악성 대장 폐쇄 환자에서 고식적 치료로서 자가 팽창성 금속 스텐트의 임상적 유용성

정지봉 ( Ji Bong Jeong ),이국래 ( Kook Lae Lee ),권순범 ( Soon Beom Kwon ),김준석 ( Joon Suk Kim ),이재경 ( Jae Kyung Lee ),김원 ( Won Kim ),정용진 ( Yong Jin Jung ),김지원 ( Ji Won Kim ),김병관 ( Byeong Gwan Kim ) 대한장연구학회 2010 Intestinal Research Vol.8 No.2

Background/Aims: This study was designed to evaluate the outcomes of self-expanding metal stents (SEMS) as palliative treatment for malignant obstruction of the colon and rectum. Methods: From January 2003 to September 2009, 28 patients (12 men and 16 women) with malignant colorectal obstruction received placement of uncovered or covered stents for palliative purposes under endoscopic or fluoroscopic guidance. The rates of technical success, clinical success, and the complications associated with stent insertion, patient survival, and long-term stent patency were evaluated. Results: The technical and clinical success rates were 100% (28/28) and 89.3% (25/28), respectively. Among the 25 patients with technical and clinical success, seven patients (28%) experienced complications: A case of perforation (n=1) was managed by surgical intervention, cases of tumor ingrowth (n=4), tumor ingrowth and overgrowth (n=1), and tumor overgrowth (n=1) were managed successfully with an additional stent. The median survival duration was 128.0±54.8 days. The median stent patency duration was 93.0±29.1 days, and the patency rates at 30, 90, and 180 days were 92%, 52%, and 25%, respectively. Conclusions: The placement of a self-expanding metal stent was safe and effective palliative treatment for malignant colorectal obstruction. Stent-associated complications can be managed with the placement of additional stents in the majority of the patients and long-term stent patency is favorable. (Intest Res 2010;8:135-141)

최신 연구 소개 : 혈액요소질소(BUN) 수치의 초기 변화가 급성 췌장염 환자의 사망을 예측할 수 있는가?

정지봉 ( Ji Bong Jeong ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

과민성 장증후군 환자에서 식후 대장내압검사

정지봉(Ji Bong Jeong),양용모(Youg Mo Yang),전원중(Won Joong Jeon),서정철(Jeong Chul Seo),이경수,이현희(Hyun Hee Lee),고병성(Byeong Seong Ko),채희복(Hee Bok Chae),박선미(Seon Mee Park),윤세진(Sei Jin Youn) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1

N/A Background/Aims: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. Methods: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean±SE%) over the basal period in response to a meal. Results: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal Ml during the first 30 min after the meal are significantly increased (p<0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62±18 in A, 29±18 in B, 12±8 in C and 306±l02% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p<0.05). 3) In B and C, the percentage changes in the l MI during the first 30 min after the meal in the descending colon were 105±38, 11±7, respectively, which shows a significant difference between the two groups (p<0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62±18, 12±8, respectively, which shows a significant change between the two groups (p<0.05). Conclusion: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome. (Korean Journal of Gastrointestinal Motility 2(00;6:20-31)

담관낭종이 동반된 췌담관 합류 이상에서 췌장염 발생의 위험 인자 분석

정지봉 ( Ji Bong Jeong ),김용태 ( Yong Tae Kim ),윤용범 ( Yong Bum Yoon ),황진혁 ( Jin Hyeok Hwang ),김정룡 ( Chung Yong Kim ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.4

