Moxifloxacin 기반 순차 요법에 실패 후 2차 치료로써 Bismuth 포함 사제 요법의 헬리코박터 제균 치료 효과

권수훈 ( Soohoon Kwon ),이동호 ( Dong Ho Lee ),강재빈 ( Jae Bin Kang ),김나영 ( Nayoung Kim ),박영수 ( Young Soo Park ),신철민 ( Cheol Min Shin ),윤혁 ( Hyuk Yoon ),최윤진 ( Yoon Jin Choi ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4

목적: 전 세계적으로 표준 삼제 요법의 H. pylori균 제균율이 떨어지고 있어 새로운 약제에 대한 필요성이 대두되고 있으며, moxifloxacin 기반 순차 요법은 새로운 대안 중 하나로 주목받고 있다. 그러나 여러 가지 항생제로 이루어진 이 치료에 실패 시 적절한 2차 약제 선정에 대한 연구는 아직까지 없는 실정이다. Bismuth 포함 사제 요법은 여러 연구를 통해 clarithromycin 및 metronidazole 내성이 있는 경우에도 높은 제균율을 보이는 치료 약제로 알려져 있다. 본 연구는 새로운 초치료 약제인 moxifloxacin 기반 순차 요법 및 역순차 요법에 실패한 경우 bismuth 포함 사제 요법의 2차 치료 약제로써 효과 및 순응도, 부작용에 대해 알아보고자 한다. 대상 및 방법: 2013년 1월부터 2016년 3월까지 분당서울대학교병원에서 H. pylori 감염자 중 초치료로써 moxifloxacin 포함 순차 요법 및 역순차 요법에 제균 실패하고, 2차 치료로써 bismuth 포함 사제 요법을 시행한 환자 23명을 대상으로 하였다. 의무기록을 바탕으로 연령, 성별, 흡연 여부, 음주 성향, 동반 질환, 제균 성공률, 순응도 및 부작용에 대해 조사하였다. 결과: 총 23명의 환자에서 bismuth 포함 사제 요법을 적용하여 치료하였고, 4명의 추적 관찰 탈락이 있었다. 전반적인 제균율은 ITT 분석에서 60.87% (14/23), PP 분석에서 73.68%(14/19)의 제균율을 보였다. 모든 환자들의 순응도는 100%였으며, 심각한 부작용은 관찰되지 않았다. 결론: Bismuth 포함 사제 요법은 moxifloxacin 기반 순차 요법 및 역순차 요법에 실패한 환자에게 있어 아직까지 2차 약제로써 만족스러운 효과를 기대하긴 어렵겠지만, 좀 더 많은 수의 환자를 대상으로 연구를 진행하여 이에 대해 입증하는 과정이 필요하겠다. Background/Aims: Moxifloxacin-based sequential therapy showed an excellent eradication rate as the first line treatment of Helicobacter pylori (H. pylori) infection. However, to the best of our knowledge, there were only a few studies on the treatment of those with failed moxifloxacin-based sequential therapy. Hence, this study was to investigate the efficacy of bismuth-containing quadruple therapy in those with failed moxifloxacin-based sequential or reverse sequential therapy for H. pylori eradication. Methods: Between January 2013 and March 2016, we retrospectively analyzed patients who failed to eradicate H. pylori using moxifloxacin- based sequential (rabeprazole 20 mg bid and amoxicillin 1 g bid for 5-7 days, followed by rabeprazole 20 mg bid, metronidazole 500 mg bid, and moxifloxacin 400 mg qd for 5-7 days) and 10 days moxifloxacin-based reverse sequential therapy as the first line treatment. Then we investigated the eradication rates of bismuth-containing quadruple therapy as the second line treatment. All subjects had no history of H. pylori eradication before. Eradication rates were described as intention-to-treat (ITT) and per-protocol (PP) analyses. H. pylori status was evaluated by ¹³C-urea breath test 6 weeks after the end of the treatment. Moreover, we examined any side effects that caused discontinuation of therapy. Results: Twenty-three patients received bismuth-containing quadruple therapy as the second line treatment. The overall eradication rates by ITT and PP analyses were 60.87% (n=14/23) and 73.68% (n=14/19). All the patients showed good compliance, and there were no serious adverse events. Conclusions: Bismuth-containing quadruple therapy is insufficient as the second line eradication treatment after a failed attempt of moxifloxacin-based sequential or reverse sequential therapy. Large-scale clinical trials should be performed to establish better clinical evidence. (Korean J Gastroenterol 2018;71:196-203)

Hybrid 요법 실패 후 2차 치료로써 Moxifloxacin 포함 삼제 요법의 헬리코박터 제균 치료 효과

권수훈 ( Soohoon Kwon ),이동호 ( Dong Ho Lee ),강재빈 ( Jae Bin Kang ),김나영 ( Nayoung Kim ),박영수 ( Young Soo Park ),신철민 ( Cheol Min Shin ),윤혁 ( Hyuk Yoon ),최윤진 ( Yoon Jin Choi ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.2

