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.

병원간 응급의료 전달체계에 대한 연구 : 영동세브란스 병원 응급진료센타를 중심으로

최성욱,김인병,이한식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Transporting an emergent patient to a hospital has a crucial role in proper patient care. Objective of this study is to review the current methods and various patient transport system used between the hospital. We have conducted a retrospective analysis of consecutive 753 patients who was transport-in and out from emergency department of YoungDong Severance Hospital from Sep. 1, 1994 to Feb. 28, 1995. All transferred patients were divided into two large category of trauma versus non-trauma, 363 to 390 patients, respectively. Average ISS(injury serverity score) for trauma patients were 7.31 point and average GCS score of 14.29 point for non-trauma patients. Most of the patients were trasfered-in during day and evening hours(84%), but there was no peak hours for transfer-out patients. Little more than half of all transferred patients used ambulance as a mode of transportation. Among all transfer-in patients, 65% were admitted for general care, emergency operation and ICU care. Others, 17%, 18% were discharged or transfer-out to other hospital, respectively. For transfer-out patients, 72% of transfer-out patients were for admission following recommandation by an emergency physician. Each level of hospital was divided into 4 subgroup ; private clinic, small hospital, general hospital and university hospital. ISS was also divided into score less than 10 points for mild and more than 11 points for moderate to severe injury. As a results, all of patients transferred from private clinic bad less than 4 point of ISS. Where as increasing percentage of patients with higher ISS was transferred-in from higher level of hospitals. Transfer-out hospitals were carefully selected by emergency physicians according to patient health status, speciality of referring hospital and closeness to patient residence For non-traumatic patient, GCS score was divided into GCS score 14or less and 15 point. Similar to trauma patient, there was increasing percentage of patient with lower GCS score transfer-in as hospital level increase. Patients with ISS less than 10 point and GCS score 15 point can be transferredto anappropriate level of hos-pital if EMSS operates properly. We suggest with a well organized EMSS, mandatory inter-hospital communication and good transfer record, proper patient transfer and treatment can be achieved.

병원 도착 전 사망 환자의 사인기재에 관한 고찰

강용선,이경룡,박인철,조광현,김승호,이한식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. Material & Method: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. Results: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7∼ 14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians,35(4.9%) failed to adhere to the death certification guidelines, Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. Conclusion: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments, Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.

감귤로부터 분리한 Sucrose Synthase 유전자 특성 분석

김인중,김찬식 제주대학교 방사능이용연구소 2006 방사선응용과학연구소논문집 Vol.20 No.-

전기손상으로 인한 심장질환자의 회복 1례

장문준,황태식,최성욱,김인병,손대곤,조광현,이한식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

An unconscious 20 year old male carried into the emergency department after an electric shock injury 20 minutes earlier. Cardiopulmonary resuscitation was undertaken when asystole appeared on the electrocardiograph monitor. A 12-lead electrocardiograph was taken when in that myocardial infarction was found after performing cardiopulmonary resuscitation on an electrical injury patient. We present out case's electrocardiographs with echocardio-graphic findings and radionuclide imaging studies.

Serum selenium levels in Korean hepatoma patients.

Kim, In-Wook,Bae, Su-Mi,Kim, Yong-Wan,Liu, Hai-Bo,Bae, Si Hyun,Choi, Jong Young,Yoon, Seung Kew,Chaturvedi, Pankaj Kumar,Battogtokh, Gantumur,Ahn, Woong Shick Humana Press 2012 Biological trace element research Vol.148 No.1

<P>The aim of this study was to determine serum selenium (Se) levels during the development of liver disease as well as the possible Se supplementation benefits in liver disease patients. Serum was collected from 187 patients with liver diseases and 120 normal healthy people living in Seoul. The samples were collected at the Kangnam St. Mary's Hospital College of Medicines, The Catholic University of Korea, in accordance with procedures approved by the Institutional Review Board of the Catholic University of Korea. Serum Se levels were quantified by inductively coupled plasma mass spectrometry and were compared between healthy and liver diseases patients. Se levels were 92.65??32.50?μg/l in hepatitis infection, 92.33??30.66?μg/l in hepatitis B virus infection and 96.41??51.50?μg/l in hepatitis C virus infection, 96.42??32.80?μg/l in cirrhosis, and 67.47??14.30?μg/l in hepatoma patients. Findings were significantly lower in hepatitis and hepatoma as compared with the healthy participants (P?<?0.001). The Se level of the healthy population was 108.38??29.50, 119.37??28.31 for males and 97.87??26.99?μg/l for females. Our data shows the same parallelism between liver disease progression and decrease of Se levels except in the case of liver cirrhosis. And also, our study confirms the previous findings of significantly lower Se levels in Korean hepatoma patients. Se levels that decrease parallel to liver disease progression should be further integrated and analyzed with liver function blood biomarkers.</P>

