Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites

Sung Yong Park,Dae Hee Kim,Han Bum Joe,Ji Young Yoo,Jin Soo Kim,Min Kang,Yong Woo Hong 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.5

Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB. Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

Reduction of Bacillus cereus Contamination in Biofilms on Stainless Steel Surfaces by Application of Sanitizers and Commercial Detergent

Lee, Min-Jeong,Ha, Ji-Hyoung,Kim, Yong-Su,Ryu, Jee-Hoon,Ha, Sang-Do The Korean Society for Applied Biological Chemistr 2010 Applied Biological Chemistry (Appl Biol Chem) Vol.53 No.1

We established the effectiveness of a washing, detergent and sanitizer treatments for reducing Bacillus cereus (B. cereus) contamination in biofilms on stainless steel surfaces. A water treatment did not affect biofilms and chlorine treatments at 200 ppm for 10 min and 300 ppm for 5 min, iodophor at 200 ppm for 10 min, and QAC at 400 ppm for 10 min were used to eliminate all B. cereus cells. B. cereus cells after detergent treatment were eliminated by chlorine at 100 ppm for 10 min, 200 ppm for 5 min, and 300 ppm for 3 min, and with iodophor at 100 ppm for 10 min and 200 ppm for 10 min, and QAC at 400 ppm for 10 min.

쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

실험적 급성 허혈성 신부전에서 Verapamil 이 혈중 Polyamine 동태에 미치는 영향

원동준(Dong Jun Won),권현민(Hyun Min Kwon),김용섭(Yong Seop Kim),구자룡(Ja Ryong Gu),권영주(Young Ju Kwon),조원용(Won Yong Cho),김형규(Hyung Kyu Kim) 대한내과학회 1991 대한내과학회지 Vol.40 No.6

N/A It has been proposd that calcium entry from an external medium increases intracellular free calcium to toxic levels during ischemic acute renal failure, and verapamil (ARF) has been suggested as the agentblocking calicium entry into renal cells and protecting renal function during ischemic injury. Polyamines, anorganic cations that play various roles in normal cellular proliferation and differentiation, accumulate in renal failare. Alsa it has been suggested tht the synthesis and metabolism of polyamine are influence by acute changes of the general condition, such as acute renal failure, and are mediated by a calcium influx into the cells. The study was designed to study the protective effects of systemic verapamil pretreatment on renal function and the influence on polyamine metabolism in experimental ischemic ARF in cats. For these purpose, the experimental animals were divided into 2 groups. While Group I (n=5) was an ischemic ARF model by renal artery clamping for 60 minutes, Group II (n=5) was ischemic ARF with systemic verapamil (5 ml/min/kg) pretreatment. The creatinine clearance and plasma and urinary polyamine were measured in each group before and after the renal artery clamp. The results were as follows: 1) Creatinine clearance before and after the renal artery clamp were 10.64±7.18 ml/min/kg and 2.09±1. 70 ml/min/kg in Group I, 4.47±3.38 ml min/kg and 0.60±0.79ml/min/kg in Group II, respectively, So creatinine clearance decreased more significantly in Group II campared with Group I. 2) Plasma polyamine increased after ischemia in Group I. In group I, plasma levels of putrescine, spermidine, and spermine before ischemia were 4.75±0.40 nmol/ml, 0.69±0.09 nmol/ml, and 0.83±0.63 nmol/ml, were elevated to 7.17±2.91 nmol/ml, 9.83±1.46 nmol/ ml, and 2.64±1.14nmol/ml after ischemia. But in Group II, the plasma level of polyamine was not changed, and especially, spermine decreased significantly from 0.83±0.27 before ischemia to 0.49±0.23 nmol/ml after ischenmine (p=0.033). 3) Urine polyamine excretion decreased after ischemia in Group I and Group II. In Group II, urinary excretion of spermidine and spermine before ischemia, 0.13±0.10 nmol/min and 0.17±0.13nmol/min, decreased after ischemia to 0.01±0.01nmol/min (p=0.019) and 0.032±0.26 nmol/min (p=0.0257). 4) In renal tissue, spermine content vas highest. In Group II, preischemic spermine were 397.20 nmol/g and increased to 646.66nmol/g after ischema, But there were no significant changes in the polyamine contents in Group II. From these data, it was suggested that systemic verapamil pretreatment exerts no protective effect on ischemic ARF. Plasma polyamines are elevated in ischemic ARF, and verapamil may protect these elevations.

