태아 긴박증에서 태아 심장박동의 비선형 동력학 및 카오스 분석

김사진(Sa Jin Kim),신종철(Jong Chul Shin),정대영(Dae Young Chung),심영보(Young Bo Sim),이상훈(Sang Hoon Yi),김창이(Chang Yi Kim),김수평(Soo Pyung Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

목적 : 태아의 건강을 평가하기 위한 새로운 분석 방법을 개발하기 위함이다. 방법 : 전자식 태아 감시장치를 이용하여, 긴박증 태아에서 발생되는 심박동 신호를 컴퓨터로 받아들여 데이터 전처리 (low pass filtering; LPF)후에 비선형 분석으로 지연시간 (delay time), 매립차원 (embedding dimension), 상관차원 (correlation dimension), Isoangular return map을 통한 mean crossing, information entropy를 구하였고, 태아 긴박증 소견을 보인 신생아 22명의 출생후 제대 혈액 가스값을 산혈증군 5명과 비산혈증군 17명으로 나누어 비선형 카오스 분석 결과와 비교하였다. 결과 : 1. 데이터 전처리를 거친 지연 시간은 15.73±2.47 이었다. 2. FNN 법으로 계산한 매립 차원은 5.00±0.82 이었다. 3. 산혈증군의 상관차원은 1.41±0.20으로 비산혈증군의 상관차원 1.10±0.38 보다 높았으나 통계적 유의성은 없었다. 4. Isoangular return map 의한 mean crossing값은 산혈증군이 28.80±11.34이었고 비산혈증군은 16.65±7.00으로 통계적으로 유의성이 있었다 (P=0.008). 5. Information entropy에 의한 1-D ED 비교에서 산혈증군은 6.32±0.38, 비산혈증군은 6.20±0.28로 통계적인 의의가 없었다. 또한 2-D ED 값의 비교에서는 산혈증군은 10.20±0.34로 비산혈증군의 9.51±0.44보다 통계적으로 의의있게 높았다(P=0.004). 그러나 2-D EP 값 비교에서는 산혈증군은 8.70±0.90, 비산혈증군 9.22±0.74로 통계적으로 유의성이 없었다 (P=0.281). 또한 2-D ED(DI) 값도 산혈증군은 10.64±0.14, 비산혈증군은 10.51±0.18로 통계적으로 유의성이 없었다 (P=0.141). 결론 : 태아 심박동 자료로 컴퓨터를 이용한 비선형 및 카오스 동력학 분석이 실시간으로 태아의 건강상태를 평가할 수 있는 새로운 진단 방법으로 역할을 할 수 있다는 것을 알 수 있었으나, 임상에 적용하기까지는 향후 더 많은 연구를 통하여 이의 진단 기준 확립과 컴퓨터 프로그래밍화하여 실시간 진단 방법이 임상에 적용되어야 할 것으로 생각된다. Objectives: For estimating the antenatal fetal wellbeing to develop new analysis method of fetal heart rate(FHR) with electronic Fetal Heart Rate Monitoring(eFHRM) and computer.Methods: Heart rate signal is received from distressed fetus using eFHRM. It is necessary to carry out low pass filtering as a preprocess for the nonlinear method. Nonlinear parameters are calculated and classified to investigate the relations between these parameters and values of umbilical cord blood gas.Results: By dividing values of the umbilical cord blood gas into 5 fetuses of acidemic group and 17 fetuses of non-acidemic group after 22 neonates who presented fetal distress were born, the following results as compared with nonlinear chaotic analysis result were obtained. 1. Delay time through AMI for acidemic group was 16.80±3.11, and was higher than 15.41±2.27 for non-acidemic group, and is not significant in statistics.2. Embedding Dimension calculated with FNN method was 5.60±2.07 for acidemic group, and 4.71±1.26 for non-acidemic group, and it was not significant statistically.3. Correlation dimension for acidemic group was 1.41±0.20, and was higher than 1.10±0.38 for non-acidemic group, and is not significant in statistics.4. Mean crossing value by isoangular return map was 28.80±11.34 for acidemic group, and 16.65±7.00 for non-acidemic group, and it was significant statistically(P=0.008).5. In comparison of information entropy in 1-D ED, acidemic group was 6.32±0.38 and non-acidemic group was 6.20±0.28 and it was not significant statistically. Also, in comparison of value in 2-D ED, acidemic group was 10.20±0.34. It was higher than non-acidemic group of 9.51±0.43 significantly in statistics(P=0.004). But, in comparison of value in 2-D EP, acidemic group was 8.78±0.86 and non-acidemic group is of 9.22±0.74 and it wasn't significant statistically. And, 2-D ED(DI) value was 10.64±0.14 for acidemic group and 10.51±0.18 for non-acidemic group, and it wasn't significant statistically.Conclusions: By the above result, nonlinear dynamics and chaotic analysis of heart rate data with computer can serve as a new diagnosis method which may estimate the fetal wellbeing with real time. Through further studies for establishment of diagnosis standard and computer programming, real time diagnosis method shall be applied to clinical practice.

