대장내시경 전처치를 위한 4 L Polyethylene Glycol 단독요법, 4 L Polyethylene Glycol 분할요법 및 2 L Polyethylene Glycol과 Sodium Phosphate 용액 병합요법 비교

조소영 ( So Young Jo ),김나영 ( Nayoung Kim ),이정원 ( Jung Won Lee ),임지환 ( Ji Hwan Lim ),최치언 ( Chiun Choi ),전일영 ( Il Young Chon ),길호 ( Ho Kil ),민보영 ( Bo Young Min ),변영상 ( Young Sang Byoun ),이반석 ( Ban Seok Lee 대한소화기학회 2012 대한소화기학회지 Vol.59 No.6

Background/Aims: The aim of this study was to compare polyethylene glycol (PEG) 4 L, split method of PEG 4 L and PEG 2 L plus sodium phosphate (NaP) in the aspect of bowel preparation quality, safety, patients` compliance and preference. Methods: Total 249 subjects were prospectively enrolled and received bowel preparation for colonoscopy from August to October in 2010; PEG 4 L (93 subjects), split method of 4 L PEG (74 subjects) and PEG 2 L plus NaP 90 mL group (82 subjects). To investigate the completion, preference for bowel preparation and safety, a questionnaire survey was conducted before colonoscopy. Results: There were no significant intergroup differences in the aspect of completion of preparation, cecal intubation time and success rate. Satisfaction and preference were higher in PEG 2 L plus NaP 90 mL and split method of 4 L PEG compared with PEG 4 L. In the aspect of the bowel preparation quality PEG 4 L showed significantly higher quality in the morning colonoscopy (p<0.001). However, in the afternoon colonoscopy PEG 2 L plus NaP 90 mL showed better result than PEG 4 L (p=0.009). Hyperphosphatemia was most frequently observed in PEG 2 L plus NaP 90 mL, but no severe adverse events occurred (p<0.001). Conclusions: PEG 4 L showed better result than split method of 4 L PEG or PEG 2 L plus NaP 90 mL in the aspect of bowel preparation quality and safety. (Korean J Gastroenterol 2012;59:414-422)

Methoxy Polyethylene Glycol-Epoetin Beta에 의해 유발된 백혈구파쇄성 혈관염

이상윤 ( Sang Yoon Lee ),고재완 ( Jae Wan Go ),김신한 ( Shin Han Kim ),손현옥 ( Hyun Ok Son ),조한경 ( Han Kyoung Cho ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.1

Methoxy polyethylene glycol-epoetin beta (Mircera(R), Roche), a third-generation erythropoiesis-stimulating agent (ESA) is known as a continuous erythropoietin receptor activator (CERA). In patients with anemia associated with chronic kidney disease (CKD), it is administered intravenously or subcutaneously. Treatment-related adverse events induced by methoxy polyethylene glycol-epoetin beta occurred in 6%. Hypertension, diarrhea and nasopharyngitis were the most commonly reported adverse events. Cutaneous adverse reactions are rarely experienced with methoxy polyethylene glycol-epoetin beta including maculopapular eruption, facial erythema, and tinea pedis. To the best of our knowledge, no cases of leukocytoclastic vasculitis associated with methoxy polyethylene glycol-epoetin beta have ever been published in medical literature. Herein, we report on a case of leukocytoclastic vasulitis induced by methoxy polyethylene glycol-epoetin beta in a patient with anemia associated with chronic kidney disease. (Korean J Dermatol 2013;51(1):49∼52)

대장내시경 전처치액으로서 Polyethylene Glycol용액과 Sulfate Free Polyethylene Glycol용액의 선호도에 관한 전향적 비교

이준석,박영숙,김남인,조윤주,김성환,송문희,전대원 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.5