목적: 전 세계적으로 표준 삼제 요법의 H. pylori 제균율이 떨어지고 있어 새로운 약제에 대한 필요성이 대두되고 있으며, hybrid 요법은 그 새로운 대안 중 하나로 주목받고 있다. 그러나 이러한 hybrid 요법에 실패 시 적절한 2차 약제에 대한 연구는 아직까지 없는 실정이다. Moxifloxacin 포함 삼제요법은 여러 연구를 통해 2차 치료 약제로써 효과가 있는 것으로 보고되고 있다. 본 연구는 새롭게 각광받고 있는 hybrid 요법 치료 실패 시, 2차 치료로써 moxifloxacin 포함 삼제 요법의 제균 치료 효과를 알아보기 위해 진행하였다. 대상 및 방법: 2013년 1월부터 2016년 3월까지 분당서울대학교병원에서 H. pylori 감염자 중 초치료로써 hybrid에 제균 실패하고, 2차 치료로써 moxifloxacin 포함 삼제 요법을 시행한 환자 11명을 대상으로 후향적 의무기록을 통해 연령, 성별, 흡연 여부, 음주 성향, 동반 질환, 제균 성공률, 약제의 순응도 및 부작용을 알아보도록 하였다. 결과: 총 11명의 환자에서 moxifloxacin 포함 삼제 요법의 제균율은 ITT 분석에서 72.73% (8/11), PP 분석에서 80% (8/10)의 제균율을 보였다. 모든 환자들의 순응도는 100%였으며, 심각한 부작용은 관찰되지 않았다. 결론: Moxifloxacin 포함 삼제 요법은 hybrid 요법에 실패한 환자에게 있어서 2차 약제로써 효과가 있을 것으로 기대할 수 있다. 앞으로 좀 더 큰 규모의 연구를 통해 이에 대한 검증이 필요하겠다. Background/Aims: Hybrid therapy was successful in eradicating Helicobacter pylori (H. pylori) according to previous reports. However, to the best of our knowledge, there have only been a few studies evaluating the optimal choice after hybrid failure. Hence, we aimed to evaluate the efficacy of moxifloxacin-containing triple therapy after hybrid therapy failure in H. pylori eradication. Methods: Between January 2013 and March 2016, we retrospectively reviewed patients who underwent failed hybrid therapy, as first line treatment, in eradicating H. pylori (rabeprazole and amoxicillin b.i.d for 14 days, in addition to clarithromycin and metronidazole b.i.d for final 7 days). Then, we investigated the eradication rates of moxifloxacin-containing triple therapy (rabeprazole, amoxicillin b.i.d and moxifloxacin qd) as the second line of treatment. Intention-to-treat (ITT) and per-protocol (PP) analyses were used to determine the eradication rate. We evaluated the status of H. pylori by using ¹³C-urea breath test 6 weeks after the final treatment. Moreover, compliance and adverse effects of each patient were analyzed. Results: Among those who failed the initial hybrid therapy, 11 patients received moxifloxacin-containing triple therapy. The overall eradication rates, as determined by ITT and PP, were 72.7% (n=8/11) and 80% (n=8/10), respectively. The compliance rate was 100%, and there were no serious adverse effects. Conclusions: Moxifloxacin-containing triple therapy can be used as a second line therapy in case of hybrid therapy failure. A large scale study is necessary to confirm the findings of this study and establish clinical evidence. (Korean J Gastroenterol 2017;70:72-80)

Drop box weir의 水理特性에 關한 硏究

吳壽勳,權純國 서울大學校 農科大學 1986 서울대농학연구지 Vol.11 No.1

This study was intended (1) to estimate the accurate stage discharge relationship through field measurement on a weir located at the outlet of the Sangrim watershed, (2) to investigate the reliability of the stage-discharge relationship of the Sangrim Drop-box weir in relation to the approach angles of flow and the stream slope and the maximum probable sedimention using the fixed bed model and the movable bed model tests respectively, (3) to find a new stage gaging point which would supplement the gaging point which it currently used (G-1), and finally, (4) to find the usage limit of the Drop-box weir for other hydrologic studies of the watershed. The results of the study can be summarized as follows; 1. Stage-discharge relationship of the Drop-box weir was ?? at stage gaging point G-1. 2. The stage-discharge relationship at the stage gaing point G-1 appeared to have little effect with different approach angles. With different stream slopes, the relationship was one curve at discharges up to about 4㎥/s. On the whole the stream slope change appeared to influlence slightly to the stage-discharge relationship. 3. The maximum probable sediment accumulation estimated using the movable bed model test was 1.2~1.5 meters high meausred at 1.8 meters upstream from the weir head wall. This sediment accumulation showed little effect on a reliability of the stage-discharge relationship at the stage gaging point G-1. 4. The stage gaging point G-2 selected to supplement the limitations of the stage gaging point G-1 showed a straight lime stage-discharge relationship. This G-2 was generally safe against the approach angles, stream slope changes and sediment deposition at weir upstream. It can therefore be recommended that the gaging point be set up at G-2. 5. The greatest storm for a single event during the period of study was only 75mm. In the future it recommended that the stage-discharge relationship for the weir under study must be newly tested at high flow rates created by the greater storms. 6. From the results of the laboratory experiment and the observed operation of the drop box attached to the weir, it can be conclude that the Sangrim Drop-box weir is acceptable and representative of field weirs for other hydrologic studies in Korea.

