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.

마우스에서 16,16-dimethyl ProstaglandinE₂가 방사선조사로 인한 탈모에 미치는 억제효과

손승창 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Objective : Alopecia, a common problem in radiotherapy of brain tumors, increases patient stress to the extent that refusal of treatment may occur. Methods and materials : To investigate prostaglandin-induced radiation protection against alopecia, the hair of ICR male mice was plucked from the right thigh and adjacent area to induce anagen. Fourteen days later, mice were injected subcut aneously into the dorsum of neck with 10㎍ 16,16-dimethyl PGE2 in 0.2㎖ of vehicle, or with vehicle alone. One hour later, graded single doses from 0 to 15 Gy, 4 MeV electron irradiation were given to groups of 7 animals. On day 14 post plucking, all irradiated animals were sacrificed with ether inhalation 12 hours after irradiation and a portion of irradiated skin were excised in experiment 1. Apoptotic index was calculated after counting apoptotic cells or fragments and all follicular cells. On day 21post plucking, all animals were killed and a portion of irradiated skin were excised in experiment 2 and 3. After 10% Formalin fixation, the hairs were photograghed and counted in experiment 2. In experiment 3, the number of hair follicles were counted and evaluated morphologically after H&E staining on day 21 post plucking. Results : The average apoptotic indices in control group were 2.09±1.90(0Gy), 8.75±4.34(6 Gy), 11.19±5.90(9 Gy), 19.05±6.37(12 Gy) and 37.75±9.20(15 Gy). In PGE2 treated groups, the corresponding results were 2.16±1.94, 5.31±2.27, 6.75±4.40, 14.10±5.45 and 25.58±7.38. Conclusions : Above results showed significant radioprotective effects of 16,16-dimethyl PGE2 on the hair follicles of mouse.

전측 시개전핵의 하행성 통각 조절계에 대한 하올리브 수준의 복측 연수의 관여

이배환,홍승길,안창일,손진훈,김기석 한국심리학회 한국심리학회지 생물 및 생리 Vol.6 No.1

본 연구는 전측 시개전핵의 자극으로 인한 하행성 통각 억제 체계에 하올리브 수준의 복측 연수가 관여하는가를 알아보기 위해 수행되었다. 펜토바비탈로 마취된 쥐의 꼬리튀기 반사를 사용하여 전측 시개전핵을 전기자극하고 복측 연수를 전기손상시키거나 리도카인을 주입한 결과 전측 시개전핵의 자극으로 유발된 무통 효과가 억제되었다. 반대로 복측 연수를 전기자극하거나 글루타메이트를 주입하여 세포체를 활성화시키면 마찬가지로 무통이 발생하였다. 이 결과는 전측 시개전핵의 하행성 통각 억제 체계에 하올리브 수준의 복측 연수가 관여한다는 것을 시사한다. The present study was conducted to determine whether the ventral medulla (VM) at the level of the inferior olive (IO) is involved in descending pain inhibition system including the anterior pretectal nucleus (APTN). Pain sensitivity was assessed using tail-flick test to radiant heat in the rat anaesthetized with pentobarbital. Electrolytic lesions of the VM or microinjections of lidocaine into the VM inhibited the analgesic effects of stimulating the APTN. Electrical stimulation of the VM or microinjections of glutamate into the VM produced analgesic effects similar to those of stimulating the APTN. These results suggest that the VM including the IO is involved in a descending antinociceptive pathway originating in the APTN.

구속된 비행 청소년들의 석방 후 6개월 이내 재범의 예측요인

서동혁,정선주,손창호,김원식,고승희,함봉진,조성진,김영기,이중재 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.3

