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백서의 척수신경결찰모델에서 Morphine의 투여가 항이질통 효과와 척수 α<sub>2</sub> 아드레날린계 수용체 아형 mRNA 발현에 미치는 영향
정규연,신상욱,권수아,김태균,백승훈,백승완,Chung, Kyu Yeon,Shin, Sang Wook,Kwon, Su Ah,Kim, Tae Kyun,Baek, Seung Hoon,Baik, Seong Wan 대한통증학회 2009 The Korean Journal of Pain Vol.22 No.1
Background: The neuropathic pain arising from nerve injury is difficult to treat and the therapeutic effects of opioid drugs remain debatable. Agonists acting at the ${\alpha}_2$ adrenergic and opioid receptors have analgesic properties and they act synergistically when co-administered in the spinal cord. The lack of subtype-selective pharmacological agents has previously impeded the synergistic effects that are mediated by the adrenergic receptor subtypes. Methods: We created neuropathic pain model by ligating the L5 spinal nerve in Sprague-Dawley rats (n = 18). We divided the rats into three groups (n = 6 for each group), and we administered intraperitoneal morphine (1 mg/kg, 3 mg/kg, 5 mg/kg) and then we measured the mechanical allodynia with using von-Frey filaments for 8 hours. We then injected morphine (5 mg/kg) intraperitoneally, twice a day for 2 weeks. We measured the tactile and cold allodynia in the morphine group (n = 9) and the saline group (n = 9). After 2 weeks, we decapitated the rats and harvested the spinal cords at the level of lumbar enlargement. We compared the ${\alpha}_2$ subtype mRNA expression with that of control group (n = 6) by performing real time polymerase chain reaction (RTPCR). Results: Intraperitoneal morphine reduced the neuropathic pain behavior in the dose-dependent manner. Chronic morphine administration showed an antiallodynic effect on the neuropathic pain rat model. The rats did not display tolerance or hyperalgesia. The expression of the mRNAs of the ${\alpha}_{2A}$, ${\alpha}_{2B}$, ${\alpha}_{2C}$ subtypes decreased, and morphine attenuated this effect. But we could not get statistically proven results. Conclusions: Systemic administration of morphine can attenuate allodynia during both the short-term and long-term time course. Morphine has an influence on the expression of ${\alpha}_2$ receptor subtype mRNA. Yet we need more research to determine the precise effect of morphine on the ${\alpha}_2$ subtype gene expression.
VERO system을 이용한 정위적 체부 방사선치료(SBRT)의 정확성 평가
이위용,김현진,윤나리,홍효지,김홍일,백승완,Lee, Wi Yong,Kim, Hyun Jin,Yun, Na Ri,Hong, Hyo Ji,Kim, Hong Il,Baek, Seung Wan 대한방사선치료학회 2019 대한방사선치료학회지 Vol.31 No.1
목 적: 본 연구는 정위적체부방사선치료(Stereotactic Body Radiation Therapy, SBRT)용으로 개발된 선형가속기 VERO치료 시, 동중심점(Isocenter) 일치성과 점선량(Point dose)의 정확성을 평가하고자 한다. 대상 및 방법: 2018년 6월부터 12월까지 본원에서 시행한 SBRT 중 무작위로 선정한 10건의 치료계획으로 분석하였다. 선형가속기의 출력 안정성을 평가하기 위해 출력검출기 PTW-LinaCheck로 출력균일성(Output constancy)을 측정하였다. Laser와 kV imaging, MV beam의 기하학적 Isocenter의 정확성을 Isocenter Phantom(Tofu Phantom, Brain Lab)을 이용해 측정하고 평가하였다. 계획선량과 치료선량의 정확성 평가는 아크릴 팬텀($30{\times}30{\times}20cm$), 이온챔버 CC-01(IBA Dosimetry)와 Electrometer(IBA Dosimetry)를 이용해 선량을 측정하여 비교 및 분석하였다. 결 과: VERO의 출력균일성을 측정한 결과 0.66 %로 계산되었다. 기하학적 Isocenter 정확성은 Phantom 내부 Ball Isocenter의 오차 값을 분석한 결과 X축 방향에서는 최대 0.4 mm, 최소 0.0 mm로 평균값 0.28 mm였고, Y축 방향에서는 최대 -0.4 mm, 최소 0.0 mm로 평균값 -0.24 mm의 결과값을 얻었다. 치료계획선량과 실제측정선량을 비교 및 분석한 결과 치료계획선량과 실제측정선량의 오차는 최대 0.97 %, 최소 0.08%로 측정되었다. 결 론: 장비의 출력선량 평균은 0.66 %로 권고기준 ${\pm}3%$에 충족하고 매우 균일하게 출력되었다. 기하학적 Isocenter 정확성 평가에서 권고기준 ${\pm}1mm$ 이내로 환자 자세의 재현성이 매우 우수하다고 생각된다. 치료계획선량과 실제측정선량의 차이는 평균 0.52 %로 권고기준 3 % 이내로 충족하여 예측한 선량을 얻을 수 있음을 확인하였다. 