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주영실 대한임상노인의학회 2004 대한임상노인의학회지 Vol.5 No.1
1. 골관절염 환자의 치료에 있어서 가장 중요한 것은 환자 교육, 체중 조절, 적절한 운동이다. 2. 경구용 약물요법으로는 비스테로이드성 항염제(NSAIDs), COX-2 선택적 억제제(CSI; cyclooxygenase-2 specific inhibitors), 비마약성 진통제 및 마약성 진통제가 있고, 치료에 도움이 된다. 3. 관절강 내 주사제로는 부신피질호르몬제와 하이얄루론산이 있고 증상 완화에 도움이 된다. 4. 약물 투여에 의한 부작용을 최소화하기 위한 노력을 반드시 해야 한다. 5. 관절 구조 개선을 지향하는 약물의 개발(Pharmacologic structure-modifying interventions)을 위한 노력은 현재 진행 중이다.
류마티스관절 활막세포에서의 Receptor Activator of NF-kB Ling (RANKL)의 발현 및 파골세포 생성
주영실 ( Yeong Shil Joo ),정명아 ( Myeong A Cheong ),신동혁 ( Dong Hyuk Sheen ),임미경 ( Mi Kyoung Lim ),심승철 ( Seung Cheol Shim ),정덕환 ( Duke Whan Chung ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.4
Objective: A number of soluble factors which play important role in the pathophysiology of rheumatoid synovitis are also known to be involved in osteoclast differentiation and activation through RANKL (Receptor activator of NF-κB ligand). To investigate the importance of RANKL in the pathogenesis of bone erosion in rheumatoid arthritis (RA) patients, we analyzed the expression of RANKL and Osteoprotegerin (OPG) and examined the formation of osteoclasts in rheumatoid synovial fibroblasts under the influence of various osteotropic factors. Methods: Primary culture synoviocytes or fibroblast-like synoviocytes isolated from synovial tissues of 8 RA patients were cultured and treated with IL-1β (2 ng/ml), TNF-α(2 ng/ml), INF-γ (1000 /ml), IL-15 (10 ng/ml), IL-12 (10 ng/ml), dexamethasone (10(-9) M), PMA (10 ng/ml) or 1,25 (OH)2D3 (10(-9) M) for 18 hours. Expression RANKL or OPG mRNA was measured by semiquantitative RT-PCR within linear amplification condition. TRAP (+) MNC (tartrate resistant acid phosphatase-positive multinucleated cell) formation was induced from primary culture synoviocytes or in coculture system of synovial fibroblasts with PBMCs in the presence of M-CSF and 1,25 (OH)2D3. Results: 1. The intensity of base-line expression was different from patient to patient. Primary culture synoviocytes and synovial fibroblasts express RANKL and OPG mRNA with decreasing intensity when they are passaged. 2. Expresssion of RANKL mRNA was significantly increased by 1,25 (OH)2D3 and IL-1β (158.8±21% and 197.2±17% of controls, p<0.05 and p<0.005, respectively), while decreased significantly by dexamethasone (25.6±4.6% of controls, p<0.005). Expression of RANKL mRNA was significantly increased by IL-1β and decreased by dexamethasone, in a dose- and time-dependant manner. 3. TRAP (+) MNCs are formed from primary culture synoviocytes or in coculture system of synovial fibroblasts and PBMC in the presence of M-CSF and 1,25 (OH)2D3. Dexamethasone clearly inhibited TRAP (+) MNCs formation from synovial cells. Conclusion: The regulatory mechanism for the expression of RANKL or OPG in rheumatoid synoviocytes might be different from that in bone marrow cells. Modulating the expression of these molecules could have potential therapeutic implication targeting bone destruction in RA.
주영실 ( Yeong Shil Joo ),이신석 ( Shin Seok Lee ),김완욱 ( Wan Uk Kim ),민준기 ( Jun Ki Min ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),이상헌 ( Sang Heon Lee ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
Objectives: To assess the extent of generalized osteoporosis in Korean rheumatoid arthritis patients and evaluate the importance of disease activity, duration of disease, menopausal status, corticosteroid use and markers of bone metabolism. Methods: Bone mineral density was measured by dual energy x-ray absorptiometry (DEXA) at 3 locations in 134 rheumatoid arthritis patients, aged 21~80 (57 premenopausal and 66 postmenopausal patients). Markers of bone metabolism were measured and assessed in relation to the disease activity and corticosteroid use. Results: The mean age of the study population was 49 years and mean age of the menopause was 48.1±3.6 years. Decreased bone mineral density was observed at all 3 locations measured in the study population (Z-score -0.36, -0.14 and -0.66 for BMD of L-spine, femoral neck and femur Ward`s triangle respectively). Fifty nine percent of the patients showed osteopenia (T-score <-1) and 13.4% showed Tscore lower than -2.5. The best independent predictors of bone mass (stepweise multiple regression analysis) was body mass index, cortocosteroid use, and CRP in premenopausal patients and years post menopause, age, alkaline phosphatase and rheumatoid factor in postmenopausal patients. Urinary excretion of deoxypyridinoline was increased in both pre- and postmonopausal RA patients while serum osteocalcin level was normal in both groups. Deoxypyridinoline level was significantly correlated with CRP in premenopausal RA patients. Conclusion: Generalized osteoporosis is also prevalent in Korean rheumatoid arthritis patients. Bone metabolism appears to be uncoupled. Deoxypyridinoline correlated best with CRP and thus can provide a rational approach for selecting and treating patients with RA to reduce the risk of osteoporotic fracture.
동맥혈 칼슘 자극 검사로 진단된 국소성 췌도 세포 증식증 1예
윤진훈,안규정,주영실,김병준,김성훈,권계형,정명아,양진수,정인수,김충현,조성범,이태석,김은경 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4
We report a 40-year-old female patient with clinical findings suggestive of insulinoma. Although imaging studies did not reveal any tumors in the pancreas, a selective arterial calcium stimulation test (SACI), procedurally simpler and more effective than transhepatic pancreatic venous sampling, was performed. And then near total pancreatectomy was carried out because the possibility of small insulinoma could not be completely excluded. Grossly, the surgically removed pancreas did not reveal any tumors. However, the pancreas exhibited islets cell hyperplasia. To our knowledge, this is the first reported authentic case in a Korean adult of islet-cell hyperplasia diagnosed by selective arterial calcium stimulation test