체외수정시술시 배아의 보조부화술을 이용한 임신율 향상에 관한 연구

김석현,김광례,채희동,이재훈,김희선,류범용,오선경,서창석,최영민,김정구,문신용,이진용,Kim, Seok-Hyun,Kim, Kwang-Rye,Chae, Hee-Dong,Lee, Jae-Hoon,Kim, Hee-Sun,Ryu, Buom-Yong,Oh, Sun-Kyung,Suh, Chang-Suk,Choi, Young-Min,Kim, Jung-Gu,Moon, S 대한생식의학회 1997 Clinical and Experimental Reproductive Medicine Vol.24 No.1

In spite of much progress in vitro fertilization and embryo transfer (IVF-ET) program, the pregnancy rate remains at 20-30%, and the endometrial implantation rate per embryo transferred at 10-15%. As a result, about 90% of embryos may fail to implant to the endometrium, and many attempts such as optimization of follicular development, improvement of in vitro culture system including coculture, and micromanipulation of zona pellucida have been made to improve embryonic implantation after IVF-ET. Recently, several procedures of assisted hatching (AH) using micromanipulation have been introduced, and pregnancies and births have been obtained after AH. To develop and establish AH as an effective procedure to improve embryonic implantation, AH with partial zona dissection (PZD) was performed in 116 cycles of 89 infertile couples who had previous repeated failures of standard IVF-ET more than two times (Group I: 71 cycles in 54 patients), or who had implantation failure of embryos with good quality (Group II: 15 cycles in 13), or who had undergone AH without specific indication (Group III: 30 cycles in 22) from January, 1995 to Februry, 1996, and the outcomes of AH were analyzed according to pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was $9.9{\pm}7.1$ in Group I, $11.5{\pm}4.5$ in Group II, and $7.9{\pm}6.4$ in Group III. The number of embryos transferred after AH was $4.7{\pm}1.8$ in Group I, $5.3{\pm}1.3$ in Group II, and $3.5{\pm}2.4$ in Group III. The mean cumulative embryo score (CES) was $56.8{\pm}30.0$ in Group I, $76.1{\pm}35.9$ in Group II, and $38.5{\pm}29.9$ in Group III. The overall clinical pregnancy rate per cycle and per patient was 12.7% (9/71) and 16.7% (9/54) in Group I, 33.3% (5/15) and 38.5% (5/13) in Group II, and 6.7% (2/30) and 9.1% (2/22) in Group III, respectively. There were significant differences in the numbers of oocytes retrieved and embryos transferred, CES, and the clinical pregnancy rate per cycle among three groups. There was a significant inverse correlation between basal serum FSH level and CES, and no pregnancy occurred in patients with CES less than 20. In conclusion, AH of human embryos with PZD prior to ET has improved the implantation and pregnancy rates in IVF-ET patients with the past history of repeated failures, especially in spite of transfer of embryos with good quality, and AH will provide a range of novel techniques which may contribute much to effective management of infertile couples.

착상 전 유전진단 기술 개발의 동물실험 모델로서 할구 생검된 생쥐 배아에서 동결보존 융해 후 배아 발생 양상과 공배양 효과에 관한 연구

김석현,김희선,류범용,최성미,방명걸,오선경,지병철,서창석,최영민,김정구,문신용,이진용,채희동,김정훈,Kim, Seok-Hyun,Kim, Hee-Sun,Ryu, Buom-Yong,Choi, Sung-Mi,Pang, Myung-Geol,Oh, Sun-Kyung,Jee, Byung-Chul,Suh, Chang-Suk,Choi, Young-Min,Kim, Jung 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.1