Background/Aims: The clinical features of pancreatitis in patients with anomalous union of pancreatobiliary duct (AUPBD) are not known well. We analyzed the pathogenic mechanisms, risk factors, and clinical courses after treatment in patients with AUPBD. Methods: We retrospectively reviewed the medical records and cholangio-pancreatograms of 58 patients with AUPBD and choledochal cyst diagnosed in Seoul National University Hospital between 1982 and 2001. Results: The incidence of pancreatitis was significantly higher in patients with a long common channel length (>21 mm), wide common channel diameter (>5 mm), wide diameter of proximal pancreatic duct (>2.5 mm), filling defect in the common channel, and pancretic duct anomaly. However, age, sex, type of choledochal cyst, type of AUPBD, diameter of the bile duct, angle between the pancreatic duct and bile duct, biliary stone, and pancreticobiliary malignancy were not associated with the risk of pancreatitis. Patients underwent cyst excision (n=9), choledochocystojejunostomy (n=1), pancreas head resection (n=3), or conservative management only (n=3). Pancreatitis recurred in 3 of the 16 patients treated during a mean follow-up of 37.5 months. Bile reflux to the pancreatitc duct seems to be the main mechanism of pancreatitis in AUPBD, considering the fact that choledochal cyst excision prevented pancreatitis recurrence. Conclusions: Morphological characteristics of the common channel and pancreatic duct contribute to the development pancreatitis in patients with AUPBD and choledochal cyst probably due to the bile reflux into the pancreatic duct. (Korean J Gastroenterol 2003;41:309-315)

김치 유산균 Starter 를 이용한 김치의 발효 특성 및 기능성 증진 효과

봉연주 ( Yeon Ju Bong ),정지강 ( Ji Kang Jeong ),박건영 ( Kun Young Park ) 부산대학교 김치연구소 2013 김치의 과학과 기술 Vol.16 No.-

chi by inoculating kimchi lactic acid bacteria (LAB) starters were studied. We manufactured single LAB starter kimchi (Lactobacillus plantarum pnuK, Lactobacillus plantarum 3099K, Leuconostoc mesenteroides pnuK), mixed LAB starter kimchi (Lb. plantarum pnu/Leu. mesenteroides pnuK, Lb. plantarum 3099/Leu. mesenteroides pnuK) with inoculum size of 106 CFU/g, as well as naturally fermented kimchi (NK), and fermented them for 6 days at 15°C. The pH and acidity of the early phase of fermentation were not different, but kimchi with the starters showed rapid changes in the pH and acidity from 2 days of fermentation. As the fermentation progressed, the level of total aerobic bacteria and Lactobacillus sp. increased similarly with or without Lb. plantarum (LP) inoculation. However, the level of Leuconostoc sp. was high in kimchi inoculated with Leuconostoc sp. starter. In the sensory evaluation test, kimchi with starters received higher overall acceptability scores than those of NK; mixed starter added kimchi earned the highest score. In DPPH and hydroxyl radical scavenging activity, kimchi with the starters exhibited higher activity than that of NK. In the MTT assay of HCT-116 and HT-29 human colon cancer cells, NK showed inhibition rates of 63.4 and 51.9%, but LPpnuK achieved 77.1 and 68.8%, respectively. This study showed that inoculating starters in kimchi increased in vitro antioxidant and anticancer activities, and single starter (LP) added kimchi revealed higher functionality than the kimchi with mixed starter. Kimchis with the starters effectively up-regulated the gene expressions of the pro-apoptotic gene of Bax, but down-regulated Bcl-2. They promoted expressions of p53 and p21, and suppressed expressions of inflammation-related genes, iNOS and COX-2, compared with NK. Taken together, it is expected that using starters may help manufacture kimchi with improved sensory quality and health functionality.

강화되는 수질환경오염규제와 주정산업의 변화

정지봉,Jeong, Ji-Bong 한국주류산업협회 1991 주류산업 Vol.11 No.1

김치 유산균 Starter를 이용한 김치의 발효 특성 및 기능성 증진 효과

봉연주(Yeon-Ju Bong),정지강(Ji-Kang Jeong),박건영(Kun-Young Park) 한국식품영양과학회 2013 한국식품영양과학회지 Vol.42 No.11