금속광물자원의 전주기 기술개발에 따른 경제적 효과 추정

김신종 ( Shin Jong Kim ),김덕한 ( Dok Han Kim ),박중구 ( Jung Gu Park ) 한국환경경제학회 한국자원경제학회 2009 자원·환경경제연구 Vol.18 No.2

조기파수와 Cytochrome P450 1A1 및 1A2 유전자 다형성과의 연관성

김사진 ( Sa Jin Kim ),박철훈 ( Cheol Hoon Park ),신종철 ( Jong Cheol Shin ),양동은 ( Dong Eun Yang ),박인양 ( In Yang Park ),고현선 ( Hyun Sun Ko ),김연희 ( Yeun Hee Kim ),안현영 ( Hyun Young Ahn ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

목적 : 조기분만은 신생아 사망 및 이환의 가장 중요한 원인이지만 아직 원인이나 병태생리가 잘 밝혀져 있지 않다. 최근에 조기분만의 원인 및 발생기전을 유전학적 관점에서 접근하는 경향이 있다. 한국 여성에서 CYP1A1 및 CYP1A2 유전자 다형성이 조기파수에 의해 조기분만한 임신부와의 연관성을 알아보고자 이 연구를 시행하였다. 연구 방법 : 2002년 8월부터 2003년 10월까지 가톨릭의대 부속 병원들에서 37주 이후에 분만한 264명의 산모들과 Objective : Preterm delivery (PTD) is the leading cause of perinatal mortality and morbidity. However, its etiology and pathogenesis remain unknown in most cases. Recently, some research put forth the hypothesis that PTD results, at least in part, from a

유도 분만시 미소프로스톨 투여용법의 임상적 고찰

김사진 ( Sa Jin Kim ),신종철 ( Jong Chul Shin ),윤철구 ( Chul Gu Yoon ),양용재 ( Yong Jae Yang ),이근호 ( Keun Hoo Lee ),박태철 ( Tae Chul Park ),나종구 ( Jong Gu Rha ),김수평 ( Soo Pyung Kim ),이희중 ( Hee Joong Lee ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.12

목적 : 임신 말기에 필요에 따라 프로스타그란딘 E1 유도체인 미소프로스토롤을 질 경내에 투여해서 자궁경관을 숙화시킨 후 정상 질식 분만한 산모 중에서 두 군으로 나누어 이의 결과를 비교하였다. 연구 방법 : 유도 분만을 위한 자궁 숙화가 필요한 37주 이상의 정상 만삭 임신산모에서 무작위로 35명에서는 미소프로스톨 50㎍, 32명에게는 미소프로스톨 100㎍을 질 경내에 4시간마다 최고 6회까지 투여하였고 규칙적인 진통이 없거나 진통이 있더라도 자궁경관 Objective : The purpose of this study was to compare the efficacy and the safety of two different dose regimens of intravaginal misoprostol for labor induction. Methods : Sixty-seven consenting women with maternal or fetal indication for labor and no prio

간세포 성장인자가 HT 세포주에서 c - met 의 발현과 침투성에 미치는 영향

신종철(Jong Chul Shin),이지현(Jee Hyun Lee),양동은(Dong Eun Yang),오민정(Min Jeong Oh),문희봉(Hee Bong Moon),이영(Young Lee),김사진(Sa Jin Kim),이종승(Chong Seung Yi),김수평(Soo Pyung Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8

