지속성 외래 복막투석 환자에서 염증 지표와 고해상도 B 모드 경동맥 초음파 소견의 연관성에 관한 연구

송현용,송영수,안철우,강신욱,최규헌,하성규,이현철,이호영,한대석 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

배 경 : 저알부민혈증 및 C-반응 단백(C-reactive protein, CRP)이 증가된 지속성 외래 복막투석 환자의 사망률이 높은 정확한 이유는 밝혀져 않다. 혈액투석 환자에서처럼 복막투석 환자에서 저알부민혈증 및 염증반응이 심혈관계 질환 위험인자 인지 알아보고자 하였다. 방 법: 비당뇨병성 말기 신부전, 지속성 외래 복막투석 환자 93명의 심혈관계 질환 위험인자들과 복막 투과 특성 및 알부민, CRP 등의 염증지표에 따라 고해상도 초음파를 이용한 경동맥내막-중간막 두께, 내막-중간막 면적, 플라크의 유무 등을 단면적으로 비교하였다. 결 과: 복막 투과 특성은 고투과막군 14명, 중간 고투과막군 38명, 중간 저투과막군 31명, 저투과막군 10명으로 각 군간의 경동맥 내막-중간막 두께, 플라크 유무 및 내막-중간막 면적의 차이는 없었다. 기존 관상동맥 질환 환자는 8예(8.6%)로 내막-중간막 두께는 관상동맥 질환이 없는 환자보다 증가되었고(0.79±0.21 vs 0.60±0.11 mm, p<0.05) 플라크 형성은 더 많이 보이나 통계적 유의성은 없었다(75.0 vs 63.5%, p>0.05). 혈청 알부민치와 경동맥 내막-중간막 면적은 역상관관계를 보였다(r=-0.27, p<0.05). 저알부민혈증 환자(혈청 알부민 <3.5 g/dL)는 정상 알부민혈증 환자보다 내막-중간막 두께가 증가되었고(0.67±0.15 vs 0.61±0.12 mm, p<0.05), 플라크도 유의하게 많았다(68.0 vs 55.8%, p<0.05). 혈청 CRP치와 경동맥 내막-중간막 면적은 양의 상관관계가 있었으며(r=0.21, p<0.05) CRP가 높은 환자(≥0.8 mg/dL, n=18)에서플라크가 많이 관찰되었으나(65.8 vs 50.0%, p<0.05) 경동맥 내막-중간막 두께 및 내막-중간막면적은 양군간에 차이가 없었다. 다변량 회귀 분석상 경동맥 내막-중간막 두께에 영향을 미치는 인자는 고령, 높은 CRP, 기존 심혈관계질환, 낮은 혈청 알부민 순이였다. 결 론 : 복막투석 환자에서 고해상도 초음파를 이용한 경동맥 내막-중간막 두께 측정은 심혈관계 질환 유무 예측의 비침습적 검사가 될 수 있고 저알부민혈증 및 높은 CRP과 같은 만성염증 지속상태가 복막투석 환자에서 죽상 동맥 경화증의 발생을 증가시킨다고 가정할 수 있다. Background : Continuous ambulatory peritoneal dialysis(CAPD) patients with low albumin(LA) and signs of inflammation reflected by increased C-reactive protein(CRP) level have an increased mortality, but the mechanism of this phenomenon is not clear yet. Methods : To answer whether LA and inflammation also enhance cardiovascular risk in CAPD patients, we performed cross sectional study measuring carotid artery intima-media thickness(IMT), calculated intima-media area(cIM area) and the presence of plaque by high-resolution B-mode ultrasonography in 93 non-diabetic CAPD patients. Results : Patients with coronary artery disease (CAD, n=8) had significantly increased IMT(0.79± 0.21 mm vs. 0.60±0.11 mm, p<0.05) and higher prevalence of carotid plaques(75.0% vs. 63.5%) compared to the non-CAD patients. Significant inverse correlation was observed between serum albumin (SA) level and cIM area(r=-0.27, p<0.05). Those patients with LA(SA <3.5 g/dL) had significantly increased IMT compared to non-LA patients(0.67±0.15 mm vs 0.61±0.12 mm, p<0.05). Prevalence of carotid plaques was also significantly higher in LA patients (68.0% vs. 55.8%, p<0.05). CRP level revealed a significant positive correlation with cIM area(r=0.21, p< 0.05). Patients with high CRP(≥0.8 mg/dL, n=18) had higher prevalence of carotid plaques (65.8% vs. 50.0%, p<0.05) compared to those patients with CRP <0.8 mg/dL, but IMT and cIMT area were not different. By multivariate logistic regression analysis, old age, high CRP, history of CAD and low SA were the independent risk factors affecting IMT. Conclusion : Our study strongly suggests that low albumin and chronic inflammatory state of CAPD patients could be associated with increasing atherosclerotic cardiovascular disease. (Korean J Nephrol 2002;21(2):285-294)