알루미늄 PEO 코팅의 결정상에 미치는 공정 조건에 대한 연구 I. Unipolar 펄스와 코팅시간

김배연,함재호,이득용,김용남,전민석,김기윤,최지원,김성엽,김광엽,Kim, Bae-Yeon,Ham, Jae-Ho,Lee, Deuk Yong,Kim, Yong-Nam,Jeon, Min-Seok,Kim, Kiyoon,Choi, Ji-Won,Kim, Sung Youp,Kim, Kwang Youp 한국결정성장학회 2014 韓國結晶成長學會誌 Vol.24 No.2

전해질로 $Na_2SiO_3$을 사용하여 A1050 알루미늄 판재를 pulse 폭 $ 2000{\mu}sec$, impulse 420 V, 400 ${\mu}$sec의 unipolar pulse로 플라즈마 전해 산화 코팅(plasma electrolytic oxidation coating)을 하여 산화 피막을 2, 5, 15, 30분에 따라 형성시킨 다음 산화피막을 분석하였다. 표면에 형성된 산화물의 결정상은 ${\alpha}-alumina$와 ${\gamma}-Alumina$로서 시간에 따른 변화는 없었다. 반응 초반에는 ${\gamma}-Alumina$가 많이 생성되었지만 시간이 갈수록 ${\gamma}-Alumina$의 양에는 변화 없이 ${\alpha}-alumina$가 많이 생겨남을 알 수 있었다. 이런 결과는 micro plasma에 의해서 ${\gamma}-Alumina$가 우선 생성되고, 이후 계속되는 micro plasma의 열에 의해서 ${\alpha}-alumina$로의 전이가 일어나기 때문으로 판단된다. Crystallographic phases of Plasma electrolytic oxidized Al alloy, A1050, were investigated. The electrolyte of PEO was $Na_2Si_2O_3$ and KOH. Unipolar pulse, $ 2000{\mu}sec$ with $400{\mu}sec+420V$ impulse, were applied for 2 min, 5 min, 15 min, and 30 min. ${\gamma}-Alumina$, as well as ${\alpha}-alumina$, was main crystal phase. ${\gamma}-Alumina$ was appeared in the beginning, then the amount of ${\alpha}-alumina$ was increased with time, but the amount of ${\gamma}-Alumina$ remained constant without any increasing. So, it is concluded that plasma gas produce ${\gamma}-Alumina$ at the first, and then ${\gamma}-Alumina$ transform ${\alpha}-alumina$ finally. During the transformation, high temperature of micro plasma gives transformation energy.

모과내 기능성 유용성분 용매추출공정의 최적화

전주영 ( Ju Yeong Jeon ),조인희 ( In Hee Jo ),경현규 ( Hyun Kyu Kyung ),김현아 ( Hyun A Kim ),이창민 ( Chang Min Lee ),최용희 ( Yong Hee Choi ) 한국산업식품공학회 2010 산업 식품공학 Vol.14 No.2