이 실험들을 통해 VERO장비가 SBRT에 적합하고 우수한 치료 효과를 얻을 수 있을 것으로 사료된다. Purpose: The present study aims to assess the level of coherency and the accuracy of Point dose of the Isocenter of VERO, a linear accelerator developed for the purpose of the Stereotactic Body Radiation Therapy(SBRT). Materials and Method: The study was conducted randomly with 10 treatment plans among SBRT patients in Kyungpook National University Chilgok Hospital, using VERO, a linear accelerator between June and December, 2018. In order to assess the equipment's power stability level, we measured the output constancy by using PTW-LinaCheck, an output detector. We also attempted to measure the level of accuracy of the equipment's Laser, kV(Kilo Voltage) imaging System, and MV(Mega Voltage) Beam by using Tofu Phantom(BrainLab, Germany) to assess the accuracy level of geometrical Isocenter. We conducted a comparative analysis to assess the accuracy level of the dose by using an acrylic Phantom($30{\times}30{\times}20cm$), a calibrated ion chamber CC-01(IBA Dosimetry), and an Electrometer(IBA, Dosimetry). Results: The output uniformity of VERO was calculated to be 0.66 %. As for geometrical Isocenter accuracy, we analyzed the error values of ball Isocenter of inner Phantom, and the results showed a maximum of 0.4 mm, a minimum of 0.0 mm, and an average of 0.28 mm on X-axis, and a maximum of -0.4 mm, a minimum of 0.0 mm, and an average of -0.24 mm on Y-axis. A comparison and evaluation of the treatment plan dose with the actual measured dose resulted in a maximum of 0.97 % and a minimum of 0.08 %. Conclusion: The equipment's average output dose was calculated to be 0.66 %, meeting the ${\pm}3%$ tolerance, which was considered as a much uniform fashion. As for the accuracy assessment of the geometric Isocenter, the results met the recommended criteria of ${\pm}1mm$ tolerance, affirming a high level of reproducibility of the patient's posture. The difference between the treatment plan dose and the actual measurement dose was calculated to be 0.52 % on average, significantly less than the 3 % tolerance, confirming that it obtained predicted does. The current study suggested that VERO equipment is suitable for SBRT, and would result in notable therapeutic effect.
임상연구 : 경막외마취를 이용한 흉강경 수술시 Remifentanil의 목표 농도 주입의 효과
이도원 ( Do Won Lee ),김태균 ( Tae Kyun Kim ),백승훈 ( Seung Hoon Baek ),신상욱 ( Sang Wook Shin ),백승완 ( Seong Wan Baik ),권재영 ( Jae Young Kwon ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Video assisted thoracoscopic surgery (VATS) can be performed under epidural anesthesia. However, epidural anesthesia dose not provide complete analgesia during VATS. In that case, remifentanil may provide adjuvant analgesia. The aim of this study was to find safe and effective target concentration of remifentanil during VATS under epidural anesthesia. Methods: Patients were randomly allocated to target concentration of remifentanil 1 or 2 ng/ml (Group N1 or N2). Thoracic epidural catheter was inserted at T6-7 or T7-8 and 0.75% ropivacaine 6 ml was administered. Patients were positioned in lateral position and remifentanil infusion was started. If patients complained of pain, target concentration of remifentanil was elevated by 0.5 ng/ml. Hemodynamic and respiratory variables were checked during anesthesia. The degree of sedation was evaluated with Ramsey sedation scale and modified Steward recovery scale was used to evaluate recovery. Results: There was no significant difference between 2 groups in hemodynamic and respiratory variables. N2 group showed more sedation on skin incision (P < 0.05). The incidence of pain complaint in N1 group was higher than those of N2 group (P < 0.05). There was no significant difference in the incidence of side effects and ephedrine administration. Conclusions: Remifentanil target concentration of 2 ng/ml is more effective than 1 ng/ml to reduce pain without significant side effects during VATS under thoracic epidural anesthesia. (Korean J Anesthesiol 2006; 51: 318~23)