Objective: The effects of cryopreservation with or without coculture on the in vitro development of blastomere-biopsied 8-cell mouse embryos were investigated. This experimental study was originally designed for the setup of a preclinical mouse model for the preimplantation genetic diagnosis (PGD) in human. Methods: Eight-cell embryos were obtained after in vitro fertilization (IVF) from F1 hybrid mice (C57BL(표현불가)/CBA(표현불가)). Using micromanipulation, one to four blastomeres were aspirated through a hole made in the zona pellucida by zona drilling (ZD) with acid Tyrode's solution (ATS). A slow-freezing and rapid-thawing protocol with 1.5M dimethyl sulfoxide (DMSO) and 0.1M sucrose as cryoprotectant was used for the cryopreservation of blastomere- biopsied 8-cell mouse embryos. After thawing, embryos were cultured for 110 hours in Ham's F-10 supplemented with 0.4% bovine serum albumin (BSA). In the coculture group, embryos were cultured for 110 hours on the monolayer of Vero cells in the same medium. The blastocyst formation was recorded, and the embryos developed beyond blastocyst stage were stained with 10% Giemsa to count the total number of nuclei in each embryo. Results: The survival rate of embryos after cryopreservation was significantly lower in the blastomere-biopsied (7/8, 6/8, 5/8, and 4/8 embryos) groups than in the non-biopsied, zona intact (ZI) group. Without the coculture, the blastocyst formation rate of embryos after cryopreservation was not significantly different among ZI, the zona drilling only (ZD), and the balstomere-biopsied groups, but it was significantly lower than in the non-cryopreserved control group. The mean number of cells in embryos beyond blastocyst stage was significantly higher in the control group ($50.2{\pm}14.0$) than in 6/8 ($26.5{\pm}6.2$), 5/8 ($25.0{\pm}5.5$), and 4/8 ($17.8{\pm}7.8$) groups. With the coculture using Vero cells, the blastocyst formation rate of embryos after cryopreservation was significantly lower in 5/8 and 4/8 groups, compared with the control, 7/8, and 6/8 groups. The mean number of cells in embryos beyond blastocyst stage was also significantly lower in 4/8 group ($25.9{\pm}10.2$), compared with the control ($50.2{\pm}14.0$), 7/8 ($56.0{\pm}22.2$), and 6/8 ($55.3{\pm}25.5$) groups. Conclusion: After cryopreservation, blastomere-biopsied mouse embryos have a significantly impaired developmental competence in vitro, but this detrimental effect might be prevented by the coculture with Vero cells in 8-cell mouse embryos biopsied one or two blastomeres. Biopsy of mouse embryos after ZD with ATS is a safe and highly efficient preclinical model for PGD of human embryos.

미세수술적 난관복원술 후 임신에 실패한 환자에서의 체외수정시술 결과

김석현,홍준석,구승엽,서창석,최영민,김정구,문신용,이진용,Kim, Seok-Hyun,Hong, Joon-Seok,Ku, Seung-Yup,Suh, Chang-Suk,Choi, Young-Min,Kim, Jung-Gu,Moon, Shin-Yong,Lee, Jin-Yong 대한생식의학회 2001 Clinical and Experimental Reproductive Medicine Vol.28 No.4

Objective: To evaluate the clinical outcomes and influencing factors of in vitro fertilization and embryo transfer (IVF-ET) in patients with failed pregnancy after microsurgical reversal of tubal sterilization. Materials and Methods : From January, 1997 to December, 2000, IVF-ET was performed in two groups; the study TR (tubal reanastomosis) group consisted of 147 cycles in 66 patients with failed microsurgical reversal of tubal sterilization, and the control group of 115 cycles in 67 patients with bilateral tubal occlusion (BTO). The two groups were evaluated and compared for clinical characteristics, clinical pregnancy rates, and factors influencing the outcomes of IVF-ET. Results: Compared with the control BTO group, age and the previous parity were significantly higher ($36.3{\pm}2.7$ vs. $33.6{\pm}2.0$ years, p<0.05; $1.6{\pm}0.7$ vs. $0.2{\pm}0.4$, p<0.05), and the clinical pregnancy rate per cycle was significantly lower (23.8% (35/147) vs. 29.3% (34/115), p<0.05) in the TR group. Difference in the clinical pregnancy rates was age-related, since there was no significant difference between the two groups, except for the previous parity ($1.6{\pm}0.7$ vs. $0.1{\pm}0.3$, p<0.05), when the patients aged 37 years or older were excluded. No difference was found in terms of the following: the proportion of controlled ovarian hyperstimulation (COH) cycles with GnRH agonist ultrashort protocol, the duration of COH, the dosage of gonadotropins used, and the numbers of oocytes retrieved and of embryos transferred, irrespective of age correction. Conclusions: The outcomes of IVF-ET following the failed microsurgical reversal of tubal sterilization depend upon patient age. The previous fertility of patients does not seem to be a factor of better IVF-ET prognosis.

