일측 요관폐쇄에 의한 실험적 수신증에서 신조직내 MCP-1 및 TNF-α유전자 발현

나가량,황평주,김종학,구영선,강민규,서광선,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

Early cellular and molecular derangements have been suggested as potential pivotal factors for the development of renal injury, such as interstitial fibrosis after the experimental hydronephrosis. Several recent studies have been demonstrating that one of the initial events taking place in the progressive renal injury process is the mononuclear cell infiltration in the glomeruli and tubulointerstitiuim. In order to evaluate the renal light microscopic findings as well as the renal cortical MCP-1 and TNF-α gene expressions which are modulating inflammatory process and the recruitment of mononuclear cells in many experimental models of renal injury, Sprague-Dawley rats underwent unilateral ureteral obstruction (UUO) and sham operation under the thiopental sodium anesthesia(50 mg/kg intraperitoneal injection). Three and 7 days after surgery, rats were sacrificed. By the competitive RT-PCR, the levels of TNF-α and MCP-1 mRNA in renal cortical tissues were measured. The magnitude of mononuclear cell infiltration and interstitial widening were evaluated by standard point counting method. The level of MCP-1 gene expression was significantly increased in UUO group compared to sham group at 3 and 7 days after surgery(UUO 3 days 8.99 ± 0.45, UUO 7 days 11.2 ± 0.26, sham 3 days 1.00 ± 0.08, sham 7 days 0.94 ± 0.05, p < 0.01, p < 0.01, mean ± SEM, respectively). The level of MCP-1 mRNA at 7 days after surgery was significantly higher than that at 3 days in UUO group. The TNF-α gene expression level of UUO group was also significantly higher than that of sham group at 3 and 7 days after surgery(UUO 3 days 1.73 ± 0.16, UUO 7 days 2.03 ± 0.21, sham 3 days : 1.00 ± 0.06, sham 7 days 1.09 ± 0.03, p < 0.01, p < 0.01, respectively). But there was no significant difference between the levels at 3 and 7 days after surgery in UUO group(p>0.05). On the light microscopic examination, the relative volume of interstitium (RVI) and the total count of infiltrated mononuclear cells(MCC) at 3 and 7 days after surgery in UUO group were also significantly higher than those of sham group(RVI ; UUO 7 days 14.9±1.0%,sham 6.0±0.7%, MCC; UUO 7days 34.0± 1.6, sham 3.7± 0.6, p < 0.01, p < 0.01, respectively). In conclusion, we speculated that the early up-regulation of MCP-1 and TNF-α genes of renal cortical tissue in this experimental hydronephrosis model is closely related to the mononuclear cell infiltration and tubulointerstitial fibrosis.

성인 급성 신부전의 원인 및 예후인자 분석

구영선,장윤경,양종오,강민규,황평주,김종학,나기량,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Acute renal failure is a frequent complication in hospitalized patients and is strongly related to the mortality. The Clinical outcome and prognostic factors of acute renal failure(ARF) have been analyzed by many authors. The present study describes the etiologic and clinical aspects, as well as other factors related to mortality. All the patients suffering from acute renal failure admitted during the period of January 1993 - August 1998 were included in the study. The average age of the patients was 52±17 years and mortality rate was 24%. The causes of acute renal failure were hemorrhagic fever with renal syndrome(HFRS), sepsis, renal hypoperfusion, urinary tract obstruction, acute tubular necrosis, etc. The etiology of ARF was a significant prognostic factor on mortality in ARF. Other significant prognostic factors were oliguria, organ failure, use of vasoconstrictors, hypotension, serum bicarbonate, premorbid conditions, sepsis, neurologic complications, gastrointestinal bleeding. On the other hands, operation, sex, anemia, thrombocytopenia, hypoalbuminemia, BUN, serum creatinine, and hyperkalemia were not significant factors for the mortality. We conclude that major prognostic factors of acute renal failure arc premorbid conditions, sepsis and multiorgan failure, and they are responsible for persistent high mortality of acute renal failure despite of advances of medical care.

