한국인 폐확산능 정상예측식의 임상적 유용성과 정확성

나승원 ( Seung Won Ra ),박태선 ( Tai Sun Park ),홍윤기 ( Yoon Ki Hong ),홍상범 ( Sang Bum Hong ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2

연구배경: 폐확산능을 해석하는 데 필요한 정상예측식으로는 한국인을 대상으로 하여 박 등이 개발한 식(박 식)이 있으나 아직 외국 정상예측식을 많이 사용하고 있다. 이에 국내에서 많이 사용하는 외국 정상예측식인 Burrows 식과 박 식의 임상적 유용성과 정확성을 비교하고자 하였다. 방법: 1. 임상적 유용성 연구; 2006년 7월부터 12월까지 6개월간 폐확산능검사를 시행한 환자 중 두 식을 각각 정상예측식으로 적용하였을 때 폐확산능 해석이 다른 276명(대상군 A)을 대상으로 하였다. 대상군 A에게 두 식을 각각 적용하였을 때 폐확산능 해석과 임상적 판단과의 일치도를 비교하여 임상적 유용성을 평가하였다. 2. 간질성폐질환 진단의 정확성 비교; 2001년부터 2006년까지 폐조직검사를 시행하여 확진된 간질성폐질환군과 서울아산병원에서 모집한 정상군을 대상으로 하여 정상예측식으로 두 식을 각각 적용하였을 때 폐확산능 해석의 정확도를 비교하였고, 두 식이 차이가 나는지 맥니머의 카이스퀘어 검정을 하였다. 결과: 1. 임상적 판단과의 일치도 비교; 276명을 임상정보를 토대로 폐확산능을 예측하여 분류한 결과 정상 54명, 감소 220명, 불분명이 2명이었다. 예측식으로 박 식과 Burrows 식을 적용하였을 때 임상적 판단과 일치하는 환자는 각각 78%와 22%이었다(p<0.001). 2. 간질성폐질환 진단의 정확성 비교; 박 식은 민감도 90.1%, 특이도 100%이었고 Burrows 식은 민감도 64.2%, 특이도 100%로 민감도가 통계학적으로 유의하게 박 식이 높았다(p<0.001). 결론: 우리나라 정상예측식인 박 식이 외국 정상예측식인 Burrows 식을 정상예측식으로 적용하는 것보다 임상적 유용성이나 간질성폐질환 진단의 민감도에서 더 우월하였다. 향후 폐확산능검사의 정상예측식으로 박 식을 사용해야 할 것으로 사료된다. Background: Park et al. developed the Korean reference equation for the measurement of diffusing capacity in 1985. However, the equation has not been widely used in Korea and foreign reference equations have been popularly used. We intended to compare the clinical usefulness and the accuracy of the the Korean reference equation (Park`s equation) with that of the foreign equation (Burrows` equation) that is commonly used in Korea. Methods: 1. Evaluation of clinical usefulness; Among 1,584 patients who underwent diffusing capacity (DLCO) at the Asan Medical Center from July to December 2006, group A subjects included 276 patients who had different interpretations of DLCO in trials employing Burrows` equation and Park`s equation. Clinical assessment was decided by consensus of two respiratory physicians. In order to evaluate the clinical usefulness of Burrows` equation and Park`s equation, agreement of clinical assessment and DLCO interpretation were measured. 2. Evaluation of accuracy; Group B subjects were 81 patients with interstitial lung disease (ILD) and 39 normal subjects. The 81 ILD patients were diagnosed following a surgical lung biopsy. The accuracy of diagnosing ILD as well as sensitivity and specificity were evaluated according to the use of the reference equations (Burrows` equation and Park`s equation) for DLCO. Results: Agreement between clinical assessment and interpretation of DLCO was 22% for the use of Burrows` equation and 78% for the use of Park`s equation. The sensitivity and specificity of the Burrows` equation for diagnosing ILD were 64.2% and 100%. The sensitivity and specificity of the Park`s equation for diagnosing ILD were 90.1% and 100%. The sensitivity of the Park`s equation for diagnosing ILD was significantly higher than that of Burrows` equation (p<0.001). Conclusion: The Korean reference equation (Park`s equation) was more clinically useful and had higher sensitivity for diagnosing ILD than the foreign reference equation (Burrows` equation). (Tuberc Respir Dis 2008;64:80-86)

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

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.

저수지 용수공급량에 따른 신뢰도 지표인자의 상관관계 해석

박기범 한국환경과학회 2005 한국환경과학회지 Vol.14 No.3

In this study aims is water supply criteria relations for evaluating the possible performance of water resources systems. These measures describe how likely a systems is to fail(reliability), how quickly it recovers from failure(resiliency), and how severe the consequences of failure may be(vulnerability). The performance of a criteria evaluating with a variety of operating policies illustrates their use. As a result study frequency reliability and quantitative reliability is linear relations and quantitative reliability is high reliability for equality water supply policy. As reliability and vulnerability are in inverse proportion to each other. Therefore these criteria relation analysis can be for Imha dam to variety water supply policy.