본 연구에서는 모과내의 여러 가지 기능성 유용성분을 효과적으로 추출하기 위해서, 모과나무의 익은 열매로 만든 약재인 모과를 사용 하였다. 모과의 기능성 유용성분용매 추출 공정의 최적 조건을 확립하고자 하였다. 모과를 에탄올에 추출하여 반응표면 분석법으로 모니터링하여 최적 용매 조건을 설정하였다. 중심합성계획법에 따라 시료에 대한 용매비(X1)와 추출온도(X2), 추출시간(X3)을 요인변수로 하고 추출수율(Y1), 총페놀 함량(Y2), 전자공여능(Y3), 갈색도(Y4), 환원당(Y5)을 종속변수로 하여 시행하였다. 실험 결과 추출수율은 추출 온도와 추출 시간에 유의하게 영향을 받음을 알 수 있었다. 안장점에서 추출조건은 시료에 대한 용매비는 26.38mL/g, 추출온도는 72.82oC, 추출시간은 74.86 min에서 최대값을 나타내었다. 총페놀 함량은 용매비와 시간에 영향을 거의 받지 않았고 추출시간에는 영향을 받았으며, 최대값은 20.70mg/mL 로 나타났다. 이때의 추출조건은 시료에 대한 용매비는 22.61mL/g, 추출온도는 84.49oC, 추출시간은 77.25 min으로 나타났다. 전자공여능은 추출온도에 따라 유의하게 영향을 받은 것으로 나타났다. 안장점에서의 추출조건인 시료에 대한 용매비 10.65mL/g, 추출온도 67.78oC, 추출시간 96.75 min에서 추출수율은 94.12%로 예측되었다. 갈색도에 대한 추출조건은 시료에 대한 용매비 23.77mL/g, 추출온도 87.27oC, 추출시간 96.68 min 일 때 안장점이 나타났다. 환원당은 시료에 대한 용매비 26.83mL/g, 추출온도 82.167oC, 추출시간 81.94 min에서 10.55mg/mL로 최대값을 나타내었고 추출시간에 영향을 받았다. In this study, various active functional components in Chinese Quince were extracted by solvent extraction method. A central composit design for optimization was applied to investigate the effects of independent variables such as solvent to sample ratio (X1), extraction temperature (X2), and extraction time (X3) on the soluble solid contents (Y1), total phenols (Y2), electron donating ability (Y3), browning color (Y4) and reducing sugar contents (Y5). It was found that extraction temperature and extraction time were the main effective factors in this extraction process. The maximum soluble solid contents of 35.77% was obtained at 26.38mL/g (X1), 72.82oC (X2) and 74.86 min (X3) in saddle point. Total phenols were rarely affected by solvent ratio and extraction time, but it was affected by extraction temperature. The maximum total phenols of 20.70% was obtained at 22.61mL/g (X1), 84.49oC (X2), 77.25 min (X3) in saddle point. The electron donating ability was affected by extraction time. The maximum electron donating ability of 94.12% was obtained at 10.65mL/g (X1), 67.78oC (X2), 96.75 min (X3) in saddle point. The maximum browning color of 0.32% was obtained at 23.77mL/g (X1), 87.27oC (X2), 96.68 min (X3) in saddle point. The maximum value of reducing sugar content of 10.55% was obtained at 26.83mL/g (X1), 82.167oC (X2), 81.94 min (X3). Reducing sugar content was affected by extraction time.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

Casein micelle 의 조성에 관한 연구 : I. Micelle 크기 별에 따른 각 casein 의 구성비율 I. The relative amounts of individual caseins in the different casein micelles

