면역성 혈소판감소성 자반증을 동반한 크론병

김규표 ( Kyu Pyo Kim ),장혜숙 ( Hye Sook Chang ),양석균 ( Suk Kyun Yang ),명승재 ( Seung Jae Myung ),정훈용 ( Hwoon Yong Jung ),홍원선 ( Weon Seon Hong ),김진호 ( Jin Ho Kim ),민영일 ( Young Il Min ),김우건 ( Woo Kun Kim ),박찬정 대한소화기학회 2002 대한소화기학회지 Vol.40 No.5

진료현장에서 정밀의료의 적용

김규표 ( Kyu-pyo Kim ) 대한내과학회 2020 대한내과학회지 Vol.95 No.6

Precision medicine is the modern era version of “personalized medicine”, which integrates data from genomics and clinical information to optimize the care delivered to patients. As next generation sequencing (NGS) revolutionized the speed and cost of genomic sequencing, precision medicine entered clinical practice in 2017 via the national reimbursement of oncology and rare diseases. In parallel, the digitalization of clinical data through electronic health recording (EHR) and hospital information systems has allowed data collection and analysis. This has led to the integration of biomarkers and clinical records, which have introduced precision medicine into clinical practice. Today, many countries and medical institutes are endeavoring to create systems that will enable precision medicine to be applied to clinical practice. These data systems will benefit the patient by providing accurate data based on his/her characteristics rather than the conventional approach of using “average data”. Internal medicine will transform into a data-driven science that enables physicians to translate molecular biomarkers and big data analysis into improved clinical care. (Korean J Med 2020;95:382-386)

혈액투석 환자에서 발생한 허리동맥 및 아래 배벽동맥의 자발성출혈

표성희 ( Sung Hee Pyo ),서장원 ( Jang Won Seo ),박종하 ( Jong Ha Park ),김규표 ( Kyu Pyo Kim ),김상현 ( Sang Hyun Kim ),장재원 ( Jai Won Chang ),성규보 ( Kyu Bo Sung ),박수길 ( Su Kil Park ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.6

암 치료를 위한 Poly(ethylene glycol)-Doxorubicin/SPION 자성 나노입자의 제조 및 특성분석

김유경(Yugyeong Kim),이선민(Seonmin Lee),김단비(Danbee Kim),노강민(Kangmin Noh),오근상(Keun Sang Oh),조성훈(Sunghoon Cho),최은표(Eunpyo Choi),김규표(Kyu-pyo Kim),허강무(Kang Moo Huh) 한국고분자학회 2018 폴리머 Vol.42 No.6

본 연구에서는 친수성 poly(ethylene glycol)(PEG)와 소수성 항암제인 독소루비신(DOX)의 화학적 결합에 의해 합성된 PEG-DOX conjugate를 이용하여 암 진단 및 치료가 가능한 자성 나노입자를 제조하고자 하였다. 양친매성 PEG-DOX는 수용액 내에서 자기조립 특성을 보이고, 10 ㎚ 내외의 자성 나노입자(SPION)에 대해 높은 봉입능 및 봉입률을 보였다. 제조된 PEG-DOX/SPION 나노입자는 ~100 ㎚의 균일한 사이즈 분포를 가지며 phantom 실험을 통해 조영제로서의 가능성을 확인하였다. 세포독성평가에서 DOX에 비해 낮은 독성을 보였고 최대내성용량(MTD) 평가실험에서 사망 개체가 발생하지 않았다. 결과적으로, 고함량의 항암제와 SPION으로 구성된 본 나노입자 시스템은 낮은 독성, MR 조영 특성, 수동적 및 자성 표적화능 등 다양한 생기능성을 기반으로 암 진단 및 치료에 유용한 테라그노스틱 제형에 응용될 수 있을 것으로 기대한다. In this study, an amphiphilic polymer-drug conjugate was synthesized by chemical conjugation of a hydrophilic polymer poly(ethylene glycol) (PEG) with a hydrophobic anticancer agent, doxorubicin (DOX), to prepare magnetic nanoparticles for cancer diagnosis and therapy. The amphiphilic PEG-DOX polymer could self-assemble in the aqueous solution to form nanoparticles (NPs) and efficiently encapsulated superparamagnetic iron oxide nanoparticles (SPION) with high loading capacity and loading efficiency. The resulting SPION encapsulated PEG-DOX (PEG-DOX/SPION) NPs were observed to have an average size of ~100 ㎚ with a narrow and unimodal size distribution and demonstrated the characteristic of MR contrast agent from the phantom experiments. In the toxicity assessment, PEG-DOX/SPION NPs showed lower toxicity than pristine DOX, and no mortality was detected at the maximum MTD. As a result, these magnetic NPs with high contents of DOX and SPION could be utilized as a theragnostic formulation for efficient cancer diagnosis and therapy, due to their diverse potential capacities properties, such as low toxicity, MR imaging character, passive and magnetic targeting properties, and so on.