연구목적 : 본 연구는 범법행위로 인해 검참에 구속된 청소년들의 6개월 이내 재범여부를 예측할 수 있는 요인을 분석함으로써 재범의 가능성이 높은 청소년들을 조기에 선별하여 적절한 중재를 시행하기 위한 목적으로 시행되었다. 방 법 : 검찰에 구속된 후 교도소나 소년원에 수감되지 않고 석박된 남자 청소년 125명을 대상으로 하였다. 범죄기록 검토를 통해 사회인구학적, 범죄관련 변인들에 대해 조사하였고, 가족환경 및 부모양육태도, 정신병리, 성격장애, 도덕발달수준 등과 연관된 변인을 알아보기 위해, 부모-이동 갈등해결척도(CTSPC), 한국판 가정환경척도(FES), 한국형 부모양육행동척도, 간이정신진단검사(SCL-90-R), Beck 우울증척도, Beck 불안 척도, 한국판 청소년용 도덕발달수준 평가도구와 한국판 성격장애검사(PDQ-R)를 시행하였다. 결 과 : 전체 연구대상 125명 중 55명 (44%)이 석방 후 6개월 이내에 1회 이상의 재범을 행하였다. 재범군은 비재범군에 비해 구속당시 나이가 어리고, 신체적 학대력이 높았으며, 도덕발달수준이 낮고, SCL-90-R의 적대감척도점수가 높으며 PDQ-R의 반사회적 인격장애에 해당되는 경우가 많았다. 두 집단간 가족환경이나 부모양육태도에는 유의한 차이가 나타나지 않았다. 재범군은 폭력범죄로 구속된 경우가 비재범군에 비해 적었고 첫 범죄시 연령이 어리고 전과가 있는 경우가 많았다. 로지스틱 회귀분석 결과, 재범에 대한 예측요인으로 첫 범죄당시 연령(오즈비=2.91), 반사회적 성격장애(오즈비=2.85), 신체적 학대력(오즈비=2.65)의 세 변인이 포함되었으며, 재범여부에 대한 판별력은 72.8%로 나타났다. 결 론 : 본 연구결과 구속된 청소년들의 재범률이 매우 높다는 사실과 범죄행위에 가담한 연령이 어릴수록, 반사회적 성격장애가 있고 성장과정 중 부모로부터 학대를 받은 경험이 있을수록 반복적인 범죄를 저지를 위험도가 높다는 것을 알 수 있었다. 향후 비행 청소년들의 재범을 예방하기 위해서는 이러한 특성을 가진 고위험군에 대한 조기개입 및 적응을 돕기 위한 프로그램의 개발이 중요할 것으로 사료된다. Objectives : This study was performed to investigate the factors predicting recidivism within 6months after release in arrested juvenile delinquents for proper screening and intervention of high-risk-subjects. Methods : The subjects consisted of 125 arrested male adolescents who were released after legal procedure in prosecutor office and court. The socio-demographic and crime-related characteristics. Were evaluated by police records, and the familial, psychopathology and personality characteristics, and the level of moral development measured by the Conflict Tactics Scale(CTS), Family Environment Scale(FES), Parental Behavioral Inventory, Symptom Checklist-90-Revised(SCL-90-R), Beck Depression Inventory, Beck Anxiety Inventory, Korean form of Moral Developmental Inventory for adolescents, and Personality Disorder Questionnaire-Revised(PDQ-R). Results : The recidivism rate within 6 months after release was 44% of the initial sample, Recidivists were younger and had higher scores on Anger-hostility scale of SCL-90-R and lower principle morality score than nonrecidivists. More recidivists had history of physical abuse and antisocial personality disorder on PDQ-R than nonrecidivists. They also showed the crime-related characteristics of lower percent of violence crime, higher incidence of previous conviction, younger age of the first crime. Among those variables, logistic regression showed that age of first crime, antisocial personality disorder, and history of physical abuse best predicted the recidivism within 6months after release. Conclusion : These results of present study suggest that the recidivism rate of arrested male adolescents is very high, and the age of first crime, antisocial personality disorder and history of physical abuse were key factors predicting recidivism. To prevent repeated crime of delinquent adolescents, the development of programs for those high-risk groups to help rehabilitation and adaptation in community would be essentil.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

HCI에 의한 식도염에서 식도와 하부활약근의 점막과 근육세포의 염증변화

이승준(Seung Jung Lee),김창종(Chang Jong Kim),손의동(Uy Dong Sohn),이무열(Moo Yeol Lee),신용규(Yong Kyoo Shin),심상수(Sang Soo Sim) 대한약학회 2002 약학회지 Vol.46 No.1

The underlying mechanism by which the reflux of gastric juice elicits oesophagitis remains unclear. To inverttigate iidlammatory response to HCI in tissue of esophagus and lower esophageal sphincter, experimental esophagitis was elicited by perfusion of 0.1 N HCI in cats. There was no difference in phospholipase A2 (PLA2) activity of tissue between control and esophagitis. Myeloperoxidase activity in esophagitis was significantly greater than that of control. However, his- tamine content in esophageal mucosa of esophagitis was significantly smaller than that of control. These findings suggest that inflammatory response to HCI in esophagitis is related to changes of myeloperoxidase activity and histamine rather than change of PLA2 activity.