공급량 배분기법을 이용한 갈수기 병렬저수지 해석

박기범,이순탁 한국환경과학회 2006 한국환경과학회지 Vol.15 No.3

유역분할에 따른 첨두홍수량 특성에 관한 연구

박기범 한국환경과학회 2006 한국환경과학회지 Vol.15 No.4

단무지 공장에서 발생한 질식 사고의 원인과 방사선학적 소견: 중례보고 및 가스분석 결과

박충기,김만구,김흥철,안범규,박만수,황우철,최철순,강익원 江原大學校 附設 環境硏究所 1994 環境硏究 Vol.11 No.-

목 적:단무지 공장에서 질식사고를 일으켰던 가스의 종류를 알아내고, 이러한 가스중독의 방서선학적 소견을 소개하기 위하여 본 연구를 하였다. 대상 및 방법:단무지 공장에서 발생한 질식 사고자 3예중 생존자 1예를 대상으로 단순흥부X-선검사와 CT 소견을 분석하였으며, 가스의 종류를 알아내기 위하여 단무지를 유리병에 넣어 발생된 가스를 가스크로마토그래픽을 이용하여 분석하였다. 결 과:단무지 공장에서 발생한 질식사고자중 생존한 1명의 방사선학적 검사에서 신속히 호전되는 폐경결(consolidation)을 볼 수 있었으며 이는 폐부종의 소견임을 알 수 있었다. 협기성 상태에서 단무지를 담은 유리병의 상층부 가스를 실험 분석한 결과 이산화탄소, 에칠알코올이 다량으로 검출되었으나 독성가스는 주로 황화수소이였다. 결 론:단무지 공장의 질식 사고자에서 폐방사선학적 소견은 폐경결을 보이는 폐부증으로서 이는 실험을 통해 단무지에서 발생되는 유독가스인 황화수소 때문임을 입증하였다. Purpose: To identify the main toxic gas released from salted radish in rice bran(Dan-M-Ji) and to introduce the radiological findings of the patient who was exposed to the gas. Materials and Methods: Chest radiographs and CT scans of one survivor among three men who were exposed to the gas from Dan-Mu-Ji were reviewed. Gas obtained from the closed bottle containing Dan-Mu-Ji was analized by using the gas chromatography. Results: The radiographlc examinations of the survivor were suggestive of pulmonary edema with it's rapidly improving consolidations in both lung. The headapace gas within the bottle containing Dan-Mu-Ji was mainly composed with carbon dioxide, ethyl alcohol and hydrogen sulfide, of which hydrogen sulfide was considered the main toxic gas released. Conclusion: Under the anaerobic condition, Dan-Mu-Ji released toxic hydrogen sulfide. Inhalation of hydrogen sulfide might produce non-cardiogenic pulmonary edema.

가뭄기간의 저수지 운영방안에 관한 연구

박기범,이순탁 한국환경과학회 2004 한국환경과학회지 Vol.13 No.12

In this study the results of optimal water supply analysis by operating constraints of reservoirs during drought period are as follows. During drought period, water supply reliability is possible about 97~61% by CASE 1-CASE 5. Water supply reliability is possible about 97.3% in case of the Andong dam and 87.7% in case of the Imha dam by CASE 3. Also, under the constraints of CASE 4, water supply reliability is possible about 87.5% in case of the Andong dam and 73.3% in case of the Imha dam. The reason what low of available water supply ratio is decreased inflow of Imha dam. When compare standard deviation of average storage with standard deviation of storage, stable storage can be secured during successive drought period. And it also can minimize shortage of water during drought. therefore, it is impossible that reservoir supply sufficient water but change of operating condition is better than pervious on that followed by full reservoir level. It is need that the study for optimal water supply during drought period has to be continued.

건축제도 변화에 따른 일반주거지 도시조직에 관한 연구

박기범,최찬환 대한건축학회 2003 대한건축학회논문집 Vol.19 No.10

The rapid industrialization and urbanization gave rise to the shortage of urban housing from the mid of 1900s. To solve housing problem the public policy, which was to increase housing supply, focused on the private movement like subdivision of single detached housing for multi households. Illegal multifamily housing was legitimated and then enlarged in volume, height, and density. But the introduction of multifamily housing as an urban housing did not considered the differences of urban structure which was different according to the land readjustment project. There are some differences in housing form according to the relation between Building Code and the conditions of urban structure. This study focuses on the analysis of urban tissue reflecting interrelation between residential structure and Building Code. To find out the relation between Building Code and urban structure manifested in the form of multifamily housing is the best way understanding urban tissue of residential area. The change of building code has led the change of housing form, conditions of urban structure has affected the differences of housing form from the 1990. From the research, under the same legislation there are differences in volume of housing according to the condition of plot like size and border with street, under the same residential structure the differences of regulation affected the form of housing. So understanding urban tissue is the key to organize appropriate landscape of residential area.

국내 Fabry disease 환자의 a-Galatosidase A 유전자 돌연변이 검색

박기범,최지혜,강윤성,김선미,정향민,문영준,이광호 中央大學校 基礎科學硏究所 2001 基礎科學硏究所 論文集 Vol.15 No.-

Fabry disease(FD) is an X-linked recessive lysosomal disorder caused by a deficiency of a-galactosidase A(a-Gal A), localized at Xq22. Besides onset of pain and paresthesias in the extremities, FD was diagnosed by absence of a-Gal A activity. In this experiment the a-Gal A activity of Korean FD patients was spectrometrically analysed using an artificial substate, 4-Mrthylumbellifery1-a-D-galactoside. As expected, no a-Gal A activity was detected in lymphocytes and lymphoblastoid cells from FD patients. To screen the mutation in their a-Gal A genes, we performed single strand conformation polymorphism(SSCP) and PCR-direct sequencing form seven a-Gal A exons. The nonsense mutation was identified both in classically affected hemyzygotes and a heterozygote. They showed the C to T transition at nucleotide number 11,002, resulting in a arginine-to-stop(R342X). This result will be applicable for pre- and neonatal detection of FD and to define the genotype/phenotype correlation.