정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

연구논문 : 북한 미디어에 나타난 기후변화 프레임: 로동신문과 민주조선을 중심으로

박미선 ( Mi Sun Park ),윤여창 ( Yeo Chang Youn ),이효원 ( Hyo Won Lee ) 한국환경정책학회 2013 環境政策 Vol.21 No.4

Media define and interpret problems and recommend the treatment to them in environmental communication. This function of media is named as ``framing``. This paper aims to investigate how the issue of climate change as a global environmental issue has been communicated at the nationalmedia, using the theory ofmedia frame. In particular it focused on the case of North Korea. For media analysis, ‘Rodong Shinmun’ and ‘MinjuChosun’ as twomajor newspaperswere selected. The articles carrying terms of ‘climate change’ and ‘global warming’ in the title of articles were selected from1990 to 2012. The published data, places of events, cited speakers, different interest groups as victims, causers and problem solvers were coded and analyzed. Consequently the research results show four features of media frames on climate change in the North Korea. Frist, the selected articles includedmore foreign events and phenomena than the domestic. Second, governmental agencies, politicians, international organizations and scientists were represented as major speakers in the selected articles. In particular, instructions by Kim Il Sung and Kim Jong Il occupied the half of the statements by domestic speakers. Third, the diagnostic frame with description of victims and causers was dominant in the selected articles. Since 2007 the prognostic frame with representation of problem solvers was distinctly formed. Fourth, Rhodong Shinmun represented more various voices of the actors and interest groups as victims, causers and helpers to the problemof climate change thanMinju Chosun.

고혈당증과 신적출 후 신증의 실험적 흰쥐 모형에서 신사구체의 형태계측학적 연구 - 사구체 경화증의 발달 과정과 기전에 관한 연구 -

심영웅 ( Young Woong Shim ),설미영 ( Mee Young Sol ),이경민 ( Kyeong Min Lee ),최경운 ( Kyung Un Choi ),김지연 ( Jee Yeon Kim ),이진숙 ( Jin Sook Lee ),박도윤 ( Do Youn Park ),이창훈 ( Chang Hoon Lee ),서강석 ( Kang Suek Suh ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

