단기간의 저용량 Cytosine arabinoside 치료에 반응하였던 Down 증후군에 병발한 급성골수성백혈병 1례

김현수,이정호,이정찬,강정현,곽상혁,김철희,배광봉,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The incidence of hematologic disorders in patients with Down's syndrome is significantly increased, about 14∼30 - fold higher than in general population and includes neonatal transient abnormal myelopoieis and acute leukemias. The age of onset of leukemia in Down's syndrome is peaking first in the newborn period and then under 4 years of age. Down's syndrome with acute leukemia above the age of 20 is very rare and it's treatment oucome is unclear. The treatment of Down's syndrome with leukemia has been controversial because of toxicity and associated congenital cardiac and other abnormalities. But if treated adequately, children with Down's syndrome show a favorable response to anti-leukemia therapy. A 24-year-old man with Down's syndrome was first seen for the evaluation of anemia and thrombocytopenia. The peripheral blood morphology and bone marrow study revealed acute myelogenous leukemia, cytogenetic study of bone marrow showed trisomy 21. Beacuse of his sicioeconomic condition and medical abnormalities including deafness, visual loss, he was treated with low dose subcutaneous cytosine arabinoside(Ara-C) for 11 days. Complete remission was obtained after 37 days. The complete remission lasted for 5 months. He subsequently relapsed, and died 6 months later.

중증 재생불량성 빈혈 환자에서 신우신염에 대한 광범위항생제치료 중에 속발한 Saccharomyces cerevisiae 진균감염 1예

김철희,이정호,이정찬,강정현,곽상혁,배광봉,김현수,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Most patients with aplastic anemia who do not respond to immunosuppressive treatment or are not candidates for bone marrow transplantation die of infection or bleeding. The neutropenia in acute leukemia, aplastic anemia, or occurring subsequently to chemotherapy and bone marrow transplantation increases susceptibility to infection. In general, the number of infectious episodes correlate with the degree and duration of neutropenia. Global immunosuppression produced by conditioning for bone marrow transplantation or graft-versus-host disease, is associated with unusual bacterial and fungal pathogens, or serious viral and protozoan infections. In addition, repeated treatment with broad-spectrum antibiotics is associated with the emergence of resistant organisms and fungal diseases because of the altered microbial microenvironment of the host. The incidence of invasive fungal infection caused by Saccharomycetes eerevisiae in immunosuppressed patients is very rare, compared with that of infection by candida or aspcrgillus species. Cases of Saccharomycetes cerevisiae fungemia occurring in the course of treatment with broad-spectrum antibiotics are reported in patients with extensive burn or with prosthetic valve endocarditis. We experienced a case of urinary tract infection by Saccharomycetes cerevisiae in a 27-year old female patient with severe aplastic anemia. We report the case with a review of relevant literatures.

윤동주 「서시」의 의미 연구

김현수(Kim Hyeon-su) 한국시학회 2011 한국시학연구 Vol.- No.31

Yun, Dong-ju’s 「The First Poem」 is producing a variety of meanings by omitting its meanings and expressing it indirectly. This paper is to understand the meaning of the work, not the intention of the poet, based on the fact that literature is content to exist by itself. The meaning of a work is the real meaning which the work represents through linguistic combination and structure. This poem is divided into two stanzas. The first stanza of 1~8 lines is expressing the poet’s feelings, and the second stanza of 9 lines shows the imaginary scenes of nature. The first stanza is divided into 1~4 lines containing mental distress and 5~8 lines representing love and practice will. The scenes of the second stanza are symbolically representing the heart of the poet who has overcome conflicts and troubles. 「The First Poem」 is a work which has encapsulated the pure heart seeking beautiful and peaceful world with concise and implicative words. In terms of space, this poem is divided into Heaven and Earth, and in terms of conflicts, it shows the process of division and combination of the realistic ego which is tormented in the real world and the essential ego which wishes for the beautiful and peaceful heavenly world. Though the realistic ego is ambivalent and worried about the gap between reality and ideals, it recovers its essential ego through aiming for the heavenly world and pursues the peaceful and pure world which it always longs for inwardly.

