기존의 치료에 반응하지 않는 다발성 간전이 대장암 환자에서 방사선조사와 병합한 수지상세포 면역치료의 1, 2상 임상시험

최영민(Youngmin Choi),이형식(Hyung-Sik Lee),권혁찬(Hyuk-Chan Kwon),한상영(Sang-Young Han),최종철(Jong-Cheol Choi),정주섭(Ju-Seop Chung),김창원(Chang-Won Kim),김동원(Dong-Won Kim),강치덕(Chi-Duk Kang) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.2

목 적: 기존치료에 반응하지 않는 다발성 간전이를 동반한 대장암 환자에서 방사선치료와 병합한 수지상세포 면역 치료의 독성과 반응도를 조사하였다. 대상 및 방법: 2004년 5월부터 2006년 11월까지 다발성 간전이가 동반된 대장암 환자들 중에서 항암화학 요법에 반응하지 않은 환자 중 지원자를 대상으로 연구를 시행하였다. 본 임상 시험에 대하여 동아대학교병원과 부산대학교병원의 임상윤리심의위원회의 허가를 획득하였고, 동의서에 서명한 환자들을 임상 시험의 대상으로 등록하였다. 환자의 말초 혈액으로부터 수지상세포를 추출하여 배양하였다. 임상시험 일자에 맞추어서 6×106개의 수지상세포를 바이알(0.5 ml)에 넣어서 디씨백/아이알 주사를 만들었다. 수지상세포 면역치료는 2주 간격으로 간전이암조직에 3회 주사하고, 5주에 내약성 평가를 하였다. 내약성 평가를 통과한 환자에게는 8주에 4번째 수지상세포 면 역치료를 하였다. 병의 악화가 없거나 임상시험에 대한 환자의 동의 철회가 없는 경우에는 5, 6번째 수지상세포면역치료를 각각 12, 16주에 시행하였다. 방사선치료는 수지상세포 면역치료를 주사할 간전이암 부위에 주사하기 전일 및 당일에 4 Gy씩을 조사하였다. 내약성 평가는 3×106개의 수지상세포로부터 시작하여, 12×106개의 수지상세포까지 시행하였다. 내약성 평가의 최대 내성 용량으로 추가 임상시험을 하였다. 수지상세포 면역치료 주사를 맞은 모든 환자들에서 안전성 평가를 하였다. 4회 이상 주사를 맞은 환자들을 대상으로 10주에 치료 반응을 평가하여 유효성을 조사하였다. 결 과: 임상시험에 등록한 24명 중 22명에서 수지상세포 면역치료를 시행하였다. 내성약 평가에는 14명이 등록하여 11명에서 평가를 완료하였다. 시험약과의 관련성이 있을 것으로 생각되는 grade 3 이상의 약물반응으로 인한 이상반응은 없었다. 12×106개의 수지상세포를 내성용량으로 확인하였고, 내성용량인 12×106개 수지상세포 면역치료를 이용하여 8명에서 추가로 시험을 하였다. 치료에 대한 환자들의 내성은 양호하였고, grade 3을 초과하는 치명적인 부작용은 발생되지 않았다. 4회 이상의 수지상세포 면역치료 주사를 받은 환자가 17명이었고, 이 중의15명에서는 종양의 반응도 평가가 이루어졌다. 본 연구의 목적은 안전성 평가이지만, 면역치료의 유효성 평가를 위해, 방사선치료와 수지상세포 면역치료 주사가 시행된 부위 외의 간전이암에서 반응도를 조사 하였다. 면역치료의 반응은 평가가 이루어진 환자들에서 정지성 병변이 4명, 진행성 병변이 11명 이었다. 결 론: 수지상세포 면역치료와 병행한 방사선치료는 이론적으로 국소 및 전신 제어에 상승효과가 있을 것으로 기대할 수 있다. 하지만 기존 치료에 반응하지 않는 매우 진행된 직장암 환자들을 대상으로 한 본 연구에서는 방사선 치료와 병합한 수지상세포 면역치료로 인한 심각한 부작용의 발생은 없었다는 결과와 4예에서의 정지성 병변의 관찰을 보고한다. 수지상세포의 최대 투여 용량, 적절한 투여 방법, 적절한 방사선의 양, 방사선과 수지상 세포의적절한 투여 간격 등에 관한 추가 연구를 통하여, 향후 제 2상, 3상 시험으로서의 진행 여부에 긍정적인 결과를얻을 수 있다고 판단한다. Purpose: To assess the toxicity and tumor response induced by DCVac/IRⓇ dendritic cell (DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. Materials and Methods: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of 6×106 DCs were packed into a vial (DCVac/IRⓇ, 0.5 ml) at the convenience of each patient’s schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses (3×106 to 12×106 DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. Results: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The 12×106 DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. Conclusion: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The DCVac/IRⓇ immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials

3분 및 4분 상완골근위부 골절에서의 외반형 및 내반형에 따른 임상적 비교

최창혁,권굉우,김신근,이상욱,신동규,이승진 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 수술적으로 치료한 3분, 4분 상완골 근위부 골절을 외반형과 내반형으로 재분류하여 임상적 결과를 비교하고자 하였다. 대상 및 방법 : Neer 분류상 3분, 4분 상완골근위부 골절로 분류된 21례에 대해 수술적 치료를 시행하고 12개월 이상 추시된 증례를 대상으로, 골절부위의 각형성, 상완골두의 방향성, 그리고 우세 전위결절의 양상에 따라 외반형과 내반형으로 재분류하여 UCLA shoulder rating scale에 따른 기능적 평가를 시행하였다. 결 과 : 단순 방사선 소견을 기준으로 Neer의 3, 4분 상완골 근위부골절을 외반형과 내반형 및 각각의 아형(subtype)으로 분류할 수 있었다. 견관절 반치환술을 시술한 2례를 제외하고 분석한 각 그룹의 UCLA 기능적 평가는 외반형에서 양호 이상의 결과가 9례중 8례(89%), 내반형에서 10례중 4례(40%)로 외반형에서 더 우수한 임상적 경과를 보였다. 결 론 : 상완골 근위부 골절에서 골두의 방향성은 골절의 각형성 및 우세 전위결절의 양상과 높은 상관관계를 가졌으며, 내반형의 경우 혈행과 신경장애가 좀더 빈번하고 예후도 불량한 것으로 나타났고, 이러한 경우 수술시 도달 방법, 연부조직 상태에 대한 평가가 더욱 신중하게 고려되어야 할 것으로 생각되었다. Purpose : We reclassified three-and four-part proximal humerus fracture by Neer's classification into valgus & varus type, and compared the results of these groups. Materials & methods : 21 cases classified as three- and four-part fracture in Neer's classifiation were treated surgically and followed for 12 months. We reclassified the 21 cases vlagus and varus type fractures, according to angulation of fractures, facing of humeral head, and dominant displaced tuberosity. Functional evaluation was done by UCLA shoulder rating scale. Results : Neer's three- and four-part proximal humerus fractures could be reclassified based on angulation, facing of humeral head, and dominant tuberosity displacement. The functional results according to UCLA shoulder rating scale were good or excellent in 8 of 9 cases of valgus type(89%), and at 4 in cases of varus type(40%). The clinical result of the valgus type was better than that of the varus type. Conclusion : Based on reclassification system of proximal humerus fractures, clinical results and radiographic findings including angulation, facing of head and domonant tuberosity displacement showed close relationship. Neurovascular complication were more frequent in the varus type. Therefore, careful evaluation including surgical approach and soft tissue status should be considered in the varus type of complex proximal humerus fracture.

장애인 엘리트체육의 실태 분석

최승권,이인경,문준혁,임찬규,한동기,김권일 한국특수체육학회 2005 한국특수체육학회지 Vol.13 No.1

The purposes of this study are to analyze actual status of elite sports for athletes with disabilities through investigating factors such as athletes constitutions, levels of game performance, and administrative and supporting organizations, which are critical bases for establishing the policy of elite sports for athletes with disabilities. The contents and scopes are as followings. First, analyzing composition of elite athletes with disabilities and current status of sports associations/federations. Second, analyzing the levels of game performance of elite sports for athletes with disabilities(Far East and South Pacific Games for the disabled, and Paralympics). Third, analyzing the support system such as administrative organization and support for athletes, leadership training, and financial support. Forth, analyzing survey on attitude and needs for elite sports of athletes with disabilities. Literature reviews, site visits, and survey were used to analyze the current status of elite sports for athletes with disabilities in Korea. The following outcomes were driven. First, this study revealed fewer numbers of sports federations, unbalanced composition of athletes in events, sex, and ages, and aging compared to international events and games. Second, this study revealed low performance level in team sports overall, and international competitive abilities but shooting, weight lifting, and archery were shown to be low. Third, this study revealed the weak establishment of administrative and financial supporting system.

