항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

C-shaped canal의 절단면 분석을 통한 근관형태의 변화와 근관과 치아외벽간의 최소거리 분석에 관한 연구

송병철,조용범 대한치과보존학회 2007 Restorative Dentistry & Endodontics Vol.32 No.1

C-shape 근관은 주로 하악 제 2대구치에시 보이는 해부학적 변이 형태로서, 그 특징은 각 근관을 연결하는 fin이나 web이 존재한다. 이런 해부학적으로 복잡함은 근관치료시에 세정과 성형 및 근관충전을 방해하며, 과다한 기구 조작시에 뜻하지 않는 천공을 유발하기도 한다. 이 연구의 목적은 C-shape 치근을 가진 하악 제2 대구치의 해부학적인 형태와 치근의 위치에 따른 최소 근관벽 두께에 대하여 연구하고자 하였다. 발거된 하악 대구치중 C-shape 치근을 가진 치아를 30개 선별하여 방사선 사진 및 협측, 설측, 치근단 부위를 디지털 카메라를 이용하여 촬영하였다. 자가 중합형 교정용 레진 (Orthodontics resin, Densply/Caulk, U.S.A)을 이용하여 치관부를 제거한 치아를 매몰한 후 각각의 시편을 Accutom-50 (Struers, Denmark)에 고정시켜 1 mm 간격으로 절단, 연마한 다음 절단면을 수술용현미경에 연결된 디지털 카메라 (Coolpix 995, Nikon, Tokyo, Japan)를 이용하여 각각의 상을 촬영하였다. 30개 치아에서 촬영한 197개의 치아단면을 Root thickness gauge program을 이용하여 근관형태의 변화를 분류하고 부위별 근관과 치아외벽 사이에 존재하는 상아질의 최소두께에 대해 연구, 분석하였다. 1. 근관입구에서 C Ⅰ 이 가장 많이 (73%) 관찰되었으나 치근단부로 갈수록 근관 형태의 다양한 변화를 보여 C Ⅱ 와 C Ⅲ의 근관형태가 많이 관찰 되었으며, 11 개의 (36%)치아에서는 근관입구에서 치근단부까지 근관형태의 변화를 보이지 않았다. 근관입구에서 단지 2개의 치아에서 나타난 C Ⅲ type은 치근단부로 갈수록 높은 발현빈도를 나타내었다. 2. C-shape 근관은 근관입구 부위에서는 continuous 나 semicolon canal을 가지나 치근단부로 갈수록 2개나 3개의 근관을 갖는 경우가 많다. 3. 평균적인 근관과 치질사이의 최소거리는 근첨부의 설측부위에서 나타났다. The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. The main anatomical feature of C-shaped canals is the presence of fins or web connecting the individual root canals. The complexity of C-shaped canals prevents these canals from being cleaned, shaped, and obturated effectively during root canal therapy, and sometimes it leads to an iatrogenic perforation from the extravagant preparation. The purpose of this study was to provide further knowledge of the anatomical configuration and the minimal thickness of dentinal wall according to the level of the root. Thirty extracted mandibular second molars with fused roots and longitudinal grooves on lingual or buccal surface of the root were collected from a native Korean population. The photo images and radiographs from buccal, lingual, apical direction were taken. After access cavity was prepared, teeth were placed in 5.25% sodium hypochlorite solution for 2 hours to dissolve the organic tissue of the root surface and from the root canal system. After bench dried and all the teeth were embedded in a self-curing resin. Each block was sectioned using a microtome (Accutom-50, Struers, Denmark) at interval of 1 ㎜. The sectioned surface photograph was taken using a digital camera (Coolpix 995, Nikon, Japan) connected to the microscope. 197 images were evaluated for canal configurations and the minimal thickness of dentinal wall between canal and external wall using ‘Root Thickness Gauge Program’ designed with Visual Basic. The results were as follows: 1. At the orifice level of all teeth, the most frequent observed configuration was Melton’s Type CⅠ(73%), however the patterns were changed to type C Ⅱ and C Ⅲ when the sections were observed at the apical third. On the other hand, the type C Ⅲ was observed at the orifice level of only 2 teeth but this type could be seen at apical region of the rest of the teeth. 2. The C-shaped canal showed continuous and semi-colon shape at the orifice level, but at the apical portion of the canal there was high possibility of having 2 or 3 canals. 3. Lingual wall was thinner than buccal wall at coronal, middle, apical thirds of root but there was no statistical differences.