체외수정시술 후 임신된 환자에서 혈중 ${\beta}-hCG$ 측정에 의한 임신 결과 예측에 관한 연구

김석현,서창석,최두석,최영민,신창재,김정구,문신용,이진용,장윤석,Kim, Seok-Hyun,Suh, Chang-Suk,Choi, Doo-Seok,Choi, Young-Min,Shin, Chang-Jae,Kim, Jung-Gu,Moon, Shin-Yong,Lee, Jin-Yong,Chang, Yoon-Seok 대한생식의학회 1992 Clinical and Experimental Reproductive Medicine Vol.19 No.1

Serum level of ${\beta}$ subunit of human chorionic gonadotropin (${\beta}-hCG$) was studied to evaluate its predictability of pregnancy outcome in 98 in vitro fertilization and embryo transfer(IVF-ET) patients using gonadotropin-releasing hormone(GnRH) agonist. Serial serum ${\beta}-hCG$ levels were established for 42 singleton pregnancies, 20 normal multiple pregnancies, 18 preclinical abortions, 14 clinical abortions and 4 ectopic pregnancies. In comparison to normal singleton pregnancies, multiple pregnancies showed significantly higher ${\beta}-hCG$ levels on the post-ET day 10 to 13 and day 24 to 25. Clinical abortions did not show significantly lower ${\beta}-hCG$ levels in early pregnancy except the post-ET day 16-17, but showed significantly lower ${\beta}-hCG$ levels from the post-ET day 22, compared with singleton pregnancies. Preclinical abortions showed significantly lower ${\beta}-hCG$ levels than those of singleton pregnancies. Ectopic pregnancies showed lower ${\beta}-hCG$ levels than those of singleton pregnancies without statistical significance. In conclusion, determination of serum ${\beta}-hCG$ level in early pregnancy is a useful tool for the prediction of preclinical abortions and multiple pregnancies and serial measurement of serum ${\beta}-hCG$ levels will be helpful in predicting clinical abortion.

고효율 직접교환기(Direct Contact Exchanger)의 특성과 응용

김석현,Kim, Suk-Hyun 대한설비공학회 1986 설비저널 Vol.15 No.2

체외수정시술시 예후 예측에 관한 혈중 인슐린유사 성장인자 및 결합단백질의 임상적 효용성

김석현 ( Seok Hyun Kim ),구승엽 ( Seung Yup Ku ),지병철 ( Byung Chul Jee ),서창석 ( Chang Suk Suh ),최영민 ( Young Min Choi ),김정구 ( Jung Gu Kim ),문신용 ( Shin Yong Moon ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.4

목적 : 본 연구에서는 체외수정시술 (IVF-ET)시 예후 예측을 위한 혈중 인슐린유사 성장인자-Ⅰ (insulin-like growth factor-Ⅰ, IGF-Ⅰ), IGF-Ⅱ 및 인슐린유사 성장인자 결합단백질-3 (insulin-like growth factor binding protein-3, IGFBP-3) 농도 측정의 임상적 효용성을 규명하고자 하였다. 연구 방법 : 체외수정시술을 시행받은 84명의 환자를 대상으로 과배란유도시 성선자극호르몬 Objective : To evaluate the clinical efficacy of serum insulin-like growth factor-Ⅰ (IGF-Ⅰ), IGF-Ⅰ, and IGF binding protein-3 (IGFBP-3) levels in predicting the prognosis of in vitro fertilization and embryo transfer (IVF-ET). Materials and Methods : In 8

