항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

비화농성 삼출성 복수를 동반하는 질환에서 복막 침생검의 진단적 의의

정종훈,서용태,오덕환,채종구,정춘해,조건국 朝鮮大學校 附設 醫學硏究所 1986 The Medical Journal of Chosun University Vol.11 No.1

Percutaneous needle biopsies of peritoneum with Abrams needle and Cope needle were done un 64 patients with non-purulent exudative ascites, who was admitted to the department of internal medicine, Chosun University hospital, from January 1978 to Deccmber 1983. The diagnostic significance and safety of the needle biopsy was estimated. The results were as follows. 1. Adequate peritoneal tissue for pathological diagnosis was obtained in 53 cases(82.8%) among 64 cases. (Abrams needle 84.8%, Cope needle 80.6%) 2. Definitive diagnosis was obtained in 31 cases among 53 cases (58.6%). (Tuberculosis 23 cases, malignancy 8 cases). 3. As compared final diagnosis with biopsy result, the rate of final diagnosis corresponding with biopsy diagnosis was 58.8% in tuberculosis and 26.3%, in malignancy, but the rate of biopsy diagnosis corresponding with final diagnosis was 100% in both tuberculosis and malignancy. 4. Cases of chronic non-specific inflammation which were diagnosed by biopsy were 13cases(24.5%)among 53 cases, and among these cases, tuberculosis was 69.2% and malignancy 30.8% on final diagnosis and among 53 cases, histologically normal was 9 cases(16.9%) of which 33.3% was tuberculosis and 66.7% was malignancy on final diagnosis. 5. Of the malignant cases on final diagnosis, Positive cytologic examination of ascitic fluid was 16.7% 6. Primary losions of cancerous peritonitis were stomach cancer (38.9%) hepatocellular cancer(22.2%) colon cancer (11.1%) ovarian cancer (11.1%) Pancreatic cancer (5.6%). 7. Complication of percutaneous peritoneal biopsy was local swelling with leakage of ascitic fluid and the accident rate were 36.4,% in Abraham needle and 3.2% in Cope needle.

VCM을 이용한 마이크로 조립용 6자유도 정밀 정렬 장치의 설계

유용환,이수훈,송준엽,이창우,하태호,김정재,이문구 한국공작기계학회 2009 한국공작기계학회 춘계학술대회논문집 Vol.2009 No.-

This work will develop a 6-DOF precision aligner with small size and high resolution for assembling the micro parts for a mobile electronics. Here, VCM actuator that is precise and reliable will be applied to this aligner system. Arrangement of actuators will be a symmetrical based on kinematic design. This paper presents combining two modules of mechanism for the 6-DOF precision aligner. The first is a stage which can control XYθ_(z) motion, and the second can control Z motion, in other words, Z tilt motion. According to its specifications, it is expected to satisfy requirement of precision. Test of the first stage was presented to show the resolution and parasitic motion. For the test, PID algorithm was applied for feed-back control system.

자동차차체 및 부품제조업 산업장의 작업환경실태에 관한 조사 연구

서준호,문덕환,김정호,이채관,황용식,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: For the purpose of preparing the fundamental data and control the working environment and assessing the status of working environmental in manufacturing industry of bodies for motor car and of parts. Methods and Materials: Accessories for motor car and its engines the auther measured the noise level, concentration of dust, heavymetals, organic solvents, chemicals to 99 industries(24 working processes) form Feb. 2000 to Oec. 2000. Results: The results were as follows : 1. Mean noise level cutting, grinding, pressing, foundries and shot-blast was exceeded to threshold limit value(TLV) of noise. 2. Mean concentration of total dust was not exceeded to TLV. 3. Mean concentration of Mn in welding process and Pb in drying, welding, fabricating, rolling was exceeded to TLV. 4. Mean concentration for chemicals and organic solvents were not exceeded to TLV. 5. Mean concentration of dust and heavymetals were statistical significant difference between with local ventilation system and without local ventilation system. Conclusion: Above results, author suggest to prepare more passively control to working environment where exceeded the TLV.

