만성 심부전환자의 혈액에서 측정한 Tumor necrosis factor-α 및 Interleukin-6의 임상적 의의

김명구,김성구,박상호,한대희,강진환,변정득,심규혁,최병조,방덕원,온영근,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background and objectives: Many conditions are responsible for the pathophysiology and progressive mechanisms of congestive heart failure. More recently, it has also become evidence that another class of biologycally activated molecules generically reffered to as cytokine these are also over expressed in congestive heart failure. Therefore, the purpose of this study was to measure concentrations of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) in mild to severe symptoms of heart failure and compare their values with those found in normal control and analysed correlation relationship between cytokine level, clinical findings and hemodynamic indicies. Subjects and Methodology: Levels of TNF-α and IL-6 were measured on pulmonary artery during cardiac catheterization in heart failure patients(n=32) and normal subjects(n=8) as well as physical examination and echocardiogram. Cytokines assay were performed on plasma using commercially available ELISA(Enazyme-Linked Immunosorbent Assay) kits. Results: Although the levels of TNF-α and IL-6 tend to increase in congestive heart failure group, the cytokines level was not made significantly statistical difference between congestive heart failure group and controls. When analyzing the correlation between the levels of PCWP(pulmonary capillary wedge pressure) and cytokines(TNF-α, IL-6), respectively, there were statistically significant correlation coefficient 0.32,(p<0.05), 0.39(p<0.01). The cytokine IL-6 and pressure of pulmonary artery were significant correlation.(correlation coefficient 0.36, p<0.02) More significantly, there was correlated with TNF-α and IL-6.(correlation coefficient 0.57, p<0.001) Conclusions: There was tended toward high concentration of TNF-α & IL-6 in congestive heart failure and significant difference for PCWP between TNF-α & IL-6, thus may be correlated with development and progression in congestive heart failure.

만성 B형 간질환에서 라미부딘 초치료 후의 재발 양상과 재치료 효과

박종호,박능화,신정우,방성조,김대현,주광로,김도하 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3

목적: 만성 B형 간염 환자에 라미부딘은 효과적이지만 서양의 보고와 달리 국내에서는 치료 종료 후 재발률이 높은 것으로 알려져 있다. 그러나 라미부딘 치료 종료 후의 재발 양상이나 재발군에서 라미부딘의 재투여에 대한 치료 효과는 알려져 있지 않다. 본 연구에서는 치료 종료 후 재발 양상과 재발군에서 라미부딘 재치료 효과를 알아보고자 하였다. 대상과 방법: 만성 B형 간질환으로 진단받고 라미부딘을 치료받은 환자 중 치료에 반응한 후 투약을 중지한 121명 중에서 재발한 42명(만성 간염 36예, 대상성 간경변 6예)을 대상으로 하였다. 라미부딘을 1일 100 ㎎씩 6개월(평균 16개월, 범위: 6-35개월) 이상 투여하였다. 평균 연령은 39.7세였고 남녀 비는 35:7이었다. 재치료 전 혈청 ALT 평균치는 437 IU/L, AST 평균치는 227 IU/L, HBV DNA 평균치는 519 pg/mL였다. 치료반응군에서는 치료 반응이 있은 뒤 추가로 라미부딘을 투여하여 적어도 2개월 이상 반응이 유지된 후 투약을 중지하고 재발 유무를 추적 관찰하였다. 겨로가: HBeAg이 혈청전환된 192예 중 121예(63%)에서 투여를 중단하였으며 평균 추적 기간은 8.9개월(범위: 1-40개월)이었다. 66명(54.5%)에서 재발하였으며 평균 재발 시기는 5.7개월(범위: 1-33개월)이었다. 50예(75.8%)에서는 HBeAg 양성 만성 간질환으로, 16예(24.2%)는 HBeAg 음성 만성 간질환으로 재발하였다. 누적 재발률은 1개월 후 6%, 3개월 후 27%, 6개월 후 47%, 12개월 후 60%, 18개월 후 64%, 24개월 후 66%이었다. 재발과 관련된 예측 인자로는 연령, 치료 전 정량적 HBeAg치, HBV DNA치가 의미 있는 인자였으며 30세 이하의 25명 중 5명만이 재발하였다. 재발한 66명 중에서 혈청 ALT치가 지속으로 상승된 42예(64%)에서 라미부딘을 재투여 하였다. 31예(73.8%)에서 반응이 있었으며 누적 치료 반응률은 6개월 62%, 9개월 69%, 12개월 72%였다. Breakthrough는 6예(14.3%)에서 일어났으며 전부 HBeAg 양성 만성 간질환 환자였다. 적어도 24개월 이상 치료반응이 유지된 21예에서 투여를 중지하였으며 이 중 11예(52.4%)에서 재발하였다. 재치료한 HBeAg 양성군과 음성군 간에 치료반응률, breakthrough률, 재발률 등도 유의한 차이는 없었다. 라미부딘 재투여의 치료 반응 예측 인자로는 라미부딘 투여기간(p=0.003)이 유의하였으며 breakthrough와 관련된 인자는 없었다. 결론: 라미부딘 초치료 후 재발률은 높았으며 재발 형태는 HBeAg 양성뿐만 아니라 HBeAg 음성 만성 B형 간질환의 형태로도 나타났다. 라미부딘 재치료는 초치료보다는 높은 치료 반응률을 보였으나 breakthrough률과 재발률은 초치료와 비슷하였다. Background/Aims: The post-treatment relapse patterns and efficacy of lamivudine re-treatment for relapsed patients have not been clarified. The aims of this study were to evaluate the relapse patterns after discontinuing therapy and the effects of lamivudine re-treatment for relapsed patients after HBeAg seroconversion. Methods: Therapy was discontinued after HBeAg seroconversion in 121 patients. Sixty-six patients were relapsed and included in this study. The duration of lamivudine re-treatment therapy was from 6-35 (mean:16) months. Post-retreatment monitoring continued for 1-40 (mean:8.9) months. Results: Among the relapsed 66 patients, 50 (75.8%) had HBeAg reappearance while 16 (24.2%) remained HBeAg negative and anti-HBe positive. The cumulative relapse rates at 3, 6, 12 and 24 months were 27%, 47%, 60% and 66% respectively. Forty-two relapsers received lamivudine re-treatment. Among them, 33 were HBeAg positive and 9 were HBeAg negative and anti-HBe positive, Response was achieved in 31 of the 42 patients (73.8%). The cumulative response rates at 6, 9 and 12 months were 62%, 69% and 72%, respectively. Six patients (14.3%) developed viral breakthrough. All patients were HBeAg positive chronic hepatitis B. The duration of lamivudine re-treatment was the only predictable factor for response of lamivudine re-treatment. Therapy was discontinued after response in 21 patients. Eleven patients were relapsed, including 6 who were HBeAg positive and 5 who were HBeAg negative. Predictive factors for post-retreatment relapse were age and the duration of additional lamivudine therapy after response. Conclusions: The response rate of lamivudine re-treatment was significantly higher than in initial lamivudine treatments. The breakthrough and relapse rates, however, were similar in both initial and retreated lamivudine therapy.(Korean J Hepatol 2003;9:188-197)