Interleukin-34 produced by human fibroblast-like synovial cells in rheumatoid arthritis supports osteoclastogenesis

Hwang, Seung-Jun,Choi, Bongkun,Kang, Soon-Suk,Chang, Jae-Ho,Kim, Yong-Gil,Chung, Yeon-Ho,Sohn, Dong Hyun,So, Min Wook,Lee, Chang-Keun,Robinson, William H,Chang, Eun-Ju BioMed Central 2012 Arthritis research & therapy Vol.14 No.1

<P><B>Introduction</B></P><P>Interleukin-34 (IL-34) is a recently defined cytokine, showing a functional overlap with macrophage colony stimulating factor (M-CSF). This study was undertaken to address the expression of IL-34 in rheumatoid arthritis (RA) patients and to investigate its regulation and pathogenic role in RA.</P><P><B>Methods</B></P><P>IL-34 levels were determined in the RA synovium, synovial fluid (SF) and fibroblast-like synovial cells (FLS) by immunohistochemistry, real-time PCR, enzyme-linked immunosorbent assay and immunoblotting. RA activity was assessed using Disease Activity Score 28 (DAS28) activity in the plasma collected at baseline and one year after treatment. Conditioned media (CM) were prepared from RA FLS culture with tumor necrosis factor alpha (TNFα) for 24 hours and used for functional assay.</P><P><B>Results</B></P><P>IL-34 was expressed in the synovium, SF, and FLS from RA patients. The production of IL-34 in FLS was up-regulated by TNFα in RA samples compared with osteoarthritis (OA) patients. Importantly, the preferential induction of IL-34 rather than M-CSF by TNFα in RAFLS was mediated by the transcription factor nuclear factor kappa B (NF-κB) and activation of c-Jun N-terminal kinase (JNK). IL-34 elevation in plasma from RA patients was decreased after the administration of disease-modifying anti-rheumatic drugs (DMARDs) in accordance with a decrease in DAS28. CM from RAFLS cultured with TNFα promoted chemotactic migration of human peripheral blood mononuclear cells (PBMCs) and subsequent osteoclast (OC) formation, effects that were attenuated by an anti-IL-34 antibody.</P><P><B>Conclusions</B></P><P>These data provide novel information about the production of IL-34 in RA FLS and indicate that IL-34 is an additional osteoclastogenic factor regulated by TNFα in RA, suggesting a discrete role of IL-34 in inflammatory RA diseases.</P>

Radiotherapy of Uterine Cervical Cancer Using Fletcher-Suit-Delclos Cesium Applicator

손승창(Seung Chang Sohn),윤종철(Jong Chul Yoon),서현숙(Hyun Suk Suh) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.2

1983년 11월부터 1986년 2월까지 Fletcher-Suit-Delclos applicator를 이용하여 강내치료와 외부방사선치료를 완치목적으로 받은 자궁경부암환자 35국을 대상으로 소급하여 치료결과를 분석하였다. 환자의 나이는 32세에서 70세까지의 분포를 보였고 평균 나이는 53세이었다. 모든 환자에서 추적조사가 가능하였다. 추적조사 기간은 9개월에서 34개월이었고 평균 추적조사 기간은 20개월이었다. 병기별로 보면 1기가 4명, 2기가 25명, 3기가 5명, 그리고 4기가 1명이었다. 전반적인 관해율은 80%이었고 2년 생존율은 88%이었다. 방사선치료 후에 발생하는 합병증 중 특히 직장내 합병증을 분석한 바 최대직장조사량이 7000rad이하군에선 한명도 없었고 7000rad이상 조사받은 군에서는 17명중 2명에서 중간정도의 직장내 합병증이 나타났다. From Nov. 1983 through Feb. 1986, 35 patients of uterine cervical cancer were treated by external radiation therapy and intracavitary radiation therapy using Fletcher-Suit-Delclos applicator. Age of the patients ranged from 32 to 70 years (median age: 53 years). All patients had follow up from 9 to 34 months and median follow up of 20 months.4 patients were in stage I, 25 were in stage II, 5 were in stage III and 1 was in stage IV. Overall regression rate was 80% and uncorrected actuarial 2 year survival rate was 88%. The incindence of rectal complications were analyzed. There was no rectal complication in the patients who received less than 7000 rad maximal rectal dose, but 2 out of 17 patients who received more than 7000 rad developed moderate degree (grade 2) of rectal complication. In viewing of our results, Fletcher-Suit-Delclos applicator (3M) seemed to be an appropriate instrument for intracaviary radiation therapy in the patients of uterine cervical cancer.