목적 : 당뇨병의 가장 흔한 합병증의 당뇨병성 신중에서 현저한 조직 변화인 사구체의 섬유화와 이와 유사한 조직 소견을 보이는 다른 질병들과의 관련성 및 섬유화 기전의 기전의 일단을 밝히기 위하여 연구를 시행하였다. 방 법 : 당뇨병성 신증과 신 조직 일부 소실 후 발생하는 신 적출 후 신증, 생리적 노령화로 인한 사구체 섬유화 등에서 섬유화가 일어나는 시기와 부위, 섬유화의 정도와 시간 경과에 따른 변화 등을 조사하기 위하여 실험 동물 모형을 이용하여 형태계측학적 연구를 하였다. 수컷 Sprague-Dowley (이하 S-D) 흰쥐에 streptozotocin을 꼬리 정맥으로 투여하여 당뇨병성 신증 모델을 만들고, S-D 백서의 우측 신장을 절제하여 과여과 모형을 만들었다. 시술 후 일정 기간이 지난 후 시기별로 희생시켜 Sirius red 염색 표본을 만들어 시구체 단면적과 실질의 섬유화 정도를 측정하고, 전자현미경으로 얻은 사구체 소견에서 메산지움 기질의 면적, 사구체 기저막의 두께, 근위우곡세뇨관 기저막의 두께 등을 조사하였다. 이들에서 질병 시기에 따른 변화, 두 실험군 사이의 차이, 정상 대조군 및 생리적 노화 대조군과의 차이 등을 분석하였다. 결 과 : 당뇨병성 신증 모델에서 사구체 단면적은 실험8주 이후 24주까지 전 예에서 정상 대조군에 비해 크기가 의의있게 증가하였고 신 실질과 사구체 내의 섬유화는 실험 2주 째부터 대조군에 비해 의의있는 교원질 양의 증가가 있었다. 사구체 기저막은 streptozotocin 투여 1주에 희생시킨 군에서도 의의있는 두께의 증가가 있었고, 세뇨관 기저막도 3주에 측정한 군에서부터 현저한 두께의 증가가 있었다. 우측신 절제를 시행한 모형에서 사구체 평면적은 실험 7주군에서 커진 소견이 나타났고 16주 이후의 군대에서는 현저한 크기의 증가 소견이 있었다. 신실질과 사구체의 교원질 염색 소견에서 2주 이후 전 기간에 걸쳐 교원질 양의 증가가 있었고, 사구체 기저막과 세뇨관 기저막 두께는 술 후 2주에 희생시킨 군부터 두께가 의의있게 증가하였다. 생리적 노화과정을 거친 군에서도 사구체의 섬유화가 나타났는데 당뇨병 모형과 신적출 모형에 비해 그 정도는 덜하였다. 당뇨병 모형과 신적출 모형 사이의 사구체 조직 변화는 실험 기간이 긴 군들에서 사구체 평면적의 크기, 교원질 양의 증가, GBM과 TBM의 두께 등이 두 군 모두 현저한 증가를 보였고 신적출 모형에서 실험 최종 기간이 같지 않아 실험 수치의 비교가 의미가 없을 것으로 생각된다. 결 론 : 이상의 성적에 의거하면 신사구체와 간질의 섬유화, GBM과 TBM의 두께 증가는 당뇨병성 신증만의 특징적인 조직 변화는 아니고 신 실질 일부 소실이 일어나는 사구체 질환에서 공통적으로 일어나는 소견이다. 그러므로 본 연구의 대상이 된 당뇨병성 신중, 신적출 후 신증, 그리고 생리적 노화 과정 등에서 공통적으로 나타나는 사구체 모세관의 혈역동학적 변화가 사구체의 섬유화에 병인기전을 밝히는데 중요한 요소가 될 것으로 사료된다. Objective :Diabetic nephropathy and ablation nephropathy are characterized by sclerotic processes in the glomeruli. To elucidate the site, degree and time-honored changes of glomerular sclerosis, morphometric analysis was performed using the experimental animals models. Methods : The animals used were male Sprague-Dowley rats and separated into 4 groups as young mormal control, old control, streptozotocin-injected group, and right nephrectornized group. Chronologically kidney specimens were obtained after each treatment and processed to evaluated histologic changes. To evaluated the glomerular area, interstitial fibrosis and glomerular tuft fibrosis, the kidney specimens were fixed in Buin`s solution, paraffin-embedded and 2 ㎛ sections were Sirius red stained. To study the mesangial area, mesangial matrix area, glomerular basement membrane, and tubular basement membrane, the specimens were fixed in 2,5% glutaraldehyde, epon-embedded, double-stained and examined under the transmission electron microscope. All the specimens were analyzed morphometrically using the Image Pro Plus software. The obtained morphometric data were statistically analyzed to evaluate the differences of fibrotic processes and degree between experimental groups. Results : Diabetic group revealed statistically significant increase of glomerular area from 8th week after streptozotocin injection to 24th week of experimental date. The parenchymal fibrosis and glomerular tuft fibrosis was prominent from the 2nd week of injection and steadily increased until the end of experimental date. The thickness of glomerular basement membrane was significantly increased even at the first week of injection and the tubular basement membrane also increased in thickness at the 3rd week of experiment. Ablation nephropathy model made by right nephrectomy showed increased glomerular area at the 7th week of ablation and the degree were intensified after 16th week of experimental date. The amount of stainable collagen in the renal parenchyme and glomerular tuft increased in the second week kidney sample and steadily increased thereafter until the end of experimental date. The increase of thickness of GBM and TBM also started to appear at the second week of operation. The old control also revealed fibrosis but the degree was less than the diabetic and ablation groups. Both diabetic and ablation nephropathy groups exhibited extensive increase of glomerular area, stainable collagen, thickness of GBM and TBM at the end of experimental date and the ablation group revealed more extensive evidences of fibrosis without statistical significance. Comparison between the experimental groups were meaningless because the duration of the experimental manipulation was not the same. Conclusion: Glomerular and renal interstitial sclerosis and thickening of GBM and TBM are not the specific lesions of the diabetic glomerulopathy and are the common histologic changes occur in the kidney of partial parenchymal loss of any etiology. And it is suggested by this study that the common hemodynamic change involving the diabetic nephropathy, ablation nephropathy and physiologic aging is one of the important pathogenetic factors of glomerular sclerosis.

무증상 갑상선기능저하증 환자에서 Thyroxine 치료에 따른 혈청 지질 및 아포지단백의 변화

조보연,신찬수,김원배,고창순,김성연,박혜영,박건상,이홍규,박형규,김숙경 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.1

Background: Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies(J Kor Soc Endocrinol 11:41-51, 1996).