울산지역 췌담관질환 환자의 간흡충 감염 실태 : 담즙검사를 기준으로 based on bile examination

이기영,주광로,김현수,신수진,이효섭,윤태권,추연익,박종호,신정우,방성조,김도하,박능화 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 간흡충증의 진단은 분변 또는 담즙에서 간흡충의 성충 또는 충란을 발견하는 것이다. 담즙을 통한 간흡충 진단은 간흡충이 존재하는 담관에서 검체를 직접 채취한다는 장점과 이 검체가 분변이나 체액에 의해 희석되지 않으며, 특히 담관 폐색이 있을 경우 담즙배설 장애로 인한 분변검사의 위음성을 줄일 수 있는 가장 정확한 간흡충의 기생충학적 검사로 생각된다. 이에 저자들은 울산지역 췌담관 질환 환자에서 담즙검사를 기준으로 한 간흡충의 감염 실태를 알아보고자 하였다. 방법 : 내시경적 또는 경피경간 담관배액술을 통해 담즙을 채취하여 간흡충 충란 유무를 확인한 309명의 췌담과 질환 환자에서 간흡충 감염 실태를 조사하였다. 결과 : 대상 환자 전체의 충란 양성률은 27.5%였고, 남녀의 충란 양성률은 각각 35.%와 17.6%로 남자에서 더 높았다. 연령별 충란 양성률은 30대 20.0%, 40대 26.7%, 50대 24.2%, 60대 29.9%, 70대 36.2% 그리고 80대 이상이 16.7%로 연량에 따른 통계적 차이는 없었다. 질병별 충란 양성률은 담관암 32.65, 담낭암 38.5%, 파터팽대부암 11.1%, 췌장암 24.0%, 담석질환 26.4%,간흡충담관염 61.5% 그리고 이외 질환이 12.5%로 간흡충 담관염ㅇ르 제외한 질병간 의미있는 차이는 없었으며 결석의 위치, 간흡충 연관질환인지 아닌지가 충란 양성률에 영향을 미치지 못했다. 담관 조영술을 포함한 방사선 검사에서 정상 담관을 보인 환자에서 충란 양성률은 17.0%였다. 결론 : 본 연구 결과 울산지역 췌담관 질환 환자에서 간흡충 감염률은 연령, 성별, 질병의 종류에 관계없이 전반적으로 매우 높았다. 따라서 이러한 자료를 근거로 생각해 볼 때 우리 나라가 아직도 심각한 간흡충 감염의 유행지임을 추론할 수 있겠다. Background : Bile examination is believed to be the most precise method for detecting Clonorchis sinesis (CS) eggs. We carried out bile examination to evaluate infestation state of CS in patients with pancreatobiliary diseases in Ulsan, known as an endemic area of CS infestation. Methods : We examined CS eggs in bile in three hundreds and nine patients with pancreatobiliary diseases. The bile was obtained from endoscopic nasobiliary or percutaneous transhepatic biliary drainage tubes. Results : The overall egg positive rate was 27.5% (35.3% in male,17.6% in female). The egg positive rate was not significantly different according to the age group: 20.0% in thirties, 26.7% in forties, 24.2% in fifties, 29.9% in sixties, 36.2% in seventies and 16.7% in eighties or more. The egg positive rate according to the disease, except CS cholangitis, was not also statistically different: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, 11.1% in ampulla of Vater cancer, 24.0% in pancreatic cancer, 26.4% in gallstone diseases and 12.5% in the reminder. The location of gallstone and whether CS related diseases or CS unrelated diseases did not affect the egg positive rates. The egg positive rate in patients with normal radiological findings including cholangiography was 17.0%. Conclusion : This result shows that regardless of age, sex and sorts of diseases, the infestation rate of CS was very high. On the basis of our results, it if therefore presumes that clonorchiasis is still endemic disease in Korea.

Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction

Sung-Jo Bang 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1

EDITORIAL

Combination Chemotherapy with 5-Fluorouracil and Heptaplatin as First-line Treatment in Patients with Advanced Gastric Cancer

Bang Sung Jo,Kim Do Ha,Kim Gyu Yeol,Choi Dae Hwa,Min Young Joo,Shin Jung Woo,Ko Byung Kyun,Cho Hong Rae,Park Jae Hoo 대한의학회 2004 Journal of Korean medical science Vol.19 No.3

원발성 간외 담관암의 임상적 고찰 : 예후 인자 분석을 중심으로

김성호,박완,이정희,김명환,이성구,민영일,주광로,방성조,주연호,명승재,공경엽,김해경,이철룡 대한소화기학회 1999 대한소화기학회지 Vol.33 No.1

Background/Aims: The prognosis of extrahepatic bile duct carcinoma is very poor. The value of the gross morphology and location of the tumor in the bile duct as prognostic factors have been contro versial. Thus, we conducted a retrospective analysis of the prognostic factors. Methods: During the period between June, 1989 and December, 1996, 193 cases of extrahepatic bile duct carcinomas were selected and 108 cases of them were curatively resected. We collected data at the point of August 1997. Results: The mean age was 61.9 (17-87) years and the male to temale ratio was 2.5:1. Th frequency of tumor according to the location was 32.1% in the upper part, 31.6% in the middle par and 5.3% in diffuse type. The overall 1,2,3, and 5-year survival rate was 49.9%, 32.2%, 23.4%, and 17.8%, respectively. In the patients with curative surgery (n=108), the 1-, 2-, 3-, and 5- year surviva rate was 70.0%, 48.0%, 37.1% and 27.2%, respectively. In the patients without carative surgery (n=85), the 1-, 2-, 3-, and 5-year survival rate was 24.0%, 12.5%, 7.1%, and 3.0%, respectively. The survival rates of stage I were significantly better than those of stage II, stage III and stage IV-A. Th survival rates of well differentiated histology were significantly better than those of moderate or poo differentiation. Conclusions: The stage, histologic differentiation and curative resectability of the extrahepatic bile duct carcinoma were significant prognostic factors. However, the gross morphology and location of the tumor had no prognostic significance. (Kor J Gastroenterol 1999;33:114 - 123)

췌장의 낭종성 질환-수술 혹은 경과관찰

방성조 ( Sung Jo Bang ),김명환 ( Myung Hwan Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient. (Korean J Med 78:295-300, 2010)

Molecular Mechanism of Local Drug Delivery with Paclitaxel-Eluting Membranes in Biliary and Pancreatic Cancer: New Application for an Old Drug

Bang, Sookhee,Jang, Sung Ill,Lee, Su Yeon,Baek, Yi-Yong,Yun, Jieun,Oh, Soo Jin,Lee, Chang Woo,Jo, Eun Ae,Na, Kun,Yang, Sugeun,Lee, Don Haeng,Lee, Dong Ki Hindawi Publishing Corporation 2015 Gastroenterology Research and Practice Vol.2015 No.-

