불면증의 생리학적 모델

심현보,유범희,Sim, Hyun-Bo,Yu, Bum-Hee 대한수면의학회 2009 수면·정신생리 Vol.16 No.1

Relatively little is known about the neurobiology of insomnia, despite its wide prevalence and broad medical impact. Although much is still to be learned about the pathophysiology of the disorder, identification, systematic assessment, and appropriate treatment are clearly beneficial to patients. Recent research, using quantitative EEG, polysomnography (PSG), multiple sleep latency test (MSLT) and neuroimaging techniques, suggests that some broad areas can be identified as possible pathophysiological models. Sleep-wake homeostat model hypothesizes a failure in homeostatic regulation of sleep, an attenuated increase in sleep drive with time awake, and/or defective sensing of sleep need. Circadian clock model hypothesizes a dysfunctional circadian clock, resulting in changes in the timing of sleep-wake propensity that are incompatible with normal sleep. Intrinsic sleep-wake state mechanism model suggests that abnormal function of insomnia comprises the systems responsible for expression of the sleep states themselves. Extrinsic over-ride mechanism (stress-response) model suggests that insomnia reflects the consequences of overactivity of one of the systems considered "extrinsic" to normal sleep-wake control. Many current therapies for insomnia are based on these physiological models. Several attempts have been made to create a physiological model that would explain this disorder and could be used as a foundation for treatment. However, it appeared that no model can fully explain and clarify all aspects of insomnia. Future research should be necessary to expand our knowledge on the biological dimensions of insomnia.

불안과 노어에피네프린

심현보,유범희,Sim, Hyun-Bo,Yu, Bum-Hee 대한불안의학회 2006 대한불안의학회지 Vol.2 No.1

Anxiety has been suggested to be related to many neurotransmitters in brain, such as norepinephrine, serotonin, dopamine, cholecystokinin, and gamma-amino butyric acid. There are many studies to examine the relationship between anxiety and norepinephrine, and norepinephrine seems to be clearly related to the development of anxiety. We suggest that future studies to explore the pathophysiology of anxiety should be necessary, which include studies on antianxiety drugs, genetic studies, animal model studies, and brain imaging studies.

한국인 공황장애 환자에서 단기간 약물치료 후 관해 예측인자 연구

심현보,강은호,유범희,Sim, Hyun-Bo,Kang, Eun-Ho,Yu, Bum-Hee 대한불안의학회 2007 대한불안의학회지 Vol.3 No.2

Objective : The authors examined the treatment response and remission rates in patients with panic disorder after short-term pharmacotherapy in an effort to determine the factors that can be used to predict remission in Korean patients with panic disorder. Methods : Sixty-one patients with panic disorder were recruited for participation in this study. The psychological symptoms of the patients were measured using the HAMA, HAMD, STAIS, STAIT, ASI and API at baseline and after 3 months of pharmacotherapy. Results : Patients with panic disorder showed significantly lower scores on all psychological measures after 3 months of pharmacotherapy with paroxetine. The remission rate was 44.3%, and the response rate was 54.1%. The remitters showed significantly lower HAMD, HAMA, STAIS, STAIT, and ASI scores than the non-remitters. Linear regression analysis revealed that the baseline HAMA, HAMD, and ASI scores could be used to predict the remission rate after controlling for age, sex and agoraphobia. Conclusion : Compared with previous reports, our study showed a similar remission rate in Korean patients with panic disorder. Lower baseline levels of anxiety, depression, and anxiety sensitivity were found to be predictors of treatment remission in panic disorder.