체육교과의 목표 영역별 교육효과 및 수업 만족도 분석

김인숙,박윤식 연세대학교 체육연구소 2002 체육연구논문집 Vol.9 No.1

본 연구는 체육 교과에서 기존의 전통적인 평가방법과 수행평가 방법의 실시에 따른 체육 교과의 목표 영역별 교육효과 및 수업만족도 분석을 통해 새롭게 평가의 대안으로 제시되고 있는 수행평가 방법의 교육적 실효성을 검증하고자 한다. 또한 학습자의 일반적 특성의 차이가 체육교과의 목표 영역별 교육효과 및 수업만족도에 미치는 영향 분석을 통해 학습자의 특성을 고려한 바람직한 체육 교육의 방향을 제시하는데 그 목적이 있다. 본 연구를 위해서 김정식(1999)이 사용한 체육 교육의 교육적 효과에 관한 설문지, 김기춘(1999)의 학습태도 검사에 관한 설문지, 박영회 외 2인 (1999)이 편저한 스포츠 질문지 모음 중 체육수업의 성취동기 설문지를 연구 내용에 적합하도록 수정, 보완한 설문지를 사용하였다. 또한, 연구 대상은 서울에 소재하고 있는 D여자중학교 3학년 학생들을 편의 추출법(Convenience sampling method)을 사용하였고, 총 475명에게 설문지를 배포하여 실제분석에는 400부의 자료가 사용되었다. 자료 분석에는 SPSS 8.0 Package 방법을 사용하였다. 이와 같은 연구 절차를 거쳐 다음과 같은 연구 결과를 얻었다. 첫째, 평가방법에 따른 전체 교육효과 및 목표 영역별 교육효과, 수업 만족도 요인 모두에서 전통적 평가를 실시한 집단 보다 수행평가를 실시한 집단이 교육효과 및 수업만족도가 큰 것으로 나타났다. 둘째, 교과선호도에 따른 전체 교육효과 및 목표 영역별 교육효과, 수업만족도 모두에서 체육교과를 선호하는 학생 집단이 그렇지 않은 집단보다 교육효과 및 수업 만족도가 높은 것으로 나타났다. 셋째, 운동능력에 따른 전체 교육효과 및 목표 영역별 교육효과에 있어서 운동능력이 우수한 집단일수록 교육효과가 큰 것으로 나타났으며, 특히 정의적 영역에서는 운동능력의 차가 큰 집단간에 교육효과 차이가 더 큰 것으로 나타났다. 반면에, 수업만족도에 있어서는 운동능력의 차이가 영향을 끼치지 않는 것으로 나타났다. 넷째, 학업성취도에 따른 전체 교육효과 및 목표 영역별 교육효과에 있어서는 학업성취도가 우수한 학생집단이 다른 세 집단보다 교육효과가 높게 나타났으며, 특히 인지적 영역에 있어서는 학업성취도가 중위권인 집단간에도 교육효과에 차이가 있는 것으로 나타났다. 수업 만족도에 있어서는 학업성취도가 우수한 집단이 학업성취도가 가장 낮은 집단을 제외한 다른 집단보다 수업만족도가 높은 것으로 나타났다. 다섯째, 체력급수에 따른 전체 교육효과 및 인지적, 심동적 영역의 교육효과에서는 체력이 우수한 집단이 체력이 약한 집단보다 교육적 효과가 큰 것으로 나타났다. 반면에, 정의적 영역에의 교육효과 및 수업만족도에 있어서는 체력급수에 따른 집단간의 유의한 차이가 없는 것으로 나타났다. The purpose of this study was to verify the effectiveness of performance assessment method which is newly proposed evaluation method by comparing traditional evaluation and performance assessment method applied in physical education. The other objective of this study was to propose the optimal direction to the physical education by analyzing educational effect and class satisfaction with respect to learner's general characteristics according to the different domains of physical education. The measure to analyze effects of education in physical education and satisfaction of class was revised and compensated by Kim Jung Shik(1999), Kim Ki Chun (1999), and Park Young Hee's(1999) formerly used measure which was designed to measure satisfaction and effectiveness of class. The subject was sampled by convenience sampling method. 475 subjects were engaged to take part in the study. Frequency analysis, factor analysis, independent T-test, and one-way ANOVA was analyzed by SASS 8.0 package. Tukey's-b was used as post-hoc test. The results which were analyzed by formerly mentioned process are as followed. First, total effectiveness of education, effectiveness of object in different domains of physical education, and satisfaction of class reveals higher effect and satisfaction in performance assessment method than traditional evaluation method. Second, total effectiveness of education, effectiveness of object in different domains of physical education, and satisfaction of class reveals higher effect and satisfaction in the student who prefer physical education subject than other subjects. Third, total effectiveness of education, effectiveness of object in sub-field of physical education reveals higher effectiveness in higher physical ability group than lower physical ability group. Especially, affective domain reveals higher effectiveness of education in higher physical ability group. In contrary, satisfaction of class gad no difference between physical ability. Fourth, total effectiveness of education, effectiveness of object in sub-field of physical education reveals higher effectiveness in student of higher achievement group than other three group. Especially, cognitive domain reveals higher effectiveness of education in middle achievement group. Satisfaction of class reveals higher satisfaction in higher achievement group. Fifth, total effectiveness of education, cognitive, psycho-motor domain reveals higher education effect in higher physical fitness than lower physical fitness. In contrary, affective domain had no significant difference between physical fitness level.