N/A Objective : To evaluate the invasive capacity of trophoblastic cells when treated with HGF, and see whether HGF induces c-met expression in vitro. Methods : HT cell line was treated with recombinant HGF (rHGF) at different concentrations (0, 10, 50 and 100 ng/mL) and cultured for 24 hours. To evaluate according different time of culture, HT cell line was pre-treated with 50 ng/mL rHGF and cultured for 24, 36, 48 and 72 hours. We analyzed the expression of c-met mRNA using reverse transcriptase-polymerase chain reaction and the expression of c-met protein using western blot in each samples. We also observed cellular invasion capacity through the invasion assay under a microscope and confirmed 72 kDa gelatinase and 92 kDa gelatinase expression patterns by zymography assay. Results : The expressions of c-met mRNA and protein were increased in all concentrations of rHGF, compared with that of normal control although it was not in dose-dependent fashion. In invasion assay, the number of invaded HT cells were increased in dose-dependent fashion, compared with that of normal control. In zymography ssay, the expression of 72 kDa gelatinase was increased in dose-dependent fashion, compared with the control. However, 92 kDa eglatinase was not detected in any studied group. Conclusion : These results suggests that HGF might be related to upregulation of trophoblast cell invasiveness by activation of c-met and subsequent induction of 72 kDa gelatinase.

토끼 태아에서 표피성장인자 투여가 코티졸 , 티록신 , 프로락틴의 생성에 미치는 영향

김수평(Soo Pyung Kim),신종철(Jong Chul Shin),이종건(Jong Kun Lee),김용욱(Yong Wook Kim),변태섭(Tae Sup Byun),신재인(Jae In Shin),이종승(Chong Seong Yi),나종구(Jong Gu Rha) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12

N/A Respiratory distress syndrome (RDS) is a major cause of death in premature neonates, and it is caused by the failure of morphological and biochemical lung maturation (synthesis and secretion of lung surfactant). It is known that cortisol, thyroxine, prolactin, epidermal growth factor (EGF), and estrogen accelerate the lung maturation. Cortisol and thyroxine are currently used in the antenatal treatment for the prevention of RDS in premature neonates. In order to evaluate the effect of EGF on the levels of cortsol, thyroxine, and prolactin, this study was undertaken. Phosphate buffered saline (PBS) with and without EGF was directly injected into the 25 days gestational fetus in uterus. Blood was collected for the measurement of cortisol, thyroxine, and prolactin one day or two days after the injection. Body weights and lung weights were also measured. The results were as follows: 1. There was no significant difference in body weights and lung weights between PBS-treated group(control group) and EGF-treated poup(experimental group), 24 hours and 48 hours after the injection. 2. 24 hours after the injection, the levels of cortisol were significantly inaeased in the EGF-treated group compared with those in the PBS-treated group. However 48 hours after the injection, there was no significant difference in the levels of cortisol between the two groups. The levels of thyroxine and prolactin in the EGF-treated group did not significantly differ from those in the PBS-treated group 24 hours and 48 hours after the injection. In conclusion, in vivo, the synthesis of cortisol may be affected by EGF treatment, which suggests that the action of EGF for lung maturation may be partially mediated by the increased endogenous levels of cortisol.

간세포 성장인자가 HT 세포주에서 matrix metalloproteinase 의 발현에 미치는 영향

신종철(Jong Chul Shin),문희봉(Hee Bong Moon),이지현(Jee Hyun Lee),양동은(Dong Eun Yang),이귀세라(Gui Se Ra Lee),이영(Young Lee),이종승(Jong Seong Lee),김창이(Chang Yi Kim),김수평(Soo Pyung Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

N/A Objective : This study was performed to investigate the influence of hepatocyte growth factor (HGF) on matrix metalloproteinase (MMP), which are related in the lysis process of tissue during the invasion of trophoblasts. Method : HT cell line was treated with recombinant HGF (rHGF) of different concentration (0, 10, 50 and 100 ng/mL) and was cultured for 24 hours to check the changes in the expression of MMP-2 and MMP-9. Also, HT cell line was treated with recombinant HGF 50 ng/mL and was cultured for 24, 36, 48, and 72 hours to check the changes in the expression of MMPs according to the different time span. Total RNA were extracted from each cultured sample and RT-PCR and Western blotting were used to analyze the expression of MMP-2 and MMP-9. Results : MMP-2 mRNA expression with treated rHGF showed increase of 2, 2.5 and 2.2 times with the increase of concentration level of 10, 50 and 100 ng/mL accordingly, while MMP-2 protein expression were increased 1.4 and 1.5 times in 50 ng/mL and 100 ng/mL of rHGF respectively compared with that of normal control. MMP-9 mRNA showed no significant changes in its expression with all different levels of concentration, while MMP-9 protein showed 1.5 times increase with 10 ng/mL rHGF but 0.4 times decrease with 100 ng/mL. MMP-2 mRNA expression treated with recombinat HGF were increased 1.6 times with 24 hour culture and 2.3 times with 36 hour culture. MMP-2 protein showed 1.9 times increase only for the case of 24 hour culture. MMP-9 mRNA expression of recombinant HGF-treated groups was decreased 0.7 times compared with that of control group in 36 hours. MMP-9 protein expression were increased by 1.2, 1.6 and 1.9 times as culture time increase to 36, 48, and 72 hours accordingly, compared with that of normal control. Conclusion : This result suggests that the HGF might partially regulate the invasion of trophoblasts through MMP-2 and MMP-9.

