Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

Pulmonary Inflammatory Pseudotumor with Solitary Plasmacytoma of Bone Mimicking Advanced Lung Cancer

( Chang Hoon Kim ),( Jae Seok Jeong ),( Yong Chul Lee ),( So Ri Kim ),( Yeong Hun Choe ),( Seung Yong Park ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Lung cancer has been the most commonly diagnosed type of cancer and the leading cause of cancer related mortality in Korea and worldwide. Although it is fatal, most of the lung cancer patient are asymptomatic at the time of diagnosis. Therefore, radiologic screening by chest low-dose computerized tomography (LDCT) has been recommended by lung cancer specialists for early detection and improving survival. However, clinical suspicion of lung cancer by radiologic screening is quite challenging because of its high false positive rate. A wide range of benign pulmonary diseases could be misinterpreted as lung malignancy on LDCT, including infection, benign mass-forming lesion, and inflammatory changes. Therefore, physician should consider the possibility of the benign disease entities when radiologic features suggest lung malignancy. Herein, we report a case of a 50-year-old man presenting a 4.5-cm lung mass in the right upper lobe with solitary osteolytic lesion of the right 8th rib. Under the suspicion of metastatic lung cancer, the lung mass and the right 8th rib were surgically resected for the diagnostic and curative purpose. After the tissue biopsy, unexpectedly, the lung mass was diagnosed as inflammatory pseudotumor. Furthermore, histopathology of the resected rib showed solitary plasmacytoma of the bone. Our experience highlights the importance of clinical suspicion that in patients with radiologic features compatible to advanced lung cancer could be caused by coexistence of unrelated two uncommon disease entities, which can be completely treatable with surgical resection.

The Bioenergy Conversion Characteristics of Feedlot Manure Discharging from Beef Cattle Barn

Seung-Yong Oh,Chang-Hyun Kim,Young-Man Yoon 한국토양비료학회 2015 한국토양비료학회지 Vol.48 No.6

This study was carried out to assess bioenergy conversion efficiency by biogas and solid fuel production in the cattle feedlot manure discharged from beef cattle barn. Feedlot manure was sampled from the cattle farmhouse located in Yong-in, Gyeonggi during the mid-fattening stage, periodically. The chemical characteristics, BMP (Biochemical methane potential) and HV (Heating values) of feedlot cattle manures were analyzed. Total solid contents of cattle feedlot manure were in the range of 29.98~44.28%, and volatile solid contents were in the range of 23.53~24.47%. In the anaerobic digestion of cattle feedlot manure, the methane production potential has increased from 0.141 to 0.187 Nm<SUP>3</SUP> kg<SUP>-1</SUP> -VSadded. The methane production of fresh cattle feedlot manure showed the range 0.141~0.187 Nm<SUP>3</SUP> kg<SUP>-1</SUP> -Manure (average 0.047 Nm<SUP>3</SUP> kg<SUP>-1</SUP> -Manure), the LHVs (lower heating values) of the produced methane were in the range of 316~560 kcal kg<SUP>-1</SUP> -Manure (average 400 kcal kg <SUP>-1</SUP> - Manure). In the direct combustion of fresh cattle feedlot manure, the LHVs were measured in the range of 747~1,271 kcal kg<SUP>-1</SUP> -Manure (average 916 kcal kg<SUP>-1</SUP> -Manure), and LHVs of solid fuel which have the water content of 20% were in the range of 2,694~2,876 kcal kg<SUP>-1</SUP>-Manure (average 2,791 kcal kg<SUP>-1</SUP> -Manure). Then, the drying energy of average 443 kcal kg<SUP>-1</SUP> -Manure was consumed in the production of solid fuel which has a water content of 20%. Therefore, the direct combustion of cattle feedlot manure showed about 2.3 times higher LHV than the LHV of methane produced by anaerobic digestion. And LHV of solid fuel was about 6.0 times higher than the LHV of methane produced by anaerobic digestion. Then, the production of solid fuel presented more bioenergy conversion efficiency than the biogas production in the bioenergy use of cattle feedlot manure.

