정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

金文에 나타난 西周 군사력 구성과 왕권

沈載勳 중국사학회 2006 中國史硏究 Vol.41 No.-

란크릭 캅셀(플루옥세틴 20mg)에 대한 프로작 캅셀의 생물학적 동등성 시험

심상범,조요나,오한석,류재환,이경태,김남재,서성훈 경희대학교 동서의학연구소 2001 東西醫學硏究所 論文集 Vol.2000 No.-

Bioequivalence of two flouxetine capsule, ProzacR (Lilly kora Ltd.) and LanclicR (Samsung Pharm. IND. Co.), was evalated according to the guideline of KFDA. Twenty four healthy male volunteers (21-26 years old) were divided into two groups and a randomized 2×2 cross-over study was employed. After 60mg of fluoxetine was orally administered, blood was taken at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 24, 32, 48 and 72 hours after administration and just before administration. Plasma was analyzed for fluoxetine and internal standard (clomipramine) by a sensitive and validated HPLC assay. The pharmaco kinetic parameters (AUCt, Cmax and Tmax) wre calculated and ANOVA test was used for the statistical analysis of parameters. Differences in (AUCt, Cmax and Tmax between two capsules were -0.90, 3.46 and -14.08% respectively. All powers (1-β) for AUGt, Cmax and Tmax were more than 0.9. Detectable differences (Δ) and confidence interval were all less than ±20%. All the parameters above met the criteria of KFDA for bioequivalence and indicated that LanclicR capsules are bioequivalent to ProzacR capsules.

발레 그랑 쥬떼 동작의 운동학적 분석

심재희,임용규,우병훈 한국학교체육학회 2003 한국학교 체육학회지 Vol.13 No.2

본 연구의 목적은 발레에서 그랑 쥬떼(grand jete´) 동작을 3차원적 동작분석을 통하여 숙련자와 미숙련자 사이의 차이점을 운동학적인 변인으로 규명하는데 있으며, 또한 차이가 나타난 변인에 대한 원인을 분석하여 발레를 지도하는 데 있어서 과학적 자료를 제공하고자 한다. 연구결과에 기초하여 발레 그랑쥬떼 동작은 도약전에는 신체중심을 낮게 하고 오른쪽 발끝의 속도를 빠르게 하여 높은 신체중심으로 체공시간을 길게 하고 양다리를 최대로 신전하여 좌·우 대퇴각은 수직과 수평으로의 더 많은 공간과 힘을 이용하는 것이 효율적인 동작을 수행할 수 있는 결과로 사료된다. The purpose of this study is to analyze the movement of Grand Jete´ through the analysis of 3-dimensional movement, and to find out the difference between experts and the unskilled through kinematical cause. And the purpose is also to provide scientific source by analyzing the cause of its difference when teaching ballet. I come to the condusion below through the kinematical analysis in order to achieve this purpose of the study. 1. The time required means the time needed between each event. It takes the experts 0.361 second from E-3, which is from jumping to reaching the highest point, to E-4, which is a landing point, on the other hand, it takes the unskilled 0.252 second. It takes the longest time to stay in the air between E-3 and E-4. The total required time is 0.694 seconds in case of the experts, and 0.548seconds in case of the unskilled. Concerning the duration of staying in the air, the case of the former is longer than the one of the latter. There is the significant difference between the former and the latter (P<.05). 2. In case of experts, the displacement of the bodily center is 83.44±1.09% in E-3, and in case of the unskilled, 76.44±1.00%. Concerning the height of the bodily center, the case of the former is higher than the one of the latter. There is the significant difference between the former and the latter (P<.01). 3. The speed of the tiptoe to the right side is the top speed between E-3 and E4. The speed of experts in E-2 is 7.69±3.57m/s, and the one of the unskilled in E-2 is 9.51±0.99m/s. The speed of the former is remarkably reduced compared to the one of the latter. There is the significant difference between the former and the latter (P<.01). 4. In the case of the displacement in angle of the right and left ankle joints, temporary reduction of the angle of the experts right ankle in E-2 influences the vertical rise and the horizontal movement. There is the significant difference in E-4 (P<.05). 5. Concerning displacement in angle of the right and left coxae, the experts right coxa angle is 100.58±6.98°, and their left one is 108.92±3.58°. In case of the unskilled, the right coxa angle is 89.66±6.58°, and the left one is 130.33±5.49°. The unskilled need the power and flexibility of the femoral muscle of the left coxa. There is no significant difference between the former and the latter. Based on the result of the study, they should lower the bodily center before jumping and make the speed of the right tiptoe fast when they practice the movement of Grand Jete. And then using high bodily center, they have to prolong the time of staying in the air. Simultaneously, they should stretch both legs so that the right and left femoral ankle can use more space and power vertically and horizontally. Those series of movement can make them practice Grand Jete better.