Background/Aims: The standard polyethylene glycol (PEG) solution for colonic cleansing has a salty taste and a large volume of it is required, which can cause failure for the patient to ingest the required dosage. This has been a limitation for its usage. Sulfate free PEG (SF-PEG) has a less salty taste due to removal of the sodium sulfate, but the published studies in western countries about the preference and the degree of patient’s satisfaction with these two solutions has shown conflicting results. The object of this study was to compare SF-PEG with PEG solution in regard to preference, the degree of patient’s satisfaction and the adverse effects in Korean patients. We also attempted to determine whether these factors were associated with preference. Methods: Ninety-four patients scheduled for colonoscopy were given one liter of both solutions (SF-PEG and PEG) and then the patients were allowed to select either of the two solutions for the further two liters intake under informed consent. Before colonoscopy, the preferred solution, the degree of patient’s satisfaction, the adverse effects and other information were recorded by questionnaire. Results: Fifty-nine patients among the 94 patients (63%) preferred the SF-PEG solution (p<0.05). Especially, the young patients under the age of 35 preferred the SF-PEG solution (83% vs 58%; p=0.045), and patients who had already experienced colonoscopy with PEG solution tended to prefer the SF-PEG (54% vs 78%; p=0.054). Conclusions: Korean patients preferred the SF-PEG over PEG, and especially young aged patients and the patients who had already taken the PEG solution. Similar results were obtained for both solutions concerning the adverse effects, cleansing quality and compliance, and the degree of satisfaction was not much improved, which was probably due to the same large volume of fluid that is required for colon cleaning. 목적: Polyethylene glycol (PEG)용액은 정결효과가 우수하고, 안전하여 대장내시경 전처치액으로 널리 사용되고 있으나, 복용량이 많고, 고유의 짠맛으로 인하여 복용이 힘든 문제점이 있다. 1990년에 Sodium sulfate를 제거하여 짠맛을 줄인 sulfate free PEG (SF-PEG)용액이 개발되어 기존 PEG용액에 비해 복용 만족도, 순응도 및 부작용 등이 향상 될 것으로 생각되었다. 본 연구는 서양인과 다른 식이습관을 가진 한국인에서 기존 PEG용액과 SF-PEG용액간의 선호도, 만족도, 순응도, 부작용 및 장 정결도에 대해 비교하고, 선호도에 영향을 미치는 인자에 대해 알아보고자 하였다. 대상 및 방법: 을지대학교 노원을지병원에서 대장내시경을 시행한 환자 중 94명을 대상으로 모두에게 PEG와 SF-PEG용액 각각 1 L씩을 복용하게 한 후 나머지 2 L는 환자가 선택하여 복용하도록 하였다. 모든 대상자에서 선택한 전처치액을 조사 하였으며, 대장내시경 시행 전 설문지를 이용하여 만족도, 부작용, 남긴 양, 이전 대장내시경검사의 과거력 등에 대해 조사하였다. 복용 만족도는 visual analogue scale을 이용하여 평가하였으며, 대장내시경 시행 후 담당의가 대장 정결도에 대해 bad-fair-good-very good의 4단계로 나누어 평가 하였다. 결과: 총 94명중 SF-PEG용액을 선택한 환자가 59명으로(63%, p<0.05) 통계적으로 유의하게 선호도가 높았으며 복용 순서에 따른 차이는 없었다. 특히 35세 이하군에서 통계적으로 유의하게 SF-PEG용액을 더 선호하였다(83% vs. 58%, p=0.045). 이전 대장내시경 시행 당시 전처치액으로 PEG용액을 사용하였던 경험이 있는 군과 처음 대장내시경을 시행한 군을 비교하였을 때, 이전에 PEG용액을 복용하였던 군에서 SF-PEG용액을 더 선호하는 경향을 보였다(78% vs. 54%, p=0.054). 복용만족도, 부작용, 대장 정결도는 양군 간에 차이가 없었고 복용 순응도를 개선시키지는 못하였다. 결론: 본 연구에서는 대장내시경의 전처치액으로 기존 PEG용액에 비해 SF-PEG용액이 더 선호되는 것으로 조사되었으며, 특히 젊은 연령에서, 그리고 이전에 전처치액으로 PEG용액을 사용하였던 군에서 SF-PEG용액의 선호도가 더 높음을 알 수 있었으나 만족도와 순응도는 개선하지 못하였다.