단백뇨를 보이는 사구체 질환 및 당뇨병성 신병증에서의 Lp(a)

권태환,김준홍,조성,김석재,김용림,조동규,백미영 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

Background: Recently there has been evidences that serum Lp(a), an independent risk factor to atherosclerotic cardiovascular diseases, were increased in proteinuric disorders such as nephrotic syndrome and diabetic nephropathy. Methods: We intended to search of altered concentrations of Lp(a) in proteinuric disorder measuring serum Lp(a) concentrations with ELISA in 44 glomerulonephritic patients(25 nephrotic syndrome(NS), 19 non-nephrotic range proteinuric glomerulonephritis(GN), 25 diabetic nephropathy patients(DN), and 31 healthy controls(HC). Also, we compared Lp(a) concentration between glomerulonephritis patients and diabetic nephropathy patients with proteinuria of similar degree. Results: 1) There were significantly increased levels of total choesterol, triglyceride, and LDL-cholesterol in Ns compared to GN, DN, HC. 2) There were significantly increased concentrations of serum Lp(a) in NS compared to HC, but no signiicant difference in serum Lp(a) among NS, GN, and DN. 3) There was no significant difference in serum Lp(a) concentrations between NS & DN with 24 hour urine protein greater than 3.0g. 4) There was no significant difference in serum Lp(a) concentration between GN with 24 hour urine protein greater than 0.5g and less than 1.5g and DN with proteinuria of simial degree. 5) In glomerulonephritis patients, there was negative correlation between serum Lp(a) concentration and serum albumin level but correlation with 24 hour urinary protein, total cholesterol, Ldl-cholesterol, and HDL-cholesterol was not shown. In diabetic nephropathy, there was no significant correlation among serum Lp(a) concentration and all parameters including serum albumin, 24 hour urinary protein, and other lipid profiles. Conclusion: The present study confirmed that patients with nephrotic syndrome of diverse etiologies have makedly increased plasma level of Lp(a), in conjunction with other lipid abnormalities. However, this study shows no difference in Lp(a) concentrations between diabetic nephropathy and glomerulonephritis with similar degree of proteinuria.

냉동 제대혈 세포의 체외 증폭

김삼용,김철희,배광봉,김현수,박상준,김종숙,윤환중,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background : Cord blood(CB), which has no HLA restriction, is an alternative to bone marrow for hematopoietic stem cell transplantation. The use of cord blood, however, is limited by the number of progenitor/stem cells necessary to reconstitute the older child or adult. Therefore, ex vivo expansion of CB could have tremendous impact on diverse clinical settings. We studied the ex vivo expansion of isolated population of CD34_(+) cells from cryopreserved CB cells. Methods : CD34 cells were isolated from cryopreserved CB mononuclear cells. Purified cells were cultured with various combinations of hematopoietic growth factors including erythropoietin(EPO), stem cell factor(SCF), granulocyte-colony-stimulating factor(G-CSF), gra-nulocyte, macrophage-colony-stimulating factor(GM-CSF), interleukin-1β(IL-1β), 1L-3, and IL-6. After 7, 10 or 14 days of culture, the fold increases of colony-forming unit- granu-locyte, macrophage(CFU-GM), burst-forming unit-erythroid(BFU-E), colony-forming unit-mix (CFU-Mix), and high proliferative potential colony-forming cell(HPP-CFC) were evaluated. Results : Ten-day culture with the combination of EPO, SCF, G-CSF, IL-1β, and IL-3 resulted in a median of 60-fold increase of CFU-GM, which was greater than those with the combinations of less than 5 growth factors. The addition of IL-6 or GM-CSF to this combination did not enhance CFU-GM expansion. Ten-day culture was significantly superior to 7-day culture for CFU-GM expansion. Prolongation of culture to 14 days, however, revealed decreased expansion of CFU-GM compared to 10 days. BFU-E and CFU-Mix were expanded to 2~5 folds in 7-day culture with the combination of EPO, SCF, and G-CSF. Further expansion was not achieved in 10-day culture and colonies disappeared in 14-day culture. HPP-CFC was expanded to a median of 7.5 folds in 7-day culture with the combination of EPO, SCF, G-CSF, IL-1β, IL-3, and IL-6. Neither 10-day or 14 day-culture enhanced expansion of HPP-CFU. Conclusion : Cryopreserved cord blood cells maintain ex vivo expansion potential. In our system, 10-day culture with the combination consisting of EPO, SCF, G-CSF, IL-1β, and IL-3 seems to be adequate for hematopoietic progenitor/stem cell expansion from cryopreserved cord blood cells.

