정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

만성 정신분열병 환자에서 지연성 운동장애와 음성증상 및 인지기능 장애와의 연관성

심주철,반철식,성기수,이정구,정도운,정청,윤진상,김영훈 대한신경정신의학회 2000 신경정신의학 Vol.39 No.4

연구목적: 정신과 전문병원에 입원해 있는 만성정신분열병 환자들을 대상으로 첫째 지연성 운동장애의 유병율과 위험인자들을 조사하고, 둘째 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성을 조사하고자 한다. 방법: 연구대상자는 마산동서병원에 입원 중인 환자 중 DSM-IV의 정신분열별 진단기준에 부합하며, 최근 3개월 이상 동일 용량의 항정신병약물 복용한 271명(남자 174명, 여자 97명)의 환자들이었다. 지연성 운동장애에 대한 평가는 Abnormal Involuntary Movement Scale(AIMS)을 이용하였고, DSM-IV와 Sc-hooler와 Kane(1982)의 진단기준 양자에 부합하는 환자들만을 지연성 운동장애군으로 분류하였다, 정신 분열병 정신병리에 대한 평가는 Brief Psychiatric Rating Scale(BPRS)와 Schedule for the Deficit Syndrome(SDS)을 이용하였고, 인지기능에 대한 평가는 Mini-Mental Status Examination(MMSE)을 이용하였다. 결과: 지연성 운동장애의 유병율은 50.9%이었고, 50세 이상, 남자에서 높았다. 그러나 입원기간과 항정신병 약물의 일일 사용량에 따른 차이는 없었다. 지연성 운동장애의 호발부위는 혀, 상지, 입술과 입 주위의 순이었다. BPRS 총점 및 소항목 척도점수와 SDS 척도점수는 지연성 운동장애의 유무에 따른 차이가 없었다. MMSE 총점 및 소항목 점수도 지연성 운동장애의 유무에 따른 차이가 없었다. 결론: 평균입원기간이 9년 이상인 만성정신분열병 환자들에게서의 지연성 운동장애의 유병율은 50.5%이었고, 연령이 가장 의미있는 위험인자임을 확인했다. 만성정신분열병 환자들이 주 대상인 본 연구에서는 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성은 입증하지 못했다. Objectives: The purpose of present study was to determine the prevalence rate of tardive dyskinesia and to search for its risk factors in chronically institutionalized schizophrenic subjects. We also examined the relationship between tardive dyskinesia and both negative symptoms and cognitive impairments in the same subjects. Methods: Subjects were 271 in-patients(174 males, 97 females) at Masan Dongsuh Hospital. They met DSM-IV criteria for schizophrenia and had been taking fixed doses of antipsychotics for at least 3 months. Tardive dyskinesia was assessed by Abnormal Involuntary Movement Scale(AIMS). Cases of tardive dyskinesia were ascertained by the criteria of Schooler and Kane (1982) and DSM-IV. The rating of psychopathology was acquired using Brief Psychiatric Rating Scale(BPRS) and Schedule for the Deficit Syndrome(SDS) and the assessment of cognitive function using Mini-Mental State Examination(MMSE). Results: The prevalence of tardive dyskinesia is 50.9% and the frequency of tardive dyskinesia was high est in male above the age of fifty. But there was no statistically significant relationship between the frequency of tardive dyskinesia and both the length of hospitalization and the daily dose of antipsychotics. The frequency order of abnormal movement in the patients with tardive dyskinesia was as follows : tongue, upper extremities, lips and perioral area. We couldn't find any significant difference in the total and subscale scores of BPRS between the groups with and without tardive dyskinesia. There were no differences in MMSE scores between the groups with and without tardive dyskinesia. Conclusion: This study gave us that the prevalence of tardive dyskinesia was high in chronically institutionalized schizophrenic inpatients and that age was the most significant risk factor of tardive dyskinesia. The relationship between tardive dyskinesia and both negative symptoms and cognitive impairment, however, was not revealed.