수정 Cam-clay 이론을 이용한 점토의 비배수 강도 예측에 관한 연구

이송 ( Lee¸ Song ),이규환 ( Lee¸ Kyu-hwan ),김태훈 ( Kim¸ Tae-hwoon ) 한국구조물진단유지관리공학회 2002 한국구조물진단유지관리공학회 학술발표대회 논문집 Vol.6 No.2

국내 지역에서 대부분의 자연 연약점토는 약간 또는 매우 과압밀된 상태를 갖고 있다. 이러한 연약한 지반에 제방을 건설하기 위해서는 지반의 지지력이 결정되어야 하며, 응력이력에 따른 비배수 전단강도는 단계하중재하시 재방의 단계성토고와 안정성을 분석함에 매우 중요하게 하다. 이러한 점에서 한계상태이론의 Cam-clay 이론은 정규압밀과 과압밀된 점토지반의 비배 수 전단강도를 예측함에 있어 합리적인 결과를 주며, 비등방조건에서 비배수 전단강도의 예측 은 실내삼축시험과 잘일치하고 있다. 따라서, 본 논문에서는 MCCM 이론의 적용성을 국내 저소성 실트질 점토를 블록 샘플링하여 실내 등방 및 비등방 시험을 실시하여 검증하였으며, 과거 여러 지역에서 연구된 결과들과 비교하여 재분석하였다.

방진마스크의 Stainless steel arc 용접흄 여과효율에 관한 연구

송경석,권용식,한규태,정규혁,이용묵,유일재 한국산업위생학회 2001 한국산업보건학회지 Vol.11 No.1

The purpose of this study was to investigate for filtration efficiency of several dust masks, comparing with filtration efficiency certified by KOSHA(Korea Occupational Safety & Health Agency), and to require of the right use of protective respirator. Using a welding fume generator and chamber, several dust masks, which were widely used in the workplaces in korea, were tested for their filtering efficiency for stainless steel are welding fume. The filtration efficiency testing system consisted of a welding fume generator, a chamber and a filtration unit. The filtration unit was made of a mask which was inserted into the sampling cassette and another sampling cassette, which contained mixed cellulose ester filter paper. These two cassettes were connected with tubing. Stainless steel arc welding fume generator was delivered into an chamber. The welding fume in the chamber was passed into the filtration unit with flow rate of 30 liter/min. The welding fume filtration efficiency was evaluated by gravimetric measurement. Metal concentrations in the welding fume before and after filtration were measured with inductive coupling plasma analyzer. Following results were obtained: Filtration efficiency of welding fume for comm hygienic mas was 63.82% and the average efficiencies for A, B, C, D, E, F and G masks were 94.62% 96.58%, 83.20%, 82.76%, 77.25%, 86.55% and 93.22%, respectively. Our results indicate that dust masks used widely in the welding workplaces in korea are not proper for protecting worker's health and then the use of fume mask should be required.