Polyethylene Glycol을 이용한 대장정결 후 발생한 급성 저나트륨 뇌병증 1예

허채,오형철,김정욱,김재규 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.3

Preparation for colonoscopy involves a thorough cleansing of the large bowel. Cleansing is performed using several methods, including ingestion of 4 liters of polyethylene glycol solution. However, these methods can induce hyponatremia by various mechanisms. Severe or rapidly progressing hyponatremia can result in the swelling of the brain, and the symptoms of hyponatremia are mainly neurological. Recently, we encountered a 41-year-old woman who developed acute hyponatremia with encephalopathy after undergoing bowel preparation for colonoscopy. She presented with general weakness, nausea, headache, agitation, delusions, and slurred speech one day after the ingestion of polyethylene glycol solution. Her serum sodium level was very low (110 to 115 mEq/L). Her symptoms pertaining to hyponatremia continued to persist for more than 2 days despite continuous intravenous administration of hypertonic saline for the correction of hyponatremia. Polyethylene glycol (PEG) 용액을 이용한 대장정결은 수분과 전해질 대사에 크게 영향을 주지 않는다. 그러나 이 장정결법은 일부에서 저나트륨혈증을 유발 할 수 있다. 급격하거나 심한 저나트륨혈증은 뇌부종으로 인한 신경학적 증상을 유발 할 수 있다. 저자들은 41세 여자에서 대장내시경검사를 위해 PEG 용액을 이용한 장정결 후 뇌병증을 동반한 저나트륨혈증을 보인 증례를 경험하여 보고한다. 환자는 대장정결 24시간 후 전신쇠약, 욕지기, 두통, 초조, 망상, 불명료 언어의 증상을 보였으며 혈청 나트륨은 110에서 115 mEq/L으로 매우 낮았다. 환자의 저나트륨혈증과 연관된 증상은 2일간 고장 식염수 투여 후에 개선되었다.

곁사슬형 Polyethylene Glycol을 가진 Adenosine Deaminase 거대분자 결합체의 생화학적 특성

서선복,이순용 인제대학교 1995 仁濟醫學 Vol.16 No.4

혈색소, 홀몬 및 효소들과 같은 단백질은 질병 치료에 흔히 이용되고 있으나 이들은 생체 내로 투여하였을 때 치료제로서의 안정성과 항원성이 문제가 되어 그 효능을 기대하기 힘든 경우가 적지 않다. 저자들은 이러한 결점을 개선해 보고자 그 첫 단계로 비항원성 합성 고분자 화합물인 곁사슬형 polyethylene glycol(PEG)을 단백질의 실험모델로 사용한 효소 adenosine deaminase(ADA)에 결합시켜 이 복합체(PEG-ADA)의 물리적 및 생화학적 성질에 대하여 조사하였다. 연구 결과 곁 사슬형 PEG-ADA는 PEG로 인해 ADA가 변형되었지만, 효소활성이 유지되고 있었으며 단백질 분해효소에 대해서도 안정되어 있음을 보여 주었다. The enzyme is usually limited to use as a therpeutics because of its own instability and antigenicity. Adenosine deaminase(ADA), which was selected as a model of enzymes in this study, was modified by a pendant-type polyethylene glycol(PEG) in order to reduce the nzyme's own disadvantages, and the authors studied about the biochemical characteristics of the pendant type PEG-ADA conjugate to elucidate whether this conjugate could be a more improved and effective therapeutic enzyme haying stability and non-antigenicity. Calf adenosine deaminase was modified with pendant-type polyethylene glycol using cyanuric chloride as a coupler. The covalent attachmant of PEG to ADA altered the kinetic profile of the enzyme in which the value of Km for adenosine was decreased. The Km value of the ADA and PEG-ADA10 were 30 μM, 25 μM against adenosine, respectively. But the PEG-ADA20 exhibited reasonable retention of catvlytic activity with an increased Km, which was 50 μM against adenosine. The ADA and PEG-ADA showed optimum in acidic direction. The ADA and PEG-ADA had same temperture optima of 50℃. Thermal inactivation at the temperature above optima was essentially the same between the native and modified enzymes. PEG appeared to have no effect of stabilizing enzymes on high temperature. This suggested that PEG attachment caused some destabilization of the adenosine deaminase structure. PEG-ADA also demonstrated a resistance to the proteolytic digestion by trypsin and chymotrypsin. The electrophoretic mobility in polyacrylamide gels of PEG -ADA was reduced as compared to the native enzyme. The unmodified enzymes showed single band, whereas the modified ones formed a mumber of bands throughout the gels. The decreased electrophoretic mobility of PEG-ADA might be due to a charge-shielding effect of the hydrophilic PEG shell surrounding the enzyme. In addition, the increased size of the adducts might serve to retard migration in the polyacrylmide gels. The alteration of the pH dependance and the dramatically decreased mobility in polyacrylamide gel electrophoresis of the PEG-enzyme pointed up the effect of PEG modification on the apparent charge of the enzyme molecules. It was believed to be due to a change in conformation dictated by the charge of the PEG-enzyme or imposed by the covalent attachment of PEG to the enzyme. These results showed that the biochemical properties of adenosine deaminase were altered after chemical modification by pendant type PEG. The preparation of PEG-ADA retained the enzyme activity and had resistance against proteolytic enzymes. The authors concluded that the pendant-type PEG-ADA might be available in the medical field in the future.