Graves 병 환자에서 항갑상선제 투여에 의한 TSH 수용체 항체의 변동에 관한 연구 : 치료 용량 및 기간에 따른 차이 및 임상상과의 관계 its relation to dose and duration of treatment~and clinical features

이문호,조보연,문대혁,고창순,민헌기,서교일 대한내과학회 1986 대한내과학회지 Vol.30 No.3

We undertook a prospective study of 59 patients with Graves' disease in order to clarify the influence of antithyroid drug on the immunological indices and to determine the association of the changes of TSH receptor antibodies activities with drug dosage, duration of treatment and clinical features according to mode of antitbyroid drugs treatment. Patients were divided into two groups. High dose group included 28 patients and conventional dose group 31 patients. We measured TBII activities, antimicrosomal antibodies, and the size of goiter every 3 months, comparing them with clinical features and laboratory findings. TBII activities declined from R months until 9 months following drug treatment. Therafter no significant change of TBII activities were observed. Antimicrosomal antibodies showed the same pattern of change. There was no statistically significant difference of declining rate of TBII activities, antimicrosomal antibodies, and reduction of size of thyroid between two treatment groups. TBII activities fell into normal range in 15 patients among those 44 patients who had been followed for more than 9 months (8 high dose group, 7 conventional dose group). In those 15 patients, TBII activities and frequency of exophthalmos were less than those whose TBII activity did not normalized. We conclude that TSH receptor antibodies activities and antithyroid autoantibodies are diminished by antithyroid drug treatment in patients with Graves disease and there is no relationship between dose of drug and declining of TBII activities. We suggest that changing levels of TBII activities might be secondary phenomenon which can be achieved by control of thyroid function by antithyroid drug rather than direct immunosuppressive effect of antithyroid drug per se.

Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats

Choi, Chang Won,Lee, Juyoung,Oh, Joo Youn,Lee, Seung Hyun,Lee, Hyun Ju,Kim, Beyong Il Nature Publishing Group 2016 Pediatric research Vol.79 No.2

<P><B>Background:</B></P><P>Prenatal or postnatal systemic inflammation can contribute to the development of bronchopulmonary dysplasia (BPD). We investigated whether prenatal intra-amniotic (i.a.) inflammation or early postnatal systemic inflammation can induce BPD in a rat model.</P><P><B>Methods:</B></P><P>One microgram of lipopolysaccharide (LPS) or vehicle was injected into the amniotic sacs 2 d before delivery (E20). After birth, 0.25 mg/kg of LPS or vehicle was injected into the peritoneum of pups on postnatal day (P)1, P3, and P5. On P7 and P14, peripheral blood (PB), bronchoalveolar lavage fluid (BALF), and lung tissue were obtained and analyzed.</P><P><B>Results:</B></P><P>Postnatal i.p. injections of LPS significantly increased neutrophil counts in PB and BALF on P7 and P14. Similarly, proinflammatory cytokine and angiogenic factor transcript levels were increased in the lung by i.p. LPS on P7. Alveolar and pulmonary vascular development was markedly disrupted by i.p. LPS on P14. However, pretreatment with i.a. LPS significantly negated the detrimental effects of postnatal i.p. LPS on PB and BALF neutrophil counts and on lung proinflammatory cytokine expression and histopathological changes.</P><P><B>Conclusion:</B></P><P>Exposure to early postnatal systemic LPS induces BPD, an arrest in alveolarization, in neonatal rats. Preceding exposure to i.a. LPS protects the lungs against BPD triggered by postnatal systemic inflammation.</P>

소아에서 발생한 요추 추간판 탈출증

정창훈(Chang Hoon Jeong),이기행(Kee Haeng Lee),김윤수(Youn Soo Kim),문찬웅(Chan Woong Moon),박일중(Il Jung Park),정상룡(Sang Lyong Jung),김형민(Hyoung Min Kim) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.2

요추 추간판 탈출증은 추간판의 퇴행성 변화가 있는 30-40대에 흔하게 발생한다. 그러나, 추간판의 퇴행성 변화가 없는 소아(12세 이하)에서는 매우 드물며 그 임상증상 및 치료 방법 역시 성인과 차이가 있다. 저자들은 소아에서 발생한 요추 추간판 탈출증 5예를 경험하였기에 이에 대해 분석, 보고하는 바이다. Lumbar intervertebal disc herniation is common in the fourth to fifth decades because the intervertebral disc undergoes degenerative change. However juvenile lumbar intervertebal disc herniation (under 12 years old) is rare because there is no degenerative change, and the clinical symptoms and treatments are different from those of adults. Herein, our experience of five juvenile lumbar intervertebal disc herniation cases are analyzed and reported.