본 연구에서는 김치 유산균 starter의 사용이 김치의 품질 특성과 건강기능성에 미치는 영향을 확인하고자 single starter 김치(Lb. plantarum pnuK, Lb. plantarum 3099K, Leu. mesenteroides pnuK), mixed starter 김치(Lb. plantarum pnu/Leu. mesenteroides pnuK, Lb. plantarum 3099/Leu. mesenteroides pnuK), 자연 발효 김치(NK)를 제조하여 15°C에서 6일간 발효하며 실험하였다. pH 및 산도는 발효 초기에는 차이가 없었으나 발효 2일부터 starter 접종 김치에서 빠른 변화를 보였다. 총호기성 세균과 Lactobacillus sp.는 발효가 진행될수록 비슷하게 증가하였으나 Leuconostoc sp.는 Leu. mesenteroides를 starter로 접종한 김치에서 높게 나타났다. 관능검사 결과 starter를 첨가한 김치에서 관능적 만족도가 높게 나타났으며, 혼합 starter 김치에서 만족도가 더 높았다. DPPH 및 hydroxyl radical 소거능 측정 결과, starter를 첨가한 김치에서 높은 항산화 효과를 보였다. MTT assay 결과, HCT-116 및 HT-29 세포에서 NK는 각각 63.4, 51.9%를 나타내었고 Lb. plantarum pnuK는 각각 77.1, 68.8%의 암세포 성장 저해율을 보였다. 따라서 starter 첨가 시 항산화 및 항암효과가 증가되며, 단일 starter 김치가 혼합 starter 김치보다 높은 기능성을 가지는 것으로 나타났다. 그중 새로 분리 동정된 Lb. plantarum pnu를 이용한 김치에서의 높은 대장암 세포 성장억제 효과를 확인하였다. Apoptosis 유도에 관련된 Bcl-2 및 Bax, 종양 억제에 관련된 p53 및 p21, 염증에 관련된 iNOS 및 COX-2 유전자 발현은 starter 첨가 김치에서 자연발효 김치보다 모두 apoptosis 유도 작용과 염증 및 종양을 억제하는 효과가 높게 나타났다. 가장 높은 효과를 보인 것은 Lb. plantarum pnuK이었으며 단일 starter 김치에서 혼합 starter 김치보다 효과가 높았다. 이상의 결과로 starter를 이용해 관능적 품질이 우수하고 기능성이 증진된 김치를 제조할 수 있을 것으로 기대된다. Fermentation characteristics and health functionalities of kimchi by inoculating kimchi lactic acid bacteria (LAB) starters were studied. We manufactured single LAB starter kimchi (Lactobacillus plantarum pnuK, Lactobacillus plantarum 3099K, Leuconostoc mesenteroides pnuK), mixed LAB starter kimchi (Lb. plantarum pnu/Leu. mesenteroides pnuK, Lb. plantarum 3099/Leu. mesenteroides pnuK) with inoculum size of 10<SUP>6</SUP> CFU/g, as well as naturally fermented kimchi (NK), and fermented them for 6 days at 15°C. The pH and acidity of the early phase of fermentation were not different, but kimchi with the starters showed rapid changes in the pH and acidity from 2 days of fermentation. As the fermentation progressed, the level of total aerobic bacteria and Lactobacillus sp. increased similarly with or without Lb. plantarum (LP) inoculation. However, the level of Leuconostoc sp. was high in kimchi inoculated with Leuconostoc sp. starter. In the sensory evaluation test, kimchi with starters received higher overall acceptability scores than those of NK; mixed starter added kimchi earned the highest score. In DPPH and hydroxyl radical scavenging activity, kimchi with the starters exhibited higher activity than that of NK. In the MTT assay of HCT-116 and HT-29 human colon cancer cells, NK showed inhibition rates of 63.4 and 51.9%, but LPpnuK achieved 77.1 and 68.8%, respectively. This study showed that inoculating starters in kimchi increased in vitro antioxidant and anticancer activities, and single starter (LP) added kimchi revealed higher functionality than the kimchi with mixed starter. Kimchis with the starters effectively up-regulated the gene expressions of the pro-apoptotic gene of Bax, but down-regulated Bcl-2. They promoted expressions of p53 and p21, and suppressed expressions of inflammation-related genes, iNOS and COX-2, compared with NK. Taken together, it is expected that using starters may help manufacture kimchi with improved sensory quality and health functionality.

