Clinical Significance of Classification of Graves` Disease According to the Characteristics of TSH receptor Antibodies

(Won Bae Kim),(Hyun Kyung Chung),(Young Joo Park),(Do Joon Park),(Hong Kyu Lee),(Bo Youn Cho) 대한내과학회 2001 The Korean Journal of Internal Medicine Vol.16 No.3

N/A Background:It has been widely accepted that the epitope (s) and/or functional characteristics of thyrotropin receptor antibodies (TSHRAb) from Graves` patients are heterogenous among patients. However, the clinical significance of such heterogeneity has not been systematically evaluatedyet. We were to elucidate and find the clinical significance of heterogeneity for TSH receptor antibodies in Graves` disease. Methods:We measured stimulating TSHRAb (TSAb) activities using CHO-hTSHR cells, FRTL-5 cells and chimeric receptor expressing cells (Mc1+2 and Mc2), specific blocking TSHRAb (TSBAb) activities using Mc2 cells and TBII activities using porcine thyroid membrane in 136 patients with untreated hyperthyroid Graves` disease. Results: Based on various TSHRAb activities from each patient, the patients could be categorized into 7 subgroups by cluster analysis; 1) Group 1 (n=41) was characterized by moderate TSAb activities bothin CHO-hTSHR cells and in FRTL-5 cells, typical TSAb epitope, rare blocking antibodies and high TBII activities. 2) Group 2 (n=16) was characterized by the presence of blocking TSHRAb in most patients, albeit the other characteristics were the same as those in Group 1. 3) Group 3 (n=19) patients had low TSAb activities bothin CHO-hTSHR cells and in FRTL-5 cells, seldom had blocking TSHRAb, but they had high TBII activities. 4) Group 4 (n=30) could be categorized as `mild disease` group, as they had low activities in all kinds of TSHRAb assay and had low antim icrosomal antibody activities. 5) Group 5 (n=14) was characterized by moderate TSAb activities with atypical epitope (s), rare blocking TSHRAb and moderate TBII activities. 6) Group 6 (n=10) patients had veryhigh TSAb activities with typical epitopes, seldom blocking TSHRAb and low TBII activities. 7) Group 7 (n=6) was characterized by very high TSAb activities with atypical epitopes and high TBII activities. Pretreatment serum thyroid hormone level was low only in group 4 patients compared to the other 6 groups (p<0.05). The size of goiter was significantly larger in those in group 1 and group 3 (p<0.05) compared to the other 5 groups. The prevalence of clinically significant ophthalmopathy was higher in group 2 patients than the other 6 groups (50%vs.27.5%,p=0.06). Among 6 kinds of TSHRAb activities, only the blocking TSHRAb activity was significantly associated with the presence of ophthalmopathy in multivariate analysis. Conclusion:These results suggest that the differences inepitopes for TSAb or the presence of blocking TSHRAb is not a major factor in determining the degree of thyrotoxicosis in Graves` disease. Although the pathogenic mechanism is not clearyet, we suggest that patients with ophthalmopathy have different TSHRAb repertoire from those without ophthalmopathy in Graves` disease.

선천성 관동정맥루의 경피적 경도관 Coil 색전 1례

조준식,김동수,서정기,장양수,김현승,이도연 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.9

축압축력을 받는 원통형 쉘의 비선형 붕괴해석

조현영,김성도,김미옥 부산대학교 1995 生産技術硏究所論文集 Vol.48 No.-

To investigate imperfection-sensitivity for the cylindrical shell structures, a numerical method for evaluating the equilibrium path of a cylindrical shell subjected to axial load and eccentrically axial load is presented. The effects of both material and geometric nonlinearities were also considered in the analysis. The nonlinear formulation was based on the total Lagrangian description and the nonlinear equations were solved by the Newton-Raphson method with load incremental procedures. Degenerate shell elements with layered approach were employed for the analysis. Comparing with experimental results, nonlinear collapse analysis of cylindrical shells subjected to axial compression is carried out. The characteristics of the elasto-plastic deformation can be found in several numerical examples and the local eccentricity of the axial load affects considerably on the level of critical load due to local buckling. 불완전량이 있는 원통형 쉘의 좌굴 거동을 조사하기 위해, 중심 축하중 및 편심 축하중을 받는 원통형 쉘의 평형 경로를 재료 및 기하학적 비선형성이 고려된 수채해석을 통하여 추적하였다. 이때의 비선형 중분 평형방정식은 total Lagrangian 정식에 따라 유도되며, 하중증분법과 Newton-Raphson 법으로 해를 구한다. 본 연구에는 충분할 해석이 가능한 degenerate 쉘 요소를 사용하였다. 비선형 붕괴해석 결과와 실제 실험결과와 비교하였으며, 여러 가지 해석예제를 통하여 탄소성 변형의 특성을 알 수 있었다. 그리고 원통형 쉘의 국부좌굴시 편심하중에 의한 내하력의 감소현상이 두드러짐을 알 수 있었다.