니켈기 초내열합금 RENE 80 의 크리프시험중 결정입계 균열생성 및 전파

조창용,김학민,박용조,김승언,이상래 대한금속재료학회(대한금속학회) 1991 대한금속·재료학회지 Vol.29 No.11

Two kinds of specimens with different microstructure were prepared by changing casting variables in vacuum investment casting. The effect of microstructural difference on the creep behavior, creep crack initiation and creep crack propagation was studied in Ni base superalloy RENE 80. The specimen having fine grained and uniformly distributed carbide exhibited superior creep properties to the large grained specimen tested at 760℃. However above 870℃, two kinds of specimens showed similar creep behavior. At higher temperature creep, crack initiation was principally caused by the reaction between the grain boundary exposed at the surface and the test atmosphere rather than the internal microstructural changes. The crack initiated at the surface propagated to the internal area and this kind of crack propagation leads to fracture of material.

The Bioenergy Conversion Characteristics of Feedlot Manure Discharging from Beef Cattle Barn

Oh, Seung-Yong,Kim, Chang-Hyun,Yoon, Young-Man 한국토양비료학회 2015 한국토양비료학회지 Vol.48 No.6

This study was carried out to assess bioenergy conversion efficiency by biogas and solid fuel production in the cattle feedlot manure discharged from beef cattle barn. Feedlot manure was sampled from the cattle farmhouse located in Yong-in, Gyeonggi during the mid-fattening stage, periodically. The chemical characteristics, BMP (Biochemical methane potential) and HV (Heating values) of feedlot cattle manures were analyzed. Total solid contents of cattle feedlot manure were in the range of 29.98~44.28%, and volatile solid contents were in the range of 23.53~24.47%. In the anaerobic digestion of cattle feedlot manure, the methane production potential has increased from 0.141 to $0.187Nm^3kg^{-1}-VS_{added}$. The methane production of fresh cattle feedlot manure showed the range $0.141{\sim}0.187Nm^3kg^{-1}$-Manure (average $0.047Nm^3kg^{-1}$-Manure), the LHVs (lower heating values) of the produced methane were in the range of $316{\sim}560kcalkg^{-1}$-Manure (average $400kcalkg^{-1}$-Manure). In the direct combustion of fresh cattle feedlot manure, the LHVs were measured in the range of $747{\sim}1,271kcalkg^{-1}$-Manure (average $916kcalkg^{-1}$-Manure), and LHVs of solid fuel which have the water content of 20% were in the range of $2,694{\sim}2,876kcalkg^{-1}$-Manure (average $2,791kcalkg^{-1}$-Manure). Then, the drying energy of average $443kcalkg^{-1}$-Manure was consumed in the production of solid fuel which has a water content of 20%. Therefore, the direct combustion of cattle feedlot manure showed about 2.3 times higher LHV than the LHV of methane produced by anaerobic digestion. And LHV of solid fuel was about 6.0 times higher than the LHV of methane produced by anaerobic digestion. Then, the production of solid fuel presented more bioenergy conversion efficiency than the biogas production in the bioenergy use of cattle feedlot manure.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

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.

Using Real-Time Electron Microscopy To Explore the Effects of Transition-Metal Composition on the Local Thermal Stability in Charged Li_<i>x</i>Ni_<i>y</i>Mn_<i>z</i>Co_{1–<i>y</i>–<i>z</i>}O<sub>2</sub

Hwang, Sooyeon,Kim, Seung Min,Bak, Seong-Min,Kim, Se Young,Cho, Byung-Won,Chung, Kyung Yoon,Lee, Jeong Yong,Stach, Eric A.,Chang, Wonyoung American Chemical Society 2015 Chemistry of materials Vol.27 No.11