다발성 전이를 동반한 심부 양성 섬유조직구종

심현보 ( Hyun Bo Sim ),김민지 ( Min Ji Kim ),채수열 ( Soo Yuhl Chae ),이원주 ( Weon Ju Lee ),이석종 ( Seok-jong Lee ),김도원 ( Do Won Kim ),장용현 ( Yong Hyun Jang ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.5

Some morphological variants of benign fibrous histiocytoma (dermatofibroma) present with distinct clinical features. In particular, atypical, aneurysmal, and cellular fibrous histiocytoma are associated with a significant risk of local recurrence. Furthermore, very rarely, cutaneous fibrous histiocytoma can lead to metastatic disease. Deep benign fibrous histiocytoma is an uncommon and poorly recognized clinical subtype that arises in subcutaneous or deep soft tissue. Deep benign fibrous histiocytoma has many histologic features in common with cellular fibrous histiocytoma. Deep benign fibrous histiocytoma recurs in approximately 20% of cases and may rarely metastasize. We report a rare case of deep benign fibrous histiocytoma with metastatic potential in a 38-year-old man who presented with a 2-year history of a recurrent hard mass on his left shoulder. (Korean J Dermatol 2017;55(5):301∼304)

신규 양성형 감광성 폴리암산의 합성 및 특성 연구

심현보(Hyun Bo Sim),유영임(Yeong Im Yu),이미혜(Mi Hye Yi) 한국고분자학회 2006 폴리머 Vol.30 No.2

세라믹 대퇴 골두 및 교차결합 초고분자량 폴리에틸렌 라이너를 이용한 65세 이상 무시멘트형 인공 고관절 전치환술

윤호현(Ho Hyun Yun),정지영(Ji Young Cheong),심현보(Hyun Bo Sim),박재홍(Jae Hong Park) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.6

목적: 65세 이상 노인 환자들을 대상으로 세라믹 대퇴 골두 및 교차결합 폴리에틸렌 라이너를 인공 관절면으로 사용한 무시멘트형 인공 고관절 전치환술의 최소 5년 이상 임상 및 방사선 추시 결과들을 분석하여 세라믹-폴리에틸렌 관절면의 유용성 여부를 알아보고자 하였다. 대상 및 방법: 2010년 3월부터 2012년 9월까지 65세 이상 노인 환자 51명(56 고관절)을 대상으로 후향적 연구를 진행하였다. 평균 연령은 70.9±5.1세였다. 임상 평가는 Harris hip score를 이용하였고, 방사선 평가는 비구 컵 경사각 및 전염각, 대퇴 스템 정렬 상태, 마모를 측정하였다. 수술 후 합병증 발생 유무도 조사하였다. 결과: 임상 평가상 Harris hip score는 수술 전 평균 48점에서 최종 추시 시 평균 87점으로 향상되었다(p<0.05). 방사선 평가상 평균 비구 컵 경사각은 40.9°±6.4°, 평균 비구 컵 전염각은 20.3°±8.1°였다. 거상 라이너를 사용한 16예에서 평균 비구 컵 전염각은 14.3°±7.9°, 중립 라이너를 사용한 40예에서 평균 비구 컵 전염각은 22.4°±9.1°였다(p<0.05). 평균 대퇴 스템 정렬각은 0°도(범위, 내반 4°–외반 4°)였다. 평균 선상 마모량은 0.458±0.041 mm였으며 평균 연간 선상 마모율은 0.079±0.032 mm/yr였다. 수술 후 합병증으로 대퇴 스템 주위 골절 6예(10.7%)가 발생하였다. 결론: 본 연구 결과 분석상 탈구나 세라믹-폴리에틸렌 관절면에서 기인한 합병증이 없으므로 65세 이상 노인 환자에서 무시멘트형 인공 고관절 전치환술 시행 시 세라믹-폴리에틸렌 관절면을 유용하게 사용할 수 있으나 수술 중 대퇴 스템 주위 골절 발생을 방지하기 위한 좀 더 세심한 노력이 필요하다. Purpose: To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner. Materials and Methods: From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was 70.9±5.1 years old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined. Results: The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p<0.05). The mean cup inclination was 40.9°±6.4° and the mean cup anteversion was 20.3°±8.1°. The mean cup anteversion of the elevated liner-used group (16 cases) was 14.3°±7.9° and the mean cup anteversion of the neutral liner used group (40 cases) was 22.4°±9.1° (p<0.05). The mean stem alignment angle was 0° (range, varus 4°–valgus 4°). The mean linear wear amount was 0.458±0.041 mm and the average annual linear wear rate was 0.079±0.032 mm/yr. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered. Conclusion: Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

