, which and was confirmed to be negative. The patient underwent CT scan using iodixanol after premedication with chlorpheniramine 4 mg and methylprednisolone 40 mg, and hypersensitivity reactions did not recur. We report a case of a patient showing hyper reactivity to multiple ICMs despite negative intradermal skin tests, who eventually underwent successful enhanced CT scans after choosing ICM by the graded challenge test. (Allergy Asthma Respir Dis 2015;3:449-451)

난소 종양에서의 MAGE (Melanoma Antigen Gene) 유전자 발현

이천준 ( Chun June Lee ),남영일 ( Young Il Nam ),서자영 ( Ja Young Seo ),이인철 ( In Cheol Lee ),김영환 ( Young Hwan Kim ),김원규 ( Won Gyu Kim ),김흥열 ( Heung Yeol Kim ),김성한 ( Sung Han Kim ),박은동 ( Eun Dong Park ),김영옥 ( 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.6

목적 : 대부분의 난소암이 진행된 시기에 발견되기 때문에 효과적인 치료법의 대안이 필요하다는 점을 고려할 때 난소암에서 MAGE 유전자 발현을 조사하여 그 발현과 면역 요법의 적절성을 연구하는 것은 난소암의 치료에 의미가 있다고 생각된다. 이에 저자는 정상 난소 조직, 비종양성 난소 질환과 양성 및 악성 난소 종양에서의 MAGE 1-6 common primer를 이용한 nested RT-PCR법으로 MAGE 유전자 발현을 조사하여 MAGE 유전자를 이용 Objective : Chemotherapy of ovarian cancer has a main role in the post-surgical treatment of ovarian cancer. However, relapsing patients are usually resistant to an additional chemotherapy. The development of immunotherapy is therefore needed to offer oth

Experimental Research Article : Kappa-opioid receptor activation during reperfusion Limits myocardial infarction via ERK1/2 activation in isolated rat hearts

( June Hong Kim ),( Young Ho Jang ),( Kook Jin Chun ),( Jun Kim ),( Yong Hyun Park ),( Jeong Su Kim ),( Jin Mo Kim ),( Mi Young Lee ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.5

Background: We investigated whether p42/p44 extracellular signal-regulated kinases (ERK1/2) and/or phosphatidylinositol-3-OH kinase (PI3K)-Akt play a crucial role in cardioprotection by κ-opioid receptor (KOP) activation. Methods: Langendorff perfused rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Antagonists of ERK1/2 and PI3K were perfused in hearts treated with the KOP agonist U50488H (U50). Infarct size was measured after 2 h of reperfusion. The phosphorylation states of ERK1/2 and Akt by Western immunoblots were determined. Drugs were perfused for a period of 5 min before and 30 min after reperfusion. Results: Inhibition of ERK1/2 (26.8 ± 2.9%, P < 0.05 vs. U50) but not PI3K (15.5 ± 1.1%, P > 0.05 vs. U50) completely abrogated the anti-infarct effect of U50488H. Western blot analysis revealed a significant increase in ERK1/2 but not Akt phsophorylation in U50488H-treated hearts as compared to control hearts when measured immediately after reperfusion. Conclusions: KOP activation effectively reduces myocardial infarction. The anti-infarct effect of U50488H is mediated by the ERK1/2, but not the PI3K-Akt pathway. (Korean J Anesthesiol 2011; 60: 351-356)

An Experimental Study on Heat Transfer Characteristics Just Before Critical Heat Flux in Uniformly Heated Vertical Annulus Under a Wide Range of Pressures

Chun, Se-Young,Moon, Sang-Ki,Chung, Heung-June,Chung, Moon-Ki,Masanori Aritomi 한국원자력학회 2002 Nuclear Engineering and Technology Vol.34 No.4