WEL-TEN60 母材와 熔接材의 低溫 引張 및 衝擊特性에 關한 硏究

金載勳,沈奉植,邕章祐 忠南大學校 産業技術硏究所 1987 산업기술연구논문집 Vol.2 No.2

This study was aimed to determine tensile and impact properties of base and weld metals of WEL-TEN60 of temperatures from-70℃to 70℃. It is particularly important to assess tensile properties, absorbed energy change, lateral expension ratios and fracture appearance in order to prevent brittle fracture of this material at low temperatures. The obtained results were as follow: In case of base metal, the ultimate tensile strength, yield strength and elongation increase as the temperature decreases. The weld metal showed almost the same reactions as the base metal did. The fracture morphology of base and weld metals was that of dimple fracture at all temperature ranges. The dimple size got smaller as the temperature decreased. The fact that as the temperature increased, the absorbed energy increased seemed due to the increase of loading time. The curves of fibrous fracture, lateral expansion and absorbed energy kept almost the same shape. We came to conclusion that when we applied 15 ft-1b CVN temperature, the materials are safe from brittle fracture over-70℃.

지역사회획득 폐렴의 치료지침 권고안

송재훈,정기석,강문원,김도진,배현주,서지영,심태선,안중현,안철민,우준희,이남용,이동건,이미숙,이상무,이영선,이혁민,정두련,지역사회획득 폐렴 치료지침 제정위원회 대한감염학회 2009 감염과 화학요법 Vol.41 No.3

A successful therapy of community-acquired pneumonia requires appropriate empirical antimicrobial therapy. Etiology and antimicrobial susceptibility of major pathogens of pneumonia can differ by country. Therefore, an ideal treatment guideline of community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia in immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.

이득변조를 통한 모드-록 레이저 다이오우드의 광특성 연구

李鐘昌,沈載勳 弘益大學校 科學技術硏究所 1996 科學技術硏究論文集 Vol.7 No.2

In this paper the optical properties of the colliding pulse model-locked laser diodes have been investigated utilizing a realistic model of the time varing random noise source, photon density, carrier density, and optical gain. The random noise source was shown to be a key parameter in analyzing the rate equations. After initial time interval this random noise showed a reduced value. The optical gain had a negative value in the initial state and a periodic positive value by injecting current, hence the photon density and the electron density varied with the optical gain.

위그너 분포함수를 이용한 이중장벽 공명 투과다이오드의 전류-전압특성에 관한 연구

金裕承,金正勳,徐柾河,沈載勳 弘益大學校 科學技術硏究所 1996 科學技術硏究論文集 Vol.7 No.2

By means of the self consistent calculation of the related Poisson's equation and the Wigner distribution function, the quantum transport of electrons in a double barrier tunneling diode(DBRTD) has been studied. The computer simulation has been accomplished by assuming the contacts/terminals of a DBRTD are open with regard to the surrounding. The eigenvalues of the Liouville superoperator of the equation of motion were also calculated. The derived Ⅰ-Ⅴcharacteristic of a DBRTD shows a similar trend with the results obtained by the conventional tunneling models.

유효질량의 공간적 변화를 고려한 Wigner 함수 모형에 대한 연구

方誠晩,徐柾河,沈載勳 弘益大學校 科學技術硏究所 1998 科學技術硏究論文集 Vol.9 No.2

본 논문에서는 유효질량의 공간적 변화 형태를 구체화하여 Wigner 함수 모형을 개선하였다. 비국부적 형태의 운동에너지 연산자가 소거길이 이상의 영향을 포함하도록 하여 Liouville 방정식을 차분화하였다. 모의실험을 위한 차분화 모형은 밀도 연산자의 대각성분을 포함하도록 하였으며, 차분화 모형에 weighting 함수를 도입하여 유효질량의 공간적 변화 형태에 따른 영향을 고찰하였다. 공명투과 다이오드의 정상상태 전류-전압 특성을 계산한 결과, 유효질량의 공간적 변화는 공명투과에 의한 peak 전류에만 영향을 미치는 것으로 나타났다.

단일부위 경부 창상에 의한 다발성 뇌신경 손상 -증례 보고

박정미,김성훈,심재호 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.3