건설감정에 있어서 적정한 일반관리 비율 및 이익률 고찰

김석현(Kim, Suk Hyun) 한국공공사회학회 2014 공공사회연구 Vol.4 No.1

본 연구에서는 건설 분쟁 중 하자보수금 및 공사대금 등 공사비를 산정해야하는 경우에는 대부분 건설 감정이 이루어진다. 이와 같이 건설 감정을 수행하는 경우에는 직접공사비는 건설표준품셈 등 객관적인 자료를 적용하여 산출이 가능하나, 일반관리비 및 이익 등의 간접공사비의 산정은 조달청에서 제안하는 원가계산제비율표의 요율을 적용하게 된다. 조달청의 원가계산제 비율에서 일반관리비율 및 이익률은 상한선을 제시하고 감정목적물의 성격등을 감안하여 비율을 축소 적용 가능하도록 하고 있다. 그러나 건설감정인의 주관적인 판단에 따라서 일반관리비율 및 이익률을 적용하는 요율이 차이가 발생하게 되고 그 차이는 재판 결과에 직접적인 영향을 미친다. 이러한 재판결과는 당사자들은 입장에 따라서 불만을 나타내는 경우가 많다. 따라서 이러한 불만을 최소화하기 위해서 공사금액 산정 시 적정한 일반관리비율과 이익률을 제시하기 위해서 각 국의 사례와 국내의 공기업의 사례를 검토하고, 대한건설협회의 경영분석과 한국은행의 경영분석 자료를 분석하여 적정한 일반 관리비율과 이익률을 제시함으로써 소송 당사자의 불만을 해소하고 재판의 효율성을 높이고자 한다. When construction cost estimate(repair cost of defects, cost of construction, etc.) is required under construction dispute, there is mostly construction appraisal. In case of construction appraisal, direct construction cost can be calculated by objective standards such as Quantity per unit Method, but computation of indirect construction cost(such as general management expenses and profits) applies the ratio of standard-cost system provided by the General Services Administration. The permitted general management ratio and profit ratio on the standard-cost system present maximum and take feature of the appraisal object so that it allows application of reduction ratio. Since there is a construction appraiser"s subjective judgment involved, however, there might be difference of the application rate of these two ratios, and it influences the result of the trial directly. Because of these issues, the parties to a suit may show dissatisfaction, which depends on their position. Therefore, to minimize this dissatisfaction and improve efficiency of the trial, appraisers should inquire into cases of other countries and internal public enterprises and do business analysis of Construction Association of Korea and the Bank of Korea to provide the permitted general management ratio and profit ratio properly.

신부전이 없는 환자에서 발생한 Cefepime에 의한 뇌병증 1예

김석현 ( Suk Hyun Kim ),남영희 ( Young Hee Nam ),전동섭 ( Dong Sub Jeon ),이혜원 ( Hye Won Lee ),남희주 ( Hee Joo Nam ),이수걸 ( Soo Keol Lee ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.3

Cefepime is an extended-spectrum, fourth-generation cephalosporin that has been widely used for approved indications such as febrile neutropenia. Common adverse events of cefepime include headache, skin rash, gastrointestinal problems, and fever. However, encephalopathathy caused by cefepime has been sporadically reported worldwide over the last decade. We experienced a rare case of cefepime-induced encephalopathy. A 75-year-old man with a 30-year history of chronic obstructive pulmonary disease was admitted to the medical intensive care unit under a diagnosis of pneumonia. Initial antibiotic therapy was started with piperacillin/sulbactam and ciprofloxacin. His condition was improved with this treatment. About 2 months later, his condition was aggravated again, with mild fever and purulent sputum. Intravenous cefepime was selected on the basis of antibiotic susceptibility to Pseudomonas aeruginosa isolated from his sputum. However, his mentality became drowsy 48 hours after cefepime adminstration. He showed tremors and right facial paralysis. Neurologic examination for motor power and sensory function revealed normal findings. Laboratory tests, including serum electrolytes, glucose, osmolality, and ammonia, gave normal results. Brain magnetic resonance imaging showed chronic ischemic and atropic changes, and an electroencephalography revealed triphasic waves. The administration of cefepime was stopped, and his symptoms started to improve within 48 hours. Electroencephalography results became normalized, and he completely recovered within 48 hours after discontinuation of cefepime.