항암화학요법을 받는 암 환자에 대한 Nucare^R의 영양지지효과

조덕연,김현수,곽상혁,강정현,김철희,배광봉,김종숙,박상준,윤환중,김삼용 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Purpose : The purpose of this study was to evaluate the effect of nutritional support with enteral liquid supplement in cancer patients receving chemotherapy for possible benefit in nutritional, immunologic and golbal function of patients. Patients and Methods : From October 1995 to February 1997, 30 advanced cancer patients receving chemotherapy were divided two roups. The Nycare group, in addition to normal diet, Nucare^R enteral supplement was given for 1week right after chemotherapy for the duration of 2 chemotherapy cycles. Control group received only normal diet without parenteral fluid supplement for 2 chemotherapy cycles. Results : Median ages were 53 end 56 years for Nucare group and Contrl group respectively. Performance scores was less than 2 by ECOG scale. All patients were stage Ⅲ or Ⅳ. The physical parameters, such as weight, arm muscle circumference(AMC) and triceps skin fold(TSF) were decreased in both groups after 2 cycles of anticancer therapy. but it was less severe in Nucare group(p<0.05). Serum transferrin was maintained in mild deficit state in Nucare group, whereas it aggravated form mild to moderate deficit in Control group(p<0.05). Serum albumin level increased in Nucare group without statistical significance. but it decreased from normal to mild deficit in Control group. Serum total protein did not change significantly in Nucare group. but in Control group, serum total protein was decreased from 7.24±0.9 to 6.52±0.5(P<0.05). Total lymphocyte count did not change significantly in both groups. Conclusion : This study shows that the nutritional support with Nucare^R was effective in the prevention of nutritional deficit status in patients receving a nticancer chemotherapy.

Effect of Ultrasonic Melt Treatment on Solidification Microstructure of Al–5Ti–1B Alloy Containing Numerous Inoculant Particles

Soo‑Bae Kim,Jae‑Gil Jung,Young‑Hee Cho,Su‑Hyeon Kim,Kwangjun Euh,Jung‑Moo Lee 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.7

The effect of ultrasonic melt treatment (UST) on the solidification microstructure of an Al–5Ti–1B alloy containing highvolumefractions of Al3Tiand TiB2particles is investigated for various UST times with different melt holding times. Theas-cast Al–5Ti–1B alloy is composed of TiB2and polygonal Al3Tiparticles (present prior to UST), plate-like Al3Tiparticles,and Al grains (formed during UST and/or solidification). The UST causes a size reduction and homogeneous distributionof the TiB2-agglomerated region containing many submicron-sized TiB2particles pushed to the grain boundaries. The USTslightly decreases the size and improves the distribution of polygonal Al3Tiparticles enriched in the TiB2-agglomeratedregion. Unlike the TiB2and polygonal Al3Tiparticles, which exhibit a minor refining effect, the plate-like Al3Tiparticlesshow a significant refinement with UST application. The UST has a significant effect on the size distribution of Al grains byinducing the formation of medium-sized grains at the expense of small and large grains; however, it only has a slight effecton grain refinement. The degree of microstructure modification increases with increasing UST time but decreases with meltholding time after UST. The mechanisms for the refinement and dispersion of the TiB2and Al3Tiparticles and Al grains arediscussed considering fragmentation, nucleation, and growth behaviors induced by the UST and subsequent solidification.

Plasma estradiol-17βand estrogen receptor increased during the artificial induce sexual maturation and it influence choriocapillary layer of eye in Japanese eel, Anguilla japonica

Ji-Yeon Hyeon,Sung-Pyo Hur,Jun-Hwan Byun,Eun-Su Kim3,Shin-Kwon Kim,Han-Jun Kim,Se-Jae Kim,Akihiro Takemura 한국수산해양기술학회(구 한국어업기술학회) 2018 한국수산해양기술학회 학술발표대회 Vol.2018 No.11

Proportion And Characteristics Of Transient Nodules In A Retrospective Analysis Of Pulmonary Nodules

