정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

생산 관리의 자동화를 위한 공정 감시 프로그램의 구현

이해각,천인국 순천향대학교 부설 산업기술연구소 1998 순천향 산업기술연구소논문집 Vol.3 No.3

In this paper, an automation program for the high-production-volume systems is proposed. The automation program is designed in two aspects. First one is a products management system in which a retrieval system is provided. The retrieval criteria are facility number, product type, and production date. This system is established for inventory management system. Second one is a supervising program for defective products, in which retrieval system for the defects are implemented. Several statistics for defects are analyzed and displayed in graphical representation. The system manager can easily find out the cause for defects and correct the system. The data is transferred from the facilities to personal computer through PLC(Programmable Logic Controller) in which analog signals are converted to digital signals. The system is designed for the interface with external data base systems, and then it can be used as a basic component for the whole company automation in further developments.

약물반응의 다양성과 약물유전학 : A Principle for the Personalized Pharmacotherapy

신재국,차인준 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Individual variation in drug response is a major problem of clinical practice and of a drug development. These variation can range from therapeutic failure to adverse or even fatal effects of drugs in some patients. The incidence of serious and fatal adverse drug reactions (ADRs) has been reported to be 6.7% and 0.32% of hospitalized patients in USA, respectively. The risk for therapeutic failure or toxicity of a drug in an individual patient is determined by the interaction of genes and environment. Environmental factors include drug-drug interactions, patient's age, weight, renal and liver dysfunction, or other disease factors or clinical variables such as smoking and alcohol consumption. Many of these environmental factors have long been considered in determining the individualized dose regimen in conventional pharmacotherapeutics. However, inherited individual variability of drug responses has been left as a so called "idiosyncrasy" that are not predictable by physicians. Recently, the rapid development of pharmacogenetics/pharmacogenomics provide us extensive informations regarding on the genetic background on the wide inter-individual variation of drug responses, which is expected to lead to the era of personalized pharmacotherapy. Pharmacogenetics is a science that is interesting to the inherited variants of genes related to pharmacokinetics (drug metabolizing enzymes, drug transporters etc.) and pharmacodynamics (receptor, ion channel, target enzyme etc.), which are associated to the susceptibility of an individual to the higher risk of ADR or therapeutic failure. This review addresses the role of pharmacogenetics/pharmacogenomics in relation to wide interindividual variation of drug responses and to the possible contribution to the prediction of personalized pharmacotherapy.

임상시험의 개요

신재국,차인준 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Clinical trial has been extensively applied not only in drug development but for the academic researches in biomedical field. Since this is an experimental research in human subjects, the highest level of ethical and scientific requirements should be asked to the investigators and their processing. Therefore, it is not surprising that clinical trial in drug development is strictly controlled by the ethical committee(institutional review board, IRB) and governmental regulations. Good clinical practice(GCP) has been developed as a guideline to keep the ethical and scientific requirements of clinica??trial. Unreliable data obtained from non-scientific approach can not be used for the best application of drugs or medical devices in to patients, which is not ethical in terms of their unnecessary exposure in human subjects. The most ideal type of clinical trial includes prospective, randomized. controlled and double-blinded approach. This short review introduces some of the important concepts in clinical trial, especially in the design and preparation of protocol.

Er:YAG laser 조사에 의한 치은연하치석 제거효과

조인구,김영준,김병국,정현주 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.3

The purpose of this in vitro study was to evaluate the efficiency of Er:YAG laser on calculus removal and the morphologic changes and hardness of the irradiated surface at different power settings. This experiment used human teeth which were extracted due to periodontal disease and had a band of calculus. Forty root slabs (5x5mm^2) were made and divided into control group and irradiated groups. Experimental groups were as follows;Control group (root planing), Group 1 (irradiated with laser at 30mj), Group 2(irradiated with laser at 60mJ). and Group 3(irradiated with laser at 100mJ). Twelve root slabs embedded in resin block were used in each group. Er:YAG laser was applied under water irrigation with the tip held perpendicular to the root surface in contact mode. The treatment time was measured until the calculus was removed completely under naked eyes. The efficiency of calculus removal was evaluated by the time for removal. Morphological changes of laser irradiated site were observed under SEM and the surface hardness was measured using a VH tester. The results were as follows; 1. The efficiency of laser scaling was increased with increasing the energy level of irradiation. (p<0.05) 2. The morphological changes such as carbonization, crater and scale-like defects in the irradiated root surface were frequently observed with increasing the energy level. 3. The surface hardness tended to increase at 60mJ and 100mJ irradiated groups than that of control group. From the results evaluting on the efficiency, morphological change, and surface hardness, lower energy level was suggested f'or the clinical application of the Er:YAG laser in scaling.

신경 회로망과 진화 프로그래밍을 이용한 Off-Line 필기체 문자 인식

김기석,홍인식,천인국 순천향대학교 부설 산업기술연구소 2000 순천향 산업기술연구소논문집 Vol.6 No.1

Generally speaking, pattern cognition system would be run since neural network is initialized by trained data. Vector, that is obtained from preprocessor, is input of neural network, and result is out of neural network. In case of time cost for pattern recognition, it is needed much more cost for training than cognition. The purpose of this paper is to reduce a cost for training and to increase the cognition speed. In pattern recognition, it is important to choose a recognizor as much as preprocessor. Therefore, back propagation neural network, that has a highly efficient for nonlinear problem, is used in implemented recognizor. Most neural network has a fixed training rate for training. But if it is trained with fixed training rate, oscillation and local maxima problem occurs in neural network, in the result, time cost will increase. Therefore, to improve these difficulties, we use a DTS(Dynamic Training Rate Selection) that selects training rate dynamically in run time. To realize DTS, We use EP algorithm. EP algorithm evolves a training-rate from 1st generation into 5th. Then, we can get a proper training-rate for training of neural network. On results of test, implemented system decreases time cost for training as 5~20%.

TDM 약동학 자문에 대한 처방의사의 수용여부 평가

김혜리,손지홍,윤영란,임은주,임영해,진영대,안문규,신재국,차인준 大韓臨床藥理學會 2001 臨床藥理學會誌 Vol.9 No.2

Prednisolone과 Prednisone의 임상약동학적 평가

신재국,윤영란,차인준,이경훈,장인진,신상구,박찬웅 大韓臨床藥理學會 1994 臨床藥理學會誌 Vol.2 No.1

만성 신부전 환자에서 혈액투석에 의한 Isoniazid의 제거

신재국,차인준,장인진,신상구,김윤구,한진석,김성권 大韓臨床藥理學會 1994 臨床藥理學會誌 Vol.2 No.2

무선 모니터링이 기능이 있는 백사장 그늘막 태양광 발전 시스템

이재민,국인성,이창성 關東大學校 産業技術開發硏究所 2008 산업기술논문집 Vol.- No.25

In order to cope with international movement for protection of environment, a positive approach to solve this problem is strongly required As one of the solutions of this problem, a beach parasol-type solar power generation system with wireless monitoring function is presented in this paper Solar power generation system is grid-connected with commercial electrical power system for optimal power consumption A RF wireless transceiver system and interface module are added to he previously solar power generation system developed by authors The proposed wireless solar power generation system can be usefully applied to the complex renewal energy system constructed on badges of the ocean.