Optimal and Safe Bowel Preparation for Colonoscopy

문원 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.3

Effective colonoscopy requires an adequate level of cleansing as a basic component. This review will describe a compact review about general considerations in bowel preparation for colonoscopy and specific considerations for various patients. A low-fiber diet instead of a regular diet on the day before colonoscopy is an independent predictor of adequate bowel preparation. Improved bowel cleansing does not result from the routine use of enemas or prokinetics in addition to oral bowel preparation. For morning colonoscopy, a split method of 4 L polyethylene glycol on the day before and the day of colonoscopy is recommended, while patients scheduled for afternoon colonoscopy typically receive a full method of 4 L polyethylene glycol on the day of the procedure. Valid alternatives are 2 L polyethylene glycol plus ascorbic acid or 2 L sodium picosulphate plus magnesium citrate. Although there are no statistically significant differences between polyethylene glycol and oral sodium phosphate for colon cleansing, polyethylene glycol-based bowel preparation is advisable in most situations because of safety concerns.

급성 척수 손상 쥐 모델에서 약물 투여 후 이차 척수 손상 감소 효과 - Statins과 Erythropoietin, Polyethylene Glycol의 효과 비교 -

유재원,손홍문,박상하 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.3

Study Design: An experimental animal study. Objectives: To evaluate and compare the neuroprotective effect of statins, erythropoietin and polyethylene glycol (PEG) after spinal cord injury (SCI). Summary of Literature Review: There are few comparative studies of pharmacological agents for acute SCI. Materials and Methods: Forty Sprague Dawley (SD) rats had a spinal cord injury at T9/10 using an Ohio State University (OSU)impactor. The animals were randomized to receive one of the following; simvastatin, erythropoietin, PEG or saline. A behavioral outcome assessment was performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals were sacrificed at the end of 6 weeks and histologic assessment was performed to measure the areas of white and gray matter. Results: For the animals treated with simvastatin, erythropoietin, PEG and saline, the mean BBB scores at 6 weeks post-injury were 13.2±0.1, 11.7±0.4, 13.3±0.3, and 11.4±0.2, and the BBB subscores were 9.2±1.1, 5.0±1.3, 9.1±1.1, 4.4±1.2, respectively. The BBB scores and BBB subscores were significantly higher in simvastain and PEG-treated animals (p<0.05). The areas of white matter at the lesion epicenter were 0.78±0.05mm2, 0.46±0.04 mm2, 0.68±0.15 mm2, and 0.41±0.04mm2 in the simvastatin, erythropoietin, PEG and saline groups, respectively. The simvastatin and PEG-treated animals showed increased sparing of the white matter at the injury epicenter and at 0.2mm rostral and 0.4mm caudal(p<0.05). Conclusion: Simvastatin and polyethylene glycol administration showed diminished secondary injury after SCI in rats. In addition, they showed almost the same efficacy. However, erythropoietin did not show neuroprotective effect. 연구 계획: 실험 동물 연구목적: 급성 척수 손상에서 statins과 erythropoietin, polyethyelene glycol(PEG)을 투여하여 신경 보호 효과를 평가하고 비교하고자 하였다. 선행문헌의 요약: 척수손상에서 치료약물의 비교연구는 드물다. 대상 및 방법: Sprague Dawley 흰 쥐 40마리(300-350gm)를 사용하여 흉추 T9/10에 Ohio State University(OSU) impactor를 이용하여 척수 손상을 시킨후 무작위로 4군으로 나누고 statins과 erythropoietin, polyethyelene glycol(PEG), 생리식염수를 투여하였다. 행동평가는 수술 후 각각 2, 4, 7일 및 매주에Basso, Bresnahan, and Beattie(BBB) score와 BBB subscore를 이용하였다. 조직학적 평가는 수상 후 6주째 쥐를 희생시킨 후 척수 조직을 채취하여 회색질과 백색질의 면적을 구하였다. 결과: simvastatin과 erythropoietin, PEG, 생리식염수 투여군에서 수상 6주째 평균 BBB score는 각각 13.2±0.1, 11.7 ± 0.4, 13.3±0.3, and 11.4±0.2이었으며, BBB subscore는 9.2±1.1, 5.0±1.3, 9.1±1.1, 4.4±1.2 이었다. BBB score와 BBB subscore는 simvastatin과 PEG 투여군에서 의의 있게 높았다(p<0.05). 손상 중심부 백색질의 면적은 simvastatin과 erythropoietin, PEG, 생리식염수 투여군에서 각각 0.78±0.05mm2, 0.46±0.04 mm2, 0.68±0.15 mm2, 0.41±0.04mm2로 측정되었다. simvastatin 과 PEG 투여군에서 손상 중심부 및 두부 2mm와 미부 4mm에서 백색질의 보존이 많았다(p<0.05). 결론: 쥐의 급성 척수 손상후 simvastatin과 PEG 투여한 결과 이차 손상의 감소 효과가 확인되었으며 두 약물은 비슷한 효과를 보였다. 그러나erythropoietin은 신경보호 효과가 없었다.

