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최문영 ( Choe Mun Yeong ),송현주 ( Song Hyeon Ju ),김미연 ( Kim Mi Yeon ),이영숙 ( Lee Yeong Sug ),김승정 ( Kim Seung Jeong ),최규복 ( Choe Gyu Bog ),윤견일 ( Yun Gyeon Il ),강덕희 ( Kang Deog Hui ),박기덕 ( Park Gi Deog ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2
Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure. (Korean J Nephrol 2004;23(2):353-357)
유지 혈액투석 환자에서 관상동맥 석회화와 C-반응단백 및 감염질환 항체가와의 상관관계
최대희 ( Choe Dae Hui ),한선숙 ( Han Seon Sug ),이성원 ( Lee Seong Won ),이희영 ( Lee Hui Yeong ),정해혁 ( Jeong Hae Hyeog ),이승준 ( Lee Seung Jun ),이상현 ( Lee Sang Hyeon ),한헌 ( Han Heon ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2
목 적 : 말기신부전 환자에서 심혈관계 질환의 유병률과 그로 인한 사망률은 매우 높으나 그 원인 인자에 대해서는 명확히 밝혀져 있지 않다. 최근 고전적 위험인자 외에 염증반응이나 만성감염성 질환이 심혈관계 질환 발생에 관여함을 시사하는 연구 결과들이 나오고 있다. 저자들은 말기신부전 환자에서 관상동맥 질환의 발생을 관상동맥 석회화 수치 (coronary artery calcification score, CACs)를 측정하여 알아보고 이들 새로운 위험인자들과의 관련성을 밝혀보고자 하였다. 방 법 : 강원대학교병원에서 유지 혈액투석 중인 33명의 환자 (남:여=23:10, 연령=57±12세)를 대상으로 단면적 연구를 시행하였다. Multirow spiral CT (MSCT)를 이용하여 면적과 부피를 기준으로 CACs를 측정하였고, 염증반응의 지표로서 high sensitivi쇼 C-반응단백 (hs-CRP)과 IL-6를 측정하였으며, C. pneumoniae의 IgA 및 IgG 항체가와 H. pylori, cytomegalovirus, herpes simplex 등의 IgG 항체가를 측정하여 다음과 같은 결과를 얻었다. 결 과 : MSCT로 측정한 CACs는 중앙값 (범위)이 면적:379 (0-3662), 부피:338 (0-2,968)이었고, 면적 및 부피에서 100 이상의 높은 수치를 보인 경우는 각각 24명으로 73%에서 관찰되었다. Log (hs-CRP)와 log (CACs)는 상관관계 (면적:r=0.37, p<0.05, 부피:r=0.39, p<0.05)를 보였으나 log (IL-6)는 log (CACs)와 유의한 상관관계를 보이지 않았다. C. pneumoniae IgA와 IgG 양성률 (>1:64)은 각각 35%와 97%였고, C. pneumoniae의 IgA 및 IgG 항체가는 CACs와 유의한 관련성이 없었으며, H. pylori, cytomegalovirus IgG, herpes simplex 등의 IgG 항체가도 CACs와 관련성이 없었다. 환자의 연령과 log(CACs)는 양의 상관관계 (면적:r=0.39, p<0.05, 부피:r=0.39, p<0.05)를 보였으나, 당뇨유무, 흡력, 투석기간, 신체질량지수, 혈압, 혈중 cholesterol, albumin, PTH, calcium, phosphorous 등은 CACs와 유의한 관련성이 없었다. 결 론 : 혈액투석 중인 말기피신부전 환자에서 관상동맥의 심한 석회화를 흔하게 관찰할 수 있었고, 염증지표인 hs-CRP가 관상동맥 석회화와 관련이 있었다. C. pneumoniae 등 만성감염성 질환들의 항체가는 관상동맥 석회화와 유의한 관련성을 보이지 않았으나, 향후 보다 많은 환자를 대상으로 전향적인 연구가 필요할 것으로 생각된다. Background : Cardiovascular mortality is high in patients with end-stage renal disease (ESRD). Although the factors contributing to ESRD-related vascular disease are incompletely understood, recent studies suggest that inflammatory reaction or chronic infectious disease may play an important role as new risk factors. The aim of present study was to measure coronary artery caleification score (CACs) and to investigate the association with various markers of systemic inflammatory reaction. Methods : We conducted a cross-sectional study in 33 ptients (M : F=23:10, age=57±12 years) on maintenance hemodialysis. Multirow spiral CT (MSCT) was performed in all patients to measure CACs utilizing area and volume calculations. We measured high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) as indicators of inflammatory reaction, and measured IgA and IgG antibodies to