유방병변에서의 Nucleolar Organizer Regions에 대한 연구

송규상 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

To study the proliferative activity of cells in benign and malignant breast lesions, a one step silver staining technique to identify argyrophilic nucleolar organizer regions had been applied in 11 cases of fibrocystic change, 11 cases of fibroadenoma, 15 cases of invasive ductal carcinoma without metastasis, 9 cases of invasive ductal carcinoma with metastasis, and 3 cases of medullary carcinoma, respectively. The results were as follows: 1. AgNORs in both fibrocystic disease and fibroadenoma were relatively small and uniform in size and shape. Epothelial cells in fibrocystic change had 1.49 AgNORs per cell in average Stromal cells and epithelial cells in fibroadenoma contained 1.58 AgNORs and 2.02 AgNORs per cell in average, respectively. 2. Invasive ductal carcinomas and medullary carcinomas showed relatively irregular AgNORs. The mean numbers of AgNORs in invasive carcinoma with or without metastasis were 3.23 and 3.41 per cell. Medullary carcinomas contained 3.18 AgNORs per cell. There were no statitical differences among malignant tumors. 3. The numbers of AgNORs were statistically different between benign and malignant lesions. These data suggested that the mean AgNORs counts was useful in differentiation between benign and malignant breast lesions. However, it seemed that they did not correlate with malignant types and status of metastasis.

백서의 복강내에 투여한 Mitomycin-C-Polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

송규상,강대영,최정목,노승무,정경수,오정연,김진향,양준목,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

To evaluate the in-vivo effects of mitomycin-C-polyglycolic acid composite(MMC-PGA) the disk: shaped composite were implanted into the peritoneal cavity of the Sprague-Dawley rats. The pathologic changes were examined at various time points up to 12 weeks. Initially the soft tissue around the inserted disks showed capillary congestion at 3 days. Inflammatory infiltrates with foreign body giant cells appeared from the 2nd week and reached peak response at 6-8 weeks. These reaction diminished prominently at 12 weeks. No specific pathologic change was found in the liver, the kidneys, and the heart. The above results suggest that the MMC-PGA composite can serve as a new device for intraperitoneal chemotherapy of various types of cancers.

독시사이클린 나노입자가 함유된 치주용 키토산 스트럽의 제조 및 특성

송경숙,양재헌,김영일,정규호 한국약제학회 2001 Journal of Pharmaceutical Investigation Vol.31 No.4

Local drug delivery by using biocompatible polymers has been developed in the treatment of periodontitis for many years. In the field of dental therapy, doxycycline is usually a first choice because of its broad-spectrum antibiotic activity. The strip releases antibiotics for a week, and the polymer should be degradable after a week. In this study, we prepared and evaluated the chitosan strips and nanoparticle strips containing doxycycline hydrochloride, and studied their antiacterial activity, dissoultion, and degrability in vitro. The weight of cast strip containing a 5 mg of doxycycline hydrochloride and a 45 mg of chitosan polymer was 57.67±0.17 mg. The release rate of doxycycline hydrochloride from the strip was measured by HPLC. The drug released from chitosan strip and nanoparticle strip was shown to be 50 ㎍/ml, in first 24 hours. In antibacterial test showed growth inhibitory activity after 24 hrs anaerobic incubation. In vitro degradability showed demolished weight of 93.74±0.08% chitosan strip, 82.48±1.29% chitosan nanoparticle strip, 2.47±1.99% polycarprolactione strip (control). These results showed that, with this doxycycline hydrochloride strip, it is feasible to obtain a sustained release of the drug within the periodontal pocket for seven days which may be improve for local drug delivery system for treatment of periodontal disease.