일반의약품과 전문의약품 의도적 음독 자살 시도자 특성 분석 연구

조을아,조지현,조경형,심현보,Cho, Eulah,Cho, Ji Hyun,Jho, Kyeng Hyeng,Sim, Hyun-Bo 한국정신신체의학회 2020 정신신체의학 Vol.28 No.2

연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다. Objectives : Self-poisoning is the leading cause of visits to the emergency departments after a suicide attempts. This study is aimed to compare the patient characteristics according to the category of drugs ingested by the patients who attempted suicide. Methods : All medical charts were retrospectively reviewed from patients who visited the emergency center, at Seoul Medical Center, due to intentional self-poisoning from April of 2011 to July of 2019. We investigated the information regarding the subtype and quantity of the intoxication drug, how it was obtained, suicidal history, and psychiatric history, as well as, sociodemographic information. Variables were compared between prescription drug (PD) and non-prescription drug (NPD) poisoning groups. Results : The mean age of the NPD poisoning group was significantly lower than that of the PD poisoning group. The patient ratio of those enrolled in national health insurance and living with spouses were significantly higher in the NPD poisoning group. Compared to the NPD poisoning group, the PD poisoning group had a higher incidence of mental illnesses, underlying diseases and ratio of involuntary visit to the emergency department. Among the prescription drugs, the benzodiazepine poisoning group had a higher rate of self-prescription than the non-poisoning group, while the zolpidem poisoning group had a higher rate of the using someone else's prescription than other drugs. Each single drug poisoning group (benzodiazepine, zolpidem, and antidepressant single-agent) had a higher rate of no mental illness than each of the mixed-poisoning group. Conclusions : Guidelines for regulating non-prescription drugs are needed as a matter of suicide prevention. Also, this study suggests that clinicians need to be careful when issuing prescriptions and should suicidal risk according to patients' characteristics, duration of follow-up and type of drug packaging.

주요우울장애 환자에서의 심박변이도와 혈중 지질 농도와의 연관성

안은정,최진숙,장용이,이해우,심현보,Ahn, Eun-Jung,Choi, Jin-Sook,Jang, Yong-Lee,Lee, Hae-Woo,Sim, Hyun-Bo 대한수면의학회 2012 수면·정신생리 Vol.19 No.1