한 대학병원 종양내과에서 사망한 환자들의 심폐소생술 금지 지시 결정 요소

송태준 ( Tae Jun Song ),김규표 ( Kyu Pyo Kim ),고윤석 ( Youn Suck Koh ) 대한내과학회 2008 대한내과학회지 Vol.74 No.4

목적: 심폐소생술 금지 지시는 무의미한 치료와 연관된 논쟁 중 하나이며 아직 우리 나라에서는 법적으로 인정되고 있지 않다. 이에 저자들은 2001년 10월부터 병원 윤리 위원회에서 심폐소생술 금지 지시가 공식적으로 문서화되어 사용되고 있는 한 대학병원 혈액종양내과에서 사망한 환자들을 대상으로 심폐소생술 금지 지시의 현황과 결정에 영향을 미치는 요소들을 알아보고자 하였다. 방법: 2002년 1월부터 7월까지 한 대학병원 혈액종양내과에서 사망한 환자들 213명의 의무 기록을 후향적으로 분석하였다. 결과: 213명의 환자들 중 181명(85%)에서 심폐소생술 금지 지시가 있었고, 이 중 1명의 환자에서 심폐소생술이 시행되었다. 심폐소생술 금지 지시를 담당의사가 제기한 경우가 83.9%이고 가족 구성원이 제기한 경우는 16.1%였다. 입원횟수가 많은 환자들(3.7±2.6 vs. 2.9±1.7, p<0.05)과 교육수준이 높은 환자들(고졸 이상의 학력 89.5% vs. 10.5%, 고졸 이하의 학력 77.3% vs. 22.7%, p<0.05)에서 심폐소생술 금지 지시의 비율이 높았다. 소화기 계통의 암을 앓고 있던 환자들에서 폐암이나 혈액암을 앓던 환자들에 비해 심폐소생술 금지 지시의 비율이 높았다(p<0.05). 심폐소생술 금지 지시에 동의한 이후 치료 수준은 심폐소생술 유보가 31명(17.2%), 추가적인 치료 유보가 133명(73.9%), 그리고 치료 중단이 16명(8.9%)이었다. 결론: 입원 횟수와 암의 종류, 교육수준 등이 암환자들의 심폐소생술 금지 지시 결정에 영향을 미칠 수 있는 요소가 될 수 있을 것으로 사료된다. Background/Aims: Do-Not-Resuscitate (DNR) orders have been one of the critical issues considered in futile medical management, but they have not been legally defined in Korea. The aim of this study was to observe the factors that influence DNR agreement and to determine the current status of DNR orders in the hemato-oncology wards of a university hospital, in which DNR orders were formally implemented through the Hospital Ethics Committee in October 2001. Methods: We retrospectively analyzed the records of 213 patients who had died in the hemato-oncology department at a university hospital between January 2002 and July 2002. Results: Of the 213 patients, 181 (85%) agreed to a DNR order. Cardiopulmonary resuscitation was done in 1 out of 181 patients. The DNRs were suggested by attending physicians in 83.9% of cases and by family members in 16.1%. The patients with more frequent admission to the hospital (3.7±2.6 vs. 2.9±1.7, p<0.05) and with higher educational level (p<0.05) were more likely to agree to a DNR order. Patients with gastrointestinal tract cancer were more likely to agree to a DNR order than patients with lung cancer or hematologic malignancy (p<0.05). The levels of care after DNR agreement were: withholding of resuscitation only (17.2%), withholding of additional support (73.9%), and active withdrawal of provided support (8.9%). Conclusions: The frequency of admission, type of malignancy, and educational level of patients were determining factors for the establishment of DNR orders in patients with malignancy.(Korean J Med 74:403-410, 2008)

담낭의 운동장애로서 과잉수축의 임상적 의의는 ?

김명환(Myung Hwan Kim),김인(In Kim),박도현(Do Hyun Park),박상현(Sang Hyun Park),이상수(Sang Soo Lee),박주상(Ju Sang Park),손희정(Son Hee Jeong),황창연(Chang Yun Hwang),김규표(Kyu Pyo Kim),서동완(Dong Wan Seo),이성구(Sung Koo Lee),민영 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.1

N/A At present, the gallbladder dysfunction implies a disorder of decreased gallbladder contractility. Other motor disorder such as overactive gallbladder which shows excessive contraction cannot be excluded in the motility disorder of gallbladder. Thus, this study was done to define the diagnostic criteria and to develop the techniques to induce the excessive contraction of gallbladder. Methods: CCK-op at 20 ng/kg by slow continuous infusion for 30minutes, that is known as most physiologic method for gallbladder contraction, was given for assessment of gallbladder emptying in 12 normal volunteers. Also, rapid bolus injection of cholecystokinin octapeptide (CCK-op) at 20 ng/kg or 40 ng/kg was performed to induce the excessive contraction of gallbladder. Gallbladder contractility was represented as the ejection fraction (GBEF) measured by cholecystokinin- cholescintigraphy. Results: 1. With a slow continuous infusion of CCK-op, the mean GBEF was 78.2±5.6% (mean±SD). 2. With a rapid bolus injection of CCK-op, GBEF showed variable results (10-86%) among subjects who had normal gallbladder. 3. Based on the results obtained by slow continuous infusion of CCK-op in normal volunteers, overactive gallbladder was defined when GBEF approached more than 70% within 15minutes after bolus injection of CCK-op. The overactive gallbladder was noted in 6 (50%) subjects who received rapid bolus injection of CCK-op (40 ng/kg). 4. Abdominal pain developed only in high-dose (40 ng/kg) bolus injection group (6/12, 50%), concomitantly with increased bowel movements, irrespective of excessive gallbladder contractility. Conclusion: Excessive gallbladder contraction had no clinical significance in the experimentally induced clinical model.(Korean Journal of Gastrointestinal Motility 2002;8:37-43)