활성슬러지 세균에 의한 장바이러스의 제거에 관한 연구

최동혁,우수민,김태동 7개 국립대학교 환경연구 논문집 공동발행 위원회 2003 공업기술연구 Vol.3 No.-

At present, the activated sludge process is claimed to have a high capability of removing viruses if the process is operated properly. In this research, in order to obtain fundamental information needed to establish a new technology for virus removal using microbes in the activated sludge process, the roles played in virus removal by some typical bacteria found in activated sludge basin were inveatigated using poliovirus as model virus. The results showed that the virus in the liquid phase decreased by a reversible absorption phenomenon of the virus to the surface of the bacterial flocs.

화학물질 누출에 의한 대량재해 : Methyl Isocyanate 누출을 중심으로

양혁준,최중명,유동준 한국응급구조학회 1999 한국응급구조학회지 Vol.3 No.1

Background: We are in the edge of some human made disasters such as hazardous materials and air pollution, for example, the world news reported that the city of Bhopal, India had serious victims related with a leaking out of the chemical materials, Methyl Isocyanate and many people in India were killed by. These situations many people who live in this world are world are worrying about are not others, but just ours and people consider about that kind of the disasters are the possible situation to happen to all the people. Therefore, we performed this basic study to recognize the risk of Methyl Isocyanate leak accident and to prepare local disaster plan with EMS system. Method : Trace 8.0, a simulation software made by the U.S. company Safer System was used as a tool to estimate the diffusion distance, area and its victims at the concentrations of 0.02ppm, 0.2ppm 5ppm respectively for an assumed B-city of 2 hundred thousands population count in which was presumed 500kg Methyl Isocyanate gas to leak out. Results : 1. During 1 hour, maximum diffusion distances of 0.02ppm 0.2ppm and 5ppm were 5.41km, 1.61km and 0.29km respectively on the plume impact. 2. Maximum population counts influenced by Methyl Isocyanate gas at the concentrations of 0.02ppm 0.2ppm and 5ppm were 40838, 4346 and 222 on the plume impact, while those were 138238, 17261 and 1588 on the vulnerability impact, respectively. 3. Therefore, 17261 persons must put on respiratory device and 138283 persons must be evacuated to safety place within 1 hour. Conclusions : Only small amount leak of Methyl Isocyanate may cause tremendous chemical disaster in urban area so its disaster plan must be prepared with an accident simulation program and Material Safety Data Sheets(MSDS). Especially, nearby emergency center of an industrial complex must have a strong position about preparation of chemical disaster plan and perform a disaster dill of hazardous material accident annually.

상악 제1대구치 근심협측 치근의 근관계에 관한 연구

조동현,최호영,박상혁,최기운 大韓齒科保存學會 2003 Restorative Dentistry & Endodontics Vol.28 No.3

This study is to investigate the canal system in the mesiobuccal root of the maxillry first molar. 61 maxillary first molars were randomly selected. Serial transverse sections were made perpendicular to the long axis of the mesiobuccal root. Each section was placed in 3% sodium hypochlorite for 24 hours and rinsed in water and dried. The resected surface was stained with 2% methylene blue dye and examined with stereomicroscope. 1. Canal configuration analysis showed that 36.1% of the specimen classified as type Ⅰ, 16.4% as type Ⅱ, 37.7% as type Ⅲ and 9.8% as type Ⅳ. 2. Type Ⅱ canal was merged in one canal within 1 to 4mm of the apex. 40% of type Ⅱ cnal coverged at 2mm of the apex. 3. Type Ⅳ canal was divided into two canal within 2 to 4mm of the apex. 66.6% of type Ⅳ canal branched off at 2mm of the apex. 4. None of the sections had more than two main root canal. 5. 48.4% of the sections in 3mm with two canals contained an isthmusand more than 70% with two canals has isthmus at 4 to 5mm sections. 63.9% of the mesiobuccal root of maxillary first molar had two canaland 76.% of sections with two canals in 5MM had an isthmus. Because of this complexity the clinician should always search for extra canal carefullyand root canal system, including an isthmus, should be cleaned and shaped completelyand obturated three dimensionally for successful endodontic treatment.

全南住民에 있어서 惡性腫瘍의 統計的 觀察 (第2報)

曺圭赫,柳柱容,尹康爀,鄭相愚,梁東旭,李珉撤,崔燦 全南大醫大 1983 전남의대학술지 Vol.20 No.4

섬유강화 고분자 복합판의 기계적 성질에 미치는 섬유길이와 섬유함유율의 영향

이상동,김혁,허업,최종대,이동기 조선대학교 에너지.자원신기술연구소 1997 에너지·자원신기술연구소 논문지 Vol.19 No.2

This paper describes effect of chopped strand length fiber content and moisture absorption on mechanical properties of fiber-reinforced polymeric composites. It was extrusion compounded long fiber-reinforced polypropylene containing 20, 30 and 50 percent and short fiber-reinforced ABS and PAS containing 30 percent b37 the weight of glass fiber. The test methods of ASTM D638, D3410-87 and D79OM are applied for tensile, compressive and bending tests respectively. The results show that, in the case of 0.2% moisture absorption, the residual strength decreases dramatically.