긍정심리자본이 종업원 인게이지먼트와 이직의도에 미치는 영향

이윤성(Lee, Youn-Sung),장영철(Chang, Young-Chul),정병헌(Chung, Byung-Heon),김진욱(Kim, Jin-Wook)0 글로벌경영학회 2014 글로벌경영학회지 Vol.11 No.2

오늘날 기업들은 다양한 변화 속에서 지속적인 성장을 위해서 부단한 노력을 기울이고 있다. 특히 인적 자원의 효과적인 관리가 조직의 성장의 중심에 있기 때문에 조직구성원 자신이 속해있는 조직과 자신의 직무에 몰입을 할 수 있는 환경을 만들어 가는 것에 대한 연구를 진행하였다. 이로 인하여 조직구성원들의 이직을 방지하여 인적자원 개발에 투자되는 시간과 비용을 절감할 수 있는 방법에 대한 방안이 도출 될 수 있을 것이다. 본 논문에서는 긍정심리자본의 하위요인 가운데 종업원 인게이지먼트(조직몰입과 직무몰입)에 영향을 주어 이직의도를 낮추는 요인이 무엇인가를 검증하였다. 긍정심리자본은 경제적 자본, 인적 자본, 그리고 사회적 자본을 넘어선 하나의 자본 개념이다. 최근 긍정심리자본과 직무성과 관련 연구가 많이 이루어지고 있는데, 긍정심리자본은 직무성과의 선행요인으로 직무성과에 긍정적 영향을 주는 것으로 보고되고 있다. 본 연구의 결과, 긍정심리자본의 4가지 요인 중 희망과 복원력이 조직몰입 및 직무몰입에 정(+)의 영향을 주는 것으로 나타났다. 또한 이직의도를 낮추는 긍정심리자본의 요인으로도 희망과 복원력이 중요한 영향을 미치는 것으로 연구되었다. 이는 목표를 향해 에너지를 집중하는 긍정적인 동기적 상태인 희망과 위험한 상황 또는 역경에 직면했을 때 긍정적으로 상황에 대처하고 적응하는 특성인 복원력이 종업원의 직무 및 조직 몰입을 높이고 이직의도을 낮추는 데 의미있는 요인으로 작용하는 것을 알 수 있다. Companies these days make ceaseless efforts to continue their sustainable growth in the midst of diverse and turbulent changes. It is not too much to say that at the core of organizational growth lies efficient management of human resources. It is very much important to create an environment where each and every member of the organization can be fully engaged in his/her job and organization, which is a key to preventing turnover of members and, in turn, saving time and cost for development of human resources. This paper validates which factor of the positive psychological capital influences employees’ engagement (organizational engagement and job commitment) so as to lower down the intention to quit. This paper shows that hope and resilience among the four factors of the positive psychological capital positively influence organizational engagement as well as job commitment. Hope and resilience are also found out to play an important role in reducing the intention to quit. This can be translated into that hope, a state of being positively motivated to focus one’s energy toward the goal and resilience, capacity to sustain and bounce back when beset by adversity and risky situations, play a meaningful role to enhance organizational and job commitment of employees as well as to reduce the intention to quit.

신장 ; 혈액투석에서 투석액 칼슘농도와 칼시트리올이 골대사에 미치는 영향

염지연 ( Ji Youn Youm ),김현철 ( Hyun Chul Kim ),이영철 ( Young Chul Lee ),최종욱 ( Jong Wook Choi ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