목 적 : HRV 검사는 교감 신경과 부교감 신경의 억제 체제에 의해 조절되는 심박변이도를 측정하고 분석하는 도구로서, 현재 민감하고 비침습적인 도구로 인정받고 있다. 우울증 환자들은 불안, 우울과 같은 정신적 스트레스를 지속적으로 받으면서 자율신경계 억제 기전의 교란을 받게 된다. 우울증은 또 심혈관 질환의 이환과 사망률을 예측하는 독립적 예측인자라고 보고되고 있다. 본 연구에서는 HRV 검사를 통하여 정상인과 우울증 환자 사이에서 HRV와 lipid level 사이의 상관관계를 알아보려고 하였다. 방 법 : 2011년 7월부터 2012년 3월까지 서울의료원 정신건강의학과 우울증 클리닉에 내원한 외래 및 입원 환자 중, 만 19세 이상 65세 이하 환자(42명)를 대상으로 하였고, 환자들과 나이, 성별을 일치시킨 병원에서 근무하는 직원 중 정신과 과거력과 신체 질환이 없는 사람(32명)을 대상으로, HRV, 혈중 지질 농도, HAM-A(hamilton anxiety scale), HAM-D(hamilton depression scale)를 조사하였다. 우울증 환자군과 정상대조군을 독립표본 t-검정 및 카이제곱-검정을 시행하여 비교하였다. Pearson 상관 분석을 이용하여 우울 증상의 심각도, HRV 세부지표, 혈중 지질 농도 간의 상관관계를 살펴보았다(p<0.05). 결 과 : 우울증 환자군과 정상대조군 사이에 인구학적 변인은 차이가 없었으며, 우울증 환자군에게서 HAM-D & HAM-A 점수가 높았다. 혈중 지질 농도 검사에서, 우울증 환자군이 정상군보다 cholesterol, TG, LDL 수치가 유의하게 높게 측정되었다. HRV 시간영역 분석(time domain analyses)에서, 우울증 환자군이 정상군보다 SDNN이 낮게 나왔으나 유의한 차이는 보이지 않았다. 한편, ApEn(approximate entrophy)이 정상군보다 우울증 환자군에서 유의하게 높았으며, ApEn은 LDL, HAM-D, HAM-A와 유의한 상관관계를 보였다. 결 론 : 우울증 환자군의 HRV에서 ApEn이 정상대조군보다 높게 측정되었다. ApEn은 최근에 개발된 비선형적 분석으로 HRV 신호가 얼마나 복잡한 지를 통계적으로 정량화한 수치이며, 데이터 양이 적고, 잡음이 많은 생리학적 데이터를 분석하기에 적합하다고 알려져 있다. 본 연구에서는 ApEn이 우울증 환자군에서 유의하게 높게 나왔으며, ApEn이 LDL, HAM-D, HAM-A와도 상관관계를 갖는 것으로 나타났다. 향후, HRV를 임상적 상황에서 실용적으로 사용하는 연구에 있어, ApEn을 새로운 평가 도구로서 주목할 필요가 있겠다. Objectives: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. Methods: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. Results: In serum lipid profile test, MDD group showed higher cholesterol ($197.68{\pm}42.94$ mg/dL vs. $176.85{\pm}34.68$ mg/dL, p=0.044), TG ($139.45{\pm}92.54$ mg/dL vs. $91.4{\pm}65.68$ mg/dL, p=0.018), LDL ($130.03{\pm}33.18$ vs. $106.62{\pm}27.08$, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant ($32.82{\pm}14.33$ ms vs. $40.36{\pm}21.40$ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group ($1.13{\pm}0.11$ vs. $0.91{\pm}0.18$, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). Conclusions: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.

화농육아종에 대한 1% Sodium Tetradecyl Sulfate 경화요법의 치료 효과

채수열 ( Soo Yuhl Chae ),심현보 ( Hyun Bo Sim ),장용현 ( Yong Hyun Jang ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),이석종 ( Seok Jong Lee ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.10

Background: For the treatment of pyogenic granuloma (PG), surgical excision, electrocautery, and laser therapy have been employed, apart from other methods. Sodium tetradecyl sulfate (STS) sclerotherapy, as a minimally invasive treatment for vascular lesion, is frequently used for vascular malformations with considerable efficacy and safety. However, there have been a few reports about its use in the treatment of PG. Objective: This study was conducted to evaluate the efficacy, recurrence, and side effects of sclerotherapy using 1% STS in the treatment of PG. Methods: We evaluated 72 patients with PG who were treated with 1% STS from January 2008 to December 2014. Sclerotherapy using 1% STS was performed by “blind” intralesional injection without the aid of imaging such as ultrasonography. The results were evaluated by physical examination, photographic evaluation, and the patient`s subjective satisfaction, and then they were classified into 3 groups: complete remission, partial remission, and no change. Recurrence and side effects were also evaluated. Results: Complete remission of PG was achieved in 65 (90.3%) of patients after 1.23 average sessions (range, 1∼5 sessions). The remaining patients showed partial remission, with no instances of the treatment resulting in no change. One case of recurrence (1.4%) from partial remission group was seen after 3 months. Clinically, side effects such as pain, tenderness, hyperpigmentation, ulcer, numbness, scarring, and hair loss patches were noted in 18 (25%) patients, but these were all mild and transient. Conclusion: 1% STS sclerotherapy can be recommended as an effective therapeutic modality for the treatment of PG with insignificant adverse effects and low recurrence rate.