위의 양성 및 악성병변에서의 Argyrophilic Nucleolar Organizer Regions발현에 대한 연구

송규상 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

The colloid silver staining technique to reveal argyrophilic nucleolar organizer regions (AgNOR) was performed in chronic atrophic gastritis, chronic gastritis with intestinal metaplasia, dysplasia, early gastric carcinoma, and advanced gastric carcinoma with or without regional lymph node metastasis. The results were as follows. 1. There was an increasing tendency of the mean number of AgNOR from benign lesions to malignant lesions. 2. The malignant lesions had significantly higher number of AgNOR than benign lesions. 3. The mean number of AgNOR in dysplasia was significantly higher than that of chronic atrophic gastritis. However, there was no statistical difference from other lesions. 4. There was no statistical difference between early gastric carcinoma and advanced gastric carcinoma or between advanced gastric carcinoma without metastasis and advanced gastric carcinoma with metastasis These results suggest that the number of AgNOR may have significance in differentiating between benign lesions and malignant lesions of the stomach, but may not be helpful for evaluating the depth of invasion and metastasis.

표피 종양에서 Epidermal Growth Factor Receptor의 발현 비교

송준영,이규석,정재봉 啓明大學校 醫科大學 1994 계명의대학술지 Vol.13 No.4

Epidermal growth factor(EGF) and transforming growth factor alpha(TGFα) are important keratinocyte mitogens. Their effect are mediated by a cell membrane receptor(EGFR), quantitive and qualitive abnormalities of which may be responsible for deranged keratinocyte proliferation and differentiation. We have therefore examined EGFR expression immunohistochemically in a variety of benign and malignant epithelial neoplasms using monoclonal antibodies to the extracellular and intracellular receptor domains, In benign tumor(seborrheic keratosis), there was an ordered pattern of EGFR expression. In malignant tumors(basal and squamous cell carcinoma), there was loss of membrane labelling and cytoplasmic accumulation of the receptor. In premalignant prolifertation(Bowen's disease), there was loss of membrane receptor with absent cytoplasmic EGFR. In slot-blot analysis, the levels of EGFR mRNA in sguamous cell carcinoma and basal cell carcinoma revealed 3 fold elevation when compared to normal skin. We suggest that dysregulation of the EGFR may be important in the development of cutaneous epithelial malignancies.

말기 신부전 환자에서 투여 경로에 따른 유전자 재조합 인 Erythropoietin(Epokine^(�))의 효과와 안정성에 대한 연구 : 제 4상 연구 A Phase 4 Single Center Study