횡문근융해증과 급성 신부전 및 범발성 혈관내 응고장애를 동반한 열사병 1예

최대은,박수진,권오경,이한규,이영모,이상주,나기량,이강욱,신영태 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40% and central nervous system dysfunctions that results in delirium, convulsions, or coma. Heat stroke is subdivided into two forms, classic and exertional. Since strenuous exercise is one of the major exacerbating and precipitating factors, the incidence of exertional heat stroke is high among young adult, especially military personnel undergoing military training. Exertional heat stroke commonly causes rhabdomyolysis, lactic acidosis, acute renal failure, shock and pulmonary edema. We report a case of heat stroke with rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy(DIC) after strenuous exercise. A 18 year old man was admitted to the hospital because of loss of consciousness. He was a wrestler and he had tried to lose 6kg in weight by jogging and strenuous exercise on that summer day with hot temperature. The development of this illness was favoured by much clothes inappropriate for that environmental condition with a purpose to enhance sweating, and by restricted intake of water and food. On admission, the blood pressure was 80/50mmHg, and body temperature was 39.4℃ with stuporous mentality. Laboratory finding were as follows : in complete blood cell count, hemoglobin was 16.7g/dL and platelet count was 158,000/ mm³. In blood chemistry, AST 1061U/L, ALT 201U/L, BUN 30mg/dL, Cr 2.2mg/dL, LDH 941IU/L, CK 696IU/L were resulted. In arterial blood gas analysis, pH 7.39, pCO₂ 30mmHg pO₂ 86mmHg, HCO₃ 18.4mEq/L, O₂ saturation 96.7% were resulted. In urinalysis, specific gravity 1.025, protein 3+, erythrocyte 2+ were resulted. In brain imaging study, brain CT finding was normal. After appropriate treatments with rapid cooling, hydration and supportive care, he improved with alert mental status. On 2nd hospital day, in laboratory result, thrombocytopenia and coagulopathy were appeared and renal insufficiency was aggravated. So he was treated with platelet concentrate and fresh frosen plasma for DIC, and enough hydration for appropriate urine volume preservation. After all, On 22nd hospital day, he fully recovered and discharged. Nowadays, with followed for some duration, he is wellbeing with no complications.

부분 신절제 백서모델에서 Angiotensin Converting Enzyme Inhibitor 및 Angiotensin II ATI 수용체 길항제가 Plasma Renin Activity 및 Angiotensin II level에 미치는 영향

김종학,구영선,강민규,황평주,나기량,이강욱,서광선,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Renin-angiotensin-system(RAS) has been thought to have a pivotal role in renal injury mechanism. Many reports state that the inhibition of RAS prevents the progression of renal disease in 5/6 nephrectomized rats as a typical chronic renal failure model. Angiotensin converting enzyme inhibitor blocks the conversion from Angiotensin I to Angiotensin Ⅱ (A-Ⅱ ), and ATI RA inhibits the action of A-Ⅱ at the level of AT1 receptor. Therefore the PRA and A-Ⅱ level may be influenced independently by each treatment modality with these drugs. In this study, the influence of long term treatment with ACEI or AT1RA in these models on systolic blood pressure, PRA, and A-Ⅱ level was evaluated. Male Sprague-Dawley rats weighing 270-300 grams were anesthesized with thiopental sodium(50 mg/kg) and underwent right nephrectomy and partial(approximately two thirds) infarction of the left kidney by ligation of two-three segmental arterial branches. The rats were divided into four groups : sham group, control group, 5/6 subtotal nephrectomized and ACEI treated group (enalapril 100 mg/L in drinking water), 5/6 subtotal nephrectomized and ATIRA treated group (losartan, 200 mg/L in drinking water). They were treated for twelve weeks. In the twelve weeks, both groups treated with ACEI and AT1RA ingestion demonstrated a significant decrease in systolic blood pressure(165±23 vs. 132±9, mmHg, control vs. ACEI, M±SEM, p<0.05, 165±23 vs. 124±7 mmHg, control vs. ATIRA, M±SEM, p<0.01) compare to the control group. In both group treated with ACEI and AT1RA showed a significant increase in PRA(ACEI ; 7.2±2.9, AT1RA ; 4.7±0.4, control ; 2.7±1.1, sham ; 2.7±1.4, ng/ml/hr, ACEI vs. control and sham, M±SEM, p<0.05). However no significant differences were found in the sham vs. control(p>0.05), and in ACEI vs. control. The plasma A-II level was significantly increased in AT1RA treated group compared to sham and ACEI treated group(2,753±543 vs. 484±169.3, ng/ ml, AT1RA vs. Sham, p<0.01). In conclusion, treatment with ACEI and AT1RA for twelve weeks normalized systolic blood pressure, proteinuria and increased PRA compared to the control group; whereas plasma A-II level was increased only by AT1RA treatment.