FeTaNC 미세결정박막의 연자기 특성에 관한 연구

申東勳,崔雲,金亨駿,高兌赫 弘益大學校 科學技術硏究所 1996 科學技術硏究論文集 Vol.7 No.1

Magnetic properties and microstructures of FeTaNC thin films, which were deposited by magnetron reactive sputtering method, were investigated as a function of CH₄ and N₂ gas partial pressures. Magnetic properties of FeTaNC films were depended on total reactive gas pressures as well as CH₄/N₂ pressure ratios. For reactive gas partial pressures of 5 ∼ 10 %, optimum magnetic properties were observed in the FeTaNC films with proper CH₄/N₂ ratio. On the other hand, at 15% of gas partial pressure, FeTaN and FeTaC films showed superior properties to FeTaNC films. Above 15%, the magnetic properties of films rapidly degraded due to an excess incorporation of C and/or N atoms. Excellent soft magnetic properties of 17kG of Bs, 0.3 Oe of Hc, and 4000 of μ' (at 5 ㎒) were obtained in the FeTaNC films. The process windows of FeTaNC films which are showing good soft magnetic properties are larger than FeTa(N/C) films. High permeabilities of FeTaNC films could be explained by the Fe lattice distortion caused by N atoms, hence reduction of magnetic anisotopy. While precipitated TaN and TaC particles effectively supress the growth of α-Fe grains leading to a good soft magentic properties, FeN and FeC phases such as Fe3N, Fe4N, FexC have detrimental effects.

자궁탈의 임상적 고찰

김동원,노형균,안태규,최상준,송창훈,정혁 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.1

The purpose of this study was to evaluate clinical aspects of prolape uteri. This clinical and statistical study was attempted to analyze 369 cases of uterine prolapse(328 cases -operated, the other cases - not operated) from Jan. 1994 to Dec. 1998 at the Department of Obstetrics and Gynecology, Chosun University Hospital. The results were as follows. 1. The incidences of uterine prolapse was 0.62% of the total admitted gynecologic patients during the study period. 2. Age distribution at the time of operation showed that 184 cases(25.6%) were 60 to 65 years of age, and 62 cases(18.2%) were 56 to 60 years of age. 3. Age distribution at the time of development of prolapse uteri showed that 134 cases(36.3%) were 21 to 30 years of age, 126 cases(34.1%) were 31 to 40 years of age. 4. 228 cases(61.7%) were those who had suffered from uterine prolapse for more 11 years and the mean durations were 15.6 years. 5. The degree of prolapse uteri showed that 281 cases(76.1%) were 3rd degree and 61 cases(16.5%) were 2nd degree. 6. The parity showed that 297 cases(80.2%) were over 4 times and 2 cases(0.27%) was nullipara. 7. The delivery place was at home in 318 cases(86.1%) and in hospital in 51 cases(13.9%). 8. The main symptoms comprised prolapse in 311 cases(84.2%), urinary frequency in 259 cases(70.1%), and bearing down sensation in 242 cases (65.8%). 9. An operation in 328 cases was carried out of 369 cases of prolapse uteri, 301 cases were treated by the vaginal hysterectomy with either anterior &osterior repair or posterior repair, 23 cases were treated by anterior &osterior repair. 10. The postoperative complications were urinary tract infection in 7 cases(2.1%), urinary retention in 4 cases(1.2%), vaginal vault prolapse in 2 cases(0.6%). 11. The indwelling foley catheter was kept for 7 days in 279 cases and the average postoperative hospitalization was around 9 days. 12. The postoperative pathologic findings were chronic cervicitis in 211 cases(67.8%), squamous metaplasia of the cervical gland in 98 cases(31.5%), adenomyosis in 69 cases, leiomyoma in 47 cases, and dysplasia of cervix, cervical polyp, endometrial polyp were also resulted. In conclusion, clinical features of uterine prolapse were studied. The clinical evaluation of uterine prolapse include age, parity, degree of prolapse, delivery site, age of onset, symptomatology, type of operation, complications, the results of histopathological examinations. Further study is necessary before these aspects can be implicated in the clinical evaluation of uterine prolapse.