흰쥐 해마에서 경련에 의해 발현 유도된 MKP-1에 의한 MAPK 활성 조절

유범희,강웅구,안용민,정선주,전송희,박주배,김용식 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 전기경련 충격(Electroconvulsive shock, ECS) 및 카이닌산(kainic acid)에 의한 경련은 흰쥐 해마에서 mitogen activated protein kinase(MAPK)를 활성화시키며, 동시에 MAPK 불활성화 효소인 MAPK phosphatase-1(MKP-1)의 발현을 일으킨다. 이 연구의 목적은 경련에 의해 발현된 MKP-1이 역시 경련에 의해 활성화된 MAPK의 불활성화에 관여하는지를 알아보고자 하는 것이다. 방 법 : 흰쥐에 ECS를 가하여 해마에서 MKP-1 발현을 일으킨 뒤 다시 ECS를 가하고, 두 번째 ECS에 의한 MAPK의 일시적 활성화가 MKP-1의 발현상태에 의해 영향받는지를 알아보았다. 또한 흰쥐에 지속적인 MAPK 활성화 및 MKP-1 발현을 일으키는 카이닌산을 투여한 뒤 해마에서 MKP-1의 발현과 MAPK 활성과의 관계를 알아보았다. 결 과 : ECS후 해마에서 타이로신 인산화 면역블롯 및 효소활성으로 측정한 MAPK의 인산화 및 활성은 MKP-1의 발현이 일어나 있는 경우와 그렇지 않은 경우 사이에 차이를 보이지 않았다. 카이닌산의 투여에 의해 MAPK 활성화가 일어나는 경우, 뒤이어 MKP-1 발현이 일어나지만, 이렇게 발현된 MKP-1은 MAPK 활성을 충분히 감소시키지 못하였다. 결 론 : MKP-1은 흰쥐 해마에서 ECS 및 카이닌산에 의한 MAPK의 활성화를 차단하는데 큰 역할을 하지 않는다. Objectives : Both electroconvulsive shock(ECS)- and kainic acid-induced seizures activate mitogen-activated protein kinases(MAPKs) in rat hippocampus. They can also induce the expression of MAPK phosphatase-1(MKP-1) in rat hippocampus. MKP-1 is known as a specific MAPK deactivator. This study aimed to elucidate the role of MKP-1 in the deactivation of MAPKs in rat hippocampus. Methods : In order to induce MKP-1 in the hippocampus, ECS was given to the rats. At the time points when MKP-1 was sufficiently induced, the second ECS was given to them and the subsequent phosphorylation or activation of MAPKs were measured in the hippocampus. A second group of rats were injected with kainic acid and the relationship between MKP-1 expression and MAPK phosphorylation was examined in their hippocampi. Results : The expression of MKP-1 did not influence the phosphorylation or activation of MAPKs following ECS in rat hippocampus. Kainic acid-induced expression of MKP-1 did not significantly reduce the phosphorylation of MAPKs. Conclusion : MKP-1 did not play a significant role in the deactivation of MAPKs which were activated by ECS or kainic acid in rat hippocampus.