아시아 12개국의 응급의학 실태에 대한 연구 조사

정제명,왕순주,안무업,박재형,유기철,박준석,강재구,제프리 아놀드 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : To assess the current level of development of emergency medicine (EM) systems in Asia. Method : Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. Results : 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. Conclusions : Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.

A STUDY ON THE RISK PROTECTION OF THE MOLD TRANSFORMER

Chung,Young-Ki,Jung,Jong-Wook,Kim,Jae-Chul,Kwak,Hee-Ro,Lee,Su-Kyung 한국화재소방학회 1997 한국화재소방학회 학술대회 논문집 Vol.1997 No.-

This paper investigates and analyzes the installation and failure status of mold transformer being used in domestic subways and describes the extinguishing process by time through the combustion test of winding part of mold transformer. Condition of installed mold transformers and classes of fire were surveyed and the mold transformer was burned in a horizontal heating furnace. It was confirmed that the mold transformer is self extinguishing and nonflammability. According to this results, the suitable standard of fire protection for the mold transformer was demanded after review of domestic and abroad law. It is expected that the cost of fire protection equipment can be reduced by using the status and combustion test result of mold transformer.

관절염 환자의 실태와 관련요인에 대한 분석적 연구

정승기,남철현,신두만,양숙희,김기열,이미경,문기내 대한보건협회 2002 대한보건연구 Vol.28 No.3

This study was conducted to examine the condition of patients with arthritis and its related factors. Data were collected from 100 people who suffered from arthritis in Seoul. Busan, Daegu, Daejun, Junjoo, and pohang from April 2, 2000 to July 31, 2000. The results of this study are summarized as follows : 1. 6L0% of the subjects were female. The incidence rate of arthritis was higher in the higher age group, lower educated group, and thinner group. In case of male, the incidence rate was higher in the groups of single, residents in big cities, and technicians. In case of female, it was higher in the groups of the married, residents in towns or villages, and housewives. 2. According to the parts of arthritis, knee joint covered 67.4% and backspine joint covered 9.0%. The incidence rate of arthritis was higher in the groups of forties, housewives, single, irreligious people, residents in towns and villages, primary school graduates, thin people, and walk exercisers. 3. The arthritis patients felt pain most when they stood up (31.5%). According to the time when they felt pain most, the time when they were active during daytime was 31.5% and nighttime was 29.8%. When they got up in the morning was 22.4%, while 10.9% felt pain all cay long. 4. they had arthralgia knees and cramp in crook of the knees (21.8%). Their knees ticked when they moved (21.1%). The had to rest hands on anyplace when they stood up (18.7%) and they could not completely unfold their knees. 5. The medical institutions which diagnosed them showed significant difference in the variables of sex, age, marital status, religion, place in residence, education level, economic status, obesity level, exercise, parts of arthritis, and posture of feeling pain. from above results, it can be concluded that it is necessary to develop appropriate medical treatment on the basis of the respondents' socio-democraphic characteristics, pain parts, period of having a pain, satisfaction level with treatment and its related factors. Therefore, related professionals and organizations must develop education program for prevention of arthritis in order to educate them.

에어로빅스 운동시 부상 유발 동작의 운동 역학적 분석

정철수,신인식,현무성,배성제,김복영,이기청 한국운동역학회 1995 한국운동역학회지 Vol.5 No.1

One of the reason that the aerobic dance is popular for korean women is that it is considered as a moderate aerobic exercise. However, high rate of aerobic dance related injuries have been reported among the participants. The purpose of this study was to estimate the impulsive load to the body while performing certain aerobic dance movement. Based on the preliminary questionairs on aerobic dance injury for 210 replyees, two aerobic dance movements including Run and High Kick were identified as high injury induced movements. The impulsive loads during aerobic dance estimated were joint angular acceleration and the vertical ground reaction force. The joint angular acceleration was determined using a 3-D cinematography technique, and the ground reaction force was measured with using an AMTI force platform system. It was founded that : the peak vertical ground reaction force 1738.7±171.2N, 1990.9±134.9N for Run, High Kick respectively. The peak vertical ground reaction force during High kick movement reached 3.7 body weight, which exceeded 3 body weight of force that can be experienced during jogging. These results indicates that although the aerobic dance movements look moderate means of exercise, certain movement ca produce highly impulsive look to the body and can aggravate injury when the movement is, kept repeated faster than the speed of healing process.