Original Article : Changes in the seroprevalence of IgG anti-hepatitis A virus between 2001 and 2013: experience at a single center in Korea

( Sung Jun Chung ),( Tae Yeob Kim ),( Sun Min Kim ),( Min Roh ),( Mi Yeon Yu ),( Jung Hoon Lee ),( Chang Kyo Oh ),( Eun Young Lee ),( Seung Lee ),( Yong Cheol Jeon ),( Kyo Sang Yoo ),( Joo Hyun Sohn ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.2

Background/Aims: The incidence of symptomatic hepatitis A reportedly increased among 20- to 40-year-old Korean during the late 2000s. Vaccination against hepatitis A was commenced in the late 1990s and was extended to children aged <10 years. In the present study we analyzed the changes in the seroprevalence of IgG anti-hepatitis A virus (HAV) over the past 13 years. Methods: Overall, 4903 subjects who visited our hospital between January 2001 and December 2013 were studied. The seroprevalence of IgG anti-HAV was analyzed according to age and sex. In addition, the seroprevalence of IgG anti-HAV was compared among 12 age groups and among the following time periods: early 2000s (2001-2003), midto- late 2000s (2006-2008), and early 2010s (2011-2013). The chi-square test for trend was used for statistical analysis. Results: The seroprevalence of IgG anti-HAV did not differ significantly between the sexes. Furthermore, compared to the seroprevalence of IgG anti-HAV in the early 2000s and mid-to-late 2000s, that in the early 2010s was markedly increased among individuals aged 1-14 years and decreased among those aged 25-44 years (P<0.01). We also found that the seroprevalence of IgG anti-HAV in individuals aged 25-44 years in the early 2010s was lower than that in the early 2000s and mid-to-late 2000s. Conclusions: The number of symptomatic HAV infection cases in Korea is decreasing, but the seroprevalence of IgG anti-HAV is low in the active population. (Clin Mol Hepatol 2014;20:162-167)

Long-Term Outcomes After Combined Revascularization Surgery in Adult Moyamoya Disease

Cho, Won-Sang,Kim, Jeong Eun,Kim, Chang Hyeun,Ban, Seung Pil,Kang, Hyun-Seung,Son, Young Je,Bang, Jae Seung,Sohn, Chul-Ho,Paeng, Jin Chul,Oh, Chang Wan American Heart Association, Inc. 2014 Stroke Vol.45 No.10

<P><B>Background and Purpose—</B></P><P>The surgical outcomes of adult moyamoya disease are rarely reported. We aimed to evaluate the long-term outcomes of combined revascularization surgery in patients with adult moyamoya disease.</P><P><B>Methods—</B></P><P>Combined revascularization surgery consisting of superficial temporal artery–middle cerebral artery anastomosis with encephalodurogaleosynangiosis was performed on 77 hemispheres in 60 patients. Clinical, angiographic, and hemodynamic states were evaluated retrospectively using quantitative methods preoperatively and postoperatively in the short-term (≈6 months) and long-term (≈5 years) periods. The mean clinical follow-up duration was 71.0±10.1 months (range, 60–104 months).</P><P><B>Results—</B></P><P>Clinical status improved until 6 months after surgery and remained stable thereafter, as assessed by the Karnofsky Performance Scale and modified Rankin Scale. The revascularization area relative to supratentorial area significantly increased in the long-term period compared with that in the short-term period (54.8% versus 44.2%; <I>P</I><0.001). Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period (68.7 versus 59.1; considering blood flow of the pons as 50; <I>P</I><0.001) and thereafter became stable (65.5 in the long term; <I>P</I>=0.219). The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres.</P><P><B>Conclusions—</B></P><P>Combined revascularization surgery resulted in satisfactory long-term improvement in clinical, angiographic, and hemodynamic states and prevention of recurrent stroke.</P>