초음파 및 Phased Array를 이용한 터빈 블레이드 루트부 건전성 평가에 관한 연구

길두송,박상기,조용상,이상국,허광범 한국비파괴검사학회 2003 학술대회 논문집 Vol.- No.1

Power plant is consisted of many component parts for the generation of the electricity, and occasionally, turbine equipment may be caused in break-down because of the damage of the blade root. Phased array ultrasonic testing system has become available for practical application in complicated geometry such as turbine blade root, tenon, disc in power industry, This research describes the characteristics of phased array ultrasonic testing signal for various type of blade roots in thermal Power Plant turbines. This application of Phased array ultrasonic testing system has been promoted mainly to save inspection time and labor cost of turbine inspection. The characteristic of phased array ultrasonic testing signal for power plant component in very simple to understand but to difficult for perform the inspection. This paper is focused on the safety of the turbine equipment by the ultrasonic measurement and phased array analysis. As a result of the test through ultrasonic and phased array method, we have concluded that the main damage in these turbine blade root parts could be generated by the concentrated stress and centrifugal force.

휘발성유기화합물(VOCs)의 변이원성 검정

박종천,이용탁,송현철,이우범 國立麗水大學校 環境問題硏究所 2004 環境硏究論文集 Vol.6 No.-

The mutagenicity of six kinds of VOCs(benzene, m.p-xylene, chloroform, toluene, methylethylketone, 1,2-dichloroethane) detected in high concentration and frequency in Kwangyang Bay was investigated. VOCs are water-insoluble and volatile. Therefore, when they are tested by the classical Ames test in the assay of mutagenicity, there may be experimental errors. To overcome this limitation, modified Ames test was used to assay mutagenicity of VOCs. By this modified Ames test, we could obtain much more satisfactory results. Even at extremely low concentration(0.0001㎍/㎖). bezene, m,p-xylene, and methylethylketone showed a weak mutagenicity. When S-9 mixture is added in the assay system, all tested VOCs except methylethylketone showed mutagenicity. When Salmonclla typhimurium TA 98 and Salmonella typhimurium TA 100 are exposed to VOCs of high concentration(100㎍/㎖). the number of colony decreased irrespective of the S-9 mixture treatment. It seem to be that the decrement results from the toxic effect of high concentration of VOCs.

콤포짓트 레진의 중합체계에 따른 중합률 및 잔류단량체 유출

문현정,임범순,이용근,송재경,김철위 대한치과기재학회 2001 대한치과재료학회지 Vol.28 No.2

Newly developed curing units for the dental composite resins are claimed to result in optimum properties and short curing time. The purpose of this study was to detemine the curing effectiveness of the curing units, and to evaluate the relationship between the degree of polymerization and leachability of residual monomer. Three composite resins were tested (Z100; z100, Herculite XRV; HX, Heliomolar; HM). Disk specimens of 2 mm in thickness and 6 mm in diameter were cured with a plasma arc [Apollo 95E; at 1370 mW/㎠, for 5 sec.(A5), 10 sec.(A10), 15sec(A15)], halogen lamp [VIP; at 500 mW/㎠, for 13 sec.(V13), 26 sec.(V26), 40 sec.(V40)] and custom made light emitting diode [LED; at 500 mW/㎠, for 13 sec.(L13), 26 sec.(L26), 40 sec.(L40)]. Specimens were immersed in 75% ethanol for 7 days. Eluates of the composites were analyzed by a high-performance liquid chromatography, and the degree of polymerization of composites were determined by a Fourier transform infrared spectroscopy. To obtain the sufficient curing by a plasma arc, the curing time should be longer than 10 sec. When the same light energy was irradiated, LED showed similar curing performance to halogen lamp. The light energy and the degree of polymerization was not correlated (p>0.05), but the light energy and the leachability of residual monomer was correlated (p<0.05). The leachability of residual monomer (TEGDMA+BisGMA) depended on the degree of polymerization.