TDx - FLM 에 의한 태아 폐성숙도 측정에 혈액 및 태변이 미치는 영향

김수평(Soo Pyung Kim),신종철(Jong Chul Shin),이영(Young Lee),이종건(Jong Kun Lee),백은정(Eun Jeong Baik),김기홍(Ki Hong Kim),정대영(Dae Young Jung),김창이(Chang I Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: We studied to determine the effect of blood or meconium contamination on the TDx-FLM assay for the assessment of fetal lung maturity. We also studied to evaluate the degree of diluted contaminants that affect the results. Methods: Nineteen samples of amnotic fluid-14 cases < GA 37weeks and 5 cases > GA 37weeks-were collected and assayed for assessment of fetal lung maturity using tbe TDx-FLM assay. Among the above 19 samples, we used 12 samples-7 cases < GA 37weeks and 5 cases > GA37 weeks-to contaminate with blood or meconium. Maternal blood was added to the amniotic fluid at increasing concentrations fro 1:10 to 1:1280. Diluted meconium (0.5g meconium/10ml amniotic fluid) was added at increasing concentration fiom 1:1 to 1:128. Each samples were assessed by TDx assay. Results: TDx values in the cases of gestational age 37 weeks or more were matured level or borderline level(TDx value > 50mg/g), but below 37 weeks, TDx values wae immature level(TDx value < 50mg/g) except one case. In preterm cases, blood or meconium contamination did not affect the TDx values significantly, although the thick meamium contamination (diluted meconium: amniotic fluid 1:1 - 1:4) increased the TDx values. In term cases, they did not affect the TDx values. Conclusion: TDx test was suitable for the evaluation of fetal lung maturity regardless of blood or meconium contamination.

인간태반에서 혈관내피성장인자 및 태반성장인자의 유전자 발현

신종철(Jong Chul Shin),이영(Young Lee),정대영(Dae Young Chung),백은정(Eun Jeong Baik),오민정(Min Jung Oh),양동은(Dong Eun Yang),김사진(Sa Jin Kim),김창이(Chang Ee Kim),김수평(Soo Pyung Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