( Jin Yeong Yu ),( Su Young Chi ),( Hee Jung Ban ),( Yong Soo Kwon ),( In Jae Oh ),( Kyu Sik Kim ),( Yu Il Kim1 ),( Sung Chul Lim ),( Song Choi ),( Yun Hyeon Kim ),( Young Chul Kim ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

고포도당이 백서 사구체 메산지움 배양세포에서 p38 MAPK 활성화 및 Fibronectin 생성에 미치는 영향

유태현 ( Yu Tae Hyeon ),허종호 ( Heo Jong Ho ),류동열 ( Lyu Dong Yeol ),김현욱 ( Kim Hyeon Ug ),이수현 ( Lee Su Hyeon ),김진주 ( Kim Jin Ju ),정동섭 ( Jeong Dong Seob ),최규헌 ( Choe Gyu Heon ),이호영 ( Lee Ho Yeong ),한대석 ( Han 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.5

목 적 : 고포도당으로 자극한 백서 메산지움 배양세포에서 p38 mitogen activated protein kinase (MAPK)의 활성화와 p38 MAPK의 상부와 하부인자로 알려져 있는 MAPK kinase 3/6 (MKK3/6)와 c-AMP responsive element binding protein (CREB)의 활성화, 그리고 fibronectin 합성을 자극 시간에 따라 관찰하고, p38 MAPK 경로와 fibronectin 합성 사이의 연관성을 규명함으로서 당뇨병성 신증의 병태생리를 규명하고자 하였다. 방 법 : 백서 메산지움 배양세포를 정상 포도당 (5.6 mM), 고포도당 (30 mM), 또는 정상 포도당+만니톨 (24.4 mM)로 자극한 후 첫째 p38 MAPK; 둘째 p38 MAPK의 상부 인자인 MKK3/6; 셋째 p38 MAPK의 하부인자인 CREB; 넷째 MAPK phosphatase-1 (MKP-1)의 변화를 자극 시간 (3분-48시간)에 따라 Western blot을 이용하여 관찰하였으며, 다섯째 fibronectin의 변화는 RT-PCR과 ELISA를 이용하여 확인하였다. 결 과 : 고포도당으로 자극한 백서 사구체 메산지움 배양세포에서 p38 MAPK 경로가 활성화 되었다. Total p38 MAPK 단백은 변화가 없었으나, 활성화된 phospho-p38 MAPK 단백은 고포도당군에서 자극 10분 후부터 정상 포도당군에 비해 의의있게 증가되었으며 (평균 1.9배), phospho-CREB 단백 역시 고포도당군에서 자극 10분 후부터 의미있게 증가되었다 (평균 2.5배). 이에 비해 p38 MAPK의 상부인자인 phospho-MKK3/6는 고포도당군에서 자극 3분 후부터 의의있게 증가되었다 (평균 2.4배). 또한, MKP-1 단백 발현은 고포도당군에서 p38 MAPK의 활성이 증가하기 시작한 시기와 동일한 시기 (자극 10분 후)부터 증가하기 시작하였다 (평균 1.9배). Fibronectin mRNA와 세포 배양액내 fibronectin은 고포도당군에서 자극 48시간 후에 각각 1.7배와 1.5배 증가되었으며, 이러한 증가는 p38 MAPK 억제제인 SB203580 (1 μM)에 의해 각각 73%와 69% 억제되었다. 결 론 : 고포도당으로 자극한 백서 사구체 메산지움 배양세포에서 p38 MAPK 경로의 활성화를 확인하였으며, p38 MAPK 억제제가 고포도당에 의한 fibronectin의 합성 증가를 억제시키는 것으로 보아 당뇨병성 신증에서 관찰되어지는 fibronectin의 축적에 p38 MAPK 경로가 관여할 것으로 생각된다. Background : The p38 mitogen-activated protein kinase (MAPK) pathway is activated by several stress factors, potentially leading to cellular apoptosis and growth. Little is known about the pattern of p38 MAPK pathway activation in mesangial cells under high glucose conditions. We examined the activity and expression of p38 MAPK members, 1x78 MAPK, MAPK kinase 3/6 (MKK3/6), c-AMP responsive element binding protein (CREE), and MAPK phosphatase-l (MKP-1) in cultured rnesangial cells exposed to high glucose. Methods : Mesangial cells were subcultured from rat glomeruli isolated by sieving technique. After serum restriction for 48 hours rnesangial cells were exposed to 5.6 mM glucose (low glucose, LG), 5.6 mM glucose+24.4 mM mannitol (LG+M), or 30 mM glucose (high glucose, HG) for 3 minutes to 48 hours with or without SU203580. Western blot was performed to determine the activity and protein expression of p38 MAPK members. R`I-I`CR and ELISA were performed for fibronectin mRNA expression and fibronectin synthesis, respectively. Results : p38 MAPK and CREB activities were significantly increased in rnesangial cells exposed to FIG compared with LG or LG+M after 10 minutes and was sustained at higher levels to 48 hours (p<0.05), but total p38 MAPK and CREB protein expressions did not differ. MKP--1 showed a similar pattern as p 3 MAPK and CREE (p<O.O.i). MKK3/6 acitvity was significantly higher in HG cells after 3 minutes and remained at higher levels throught the study period (p<0.05). Fibronectin mRNA expression and fibronectin synthesis were significantly increased in mesangial cells exposed to HG after 48 hours (p<0.05). SB203580 (1 pM) pretreatment for 1 hour significantly reduced HG-induced fibronectin mRNA expression and fibronectin synthesis by 73% and 69%, respectively (p<0.05). Conclusion : p38 MAPK activity was increased in mesangial cells exposed to HG in parallel with increased MKK3/6 activity, resulting in CREB activation and increased fibronectin synthesis. This activated p38 MAPK may play a role in the pathogenesis of diabetic nephropathy.