관상동맥 누공에 의한 급성 심근 경색 1예

서유승,최재웅,송창섭,조용범,양진수,박준섭,정인수 대한내과학회 2003 대한내과학회지 Vol.65 No.2

관상동맥 동정맥루 기형은 매우 드문 질환으로 치료가 불필요한 경우가 대부분이나 coronary steal 현상으로 인해 증상이 발생하거나 합병증이 발생한 환자에 대해선 치료를 요한다. 최근에는 시술에 적합한 누공을 가진 선택된 환자군을 대상으로 카테터를 이용한 중재적 시술이 시행되어 수술적 치료와 유사한 결과를 얻고 있다. 저자들은 젊은 남자에서 관상동맥 동정맥루 기형과 동반된 급성 심근 경색증을 진단하여 비 수술적 방법인 카테타 코일 색전술로 성공적 치료 후 증상 및 심근 재관류에 호전을 보인 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report a case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute non-Q wave myocardial infarction. A 27-year-old man visited emergency department because of severe chest pain lasting two hours. The electrocardiogram showed ST segment elevation in precordial leads V3~6. Cardiac enzymes were as follows;CK-MB:36.44 IU/L T-T:0.489 ng/mL, CPK:542 IU/L, and LDH:475 IU/L. The thallium-201 dipyridamole stress perfusion scan showed perfusion defect and reversed redistribution in the anteroseptal wall. The coronary angiogram revealed coronary artery fistula between the proximal left anterior descending artery and main pulmonary artery without significant stenoses of coronary arteries. The result of ergonovine test was negative. After micro-coil embolization to the coronary fistula, symptoms were improved. Follow-up thallium-201 scan showed normalized blood flow in the left anteroseptal wall.

수도권 지역 대학병원과 재활병원의 인턴물리치료사간 인턴 만족도 비교

강순희,전수진,정민현,정은송,이범승,최용진 韓國交通大學校 2013 한국교통대학교 논문집 Vol.48 No.-

The purpose of this study was to compare internship satisfaction of intern physical therapists working in the university hospitals with that of them working in the rehabilitation hospitals in Seoul metropolitan area. The questionnaire for internship satisfaction survey that amended from vocational interest test [Strong Interest Inventory(SII)] was used to examine satisfaction of intern physical therapists and the questionnaire was used to ask general characteristics, educational and work environment. Thirty nine intern physical therapists working in university hospital and fifty nine intern physical therapists rehabilitation hospital in Seoul metropolitan area responded. Frequency analysis, χ² test and independent t-test were conducted to evaluate differences between groups about variables of internship satisfaction survey, general characteristics, work and educational environments with using the PASW 18.0 statistical program. The results of the study were as follows. There were significant differences of intern physical therapists between university hospitals and rehabilitation hospitals in overall scores of internship satisfaction and scores of all sub-items such as duty, supervision, working condition, work mates and wages. Intern physical therapists working in the university hospitals showed higher satisfaction than that of Intern physical therapists working in the rehabilitation hospitals.

오원천의 식물플랑크톤 군집에 대한 연구

주현수,김진,박종천,정원석,송현철,이용탁,이우범 國立麗水大學校 環境問題硏究所 2004 環境硏究論文集 Vol.6 No.-

We carried out a study on phytoplankton community at Owon stream, Jeollabukdo, Korea. The author have examined 83 taxa of the phytoplankton from researched area. These were composed of 5 classes, 11 orders, 21 families, 44 genera, 79 species, and 9 varieties. The composition of occurrence species were as follows: green algae are 48.2%, diatoms are 33.7%, blue green algae are 10.8% and etc(7.3%). Dominant species were Chlamydomonas angulosa, Pandorina morum, Coelastrum microporum, Scenedesmus quadricauda, Staurastrum gracile, Melosira varians, Me. italica, Synedra ulna, Sy. acus, Cocconeis placentula, and Cymbella tumida. The standing crops varied from 1,650cells/ℓ to 47,000cells/ℓ. Phytoplankton density of Owon stream were lower about 8.6 times to a 1,531 times than those of other lakes and rivers in Korea. So, to preserve the water quality in Owon stream we have to manage continuously on the nitrogen and phosphorus.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.