복부 방선균증의 임상 양상 및 치료에 대한 반응

김지원 ( Ji Won Kim ),정지봉 ( Ji Bong Jeong ),정용진 ( Yong Jin Jung ),김병관 ( Byung Kwan Kim ),이국래 ( Kook Lae Lee ),유수종 ( Su Jong Yu ),김미나 ( Mi Na Kim ),김주성 ( Joo Sung Kim ),정현채 ( Hyun Chae Jung ),송인성 ( In Sun 대한장연구학회 2007 Intestinal Research Vol.5 No.2

Background/Aims: Abdominal actinomycosis is a rare entity and difficult to differentiate from a malignant neoplasm. A study of clinical features and therapeutic responses will contribute to the understanding of this disease. Methods: We analyzed the clinical features and therapeutic responses of 12 cases of abdominal actinomycosis from 1989 to 2007. Results: The male to female ratio of patients was 1:1, and the patients had a median age of 50 years (range 38-60 years). Abdominal pain was the most common symptom, and seven of twelve patients had a history of abdominal surgery, trauma, DM or IUD (intrauterine device) use. An abdominal CT examination revealed infiltrative lesions with disruption of the tissue plane in eight cases, and colonoscopic findings showed luminal stenosis, nodular lesions and ulceration in four cases. Surgical resection was performed in eleven cases with a right hemicolectomy with or without a salpingo-ooporectomy, a left hemicolectomy or mass excision. Of the eleven patients who underwent surgical resection, seven patients received intravenous penicillin G (10-15×106 U) followed by administration of oral antibiotics for a median 8 months (range 4-12 months) according to the presence of symptoms and signs. Conclusions: With combined adequate surgical resection and high-dose antibiotic therapy, the therapeutic responses are favorable in most of the abdominal actinomycosis patients. (Intest Res 2007;5:177-183)

플라보노이드 합성 유도체인 DA-6034가 인간 대장 점막 상피 세포주에서 Lipopolysaccharide 및 Tumor Necrosis Factor-α 자극에 의한 NF-κB의 활성화에 미치는 영향

김지원 ( Ji Won Kim ),정용진 ( Yong Jin Jung ),정지봉 ( Ji Bong Jeong ),김병관 ( Byeong Gwan Kim ),이국래 ( Kook Lae Lee ),김주성 ( Joo Sung Kim ),정현채 ( Hyun Chae Jung ),송인성 ( In Sung Song ) 대한장연구학회 2005 Intestinal Research Vol.3 No.1