목적: 현재 혈액투석에 사용 중인 투석액 칼슘 농도는 1.25mmol/L, 1.5 mmol/L, 1.75 mmol/L로 구분된다. 고칼슘 투석액은 부갑상선호르몬의 분비를 억제시키는 효과가 있으나 고칼슘혈증 위험을 증가시키고, 저칼슘 투석액은 adynamic bone disease을 개선시키는 효과가 있으나 칼슘 평형을 악화시킬 우려가 있으므로 투석액 칼슘 농도의 적절한 선택은 쉽지 않다. 저자들은 표준칼슘 농도인 1.5 mmol/L 투석액을 사용하였을 때 칼시트리올 용량 변화와 아울러 요독성 골질환에 미치는 효과를 평가하고자 하였다. 방법: 투석액 칼슘 농도 1.75 mmol/L로 1년 이상 혈액투석 중인 환자 36명에서 투석액 칼슘 농도를 1.5 mmol/L로 전환 후 1년간 경과를 추적하였다. 투석액 칼슘 농도를 낮추기3개월 전에 측정한 혈청 iPTH 농도에 따라 환자를 1군(iPTH< 150 pg/mL, n=21), 2군(iPTH 150-300 pg/mL, n=7), 3군(iPTH>300 pg/mL, n=8)으로 구분하여 혈청 칼슘, 인, 알칼리포스파타제, iPTH 농도를 3개월 간격으로 측정하였고, 인결합제 및 칼시트리올 용량 변화를 조사하였다. 결과: 투석액 칼슘 농도 1.75 mmol/L 사용 중 1군, 2군 및 3군의 iPTH 농도는 각각 57±48 pg/mL, 191±46 pg/mL, 589±200 pg/mL로 유의한 차이가 있었다(p<0.001). 투석액칼슘 농도를 1.5 mmol/L로 전환 후 1군에서 혈청 iPTH가 12개월에 걸쳐 유의하게 증가하였다(p=0.01). 3개월째부터 증가가 현저하여(57±48 vs. 287±266 pg/mL, p<0.01) 이후증가세를 유지하였다. 그러나 2군에서는 유의한 변화가 없었고, 3군의 혈청 iPTH는 12개월에 걸쳐 유의하게 감소하였는데(p=0.02) 특히 9개월째 감소가 기저치에 비해 낮았다(589±200 vs. 242±246 pg/mL, p<0.01). 혈청 알칼리포스파타제도 혈청 iPTH와 유사한 변화 양상을 보였다. 투석액칼슘 농도를 1.5 mmol/L로 전환한 후 1군과 2군에서 인결합제와 칼시트리올 투여 용량의 유의한 변화는 없었으나, 3군에서 칼시트리올 용량이 6개월째부터 유의하게 증가하였고 (4.4±5.1 vs. 9.6±2.9 μg/month, p<0.05) 나머지 기간 동안증가 추세를 유지하였다. 결론: 혈액투석액 칼슘 농도를 1.75 mmol/L에서 1.5 mmol/L으로 전환한 후 적절한 인결합제와 칼시트리올 투여 용량을 조정하면서 adynamic bone disease와 이차성 부갑상선항진증환자에서 혈청 iPTH 측정치가 호전되는 경향을 보였다. 신성골형성장애가 있는 혈액투석 환자에서 투석액 칼슘 농도 1.5 mmol/L를 선택하는 것이 효과적일 수 있다. Background/Aims: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. Methods: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH<150 pg/mL, n=21; group 2, iPTH 150-300 pg/mL, n=7; group 3, iPTH>300 pg/mL, n=8). Data were collected at 3-month intervals for 1 year. Results: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca × P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p=0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p=0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p=0.001). Conclusions: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately. (Korean J Med 2011;81:751-758)

Characterization of changes in global gene expression in the brain of neuron-specific enolase/human Tau23 transgenic mice in response to overexpression of Tau protein.

Woo, Jong-Min,Park, So Jung,Kang, Ho Il,Kim, Byoung Guk,Shim, Sun Bo,Jee, Seung Wan,Lee, Su Hae,Sin, Ji Soon,Bae, Chang Joon,Jang, Mee Kyung,Cho, Chunghee,Hwang, Dae Youn,Kim, Chuel Kyu D.A. Spandidos 2010 INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE Vol.25 No.5

<P>Tau is a neuronal phosphoprotein responsible for the formation of the neurofibrillary tangles in Alzheimer's disease. To characterize the changes in global gene expression in the brain of transgenic mice that overexpress human Tau23 protein in response to the increase of Tau23 phosphorylation, total RNA extracted from the hippocampus of 12-month-old transgenic and wild-type mice was converted to cDNA, labeled with biotin and hybridized to oligonucleotide microarrays. The microarray results were confirmed by real-time RT-PCR and Western blotting method. It was determined that 43 genes were up-regulated and 8 genes were down-regulated by Tau23 in transgenic mice compared to controls, based on the arbitrary difference in the 2-fold change. Among the up-regulated transcripts, those encoding for transporter and oxidoreductase were dramatically over-represented, followed by those related to regulatory molecule, cytoskeletal protein, signaling molecule, and extracellular matrix protein. Genes encoding for transcription factor, regulatory molecule, miscellaneous function, and chaperone were significantly reduced in the down-regulated group. The major genes in the up-regulated categories included Ecrg4, Folr1, Defb11, Aqp1 and Soctdc1. The major genes in the down-regulated categories were Ncor1, Gpm6a, and Hspd1. These results indicate that the microarray analysis identifies several gene functional groups and individual genes that respond to a sustained increase in Tau23 phosphorylation levels in the brain of transgenic mice. In addition, the results suggest the microarray test is a useful tool for increased understanding of the role of Tau23 protein in regulating neurodegenerative disorders.</P>