김영교,신동철,전우민 한국낙농학회 1984 韓國酪農學會誌 Vol.6 No.1

本 實驗은 casein miceile의 크기에 따른 각종 casein의 構成成分을 究明하고자 超遠心分離機를 利用하여 casein micelle을 크기 別로 分類하고 DEAE-cellulose column chromatography를 이용하여 각 casein의 構成比率을 조사하였다. 그 結果를 要約하면 다음과 같다. 1. 脫脂乳를 100,000×g에서 각각 30分, 60分, 90分동안, 200,000×g에서 60分동안 遠心分離하였을 때 沈澱되는 casein micelle 量은 45.00%, 61.43%, 80.00% 및 95.00%였으며 沈澱되지 않는 serum casein量은 55.00%, 38.57%, 20.00% 및 5.00%였다. 2. 脫脂乳를 100,000×g에서 時間 差에 따라서 遠心分離하였을 때 각각 沈澱되는 casein micelle量은 10分間에는 全 casein量의 23.13%, 11∼30分間에는 30.26%, 31∼60分間에는 28.11%였으며, 60分問의 遠心分離에 의해서 沈澱되지 않는 serum casein은 17.79%였다. 3. 時問 差로 遠心分離하여 얻어진 casein micelle중 각 casein의 構成比率을 測定한 結果, α_s-casein, β-casein, κ-casein 및 γ-casein의 상대적인 量은 100,000×g, 10分의 pellet에서 각각 54%, 29%, 11% 및 6%였고, 100,000×g, 11∼30分의 pellet에서는 각각 54%, 28%, 13% 및 5%였고, 100,000×g, 31∼60分의 pellet에서는 각각 51%, 28%, 16% 및 5%로 나타났으며, serum casein은 44%, 29%, 19% 및 8%로 각각 나타났다. This experiment was carried out to study on the protein composition of casein micelles. Three micellar casein pellets and a serum casein were isolated at diferent time of ultracen trifugation. And the composition of individual caseins for the fractions was determined by DEAE-cellulose column chromatography. The results are summarized as follows: 1. When skimmilk was centrifuged for 30 min, 60 min and 90 min at 100,000g and for 60 min at 200,000g, the values for the sedimented casein micelles were 45.00%, 61.43%, 80.00% and 95.00% respectively and that of serum casein was 55.00%, 38.57%, 20.00% and 5.00% respectively. 2. When skimmilk was centrifuged for different time at 100,000g, the values for the sedimented casein micelles were 23.18% for 10 min.(pellet 1), 30.26% from 11 to 30 min.(pellet 2), 28.11% from 31 to 60 min.(pellet 3) and that of serum casein which was not sedimented at 60 min was 17.79% of the total casin. 3. The relative amounts of α_s-, β-, k- and γ-caseins in casein micelles obtained after different time of centrifugation were 54%, 29%, 11% and 8% in pellet 1, 54%, 28%, 13% and 5% in pellet 2, 51%, 28%, 16% and 5% in pellet 3,44%, 29%, 19% and 8% in serum casein respectively.