두개강내 정맥기형들과 동반된 안와내 해면상 혈관종 1례

조도상,송준혁,김명현,박향권,김성학,신규만,박동빈 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.6

Cu-Al-Ni 合金에 있어서 마르텐사이트 變態에 따른 內部摩擦

趙顯麒,禹基道,金圭鎭 慶北大學校 1984 論文集 Vol.37 No.-

The internal friction measurement was carried out by the torsion pendulum method with automatic recording of the virbration patterns. The critical range of the martensitic transformation was checked by measuring the electrical resistance and by morphological observation. The extent of internal friction in the region of the peak depends on the previous rate of temperature change and decreases sharply during a few minutes of isothermal holding. The high level of internal friction found in Cu~Al-Ni alloy is likely to due to the reversible movement of interfacial and twin boundaries on exposure to alternating stresses.

제주 지역의 B형 간염 바이러스 유전자형

조지현,박도심,김태현,염주진,김학철,문주현,양재식 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: HBV 감염이 무증상의 자연 회복부터 간경변 혹은 간세포성 간암까지 다양하게 나타나는 요인들로 숙주의 요인과 바이러스의 요인으로 구분되어 제시되는데, 바이러스 요인으로는 감염된 바이러스이 유형이나 염기 변이들이 논의된다. HBV 유형을 구분하는 데는 혈청형과 유전자형이 이용되는데 근자에는 주로 유전자형이 이용된다. 이러한 HBV의 분포는 지역적으로 다르나 지역에 따라서 다른 유형들이 혼재되어 있다. 동남아시아는 B형이지만 극동아시아는 C형으로 알려져 있으며, 대만과 오키나와에서는 B와 C형이 혼재되어 나타난다. 이러한 결과로 미루어 보아 우리 나라의 남부지역에서는 B과 C형이 혼재되어 있을 가능성이 있다. 이에 본 연구는 제주 지역에서 HBV의 유전자형을 조사하고자 하였다. 대상과 방법: 원적지가 제주도이면사, HBsAg가 양성이었던 107명(평균 연령: 46.5세)을 대상으로 하였다. 이들의 혈청으로부터 HBsAg/antiHBe를 분석하고, DNA를 추출하여 7개의 유전자형에 따라 특이성을 갖는 시발체(genotype specific primer)들을 이용하여 PCR로 증폭한 후 이를 분석하였다. 주된 유전자형의 일부와 다른 유형에서 증폭에 이용되었던 시발체를 다르게 이용하여 hemi nested PCR로 증폭한 후 염기를 분석하여 계통발생학적 분석법을 이용하였다. 결과: 1. PCR에 의한 HBV DNA 양성은 107명 중 59명(55.1%)이 양성이었다. HBeAg/anti HBe의 발현 양태에 따라 음성/음성에서 2명(66.7%), 음성/양성에서 30명(41.1%), 양성/음성에서 24명(85.7%), 양성/양성에서는 3명(100%)에서 증폭되었다. 2. Multiplex PCR에서는 58명의 유전자형이 C형, 1명에서는 B형과 C형이 동반 출현하였다. 3. Genotype specific primer를 이용하여 각각 따로 PCR을 시행한 경우에 A형에 의하여 증폭된 예가 1예, B형에 의하여 증폭된 예가 1예, C형에 의하여 증폭된 예가 59예로 A형과 B형 모두가 C형에서 증폭된 예였다. 4. 한 쌍의 시발체에 의하여 증폭되었던 A형과 B형 및 C형의 일부에서 염기를 분석한 결과 모두 C 유전자형이었다. 결론: HBsAg이 양성인 제주 지역 주민의 HBV의 유전자형은 C형일 것으로 생각된다. Background/Aims: Hepatitis B virus (HBV) was classified into 8 genotypes by a sequence divergence in the entire genome designated from A o H. HBV genotypes have distinct geographic distributions. Recently, HBV genotypes have been partially found as influencing the clinical manifestation of chronic liver disease in hosts. In Korea, the distribution of HBV genotypes remains unclear. The aim of this study was to evaluate the prevalence of the HBV genotype on Jeju Island. Methods: Hepatitis B virus genotypes were evaluated among 107 hepatitis B carriers residing on Jeju Island. We used single PCR and multiplex-PCR assay with genotype-specific primer pairs for HBV genotypes A-F for the genotyping. Results: 1. Fifty nine samples (55%) were positive for HBV DNA. The positivity was different according to the pattern of HBeAg/anti-HBe expression, as -/-; 2/3 (66.7%), -/+; 30/73 (30%), +/-; 24/28 (85.7%) and +/+; 3/3 (100%). 2. In the single primer set of genotype-specific PCR, 59 samples (100%) were detected as genotype C and 2 (3%) were also detected as genotype A and B. 3. In multiplex-PCR, 58 samples (98%) were detected as genotype C and only one (2%) as a mixed pattern of genotype B and C. 4. When the PCR products were amplified with universal sense and genotype specific anti-sense from one genotype A, one B, and 2 C, all were included in genotype C. Conclusions: These results suggest that on Juju Island, almost all HBV genotypes are C.(Korean J Hepatol 2004;10:42-50)