목적: Nuclear factor κB (NF-κB)는 전염증성 사이토카인의 유전자 발현을 조절하는 전사인자로서, NF-κB를 억제함으로써 점막의 염증반응을 줄이려는 치료법들이 시도되고 있다. 쑥에서 추출한 flavonoid 성분인 eupatilin에 화학적으로 측쇄를 연결하여 만든 화합물인 DA-6034는 염증성 장질환의 동물모델에서 기존의 치료제인 sulfasalazine 및 스테로이드와 유사한 치료효과를 보인다고 보고된 바 있다. 이에 본 연구에서는 인간 대장 점막 세포주를 이용하여 DA-6034의 항염증 작용기전을 규명하고자 하였다. 대상 및 방법: HT-29 세포를 10μg/mL LPS 및 10 ng/mL TNF-α로 자극하였으며, DA-6034는 자극 전 1시간 동안 전처치를 시행하였다. 자극 후 NF-κB의 DNA 결합능은 핵 추출물을 이용한 electrophoretic mobility shift assay (EMSA)를 통하여 확인하였으며, 자극 후 inhibitory protein κB (IκB) 분해는 세포질 추출물을 이용하여 Western blot을 시행하여 확인하였다. 전염증성 사이토카인인 TNF-α와 키모카인인 IL-8의 mRNA 발현은 역전사 PCR 법으로 분석하였고, TNF-α 및 IL-8 단백질 생성은 ELISA법으로 확인 하였다. 결과: HT-29 세포를 LPS 및 TNF-α로 자극하였을 때, 두 자극 모두에 대하여 IκB가 분해되면서 NF-κB의 DNA 결합능이 증가하는 양상을 보였으나, DA-6034로 전처치를 한 경우 IκB의 분해가 억제되었으며 NF-κB의 DNA 결합능도 감소하였다. DA-6034로 전처치를 시행한 경우 LPS 자극에 의한 TNF-α의 mRNA 발현과 단백질 생성 및 TNF-α 자극에 의한 IL-8의 mRNA 발현과 단백질 생성이 억제되었다. 결론: DA-6034는 인간 대장 점막 상피 세포주에서 IκB 분해 억제를 통하여 NF-κB의 활성화를 억제함으로써 항염증 작용을 나타낼 것으로 생한된다. Background/Aims: The nuclear factor-κB (NF-κB) is associated with expression of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8). DA-6034, a derivative of flavonoid, has shown a potent anti-inflammatory effect in IBD animal model. The aim of this study was to characterize the anti-inflammatory activity of DA-6034 in terms of regulation of NF-κB. Methods: HT-29 cells were stimulated with lipopolysaccharide (LPS) or TNF-α alone or pretreated with DA-6034. The influence of DA-6034 on NF-κB DNA binding activity and inhibitory protein κB (IκB) activity was determined using an electrophoretic mobility shift assay (EMSA) and Western blot analysis. The RT-PCR method was used to determine the degree of gene expression of TNF-α and IL-8. Production of TNF-α and IL-8 protein was measured by ELISA. Results: DA-6034 prevented NF-κB activation stimulated with LPS and TNF-α and inhibited LPS- and TNF-α-induced IκB degradation. LPS-induced TNF-α mRNA expression and TNF-α-induced IL-8 mRNA expression were significantly decreased by DA-6034 pretreatment as compared to the absence of DA-6034 pretreatment. Conclusions: These results suggest that the inhibitory effect of DA-6034 on the production of TNF-α in LPS-stimulated and IL-8 in TNF-α-stimulated HT-29 cells may involve transcription regulation by suppression of NF-κB activation by interfering with IκB degradation. (Intest Res 2005; 3:38-47)

혈액투석 환자에서 Erythropoietin 의 피하주사와 저용량 Androgen 의 병용투여가 빈혈과 영양지표에 미치는 효과

서정철(Jeong Chul Seo),김혜영(Hye Young Kim),양용모(Yong Mo Yang),전원중(Won Joong Jeon),이현희(Hyun Hee Lee),이경수(Kyoung Soo Lee),정지봉(Ji Bong Jeong),엄재호(Jae Ho Earm),이기형(Ki Hyeong Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

