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최신임상강좌 : 난소암에서 항암제 감수성-저항성 검사의 역할
김종혁 ( Jong Hyeok Kim ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8
항암제 감수성-저항성 검사는 실험적으로 환자의 종양 조직 표본이 특정 항암제에 반응하는지 알아보는 검사이다. 현재까지 인간 종양 클론 측정법, 조직배양 항암제 감수성 측정법, 감별 염색 세포독성 측정법, MTT 측정법, ATP 측정법 및 극한 약제 저항성 측정법과 같은 다양한 체외 검사법들이 개발되었다. 이론적으로 항암제 감수성-저항성 검사는 환자 개인마다 가장 효과적인 약제를 투여하고 불필요한 치료를 줄일 수 있는 보다 합리적인 치료방침을 결정할 수 있는 가능성을 제시하고 있다. 난소암 환자의 항암제 감수성을 예측하기 위한 몇 가지 임상 시험에서 약 90%의 예측 정확도가 보고되었으나, 어떤 검사법도 임상에서는 적용되지 못하고 있는데 그 이유는 여러 가지 복잡한 요인들이 항암화학요법의 성적을 결정하여 생체 내 반응을 예측하기 어렵게 만들기 때문이다. 예를 들면 조직 표본이 환자의 종양 전체를 대표하지 못할 수 있고 체외 검사 결과가 종양의 반응, 환자의 생존율, 치료와 연관된 부작용과 같은 중요한 치료 성적과 완전히 일치하지 않는다. 그러므로 항암제 감수성-저항성 검사 결과가 반응률 및 생존율과 같은 환자의 치료성적과 상관관계가 있는지 평가하기 위한 대규모 무작위 임상시험이 필요하다. 만일 성공을 거둔다면 장래에 난소암 환자에게 환자 맞춤형 치료를 할 수 있게 될 것으로 전망한다. Chemotherapy sensitivity and resistance assays (CSRAs) test whether a sample of a patient`s tumor tissue shows a response such as reduced tumor survival when exposed to selected chemotherapy drugs under laboratory conditions. A variety of in vitro techniques of CRSAs have been developed so far; human tumor cloning assay (HTCA), the differential staining cytotoxicity (DiSC) assay, the methylthiazolyl-diphenyl-tetrazolium bromide (MTT) assay, the adenosine triphosphate (ATP) assay, the extreme drug resistance (EDR) assay and histoculture drug response assay (HDRA). CSRAs offer the potential of tailoring treatment to individual patients using effective agents while sparing unnecessary ones. Theoretically, use of CRSAs could lead to more rational decisions. CSRAs have been evaluated in several studies for predicting chemosensitivity to ovarian cancer and about 90% of predictive accuracy was reported. However, none of these methods have yet been applied clinically because many complex factors determine the outcomes of chemotherapy and may impair the ability of assay results to predict in vivo tumor response and other outcomes. For example, the tissue sample tested might not be representative of the behavior of the patient`s tumor. In addition, there is an imperfect relationship between tumor response and survival, or occurrence of treatment-associated adverse events, which are most important to patients. Therefore large scale, randomized trials are needed to evaluate whether the result of CSRAs is correlated with the patient`s outcome, including response to the chemotherapy and survival. If successful, this one small step will be able to be a giant leap to individualized treatment in patients with ovarian cancer in the future.
김종혁(Jong Hyeok Kim),홍예선(Yeh Sun Hong) 유공압건설기계학회 2017 드라이브·컨트롤 Vol.14 No.4
In this study, the force tracking performance of the single-rod and double-rod type EHAs (Electro-Hydrostatic Actuators) was compared by computer simulation and experiments. The force-controlled EHAs exhibit non-linear behavior that are significantly dependent on operation conditions. The investigation focused on localizing the parameters that provide significant rise to the non-linearity. For this, the single-rod and double-rod type EHAs were mathematically expressed to derive their linear models. In parallel, they were modeled by a commercial simulation program including non-linear properties based on experimental results. It was shown that the dependency of the bulk modulus of oil with entrapped air on working pressure dominated the non-linearity in force control performance in case of the double-rod type EHA. The force control of the single-rod type EHA was influenced by much more elements. Besides the asymmetrical piston geometry and the non-linear bulk modulus of oil, its pilot-operated check valves made it dependent not only on the magnitude of reference input but also on its direction.