혈액암환자에서 조혈모세포 이식 후 따르는 헤르페스 바이러스 감영 양상

이호섭,탁희상,신성훈,김양수,남성진,김혜수,박진희,정수현,김성빈,김예나 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

배경 : 헤르페스바이러스과에는 단순포진 바이러스(HERPES SIMPLEX VIRUS, HSV), 수두대상포진 바이러스 (VARICELLA-ZOSTER VIRUS, VZV), 엡스타인-바 바이러스 (EPSTEIN-BARR VIRUS, EBV), 그리고 거대세포 바이러스 (CYTOMEGALOVIRUS, CMV) 등이 있다. 헤르페스바이러스 감염은 혈액암환자에서 조혈모세포 이식 환자에서 전파 (dissemination), 이차감염, 세균 중복 감염의 심각한 합병증을 일으킬 수 있다. 하지만 항암약물치료를 받는 림파종 환자에서 항 바이러스 약제의 사용 용량과 기간에 대한 concensus는 없다. 헤르페스바이러스 감염에 대한 발생율과 위험인자를 후향성으로 분석하였다. 방법 : 고신대학교 복음 병원에서 1995년 6월부터 2009 년 2월 사이에 새롭게 진단되어 조혈모세포 이식을 받은 전체 58명의 환자들이 후향적으로 현 연구에 등록했다. 헤르페스 바이러스 감염은 임상적 진단, 혈청학적 검사 또는 병리학적 진단에 기초하여 확진한다. 환자들의 특성은 다음과 같다: 평균 연령은 44세 (범위 19-62세)였고 남녀비는 30:28이었다. 등록된 질환은 백혈병 (n=9, 15.5%), 림프종 (n=30, 51.7%), 다발성 골수종 (n=12, 20.7%), 재생불량성 빈혈 (n=6, 10.3%) 그리고 골수이형성증후군 (n=1, 1.7%)이 포함되었다. 결과는 chi-squre test나 independent samples T test를 사용하여 분석되었다. Multivariate analysises에 대해 logistic regression test를 사용하였다. 결과 : 15명의 환자들 (25.9%)에서 조혈모세포 이식후 헤르페스 바이러스 감염이 발생하였다. 조혈모세포 이식 5년간 누적 발생율은 53.9%였다. Univariate analyses에서 헤르페스 바이러스 감염에 대한 유의한 위험 인자는 없었다. 하지만 조혈모세포 이식후 생존 기간(40.18 ± 30.14 months vs 20.06 ± 26.67 months, p=0.018)은 헤르페스 바이러스 감염의 낮은 발병율과 유의한 관련성이 있었다. 이식 편대 숙주질환 (GVHD)의 존재 (37.5% in developed GVHD vs 0% in no GVHD, p=0.200), 동종조혈 모세포 이식에서 면역억제요법의 기간 (15.98 ± 14.02 months vs 6.78 ± 3.67 months, p = 0.374)은 헤르페스 바이러스 감염에 대한 위험인자가 아니었다. 결론 : 조혈모세포 이식 후 생존 기간은 어사이클로비어 예방을 받은 혈액암 환자에서 헤르페스 바이러스 감염의 낮은 발병율과 연관성이 있는 것으로 보인다. 저용량의 어사이클로비어 예방은 헤르페스 바이러스 감염의 고위험군인 조혈모세포 이식을 받은 혈액암 환자에 필요하리라 생각된다. Background : Herpesviridae family includes herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus, etc. Herpesviridae viral infection (HVI) can lead to serious complications including dissemination, secondary infection, bacterial superinfection in patients with hematologic malignancy following hematopoietic stem cell transplantation (HSCT). But there was no consensus on the dose and duration of antiviral agents prophylaxis in patients undergoing chemotherapy. We retrospectively analyzed the incidence and the risk factors for HVI. Method : A total of 58 patients who newly diagnosed and received HSCT with prophylaxis of acyclovir at the Kosin University Gospel Hospital, Busan, Korea between June 1995 and February 2009 were enrolled retrospectively in the current study. HVI