<P>Implantation of self-expanding metal stents (SEMS) is palliation for patients suffering from inoperable malignant obstructions associated with biliary and pancreatic cancers. Chemotherapeutic agent-eluting stents have been developed because SEMS are susceptible to occlusion by tumor in-growth. We reported recently that paclitaxel-eluting SEMS provide enhanced local drug delivery in an animal model. However, little is known about the molecular mechanisms by which paclitaxel-eluting stents attenuate tumor growth. We investigated the signal transduction pathways underlying the antiproliferative effects of a paclitaxel-eluting membrane (PEM) implanted in pancreatic/cholangiocarcinoma tumor bearing nude mice. Molecular and cellular alterations were analyzed in the PEM-implanted pancreatic/cholangiocarcinoma xenograft tumors by Western blot, immunoprecipitation, and immunofluorescence. The quantities of paclitaxel released into the tumor and plasma were determined by liquid chromatography-tandem mass spectroscopy. Paclitaxel from the PEM and its diffusion into the tumor inhibited angiogenesis, which involved suppression of mammalian target of rapamycin (mTOR) through regulation of hypoxia inducible factor (HIF-1) and increased apoptosis. Moreover, implantation of the PEM inhibited tumor-stromal interaction-related expression of proteins such as CD44, SPARC, matrix metalloproteinase-2, and vimentin. Local delivery of paclitaxel from a PEM inhibited growth of pancreatic/cholangiocarcinoma tumors in nude mice by suppressing angiogenesis via the mTOR and inducing apoptosis signal pathway.</P>

The hydrogen peroxide hypersensitivity of OxyR2 in <i>Vibrio vulnificus</i> depends on conformational constraints

Jo, Inseong,Kim, Dukyun,Bang, Ye-Ji,Ahn, Jinsook,Choi, Sang Ho,Ha, Nam-Chul American Society for Biochemistry and Molecular Bi 2017 The Journal of biological chemistry Vol.292 No.17

<P>Most Gram-negative bacteria respond to excessive levels of H2O2 using the peroxide-sensing transcriptional regulator OxyR, which can induce the expression of antioxidant genes to restore normality. Vibrio vulnificus has two distinct OxyRs (OxyR1 and OxyR2), which are sensitive to different levels of H2O2 and induce expression of two different peroxidases, Prx1 and Prx2. Although OxyR1 has both high sequence similarity and H2O2 sensitivity comparable with that of other OxyR proteins, OxyR2 exhibits limited sequence similarity and is more sensitive to H2O2. To investigate the basis for this difference, we determined crystal structures and carried out biochemical analyses of OxyR2. The determined structure of OxyR2 revealed a flipped conformation of the peptide bond before Glu-204, a position occupied by glycine in other OxyR proteins. Activity assays showed that the sensitivity to H2O2 was reduced to the level of other OxyR proteins by the E204G mutation. We solved the structure of the OxyR2-E204G mutant with the same packing environment. The structure of the mutant revealed a dual conformation of the peptide bond before Gly-204, indicating the structural flexibility of the region. This structural duality extended to the backbone atoms of Gly-204 and the imidazole ring of His-205, which interact with H2O2 and invariant water molecules near the peroxidatic cysteine, respectively. Structural comparison suggests that Glu-204 in OxyR2 provides rigidity to the region that is important in H2O2 sensing, compared with the E204G structure or other OxyR proteins. Our findings provide a structural basis for the higher sensitivity of OxyR2 to H2O2 and also suggest a molecular mechanism for bacterial regulation of expression of antioxidant genes at divergent concentrations of cellular H2O2.</P>

Effects of Sediment Elutriates on the Early Reproductive Outputs in the Pacific oyster, Crassostrea gigas

Jo, Qtae,Moon, Hyo-Bang,Cho, Yong Chul,Kim, Kwang Soo,Choy, Eun Jung,Ko, Sung-Chung,Song, Young-Chae 한국수산학회 2005 Fisheries and Aquatic Sciences Vol.8 No.1

This is a subsequent study to our previous finding that Pacific oysters, Crassostrea gigas, gained a so-called upper plateau concentration, around 30,000 ng/g dry weight digestive gland for benzo(a)pyrene, showed reproductive behavior but produced their ensuing reproductive outputs damaged. A serial dilution of sediment elutriates from Jinhae Bay, Korea, where pollution was progressive, were exposed to gametes of the Pacific oyster for 0, 5. 10, 20, 30, and 60 min to detail the pollutant effects on very young specimens. There was an apparent critical dilution over which adverse effects are evident. This was 10% of the present sediment elutriate, corresponding to 0.3 ng/g on the basis of total polycyclic aromatic hydrocarbons (PAHs) for the oyster. Within the dilution the embryonic development was not influenced by the duration of exposure to its gamete stage. At higher dilutions over the critical dilution, occurrence of abnormality increased dependent on the pollutant dilution and the duration of exposure. Similar trends were also found in larval mortality. However, overall, the chemical toxicity was more significant to morphogenesis than to survival, suggesting a potential recruitment of the pollutants-induced abnormal larvae in the wild population to threaten the population integrity.