진화 알고리듬을 위한 객체지향 모델링과 클래스 라이브러리 구현

정호연,이수연,곽재승,김용주,박기태,현철주 한국경영과학회 2000 經營 科學 Vol.17 No.2

In evolutionary algorithm, there exist various models for the evolution of the population with respect to schemes and strategies for reproduction, in the application of the algorithm to a specific problem, one model suitable to the problem is to be properly chosen and a program expert or a software is needed to help implement and test a designed algorithm. In this study, object oriented modeling and the class library for simple evolutionary algorithms(SEA) with one population is developed. The library proposed here can be used as a generalized tool for solving problems in a wide range of domains.

재발성 류마티즘 환자에서 발작의 유발인자

주유철,이동민,양종태,신병철,임태영,서정균,정기영,최동헌,김원,조영신,고희관 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.2

Background and Objectives : Palindromic rheumatism (PR) is known to be triggered without any obviously inciting events in most patients, although, in a few cases, attacks have been noted to relate to another events such as weather change, childbirth, ingestion of certain foods, or over-exercise. The aim of this study was to characterize the triggering factors on palindromic attacks. Materials and Methods : We evaluated sixty-four patients with PR for the presence of triggering factors and the relationship between attacks and triggering factors by interview of patients. We considered that there was an probable association between episodes and PR, if episodes within 24 hours prior to PR had triggered at least 50% of all attacks and a definite association between episodes and PR, if episodes within 24 hours prior to PR had triggered 100% of all attacks. Results : In 15 patients (35.9%), there was a possible association between episodes of PR and initiating events. In 8 patients (12.5%), there was a definite association between episodes of PR and initiating events. The triggering factors were physical over-activity including exercise (19/64: 29.7%), foods, such as rawfish, crab, and chicken, including alcohol (19/96: 19.8%). However, there were no difference between the groups with and without the triggering factor in sex ratio, duration and onset of PR, the positive rate of rheumatoid factor and involved sites. Conclusion : Our observations showed that PR was triggered by physical over-activity more than in previous reports and hypersensitivity to foods was a causative factor in some patients with PR. However, patients with triggering factors had a similiar clinical profile to patients without triggering factors.

혈뇨의 감별진단을 위한 이형적혈구의 형태학적 연구

윤철종,박정오,문희주,윤기은 韓國電子顯微鏡學會 1999 Applied microscopy Vol.29 No.3

전체 성인의 약 4%에서 정도 차이는 있지만 혈뇨가 있다고 볼 때 그 원인을 구명하는 일이 중요하다. 그 원인이 사구체성 신염인지 기타 그 외의 비사구체성 원인에 따른 질환인지를 쉽게 감별하는 일이 중요하다. 본 연구자들은 혈뇨를 동반한 소아과 환자중에서 신 생검 조직검사까지 한 5명의 환자에서 혈뇨를 표본 제작하여 먼저 위상차현미경적 표본제작법을 통하여 적혈구를 감별하였고 방법을 달리하여 주사형 전자현미경으로 요침사를 관찰하여 형태학적 고찰을 통하여 이형적혈구를 보다 명확한 3차원구조를 관찰할 수 있었다. 침생검을 통해 얻은 조직학적 소견으로는 사구체의 기저막을 통과한 혈구들의 요로를 통하여 배출과정을 광학현미경 및 투과형 전자현미경으로 확인할 수 있었다. 본 연구에서 육안적 혈뇨의 색은 유출되는 적혈구의 양과 상관관계가 있으며 용혈된 정도가 심한 경우에 콜라색 혈뇨가 있음을 알 수 있었다. 이들 결과에서 본 연구자들은 사구체성 질환을 동반한 유극적혈구 및 환형 적혈구 등과 같은 변형된 적혈구를 주사형 전자현미경으로 명확한 관찰을 함으로 사구체성 질환으로 인한 혈뇨의 감별에 주사형 전자현미경이 가장 유용한 검사 방법이라고 생각된다. Examination of the morphology of red blood cells in the urine has been shown to be a promising adjunct in determining whether hematuria represents glomerular or nonglomerular bleeding. This is due to distortion of RBCs as they pass across the basement membrane of the glomerular capillaries. It is concluded that is method can greatly help the clinician in distinguishing between glomerular and non glomerular bleeding in patients with hematuria and channeling such patients toward the most appropriate investigations. We have experimented dysmorphic red blood cells that 5 patients of the hematuria are distorted with irregular outlines and often have small blebs extruding from the red cell membrane. Tried urinary sediments were seen with phase contrast microscope and confirmed scanning electron microscope. There are seen acanthocytes, anulocytes, ghost cells and sphero-echinocytes in dysmorphic erythrocytes. Clinical diagnosis was referred from the result of the biopsy-proven. Scanning electron microscopic findings of the hematuria are good diagnostic tool that disclose in distorted red blood cells from patients with glomerular disorders.