C. pneumoniae, and IgG antibodies to H. pylori, cytomegalovirus, and herpes simplex. Results : Median CACs equaled 379 (range, 0-3,662) by area and 338(range, 0-2,968) by volume. CACs more than 100 was present in 24 (73%) patients. Log (hs-CRP) was positively correlated with log (CACs) (area : r=0.37, p<0.05, volume : r=0.39, p<0.05), but log (IL-6) was not. There was no significant relationship between CACs and antibody titers to C. pneumoniae, H. pylori, cytomegalovirus, and herpes simplex. Age was positively correlated with log (CACs) (area : r=0.39, p<0.05, volume : r=0.39, p<0.05), but the presence of diabetes, smoking history, the duration of dialysis, body mass index, blood pressure, and serum cholesterol, albumin, PTH, calcium, and phosphorous levels were not. Conclusion : Coronary artery calcification was common in ESRD patients on hemodialysis, and associated with increased hs-CRP, an indicator of the presence of inflammatory reaction. There was no significant relationship between antibodies to chronic infections such as C. pneumoniae, but large-scale longitudinal studies are needed to evaluate fully that. (Korean J Nephrol 2004;23(2):278-286)
최혜영 ( Choe Hye Yeong ),김태형 ( Kim Tae Hyeong ),손소희 ( Son So Hui ),공병기 ( Gong Byeong Gi ),최창용 ( Choe Chang Yong ),김동곤 ( Kim Dong Gon ),장미경 ( Jang Mi Gyeong ),노홍균 ( No Hong Gyun ),나재운 ( Na Jae Un ) 한국키틴키토산학회 2004 한국키틴키토산학회지 Vol.9 No.1
본 연구에서는 천연자원으로부터 α-, β- 및 γ-chitin을 분리하였고, 이를 이용하여 α-, β- 및 γ-chitosan을 제조하였다. 원재료의 화학적 조성과 chitin과 chitosan의 일반성분을 분석하였으며 상대점도측정과 Kina 적정법을 이용하여 점도평균분자량과 탈아세틸화도를 측정하였고 FT-IR spectrophotometer, soild state CP/MAS ^(13)C NMR spectrophotometer 에 의해 α-, β- 및 γ-chitin과 chitosan의 제조를 확인하였다. α-, β- 및 γ-chitin의 각각의 분자량이 701, 612 그리고 524 kDa으로 측정되었으며 α-, β-및 γ-chitosan의 분자량이 603, 607, 329 kDa임을 확인하였다. α-, β-및 γ-chitin의 탈아세틸화도가 21.8%, 3?.3% 그리고 44.7%로 확인되었고 α-, β- 및 γ-chitosan의 탈아세틸화도가 97.1%, 99.2%, 그리고 96.6% 임을 확인하였다. Chitin의 FT-IR 스펙트럼에서 amide I에서의 흡수 밴드가 α-chitin에 있어서는 이중선으로, β-chitin에 있어서는 단일선으로 나타났으며 γ-chitin에서는 α-, β-chitin의 중간형태로 나타났음을 확인하였다. Chitosan의 FT-IR 스펙트럼에서 탈아세틸화 반응에 의해 amide Ⅰ과 amide Ⅱ의 흡수 피크가 현저히 감소하였음을 확인하였다. Chitin의 Solide state CP/MAS ^(13)C NMR 스펙트럼결과에서 α-chitin의 경우 C3과 C5의 피크가 각각 73과 75 ppm에서 나타났으며 β-chitin은 74 ppm에서 단일선으로 나타났고, γ-chitin의 경우 C3과 C5의 흡수피크가 α-chitin과 유사한 형태의 피크를 나타내었다. Chitosan의 Soilde state CP/MAS ^(13) NMR 스펙트럼에서 C1~C6가 잘 나타나 있고, 탈아세틸화 반응에 의해 메틸탄소 및 카르보닐 탄소가 거의 나타나지 않았다. α-, β- and γ-chitin were isolated from crab shell, squid pen, beetles cuticles by acid, alkali treatment and α-, β- and γ-chitosan were prepared from α-, β- and γ-chitin. Chemical compositions of raw materials and elemental of chitin and chitosan were analyzed. A weight-average molecular weight and degree of deacetylation (DDA) were determines by viscometry and Kina titration. Its structural characterization was analyzed by FT-IR spectrophotometer and solid state CP/MAS C NMR spectrophotometer. A molecular weight of α-, β- and γ-chitin were determined by viscometer resulting in 701. 