신이식에서 이식신의 생존분석

오선미,김종학,황평주,구영선,강민규,나기량,김종섭,김성숙,이강욱,신영태,설종구,배진선,손기섭 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To investigate the prognostic factors for the survival of transplanted kidney in patients with end-stage renal failure, 59 cases of renal transplantation from September 1986 to Feburary 1997 in Chungnam National University Hospital were analyzed retrospectively. The results were as follows: 1)The mean age of recipients was 33.8 years and that of doners was 38.9 years. The male to female ratio of recipients was 2.5:1, and that of donors was 1.03:1 2) Living related donore(LRD) were 79.6% and living non-related donors were 20.3%. The HLA-identical donors(ID) in LRD were 18.7% and HLA-haploidentical donors(HID) were 61.0%. In living non-related donors(LNRD), mean matched HLA-AB antigens were 1.56 and mean matched HLA-DR antigens were 0.56. 3) The average 5-year patient survival fate was 94%, and average 5-year graft survival rate was 70%. The 5-year graft survival fate of HLA-ID was 100%, and those HLA-HID and LNR were 70% and 36% respectively. 4) Total 33 episodes of acute rejection were found in 45.8% of transplanted patients. The number of acute rejection episode did not show significant difference between LRD and LNRD(P > 0.05). There was no significant difference in MLC between two groups(p > 0.05). 5) In comparison between the 18 patients who lost their graft function in 5 years and 17 patients who are maintaining graft function for more than 5 years, MLC was significantly lower in patients with functioning graft than of patients with non-functioning graft (p < 0.05). The number of rejection episode was also lower in patients with functioning graft than that of the patients with non-functioning graft(p < 0.05). However, there were no significant difference in recepient and donor age and history of pre-transplantation donor specific transfusion between two groups. With the results above, we can speculate that adequate donor selection according to good matched HLA typing and low MLC is very important for graft survival in renal transplantation. Prevention and treatment of acute rejection in renal transplantation is also na important factor for graft survival.

전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.

Fenoverine에 의한 횡문근융해증 3예

나기량 ( Ki Ryang Na ),정사라 ( Sa Rah Jeong ),장동석 ( Dong Seok Jang ),이수윤 ( Soo Youn Lee ),권오경,이한규 ( Han Kyu Lee ),이영모 ( Young Mo Lee ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.4

S-428 : Coexisting polymorphic and monomorphoic lymphoproliferative disorder in renal transplant recipient.

( Ki Dae Kim ),( Kang Ryun Moon ),( Ye Jin Kim ),( Sarah Chung ),( Dae Eun Choi ),( Ki Ryang Na ),( Kang Wook Lee ),( Young Tai Shin ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Post-transplant lymphoproliferative disorder (PTLD) in renal transplant recipients has been reported to about 1-3%. PTLDs are classified as polymorphic PTLD, monomorphic PTLD, and other rare types. Although PTLD involves many organs, including the lymph node, lung, gastrointestinal tract, and central nerves system, it is rare that polymorphic PTLD and monomorphic PTLD coexist in renal transplant recipient. We report a rare coexistence of polymorphic PTLD of lung with monomorphic PTLD of small bowel in renal transplant recipient. Case: A 13-years-old girl was admitted to the hospital with the chief complaint of abdominal pain. When she was a newborn, she was diagnosed as Vater syndrome. She started peritoneal dialysis when she was 10 years old, and received a kidney from a deceased donor 8 months ago. She was taking prednisolone 5 mg once, tacrolimus 1.5 mg twice and mycophenolate mofetile 180 mg twice per day. On admission day, there was tenderness and rebound tenderness on whole abdomen. Free air under both diaphragms was found on abdominal radiograph and lung mass was found on chest radiograph. Emergent segmental resection of small intestine and double barrel stomy was done. Histologic diagnosis of small bowel lesion was confirmed as PTLD, monomorphic B-cell type, and EBV in-situ hybridization was positive in most neoplastic cells. Wedge resection of the lung mass was performed. And histologic diagnosis of lung mass was polymorphic PTLD. We started weekly administration of rituximab (325 mg/m2/week). Lung nodules were significantly decreased in size on last follow up CT scan without significant complication after 4th dose of rituximab.