Recovery of serine protease inhibitor from fish roes by polyethylene glycol precipitation

( Hyun Ji Lee ),( Hyung Jun Kim ),( Sung Hwan Park ),( In Seong Yoon ),( Gyoon-woo Lee ),( Yong Jung Kim ),( Jin-soo Kim ),( Min Soo Heu ) 한국수산과학회(구 한국수산학회) 2016 Fisheries and Aquatic Sciences Vol.19 No.3

The fractionation of serine protease inhibitor (SPI) from fish roe extracts was carried out using polyethylene glycol-4000 (PEG4000) precipitation. The protease inhibitory activity of extracts and PEG fractions from Alaska pollock (AP), bastard halibut (BH), skipjack tuna (ST), and yellowfin tuna (YT) roes were determined against target proteases. All of the roe extracts showed inhibitory activity toward bromelain (BR), chymotrypsin (CH), trypsin (TR), papain-EDTA (PED), and alcalase (AL) as target proteases. PEG fractions, which have positive inhibitory activity and high recovery (%), were the PEG1 fraction (0.5 %, w/v) against cysteine proteases (BR and PA) and the PEG4 fraction (20.40 %, w/v) against serine proteases (CH and TR). The strongest specific inhibitory activity toward CH and TR of PEG4 fractions was AP (9278 and 1170 U/mg) followed by ST (6687 and 2064 U/mg), YT (3951 and 1536 U/mg), and BH (538 and 98 U/mg). The inhibitory activity of serine protease in extracts and PEG fractions from fish roe was stronger than that of cysteine protease toward common casein substrate. Therefore, SPI is mainly distributed in fish roe and PEG fractionation effectively isolated the SPI from fish roes.

Polyethylene Glycol을 이용한 대장 전처치 후 발생한 경련을 동반한 급성 저나트륨혈증 1예

이명희,김현주,오숙경,서지영,이병희,서보정 고신대학교(의대) 고신대학교 의과대학 학술지 2012 고신대학교 의과대학 학술지 Vol.27 No.2

4 liters of polyethylene glycol (PEG) solution is commonly used to evacuate the colon before colonoscopy. This substance, however, is known to cause electrolyte abnormalities such as hyponatremia. Seizures caused by hyponatremia associated with bowel preparation have only rarely been reported. We report the case that a 75-year-old woman with no prior history of seizures was developed severe hyponatremia (112 mEq/L) with generalized tonic-clonic seizure and mental change after ingestion of 4L of PEG solution. Past medical history was notable for thiazide diuretics. Her symptoms are improved during intravenous administration of hypertonic saline for the correction of hyponatremia. Patients with impaired ability to excrete free water those with renal insufficiency, hypothyroidism, mineralocorticoid deficiency, liver cirrhosis, or heart failure as well as those taking drugs which including thiazide diuretics, NASIDs, and ACE inhibitors have risk of hyponatremia following bowel preparation for colonoscopy. We conclude that physicians should check patient's condition and electrolyte abnormalities before colonoscopy procedures.

Polyethylene Glycol을 첨가한 고가소성 점토 연구

김응수,김진호,조우석,한규성,황광택 한국도자학회 2017 한국도자학연구 Vol.14 No.1

In this study, porcelain materials with improved physical properties were synthesized by physically and chemically composing organic material into clay and applied to the manufacture of living tableware. The plasticized polyethylene glycol(PEG) was added to the porcelain materials for living tableware to improve the plasticity and the change of the characteristics of the tableware made using the modified material was observed. It was found that the plasticity was remarkably increased at the PEG content of 0.5wt.% or more and the impact strength was also increased by the plasticity of the material. 본 연구에서는 유기물을 점토에 물리․화학적으로 복합화를 통하여 물성이 향상된 도자기 소 지를 개발하여 생활식기 제조에 적용하였다. 본 기술은 생활식기용 도자소지에 가소제 Polyethylene Glycol(PEG)를 첨가하여 가소성을 증진시키고 개량된 소지를 사용하여 제조된 식 기의 품질 특성의 변화를 관찰하였다. PEG 첨가량이 0.5wt.% 이상에서 가소성이 현격히 증가 하였으며 충격강도 역시 소지의 가소성 증진에 의하여 증가한다는 사실을 알 수 있었다.