국내 거주 외국인 가정폭력 피해 여성의 임상적 특징 및 심박변이도

김규리,최진숙,장용이,이해우,심현보,Kim, Kyu-Lee,Choi, Jin-Sook,Jang, Yong-Lee,Lee, Hae-Woo,Sim, Hyun-Bo 대한수면의학회 2017 수면·정신생리 Vol.24 No.1

목 적 : 가정폭력에 노출된 여성은 우울증, 불안장애, 외상 후 스트레스 장애 등 다양한 정신 질환에 이환되기 쉽다. 심박변이도 검사는 자율신경계의 활성도와 균형을 평가하는 검사로 비침습적이고 재현성이 높아 정신 질환에 대한 연구에서도 폭넓게 활용되고 있다. 그러나 폭력 피해 여성에 대한 심박변이도 연구는 아직까지 부족한 실정이다. 본 연구는 국내 폭력 피해 여성의 인구사회학적 특징 및 심리학적 특징을 살펴보고, 한국인과 외국인 폭력 피해 여성의 임상적 특징과 심박변이도 검사 결과의 차이를 비교해보고자 하였다. 방 법 : 여성쉼터에 입소한 폭력피해 여성 중 2011년 12월 부터 2015년 12월까지 건강검진을 위해 서울의료원에 방문한 대상자 중 한국인 166명, 외국인 44명, 총 210명 대상으로 HAM-D, HAM-A, IES-R 등 임상 척도 평가와 심박변이도 검사를 실시하였다. 폭력 피해 여성 중 한국인과 외국인의 인구사회학적 특징, 심리적 특징, 심박변이도를 비교하기 위하여 카이제곱 검정 및독립 표본 t-검정 등을 시행하였다. 결 과 : 한국인과 외국인 폭력 피해 여성은 거주지, 유년시절폭력의 경험, 폭력의 지속기간에서 유의한 차이가 있었다. 한국인과 외국인 폭력 피해 여성 두 군 간의 HAM-A, HAM-D, IES-R 점수에는 유의한 차이가 없었다. 심박변이도의 세부지표에서는 ApEn 수치가 외국인 폭력 피해 여성군이 한국인보다 유의하게 높았고, RMSSD 수치는 외국인 폭력 피해 여성 군이 한국인보다 유의하게 낮은 결과를 보였다. 기타 HRV 세부지표에서는 한국인 폭력 피해 여성 군과 외국인 폭력피해 여성 군 두 군 간에 유의한 차이를 보이지 않았다. 결 론 : 국내 폭력 피해 여성은 우울, 불안, 외상 후 스트레스장애 증상을 가지고 있는 비율이 높았고 한국인과 외국인 간의 차이는 유의하지 않았다. 그러나 심박변이도 검사에서 외국인의 ApEn 값이 유의하게 높고 RMSSD 값이 유의하게 낮았다. 이는 한국인과 외국인의 인종 생리적 또는 이민 생활 등 환경적 영향의 차이일 수 있으며 향후 충분한 수의 외국인 대상자와 한국인을 비교, 추적조사를 통하여 요인간의 인과관계를 파악하는 연구가 필요할 것으로 보인다. Objectives: Domestic violence is related to many psychiatric diseases, such as depression, anxiety disorder, and PTSD. Heart rate variability (HRV) is an index of autonomic control of the heart and is related to cardiovascular and emotional disorders. Although there have been some studies on the effects of domestic violence on women's mental health, relatively little information is available on HRV in this population. The aim of this study is to investigate demographic data, psychological features, and HRV in female victims of domestic violence and difference between Korean and foreign female victims. Methods: A total of 210 female victims of domestic violence (166 Korean women and 44 foreign women) were recruited for this study. Psychological symptoms were measured using the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Impact of Event Scale-Revised (IES-R). HRV measures were assessed by time-domain and frequency-domain analyses. Results: The mean score of HAM-A was 13.81, that of HAM-D was 12.92, and that of IES-R was 33.61 ; there were no significant differences between Korean and foreign women in these measures. In HRV time domain analyses, approximate entropy (ApEn) was significantly increased in foreign women compared to the Korean women. The square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) was significantly decreased in foreign women compared to Korean women. There were no significant differences in the other HRV variables between Korean and foreign women. Conclusion: Female victims of domestic violence in Korea are associated with depression, anxiety, and PTSD symptoms. The physiologic factors of a female victim's nationality could be related to higher ApEn and lower RMSSD in foreign female victims. These findings have important implications for future study to study the relationships among ethnic and environmental factors and HRV variables.