체외수정시술시 유세포분석을 이용한 과립막세포내 아포프토시스의 정량적 측정

김석현(Seok Hyun Kim),최영민(Young Min Choi),문신용(Shin Yong Moon),이진용(Jin Yong Lee),지병철(Byung Chul Jee),서창석(Chang Suk Suh),김정구(Jung Gu Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1

목적: 체외수정시술시 난포액내 과립막세포의 아포프토시스율을 알아보고 임신 결과를 예측할 수 있는 예후인자로 작용하는지를 보고자 하였다. 연구 방법: 체외수정시술 및 자궁내 배아이식을 시행한 73명의 환자에서 난자채취후 난포액내 과립막세포를 회수하여 FITC가 부착된 Bcl2 단일클론항체와 propidium iodide 염색을 시행하고 아포프토시스율과 Bcl2 양성율을 유세포분석기를 통하여 측정하였다. 결과: 임신군과 비임신군의 비교에 있어 여성의 연령, 기저 혈중 FSH 농도, hCG 투여일에 에스트로젠 농도, 채취난자수, 이식배아수, 수정률은 차이가 없었으나 아포프토시스율은 임신군에서 유의하게 낮게 나타났다. Bcl2 양성율은 양군에서 차이가 없었다. 아포프토시스율은 기저 혈중 FSH 농도와 양성의 비례 관계를 보였으며, 아포프토시스율 6.14% 이하를 기준으로 하였을 때 임신 예측에 대한 민감도는 87.5%, 특이도는 73.7% 이었다. 결론: 이러한 결과는 난포액내 과립막세포에서 측정한 아포프토시스율이 체외수정시술시 성공적인 임신의 예측 인자로 작용할 수 있음을 시사한다. Purpose: To investigate the prognostic significance of apoptotic rates in luteinized granulosa cells recovered from patients participating in an IVF program. Methods: Seventy-three women underwent ovarian hyperstimulation for IVF and embryo transfer. After follicle aspiration, recovered luteinized granulosa cells were stained by Bcl2 monoclonal antibody with FITC and propidium iodide. Fluorescence was detected by flow cytometry, and apoptotic rates or Bcl2 positivities were determined on histogram. Results: Pregnant group showed significantly lower apoptotic rate in luteinized granulosa cells compared with nonpregnant group (p<0.0001). Age of female, basal serum FSH levels, serum E2 concentrations at hCG day, number of oocytes aspirated, fertilization rates, number of embryos transferred and Bcl2 positivities were not different in the two groups. Apoptotic rates were correlated positively with the basal serum FSH levels. Apoptotic rates in luteinized granulosa cells of 6.14% or below could predict a successful pregnancy with sensitivity 87.5% and specificity 73.7%. Conclusion: Our result indicates that apoptotic rate in luteinized granulosa cells within follicular fluids can be used as an prognostic indicator for IVF success.

신부전이 없는 환자에서 발생한 Cefepime에 의한 뇌병증 1예

김석현 ( Suk Hyun Kim ),남영희 ( Young Hee Nam ),전동섭 ( Dong Sub Jeon ),이혜원 ( Hye Won Lee ),남희주 ( Hee Joo Nam ),이수걸 ( Soo Keol Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1992 소아알레르기 및 호흡기학회지 Vol.2 No.3

Cefepime is an extended-spectrum, fourth-generation cephalosporin that has been widely used for approved indications such as febrile neutropenia. Common adverse events of cefepime include headache, skin rash, gastrointestinal problems, and fever. However, encephalopathathy caused by cefepime has been sporadically reported worldwide over the last decade. We experienced a rare case of cefepime-induced encephalopathy. A 75-year-old man with a 30-year history of chronic obstructive pulmonary disease was admitted to the medical intensive care unit under a diagnosis of pneumonia. Initial antibiotic therapy was started with piperacillin/ sulbactam and ciprofloxacin. His condition was improved with this treatment. About 2 months later, his condition was aggravated again, with mild fever and purulent sputum. Intravenous cefepime was selected on the basis of antibiotic susceptibility to Pseudomonas aeruginosa isolated from his sputum. However, his mentality became drowsy 48 hours after cefepime adminstration. He showed tremors and right facial paralysis. Neurologic examination for motor power and sensory function revealed normal findings. Laboratory tests, including serum electrolytes, glucose, osmolality, and ammonia, gave normal results. Brain magnetic resonance imaging showed chronic ischemic and atropic changes, and an electroencephalography revealed triphasic waves. The administration of cefepime was stopped, and his symptoms started to improve within 48 hours. Electroencephalography results became normalized, and he completely recovered within 48 hours after discontinuation of cefepime. (Allergy Asthma Respir Dis 2014;2:213-217)