비납솔더를 이용한 솔더접합부의 신뢰성에 관한 연구

하범용,이준환,윤준호,신영의 중앙대학교 기술과학연구소 2000 기술과학연구소 논문집 Vol.30 No.-

본 연구에선 실제적으로 전자 제품에 사용되고 있는 패키지(QFP : 피치간격 0.8mm, TSOP : 피치간격 0.4mm)를 사용하여 Sn/Ag 공정 솔더 페이스트를 사용하여 온도 조건에 따른 솔더 접합부의 초기 접합 강도를 45°Peel test를 통해 측정하였으며, Aging시간을 변수로 하여 솔더와 구리 합금 사이에서 생성되는 IMC층의 두께를 측정, 분석하여 Sn/Pb 공정 솔더 페이스트를 사용했을 경우와 비교, 검토하였다. 실험결과로부터 비납솔더인 Sn/Ag 공정 솔더를 사용하여 접합부의 품질 및 장기신뢰성(고온유지) 측면에서 만족할만한 결과를 얻었으며, Sn/Pb 공정솔더의 대체 재료 가능성을 실험을 통하여 입증하였다. As solder joint become small and fine, the reliability and solderability of solder joint is the critical issue in present electronic packaging industry. Besides the use of lead(Pb) containing solders for the interconnections of microelectronic subsytem assembly and packaging has enviromental issue. In this study, using Sn/Pb and Sn/Ag eutectic solder paste, to obtain decrease of solder joint strength with aging time, initial solder joint strength and aging strength after 1000 hour aging at 100℃ were measured by peel test. And to obtain the growth of intermetallic compound(IMC) layer thickness, IMC layer thickness was measured by scanning electron microscope(SEM). As a result, solder joint strength was decrease with aging time increasing. The mean IMC layer thickness was increased linearly with the square root of aging time. The diffusion coefficient(D) of IMC layer was found to 1.29×10 exp (-13) ㎠/s at using Sn/Pb solder paste, 7.56×10 exp (14) ㎠/s at using Sn/Ag solder paste.

다발성 골수종으로 이행한 단일형질세포종 1예

정재용,모성환,기장도,문철호,김창욱,전용준,박유환,정춘해,오윤경 조선의대 1995 The Medical Journal of Chosun University Vol.20 No.2

Sn-3.5wt%Ag 무연솔더를 이용한 μBGA 솔더접합부의 열피로수명 예측

이준환,하범용,신영의 중앙대학교 기술과학연구소 2000 기술과학연구소 논문집 Vol.30 No.-

본 연구에서는 μBGA와 Pb-free 솔더에 대한 수명평가방법을 제시하기 위하여 μBGA에 대하여 37wt%Pb-Sn 공정 솔더와 Sn-3.5wt%Ag 솔더를 채택한 3차원 유한요소해석모델을 구성해 보았다. 점탄소성거동에 대비하여 구성되어진 각각의 모델 중, 먼저 일반적인 솔더 형상을 가진 모델에 대하여 솔더 재질별로 온도범위 -40∼120℃, -20∼100℃, 20∼100℃의 세 가지 열사이클을 3회씩 가하여 솔더 접합부 계면에 집중되어진 응력과 변형율의 분포를 유한요소해석을 통해 살펴보았다. 또한 온도 변화에 따른 ΔT와 용융온도 T_M등의 변수를 이용하여 얻어진 γ를 이용하여 열피로수명식을 유도하였다. This study discusses thermal fatigue prediction of μBGA(Micro Ball Array) solder joint. Analysis method is used to three-dimensional finite element analysis with various solder alloys such as Sn-37wt%Pb, Sn-3.5wt%Ag under temperature cycling. Strain values, along with the result of solder material fatigue tests, were then used to predict the solder joint fatigue life with Coffin-Manson equation. As a result, it could be found that Sn-3.5wt%Ag has longer fatigue life than Sn-37wt%Pb in Low cycle fatigue. And using the analysis result, derive modified Coffin-Manson equation with temperature dependent factor γ.