The Structural Relationship between Kumdo Club SNS Service Users, Relationship Quality and Long-term Relationship Intention

( Ki Jae Jeon ),( Jong Woo Kim ),( Na Rae Kim ),( Seung Ho Shin ),( Byeong Ryang Moon ) 한국체육학회 2015 국제스포츠과학 학술대회 Vol.2015 No.1

Purpose: This study is to analysis interactive relationship between users in kumdo club which impact on the relationship quality and long-term relationship intention as visiting metropolitan kumdo club which are using SNS. It suggests to managers to ongoing customer retention measures and build relationships between the proposed customers through SNS. Method: Researchers used from in March 10 to 31 2015 SNS for kumdo club in the population located in Seoul and non-probability sampling extraction method were selected by convenience sampling of extraction. A total of 320 survey questionnaires were surveyed and the final analysis were used to determine 309(96%) valid questionnaires, except the 11 negative samples which are part of the insincere or reliable answers. Questionnaires were used as research tools, all questions have been composed on the basis of previous research and theory that is consistent with the purposes of the study, and all survey items were composed of 5-point Likert scale. Reliability of the questionnaires was found to appear as a credible level of validity, Cronbach`s α .942 - .808 of internal consistency reliability, and validity was verified by factor analysis. Data processing was accomplished descriptive statistics, confirmatory factor analysis, internal consistency reliability, correlation analysis, structural equation model by using Window for SPSS ver.18.0 and AMOS ver.18.0. Result: First, connectedness and sharing of participation of interactivity factors between the SNS users impact on confidence, satisfaction and immersion but reactivity appears to affect only satisfaction, not the confidence and the immersion. Second, the immersion of factor of quality of the relationship was affected in oral directional factor of long-term relationship and re-registration but satisfaction did not affect. Also the confidence had an impact only on re-registration. Conclusion: In conclusion, SNS activity is a place of communication which is various and empathy, as the judge called space which can build and promote a relationship, it will be replaced with in-depth communication is formed between the rulers. In addition it should be a variety of subjects and information of kumdo in SNS. It will have to induce to communicate effectively between administrators who manage kumdo club SNS. And administrators will involve more actively to create a chapter that can form a deep relationship in the long run through relationship of marketing managers.

IgA 신병증의 예후인자에 대한 연구

빈기태(Ki Tai Bin),나기량(Gi Ryang Na),오선미(Seoun Mee Oh),김종섭(Jong Sub Kim),김성숙(Seong Suk Kim),이강욱(Kang Wook Lee),신영태(Young Tai Shin),서광선(Kwang Sun Seo),이정호(Jeong Ho Lee) 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: IgA nephropathy is the commonest glomerulonephritis in the world. In contrast to initial report indicated a favorable prognosis, subsequent reports have shown a highly variable outcome leading to end-stage renal failure in significant proportion of patients. Because IgA nephropathy is a disease with variable rate of progression to chronic renal failure, identification of clinical and pathologic prognostic indicators for these patients is very important. Methods: To evaluate the clinical features of IgA nephropathy and clinicopathological parameters that are associated with deteriorated renal function, we analyzed retrospectively 149 patients who were diagnosed as IgA nephropathy at Chungnam National University Hospital from January, 1986 to June, 1994. We also evaluated the clinicopathological fin- dings of 23 patients who were followed for more than 36 months in order to determine the prognostic signigificance of various renal histopathological alterations and clinical parameters, Results: l) IgA nephropathy was disgnosed to 149 patients(26.5%) for same period among 565 biopsied patients. 2) It is most common in the 3rd and 4th decades. The mean age of the patients was 28.9 years, and male to female ratio ratio was 1: 1,25. 3) Fifty two percents of the patients presented with gross hematuria. Upper respiratory tract infection preceded grosss hematuria in 85% of the patients. 4) At the time of renal biopsy, 9,4% of the patients showed heavy proteinuria and nephrotic syndrome, 5) In Comparison of clinicopathological parameters between 14 patients with normal renal function and 9 patients with deteriorated renal function who had a follow-up period of more than 36 months, the results of the findings are as follows: 24 hours total urine protein more than 2.0 grams, elevated BUN and serum creatinine concentration and severe degree of renal histopathologic findings, such as mesangial proliferation and sclerosis, interstitial fibrosis and tubular atrophy showed poor prognostic results. Conclusion: Clinical features such as 24 hours total urine protein more than 2 grams, higher serum blood urea nitrogen and serum creatinine and severe degree of histopathologic features such as mesangial proliferation and sclerosis, interstitial fibrosis and tubular atrophy were associated with deteriorated renal function.