Al-Zn-Mg合金의 加工熱處理에 미치는 遷移元素의 影響

趙顯驥,李基大,金熙都 慶北大學校 1982 論文集 Vol.33 No.-

An investigation for influence of a small additions of transition metals (Mn, Zr, Cr) on the thermomechanical treatment (TMT) in Al-Zn-Mg alloys has been carried out by means of the measurements of tensile strength and micro-vickers hardness. The results obtained from this experiment are summarized as follows; 1) Hardness and strength of Al-Zn-Mg alloys are increased remarkable by a small additions of transition metals (Mn, Zr, Cr) at as-quenched state. 2) Influence of a small additions of transition metals like Mn, Zr and Cr added to Al-Zn-Mg alloys on ageing phenomena was retarding the ageing character. 3) The mechanical properties (hardness and strength) of Al-Zn-Mg alloys which were processed by TMT are increased when the deformation rate is lower than 30%, on the other hand those of Al-Zn-Mg alloys added transition metals were decreased with increasing deformation rate.

Chiral Cu(Ⅱ)착화합물과 촉매로 유도된 Carbenoid반응에 의한 2-phenylcyclopropane-carboxylic acid의 광화학 이성체의 합성

조남숙,신대현,이종철,나도영 충남대학교 1985 忠南科學硏究誌 Vol.12 No.2

(-)-(IR, 2R)-trans-menthyl-2-phenylcyclopropanecarboxylate has been synthesized with aid of chiral Cu(Ⅱ) complex catalyst by the addition reaction of menthyldiazoacetate to the styrene. The yield was 80%, the purity of trans-compound over 90% and optical purity 75%. These results show the possibility of synthesis of (-)-(IR, 2R)-trans-2-phenylcyclopropane-carboxylic acid with high purities of optical activity and geometric specificity.

경추부 인공관절 수술의 조기 방사선학적 결과

김명현,조도상 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.2

전방 경유 골유합술은 50여년 전부터 시술이 시작되어 최근까지 경추부 퇴행성 질환에 대한 대표적인 수술로 알려져 왔다3-5)18). 그 수술 결과는 이미 많은 저자들에 의해 비교적 좋은 결과를 보인다고 발표되어 왔는데, 한편으로는 수술 후 장기간의 보조구 착용으로 인한 사회 경제적인 손실, 골유합으로 인한 경추부 운동 장애, 인접한 추체와 추간판의 심한 퇴행성 변화와 이차적인 병적 상태 발생 등이 문제점으로 거론되어 왔다2)6)9)10)12)13). 특히 여러 분절에 걸친 다발성 경추부 퇴행성 질환인 경우에는 수술 후 매우 심각한 지경의 후유증이 발생한다. 어떤 보고에 의하면 인접한 분절에 발생한 병변으로 골유합술을 시행 받은 환자들 중에서 1년에 2.9%의 환자들이 재수술을 받으며, 10년 내에 25.6%의 환자가 재발된 증상에 대해 추가적인 수술을 받을 수 있다고 보고한 바 있다13). 최근 이러한 단점을 보완하기 위해 경추부의 운동 분절을 유지하며 병적 상태를 제거할 수 있는 수술법들이 시도되고 있는데 대표적인 것이 신경공 확장술(Anterior microforaminotomy)과 다양한 종류의 인공디스크 수술이다. 신경공 확장술은 추간판의 대부분을 보존하면서 비교적 경추 운동에 영향을 미치지 않는 구상돌기의 일부를 제거하여 이를 통해 신경공을 감압하는 방법이며14), 인공디스크 수술은 추간판을 모두 제거하고 이를 통해 병적인 상태를 제거한 후 운동성을 가진 인공디스크로 대체하는 일종의 인공관절 수술이다1)8)11). 인공디스크 수술은 관절 운동을 유지하고, 골유합술의 단점을 피하며, 빠른 회복을 통해 환자로 하여금 일상생활이나 직업생활로 빠르게 복귀하도록 하기 위해 고안되었다. 이 수술의 목표는 디스크의 높이를 유지하고, 신경을 압박하는 모든 병적 상태를 제거한 후 운동 관절을 유지하기 위한 것이며, 아울러서 인접한 관절의 정상적인 상태를 유지하도록 하는 것이다. 저자는 다양한 경추부 퇴행성 질환에 대해 널리 사용되는 인공디스크 중 주로 Bryan을 사용한 수술을 시행하여 그 결과를 알아보고자 하였다. Object:Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of Bryan cervical disc prosthesis. Method:The authors retrospectively reviewed radiographic and clinical outcomes in 49 patients who received the Bryan Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of the FSU, and the C2-7 Cobb angle. The range of motion(ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom’s criteria. Result:A total of 66 Bryan disc were placed in 49 patients. A single-level procedure was performed in 35 patients, a two-level procedure in 14 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made reoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom’s criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. 90% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 89.4% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 57.7% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 62.5% of the patients postoperatively. Conclusion:Arthroplasty using the Bryan disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although early and intermediate results are promising, this is also a relatively new approach, long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

Vibrio cholerae non-01/0139복막염 1예

박도심,이영진,김신무,조지현 대한임상미샐물학회 2000 Annals of clinical microbiology Vol.3 No.2