응급의료 측면에서의 의료사고 유형

김인병,정상원,장석준,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

This study reviewed 48 malpractice claims of emergency patients filed in two tertiary level hospitals and at Association of malpractice patients' family. Problems related to treatment and misdiagnosis each accounted for 18 (38%) and 19 (39%) of all claims. Especially issues concerning emergency medical service system including of inadequate transport, delay in triage and transport accounted for 9 cases (19%) of all claims. But in patients' aspect, the malpractices more problems associated with treatment (77%) than misdiagnosis (13%). The claims were analyzed according to hospital levels, primary, secondary (27 problems) and tertiary hospital (21 problems). Comparison of the causes of malpractice claims against primary, secondary and tertiary hospitals resulted in more misdiagnosis claims against primary, secondary hospitals than tertiary hospitals. The symptoms associated with the claims were in order of abdominal pain (29.7%), dyspnea (13.5%), chest pain (10.8%), fracture and wound (10.8%). 83.3% of medico-legal accidents of emergency patients result in deaths (40 cases) where as 22% in non-emergency patients result in deaths. This alerts us to the seriousness of medical accidents of emergncy patient.

흉 ·요추 분쇄골절 진단을 위한 일반 방사선촬영인자 비교

김인병,황태식,장석준,이한식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient`s age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows: 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and contusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had 1 level injury in the order of L1, T12, and L2,33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical Tine??> in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed tomography was needed in subtle bursting fracture.

Expression and Activity of Citrus Phytoene Synthase and $\beta$-Carotene Hydroxylase in Escherichia coli

Kim, In-Jung,Ko, Kyong-Cheol,Nam, Tae-Sik,Kim, Yu-Wang,Chung, Won-Il,Kim, Chan-Shick The Microbiological Society of Korea 2003 The journal of microbiology Vol.41 No.3

Citrus phytoene synthase (CitPsy) and ${\beta}$-carotene hydroxylase (CitChx), which are involved in caroteinoid biosynthesis, are distantly related to the corresponding bacterial enzymes from the point of view of amino acid sequence similarity. We investigated these enzyme activities using Pantoea ananatis carotenoid biosynthetic genes and Escherichia coli as a host cell. The genes were cloned into two vector systems controlled by the T7 promoter. SDS-polyacrylamide gel electrophoresis showed that CitPsy and CitChx proteins are normally expressed in E. coli in both soluble and insoluble forms. In vivo complementation using the Pantoea ananatis enzymes and HPLC analysis showed that ${\beta}$-carotene and zeaxanthin were produced in recombinant E. coli, which indicated that the citrus enzymes were functionally expressed in E. coli and assembled into a functional multi-enzyme complex with Pantoea ananatis enzymes. These observed activities well matched the results of other researchers on tomato phytoene synthase and Arabidopsis and pepper ${\beta}$-carotene hydroxylases. Thus, our results suggest that plant carotenoid biosynthetic enzymes can generally complement the bacterial enzymes and could be a means of carotenoid production by molecular breeding and fermentation in bacterial and plant systems.