心病辨證의 形成過程에 대한 文獻的 考察

金庸柱,崔達永,金俊錡,朴元煥 동국대학교 한의학연구소 1997 東國韓醫學硏究所論文集 Vol.6 No.1

五臟六腑中에서 心은 人體 生理活動의 主宰으로서 臟腑 가운데에서도 首位를 차지하여 人體의 思推活動이나 臟腑機能의 協調 및 氣血의 通暢등도 모두 心의 機能에 依存하는 바이므로 心을 生命活動의 中心이라고 한다. 本 論文은 辨證體系웨 形成過程을 心病辨證에 限하여 文獻的으로 考察한 것으로써, 첫째 心病의 虛症分類에 있어 心虛症이라고 包括的으로 言及되어지던 것이 心陰虛症과 心陽虛症으로 分類되었으며, 다시 心氣虛症ㆍ心陽虛病ㆍ心血虛症ㆍ心陰虛症으로 分類되었다가, 最近에 辨證分類에서는 이를 더욱 細分化시켜 心氣虛症ㆍ心陽虛病ㆍ心血虛症ㆍ心陰虛症ㆍ心氣陰兩虛症ㆍ心氣血兩虛症ㆍ心陰陽兩虛症ㆍ心陽暴脫證으로 分類 發展시키고 있다. 둘째 心病의 實證分類에 있어 가장 중요한 것은 痰과 火ㆍ熱의 問題였으며 이것들을 가지고 다양한 辨證分類를 하였는데, 初期에는 痰證과 熱證을 단지 分離하여 辨證하였던 것을, 最近에는 痰證과 火證뿐만 아니라 痰火를 같이 묶어 辨證 하였으며, 心氣虛心陽虛에서 起因된 心瘀證을 점차 重要하게 여기는 方向으로 辨證分類를 하였다. 이러한 辨證分類의 多樣化ㆍ細分化는 漸漸 多樣해지는 疾病樣相에 보다 잘 대처하려는 硏究結果로 보여지며 이후로도 보다 實證的인 硏究가 더욱 더 要望된다. The heart takes the top position as the monarch of the physiological activity in five viscera and six bowels. Activity to think and ponder, or harmony of the function of viscera and bowels and passing smoothly of qi and blood and so on, these depend on the function of heart. So it is called the center of life activity. This thesis studied bibliographically the process of formation of the system of differention of syndromes. First, in the classify of deficiency syndrome, insufficiency of the Heart is classified deficiency of the Heart-yin and insufficiency of the Heart-yang. After it classified insufficiency of the Heart-qi, insufficiency of the Heart-yang. dificiency of the Heart-blood and deficiency of the Heart-yin, At lately it classified more subdivide into insufficiency of the Heart-qi, insufficiency of the Heart-yang, 야랴ciency of the Heart-blood, deficiency of the Heart-yin. Deficiency of the Heart-qiㆍyin, deficiency of the Heart-qiㆍblood, deficiency of the Heart-yinㆍyang and sudden exhaustion of the Heart-yang. Second, It were the most important that the phlegm, fire and heat in the classify of excess syndrome. It classified various differentiation of syndrome. In the beginning of a period, it only classified phlegm syndrome and heat syndrome, but recently it classified not only phlegm syndrome and heat syndrome but also phlegm-fire. Also, It clas냐랴ed importantly gradually Heart-blood stasis caused by deficiency of the Heart-qi and the Heart-yang. Variety and subdivision of classify of differentiation of syndrome seemed resault of study to prepare various disease. And that after demanded more and more positive study.