was confirmed based on clinical diagnosis, serologic test or pathologic diagnosis. The characteristics of the patients were as follows: the median age was 44 years (range 19-62 years) with a female-to-male ratio of 30:28. The enrolled diseases included leukemia (n=9, 15.5%), lymphoma (n=30, 51.7%), multiple myeloma (n=12, 20.7%), aplastic anemia (n=6, 10.3%) and myelodysplastic syndrome (n=1, 1.7%). The results were analyzed using a chi-square test and independent samples T test. For the multivariate analysis, we used logistic regression test. Results : Fifteen patients (25.9%) developed HVI after HSCT. The cumulative incidence of HVI was 53.8% at 5 years after HSCT. In univariate analysis, there was no significant risk factor for HVI. The presence of graft-versus-host disease (GVHD) (37.5% in developed GVHD vs. 0% in no GVHD, p=0.200), duration of immunosuppressive therapy (IST) in allo-SCT (15.98 ± 14.02 months vs. 6.78 ± 3.67 months, p = 0.374) were not risk factors for HVI. Conclusion : The incidence of HVI was similar to that in historical other studies. There was no risk factor associated with development of HVI. Most of the HVI occurred within the first 24 months after transplantation. So long term use of antiviral prophylaxis may be needed to prevention of HVI after HSCT.

Azathioprine에 반응을 보인 류마티양 관절염에 의한 경막염(Pachymeningitis)1예

배광봉,이정호,이정찬,곽상혁,강정현,김철희,김현수,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Rheumatoid arthritis frequently involves the cervical spine and may lead to neurologic impairement. However, direct involvement of CNS structures by inflammatory cells has been reported infrequently. The prevalence of this complication of rheumatoid arthritis is unknown. Inflammatory CNS involvement in rheumatoid arthritis reportedly occurs in the setting of longstanding, active, erosive articular disease and is accompanied by extracranial and extraspinal nodules and vasculitis. This is diagnosed by radiologic finding of CNS nodules or meningeal thickening and by biopsy or autopsy. Treatment with corticosteroid, cytotoxic agent or surgical decompression is helpful. But the majority of patients die within several months of onset of neurologic symptom. Recently, we experienced a case of pachymeningitis caused by rheumatoid arthritis, which resolved repeatedly with azathioprine treatment.