송현용,윤향숙,강신욱,최규헌,하성규,이호영,한대석 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 국내 독자적 기술로 첫 개발된 유전자 재조합 인 에리트로포에틴(Epokineⓡ)의 투여방법에 따른 유효성과 안정성을 알아보고자 하였다. 방 법 : Epokineⓡ을 주당 100-150 U/kg, 주 2회, 12주간 피하 주사하여 목표 또는 안정된 혈색소치 유지 후 무작위로 피하 및 정맥 주사군으로 나누어 12주간 혈액투석 및 복막투석 환자13명, 28명에서 유효성, 안정성을 분석하였다. 결 과 : 양군에서 혈색소치와 헤마토크릿은 Epokineⓡ 투여 2주 후부터 증가, 혈색소치가 혈액투석 환자는 투여 전 7.3 g/dL, 투여 12주 9.5 g/dL, 24주 10.6 g/dL로, 복막투석 환자는 6.8g/dL에서 12주 10.2 g/dL, 24주 10.8 g/dL로 증가하였다. 양군에서 교정 망상적혈구수(%)는투여 1주 후부터 전 기간동안 증가하였다. 혈청 내 철분, ferritin치는 양군에서 투여 2주 후부터감소, 총 철분 결합능은 투여 2주 후부터 증가하였다. 12주째 혈액투석 환자에서 많은 Epokineⓡ용량이 필요했으나(142.2±20.5 vs 117.3±33.6 U/kg/wk, p<0.001) 24주 후 양군의 용량차이는 없었다(123.6±41.5 vs 99.2±49.3 U/kg/wk, p>0.05). 혈액투석 환자에서 피하 주사가Epokineⓡ 투여용량이 더 적었으나(97.4±15.4 vs 145.4±2.9 U/kg/wk, p<0.002) 복막투석 환자는 차이가 없었다(93.0±60.2 vs 105.4±9.7 U/kg/wk, p>0.05) 연구기간 중 9명(18.8%)에서혈압강하제 추가가 필요한 혈압상승, 근육통 동반 상기도 감염 유사증상 및 두통 등의 부작용이 있었다. 대부분 자연소실 혹은 대증요법으로 치유되었고 2명이 부작용으로 탈락하였다. 결 론 : 말기 신부전 환자의 빈혈 개선에 사용하는 Epokineⓡ의 효과는 복막투석 환자에서 더 좋았으며 투여 경로는 정맥주사보다 피하주사가 높음을 알 수 있었다. Background : We evaluated the clinical efficacy and safety of recombinant human erythropoietin(Epokine^(ⓡ)). Methods : A comparative prospective study of intravenously and subcutaneously administrated Epokine^(ⓡ) conducted 13 patients performing hemodialysis and 28 patients performing continuous ambulatory peritoneal dialysis with end-stage renal disease. Epokine^(ⓡ) was given initially at a dosage of 100 unit/kg, subcutaneously, two times a week. The patients had achieved stable or more than 10 g/dL of hemoglobin level for 12 weeks and then we randomized switching intravenously or subcutaneously administrated Epokine^(ⓡ) for another 12 weeks. Results : Hemoglobin(g/dL) and hematocrit(%) increased significantly from baseline levels beginning from 2 weeks after Epokine^(ⓡ) administration. In HD patients, hemoglobin increased significantly from 7.3 to 9.5 after 12 weeks and to 10.6 after 24 weeks. In CAPD patients, hemoglobin increased significantly from 6.8 to 10.2 after 12 weeks and then 10.8 after 24 weeks(p<0.05). Corrected reticulocyte count(%) was significantly increased from baseline levels beginning from 1 week after Epokine^(ⓡ) administration and continuously increased during study period in both group. Serum ferritin and serum iron decreased significantly and total iron binding capacity increased significantly after 2 weeks. At 12 weeks, HD patients were significantly needed more dosage of Epokine^(ⓡ) than CAPD patients(142.2±20.5 vs 117.3±33.6 U/kg/wk, p<0.001), but at 24 weeks, the dosage was not different(123.6±41.5 vs 99.2±49.3 U/kg/wk, p> 0.05). In HD patients, intravenously administrated Epokine^(ⓡ) group was more dosage than subcutaneously group(97.4±15.4 vs 145.4±2.9 U/kg/wk, p< 0.002), but CAPD patients were not different by administration method(93.0±60.2 vs 105.4±9.7 U/kg/ wk, p>0.05). The 9 cases(18.8%) were suffered from headache and flu-like syndrome, but these side effects were not severe and disappeared from conventional therapy. Conclusion : Epokine^(ⓡ) administration is safe and effective in treating anemia of ESRD patients and subcutaneously administration is significantly more effective than intravenously. (Korean J Nephrol 2002;21(2):190-198)

폐암의 세포 소멸지수에 대한 연구

송규상 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

To evaluate the apoptotic indices in the lung cancers the apoptotic bodies were stained with in situ apoptosis detection kit (Apoptag). The apoptotic indices were 3.0 in squamous cell carcinoma, 8.3 in small cell carcinoma, 2.6 in adenocarcinoma, and 0.9 in bronchioloalveolar carcinoma,respectively. The apoptotic index of small cell carcinoma was significantly higher than those of three other types of the lung cancer. The results suggest that apoptotic index may be a useful marker for predicting the biologic behavior of some types of lung cancer.