고온·알칼리성 Bacillus sp.의 Catabolite Repression 저항성 변이주로부터 Cellulase 및 Xylanase의 생산

최수철,정영철,강갑석,심기환,성낙계 慶尙大學校 1990 論文集 Vol.29 No.2

고온·알칼리성 cellulase 및 hemicellulase 생성 미생물을 분리할 목적으로 pH 10.3의 PY-CMC배지에서 55℃로 3회 연속 직접배양하여 효소 생성능이 우수한 20여균주를 분리하였고, 그 중에서 2개균주를 최종 선정하여 균학적 성상을 조사한 결과 고온·알칼리성 Bacillus속과 거의 일치하였다. 선정, 동정된 고온·알칼리성 Bacillus sp. F204와 F1020은 α-1, 4-glucose 등에서는 효소 생합성이 왕성하였으나, glucose와 같은 단당류에서는 효소가 전혀 유도되지 않았는데, 이 두 균주는 carbon catabolote repression을 받고 있었다. 2-deoxy glucose는 야생주에서는 강력한 repressor로 작용하였고, 야생주의 catabolite repression을 해제 시키는데 antimetabolite로 작용한다는 것이 밝혀졌다. NTG(500㎍/㎖, 50℃, 20∼60분)와 UV(2분) 처리후 2-DG(20mM)에 직접배양하여 강력한 catabolite repression resistant strain인 M-211과 M-367을 분리하였다. M-211과 M-367은 2-DG를 energy원으로 이용하였으며, glucose에 대하여 CMCase는 1.5%, avicelase 및 xylanase는 약 1.0%까지 저항성을 보였다. 또한 두개의 변이주의 효소 활성은 CMCase 2배, avicelase 1.5배 및 xylanase3배의 증가를 보였으며, 각 효소생합성을 위한 gene expression은 cAMP-independent transcription을 하는 것으로 나타났다. Cellulase and xylanase synthesis of thermophilic alkalophilic Bacillus sp. F204 and F1020 isolated in our lab, were repressed by glucose and induced by compounds structurally related to α-1,4 linkage (avicel cellulose and xylan et. al.). Catabolite repression-resistant mutants were obtained through treatment of NTG(500㎍./㎖), UV(2 min) and enrichment culture in 2-deoxy glucose (20 mM) containing PY-glucose on the wild type strain. T재 catabolite repression resistant mutants were not repressed by glucose and produced cellulase complex and xylansase when in grown in the presence of 1.0% glucose and 30mM 2-DC, which were repressors in wild type. Enzyme production was greater with the mutants (CMCase of 2 times, avicelase of 1.5 times, xylanase of 3 times) than with the wild type strains under various test conditions. T재 mutants M-211 and M-367 were potential catabolite repression resistant mutants and their gene expression was cAMP independent transcription.