<P>In this work, we use in situ transmission electron microscopy (TEM) to investigate the thermal decomposition that occurs at the surface of charged LixNiyMnzCo1-y-zO2 (NMC) cathode materials of different composition (with y, z = 0.8, 0.1, and 0.6, 0.2, and 0.4,and 0.3), after they have been charged to their practical upper limit voltage (4.3 V). By heating these materials inside the TEM, we are able to directly characterize near surface changes in both their electronic structure (using electron energy loss spectroscopy) and crystal structure and morphology (using electron diffraction and bright-field imaging). The most Ni-rich material (y, z = 0.8, 0.1) is found to be thermally unstable at significantly lower temperatures than the other compositionsthis is manifested by changes in both the electronic structure and the onset of phase transitions at temperatures as low as 100 degrees C. Electron energy loss spectroscopy indicates that (i) the thermally induced reduction of Ni ions drives these changes, and (ii) this is exacerbated by the presence of an additional redox reaction that occurs at 4.2 V in the y, z = 0.8, 0.1 material. Exploration of individual particles shows that there are substantial variations in the onset temperatures and overall extent of these changes. Of the compositions studied, the composition of y, z = 0.6, 0.2 has the optimal combination of high energy density and reasonable thermal stability. The observations herein demonstrate that real-time electron microscopy provide direct insight into the changes that occur in cathode materials with temperature, allowing optimization of different alloy concentrations to maximize overall performance.</P>

Safety and efficacy of dietary supplement (gintonin-enriched fraction from ginseng) in subjective memory impairment: A randomized placebo-controlled trial

Lee Woo-Jin,Shin Yong-Won,Chang Hyeyeon,Shin Hye-Rim,Kim Won-Woo,Jung Seok-Won,Kim Manho,Nah Seung-Yeol 한국한의학연구원 2022 Integrative Medicine Research Vol.11 No.1

Background: Gintonin inhibits β-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. Methods: In this 8-week, randomized, assessor and participant blinded, placebo–controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. Results: Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. Conclusion: GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. Clinical trial registration: This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636. Background: Gintonin inhibits β-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. Methods: In this 8-week, randomized, assessor and participant blinded, placebo–controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. Results: Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. Conclusion: GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. Clinical trial registration: This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636.

Prognostic Value of Serum Growth Differentiation Factor-15 in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Kim, Miyoung,Cha, Seung-Ick,Choi, Keum-Ju,Shin, Kyung-Min,Lim, Jae-Kwang,Yoo, Seung-Soo,Lee, Jaehee,Lee, Shin-Yup,Kim, Chang-Ho,Park, Jae-Yong,Yang, Dong Heon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.6

Background: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fatty acid-binding protein (H-FABP) in patients with chronic obstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome for COPD exacerbation. Methods: Clinical variables, including serum GDF-15 and H-FABP levels were compared in prospectively enrolled patients with COPD exacerbation that did or did not experience an adverse outcome. An adverse outcome included 30-day mortality and need for endotracheal intubation or inotropic support. Results: Ninety-seven patients were included and allocated into an adverse outcome (n=10) or a control (n=87) group. Frequencies of mental change and $PaCO_2$>37 mm Hg were significantly higher in the adverse outcome group (mental change: 30% vs. 6%, p=0.034 and $PaCO_2$>37 mm Hg: 80% vs. 22%, p<0.001, respectively). Serum GDF-15 elevation (>1,600 pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serum H-FABP level and frequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showed that an elevated serum GDF-15 and $PaCO_2$>37 mm Hg were significant predictors of an adverse outcome (odds ratio [OR], 25.8; 95% confidence interval [CI], 2.7-243.8; p=0.005 and OR, 11.8; 95% CI, 1.2-115.3; p=0.034, respectively). Conclusion: Elevated serum GDF-15 level and $PaCO_2$>37 mm Hg were found to predict an adverse outcome independently in patients with COPD exacerbation, suggesting the possibility that serum GDF-15 could be used as a prognostic biomarker of COPD exacerbation.