목적: 정상임신 및 비정상임신의 태반에서 혈관내피성장인자 및 태반성장인자의 유전자 발현유무 및 정도를 비교분석하기 위하여 시행하였다. 연구방법: 각 삼분기의 정상임신과 계류유산, 자궁내 태아발육지연 및 전자간증의 태반조직을 이용하여 총 RNA를 추출하였다. cDNA를 합성한 후 VEGF 및 PlGF primer를 사용하여 RT-PCR을 시행하였다. 결과: 정상임신과 계류유산의 모든 예에서 VEGF121, VEGF165 , VEGF189 등과 PlGF131, PlGF152 등이 확인되었으며, VEGF 및 PlGF 모두 임신주수에 따른 유전자 발현정도는 뚜렸한 차이를 보이지 않았다. 자궁내 태아발육지연에서는 4예 중 2예에서 4개의 VEGF 아형( VEGF121, VEGF145, VEGF165, VEGF189)이 모두 관찰되었다. 전간증에서는 3예 중 1예에서 5개의 VEGF아형이 모두 관찰되었다. 그러나 VEGF121, VEGF165, VEGF189 등과 PlGF131, PlGF152 등의 발현정도는 정상임신과 뚜렸한 차이를 보이지 않았다. 결론: VEGF 및 PlGF는 태반에서 발현될 뿐 아니라 VEGF의 경우는 자궁내 태아발육지연 및 중증 전자간증의 일부 예에서는 발현정도가 증폭되었다. 이러한 결과들은 VEGF가 정상임신 태반의 신생혈관생성에 관여하고 특히, 태아의 저산소증 상태에서는 VEGF의 생성이 증가할 가능성이 있음을 보여주고 있다. Objective : To determine whether gene expressions of VEGF and PlGF are different between the human placenta of normal and abnormal pregnancy. Methods : Placenta was collected at each trimester of normal pregnancy, missed abortion, intrauterine growth retardation and pre-eclampsia. Total RNA was extracted from placenta. Reverse transcription-polymerase chain reaction(RT-PCR) was performed using VEGF and PlGF primer. Results : VEGF121, VEGF165 and VEGF189 were identified in normal pregnancy and missed abortion. In two cases of four IUGR and one case of three pre-eclampsia, four of isoforms (VEGF121, VEGF145, VEGF165, and VEGF189) were identified. The intensity of signal was strongest for VEGF165 in all cases. PlGF131 and PlGF152 were identified in all cases. However, the signal intensities of VEGF121, VEGF165, VEGF189, PlGF131 and PlGF152 were not different according to the gestational age. They were also not different between normal pregnancy and abnormal pregnancy. Conclusion : VEGF and PlGF were not only expressed at placenta but also overexpressed in part of IUGR and pre-eclampsia. The results suggest that VEGF may play a role in the induction of angiogenesis of placenta in normal pregnancy and its production may be increased under the hypoxic condition.

통앞뇌증과 동반된 얼굴 이상형태증

김민정 ( Min Jeong Kim ),박인양 ( In Yang Park ),김연희 ( Yon Hee Kim ),최미나 ( Mi Na Choi ),김명신 ( Myung Shin Kim ),이영 ( Young Lee ),신종철 ( Jong Chul Shin ),김사진 ( Sa Jin Kim ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.4

목적: 본 연구의 목적은 통앞뇌증과 연관된 얼굴 이상형태증을 정의하고 분류하고자 하는데 있다. 방법: 1995년부터 2007년까지 가톨릭대학교 산부인과에서 통앞뇌증으로 진단된 태아 및 신생아를 대상으로 초음파 소견과 임상적, 병리학적 자료를 후향적으로 조사하였다. 결과: 통합뇌증으로 진단받은 경우는 총 12예로, 진단시 평균 임신 주수는 28주 (14~41주)였고, 8예가 조기자연분만, 2예가 계류유산, 1예가 정상 만삭 자연분만을 하였으며, 정상 만삭 제왕절개 1예였다. 관련된 태아기형의 빈도는 9예 (75%)로 단안증, 주둥이, 입술갈림증, 누두두증, 무탁융합귀증과 같은 얼굴 이상형태증이었으며, 비정상적 염색체핵형은 6예 중 3예 (50%)였다. 결론: 산전 초음파검사에서 가운데 뇌 이상이 발견되었을 때, 자세하게 얼굴 이상형태증을 산전에 초음파 등을 이용하여 확인하는 것이 주요한 구조적 이상과 예후가 좋지 않은 통앞뇌증을 좀 더 정확하게 진단하는데 도움이 될 것이다. Objective: The purpose of this study is to determine and classify holoprosencephlay with the associated facial abnormalities. Methods: This was a retrospective study in which were reviewed the sonographic findings in correlation with the clinical and pathologic data of fetuses or neonates identified with holoprosencephaly at the Department of Obstetrics and Gynecology of the Catholic University in the period 1995-2007. Results: Twelve cases with a Holoprosencephaly were found. Mean gestational age at diagnosis and delivery was 28 weeks of pregnancy (range from 14 to 41 weeks). Modes of delivery were 8 cases of preterm spontaneous delivery, 2 cases of missed abortion, 1 case of normal fullterm spontaneous delivery, and 1 case of full term cesarean delivery. Associated facial anomalies were present in 9/12 cases (75%) which involved with cyclopia, proboscis, cleft lip and palate, ethomocephaly and otocephaly. Among those anomalies, abnormal karyotypes were 3/6 cases (50%). Conclusions: When a midline brain anomaly is detected by antenatal sonography, accurate sonographic analysis of midline facial defect may allow more definitive diagnosis of holoprosencephaly, and the outcome of affected fetuses often have other major structural abnormalities and nearly always fatal.