한국인 갑상선 수질암 환자에서 RET 원종양유전자 점돌연변이 양상

김형훈,김현진,정윤재,민용기,이명식,이문규,김광원,기창석,김종원,정재훈 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경: 갑상선 수질암의 25∼30%는 유전성으로 발현되는데, MEN 2A, MEN 2B 또는 가족성 수질암의 형태로 나타난다. RET 원종양유전자의 점돌연변이가 유전성 갑상선 수질암의 발생에 중요한 역할을 하므로, 진단 당시의 연령이나 가족력 유무에 관계없이 모든 갑상선 수질암 환자나 또는 RET 변이가 발견된 수질암 환자의 가족 구성원들에서 RET 변이 검색을 하여야 한다. 또한 일부 문헌에서 RET 변이의 양상에따라 임상상이 다르게 표현됨이 보고된 바 있다. 이에 저자들은 한국인 갑상선 수질암 환자에서 RET 원종양유전자의 점돌연변이의 양성률을 알아보고, 변이 양상에 따른 임상상의 차이가 있는지를 알아보고자 본 연구를 시행하였다. 방법: 치근 7년간 본원에서 갑상선절제술을 통해 갑상선 수질암으로 진단받은 29예에서 RET 원종양유전자의 점돌연변이 검사를 시행하였다. 29예의 평균연령은 39세(20∼60세)이었고, 남자 7예, 여자 22예 이었다. 이들의 말초혈액에서 genomic DNA를 분리하고, 특이 시발차를 이용하여 RET 원종양유전자의 exon10, 11, 13, 14, 16부위를 증폭하였다. 증폭된 부위를 자동염기서열분석기를 이용하여 직접 분석하였다. 양성으로 나온 경우는 모든 가족 구성원을 대상으로 RET 변이 유무를 검색하였다. 결과: 대상 환자 29예 중 9예 (31%)에서 RET 원종양유전자 점돌연변이가 발견되었다 RET 변이가 발견된 9예 (남자 3예, 여자 6예)의 평균 연령은 33세 (20∼51세)로 RET 변이가 발견되지 않은 20예의 평균연령 42세(24∼60세)보다 의미 있게 적었다. RET 변이가 발견된 9예 중 MEN 2A가 5예, 가족성 수질암이 1예, 그리고 산발성 수질암이 3예이었고, MEN 2B는단 1예도 진단되지 않았다. MEN 2A 5예 중 4예는 exon 11의 codon 634번(C634R 2예, C634Y 2예)에서, 그리고 나머지 1예는exon 10의 codon 618번 (C618R)에서 변이가 각각 발견되었다. 가족성 수질암 1아는 codon 634번(C634W)에서, 산발성 수질암 3예도 모두 codon 634번 (C634y 2예, C634s 1예)에서 각각 변이가 발견되었다. RET변이 양상 또는 위치에 따른 임상상의 차이는 발견할 수 없었다. 결론: 갑상선 수질암 환자 31%에서 RET 원종양유전자의 점돌연변이를 발견할 수 있었다. 유전성 수질암 중 가족성 수질암 1예를 제외하고 나머지 5예는MEN 2A이었다. 저자들의 5예와 지금까지 국내에서 보고 된 7예를 합친 국내 MEN 2A 12예 중 75% (9/12)는 exon 11의codon 634번(C634R 4예, C634y 4예, C634w 1예)에서, 그리고 나머지 25% (3/12)는 exon 10의 codon618번(C618R 2예, C618s 1예)에서 변이가 발견되었다. 국내에서는 codon 634과 codon 618 두 곳에만 국한된 양상이었고, codon 634에서의 C634R 변이는 1/3에서만 나타났다. 비록 본 연구에서는 제한된 환자 수 때문에 변이 양상과 임상상의 관계를 규명할 수 없었지만, 향후 많은 수의 환자를 대상으로 전향적인 연구를 시행하여 genotype-phenotype 관계 규명을 하는 것이 필요하다. Background: Medullary thyroid carcinomas (MTC) have been reported as hereditary in about 25 -30% of cases. The identification of germline mutation in RET proto-oncogene is important in the diagnosis of hereditary MTC, and occurs in three forms: MEN 2A, MEN 2B and familial MTC (FMTC). To evaluate the prevalence of the relationship of RET proto-oncogene mutation and genotype-phenotype was studied in Korean patients with MTC. Methods: Genomic DNA was obtained from 29 patients, with MTC, who underwent a total thyroidectomy, between 1997 and 2003, at the Samsung Medical Center. There were 7 male and 22 female patients, with an average age of 39, ranging from 20 to 60 years. Exon 10, 11, 13, 14 and 16 of the RET proto-oncogene were amplified, with specific primers, using PCR. A sequencing analysis was performed on the PCR product using an automatic sequencing analyzer. Results: Nine of the 29 patients (31%) were identified as having RET mutations. The average age of these 9 patients was 33 years, ranging from 20 to 51, with a female to male ratio of 2. Five patients had MEN 2A and one had FMTC, with the other 3 thought to have non-hereditary (sporadic) MTC. The 4 patients with MEN 2A had RET mutations on codon 634 of exon 11 (2 patients, C634R; 2 patients, C634Y) and the other patient on codon 618 of exon 10 (C618R). One patient with FMTC had a mutation on codon 634 (C634W). Three patients with sporadic MTC had RET mutations on codon 634 (2 patients, C634Y; 1 patient, C634S). However, no genotype- phenotype relationship could be found, due to the limited number of patients. Conclusion: Thirty-one percent (9/29) of the patients with MTC had RET proto-oncogene mutations. Three-quarters (9/12) of the Korean patients with MEN 2A, including another 7 patients reported in 3 papers in Korea, had RET mutations on codon 634 of exon 11 (4 patients, C634R; 4 patients, C634Y; 1 patient, C634W), but a quarter (3/12) had mutations on codon 618 of exon 10 (2 patients, C618R; 1 patient, C618S). Although no relations could be found between the genotypes and phenotypes, extensive prospective studies will be required to verify this (J Kor SOC Endocrinol 18:360-370, 2003).