612, and 524, kDa, respectively. A molecular weight of α-, β- and γ-chitosan were calculated with 603., 607 and 329 kDa, respectively. The DDA of α-, β- and γ-chitin were 21.8%, 32.3% and 44.7%, respectively. The DDA of α-, β- and γ-chitosan were 97.1%, 99.2% and 96.6%, respectively. At the FT-IR spectra of chitin, α-, β- chitin. And at the FT_IR sectra of chitosan, absorption band of amide I and amide H decreased because of the deacetylation of chitin, where as the absorption band of amine group was newly formed. From solid state CP/MAS C NMR spectra of chitin, two signals appeared at around 73 and 75 ppm assigned to C3 and C5 carbon atoms in α-chitin are sharply resolved, the signals of C3 and C5 in β-chitin shows singlet at around 74 ppm. In case of γ-chitin, two signals show at around 73 and 75 ppm assigned to C3 and C5 carbon atoms. From solid stat CP/MAS C NMR spectra of chitosan, the carbon of the C1-C6 positions were cleared identified and peaks of CH_3 and C=0 decreased significantly because of the deacetylation
임상적으로 간경변증의 증후가 없는 만성 B형 간염에서 간섬유화의 지표로서 AST/ALT 비와 혈소판 수치의 임상적 유용성
박수영 ( Park Su Yeong ),강경희 ( Kang Gyeong Hui ),박지현 ( Park Ji Hyeon ),이종협 ( Lee Jong Hyeob ),조창민 ( Jo Chang Min ),탁원영 ( Tag Won Yeong ),권영오 ( Kwon Yeong O ),김성국 ( Kim Seong Gug ),최용환 ( Choe Yong Hwan ) 대한소화기학회 2004 대한소화기학회지 Vol.43 No.4
Background/Aims: Hepatic fibrosis is an important prognostic factor in chronic hepatitis B. Liver biopsy is a gold standard diagnostic tool but an invasive procedure, so it cannot be done on all patients. We evaluated the clinical efficacy of AST/ALT ratio and platelet counts as predictors of fibrosis in chronic hepatitis B. Methods: We reviewed retrospectively clinical records of 323 patients, who visited Kyungpook National University Hospital for chronic hepatitis B and underwent liver biopsy from September 1998 to May 2002. Correlation with laboratory parameters with hepatic fibrosis stage was identified. Results: Of 323 patients, there were 278 male patients with mean age 27 (9~59). Platelet counts showed a significant correlation (r=-0.343, p=0.000), and AST/ALT ratio showed a weak but significant correlation (r=0.137, p=0.013) with fibrosis stage. Patients with severe fibrosis or cirrhosis (stage 3 and 4) can be identified to have AST/ALT ratio >1 and platelet counts <150,000/mm3, which showed with positive predictive value of 66.7%. Sensitivity, specificity, and negative predictive value were 14.6%, 97.5%, and 77.0%, respectively. Conclusions: In chronic hepatitis B patients without clinical evidence of cirrhosis, severe hepatic fibrosis might be predicted using laboratory parameters of AST/ALT>1 in combination with platelet counts. However, its sensitivity is too low to replace liver biopsy. (Korean J Gastroenterol 2004;43:246-251)