Recombinant human erythropoietin(r-HuEPO)은 말기 신부전 환자의 빈혈 치료에 있어서 가장 효과적이고 중요한 치료제로 이용되고 있다. 하지만, 상당한 비용이 필요하기 때문에 r-HuEPO의 조혈효과를 향상시키는 방법들이 제시되고 있는데, 이 중 안드로겐(androgen)과 r-HuEPO의 병용투여는 효과 면에서 아직까지 논란이 있다. r-HuEPO 투여 후 단백질 대사와 운동 능력 및 영양지표의 향상이 보고되고 있으며, 강한 단백 동화작용이 있는 안드로겐의 병용 투여시 영양지표가 더 호전될 것으로 기대되지만, 이에 대한 연구는 아직 없었다. 이에 저자들은 혈액투석 환자에서 r-HuEPO 피하 단독투여와 저용량 안드로겐의 병용투여시 빈혈의 치료 및 영양지표의 변화를 비교하고자 전향적 연구를 시행하였다. 충복대학교병원에서 혈액투석을 받는 환자 중 혈색소치가 8.0g/dL 이하 또는 헤마토그리트치 24% 이하인 환자를 대상으로 A군 ( r-HuEPO 단독투여군, n=12)은 주 2회 r-HuEPO 2000단위를 피하주사하였고, B군(r-HuEPO/안드로겐 병용투여군, n=12)은 동일한 양의 r-HuEPO와 nandrolone decanoate 100mg을 2주 마다 근주하였다. 6개월 투여 전후의 혈액검사와 인체계측을 시행하여 다음과 같은 결과를 얻었다. 1) 성별, 연령, 체중, Kt/V, 체중 당 r-HuEPO 용량(A군:71.8U/자,B군: 74.9U/wk)은 양군 간에 차이가 없었으며, nandrolone decanoate 용량은 주당 0.9±0.1mg/kg이었다. 투여 전혈색소, 헤마토크리트, 혈청 저장철, 혈청 부갑상선호르몬, 비타민 B12 folate, transferrin saturation과 영양지표인 알부민, 콜레스테를, prealbumin, transferrin, 인체계측지표는 양군 간에 차이가 없었다. 2)투여 6개월 후 A군의 혈색소는 7.1±0.7g/dL 에서 8.5±1.3g/dL로, 헤마토크리트는 20.7±2.2%에서 26.0±3.8%(P<0.05)로 상승하였고, B군의 혈색소는 6.8±0.4g/dL 에서 9.4±1.4g/dL로 헤마토크리트는 21.5±3.5%에서 30.1±2.8%(p<0.05)로 상승하였다. 치료시작 후 4개월 이후부터 평균 헤마토크리트는 A군에 비하여 B군에서 유의하게 높았다(p<0.05). 치료 후 혈색소 10.0g/dL 이상 또는 헤마토크리트 30% 이상에 도달한 환자수는 A군에서 12명 중 4명(33.3%)이었고,B군에서는 12명 중 10명(83.3%)으로 차이가 있었다(p<0.05). 3) 투여 6개월 후 영양지표는 양군 간에 차이가 없었다. 4) 연구기간 동안 안드로겐 투여에 따른 부작용은 근주부위의 동통 1예, 부종 1예 이외에는 없었다. 이상의 결과로 혈액투석환자에서 r-HuEPO 피하주사 단독투여에 비하여 저용량 안드로겐의 병용투여가 빈혈의 개선에 효과적이었다. 따라서, 경제적인 이유로 실제적으로 필요한 용량보구 Recombinant human erythropoietin(r-HuEPO) is the mainstay of anemia therapy in patient with end stage renal disease(ESRD), but the use of r-HuEPO is primarily limited by its high cost. So, it encourages any strategies that potentially enhance the erythropoietic response. However, studies designed to assess whether androgens would enhance the response to r-HuEPO were inconclusive. While androgens may be less expensive and may improve several nutritional parameters, their potential adverse effects discourage usage. We carried out a prospective study to examine the effect of low-dose androgen in combination with subcutaneous r-HuEPO on anemia and nutritional paramenters in hemodialysis patients. Twenty-four hemodialysis patients with hematocrit <24% or hemoglobin <8.0g/dL were randomly assigned into two groups. Group A(n=12) received 2000U r-HuEPO subcutaneously twice a week for six months. Group B(n=12) received the same dose of r-HuEPO plus nandrolone decanoate 100mg intramuscularly biweekly. Anthropometry, albumin, cholesterol, prealbumin, and transferrin were measured as nutritional parameters. The groups showed no differences in baseline levels of the followings : Hemoglobin, hematocrit; transferrin saturation, serum ferritin; intact serum parathyroid hormon, Kt/V; vitamin Biz, folate; nutritional parameters. At the cornpletion of the study, both groups showed significant increase in hematocrit compared with baseline levels(group A 20.7±2.2M to 26.0±3.8%; group B: 21.5±3.5% to 30.1±2.8%). The mean hematocrit in group B was significantly higher than in group A after 4 month study period(p<0.05). Ten of 12 patients in group B achieved a target hematocrit of 30%, as compared with four of 12 patients in group A. Both groups didn't show significant changes in any nutritional parameters. No significant side effects of androgen were noted during this short-term study. We conclude that low-dose androgen in combination with subcutaneous r-HuEPO is effetive treatment on anemia in hemodialysis patients, but does not improve nutritional status.