Flexible transparent electrodes for organic light-emitting diodes

한태희,정수훈,이영준,서홍규,권성주,박민호,이태우 한국정보디스플레이학회 2015 Journal of information display Vol.16 No.2

The use of flexible organic light-emitting diodes (OLEDs) for the next-generation displays and solid-state lightings has been considered, but the widely used transparent conducting electrode (TCE), indium–tin-oxide (ITO), should be replaced by flexible electrodes due to its brittleness and increasing cost. Therefore, many kinds of alternative TCEs have been increasingly studied. In this paper, the properties and applications of the candidate transparent flexible electrodes classified into four categories (conducting polymer, silver nanowire, carbon nanotube and graphene) are described. This paper finally suggests how to develop alternative TCEs for replacing the conventional ITO electrode.

P형 산화물 반도체 박막트랜지스터 기술 동향

권혁인,권수훈,주효준,Gwon, Hyeok-In,Gwon, Su-Hun,Ju, Hyo-Jun 한국정보디스플레이학회 2018 인포메이션 디스플레이 Vol.19 No.3

감염 : 만성 편도선염으로 발현된 매독성 편도선염 1 예 (초)

임상혁,조은하,권수훈,조기원,이승렬,이향임,최재필 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-

호흡기 : 활동성 폐결핵 환자에서 혈청 QuantiFERON-TB Gold In-Tube 결과에 영향을 미치는 요인들 (초)

조기원,조은하,권수훈,임상혁,송숙희,김수현 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-

성대기능 이상과 연관된 호흡부전 1예 -증례 보고-

조은하,조기원,권수훈,임상혁,김혜옥,송숙희,정우찬,김수현 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.3

Vocal cord dysfunction is characterized by the paradoxical adduction of the vocal cord during inspiration, causing relapsing wheezing or stridor, chest tightness, shortness of breath, and coughing. If the patient exhibiting symptoms of asthma is not responsive to treatment, there is a need to test whether vocal cord dysfunction is complicated by asthma. Herein, we report a case of vocal cord dysfunction with acute respiratory failure in old age with underlying disease. The patient presented with resting dyspnea, an audible wheeze, and was first diagnosed with acute exacerbation of bronchial asthma. However, her symptoms were not controlled with medical treatment and laryngoscopy showed paradoxical adduction of the vocal cords. Sudden cardiopulmonary arrest occurred after meal on the day of laryngoscopic examination. Although successful cardiopulmonary resuscitation, the patient developed ventilator- associated pneumonia, and multiple organ failure, eventually leading to death. Because the case was fatal, a report is being issued.

Factors Associated with Indeterminate and False Negative Results of QuantiFERON-TB Gold In-Tube Test in Active Tuberculosis

조기운,조은하,권수훈,임상혁,손인,송숙희,김혁,김서현 대한결핵및호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.5

Background: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis. Methods: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul. Results: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay,lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32). Conclusion: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients. Background: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis. Methods: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul. Results: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay,lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32). Conclusion: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.

양파즙의 심혈관 질환 위험인자 개선 효과에 관한 연구

임상혁,조은하,권수훈,조기원,김석연 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 심혈관계 질환은 2009년 통계청 조사에 의하면 악성종양, 뇌혈관 질환에 이어 한국인의 만성 질환에 의한 사망률 3위를 차지하고 있다. 이번 연구의 목적은 다양한 생리적 활성을 가지고 있는 양파즙의 심혈관 질환 위험인자 개선 효과에 대하여 살펴보고자 하였다. 대상 및 방법: 서울 의료원에서 고혈압으로 추적 관찰 중인 58명을 대상으로 하였다. 고혈압, 당뇨병 이외의 기저질환을 갖고 있거나, 한약제, 비타민제등 결과에 영향을 줄 수 있는 약물 복용자는 제외하였다. 대상 피험자는 4주일 동안 양파즙 120ml를 하루 3~5회 4주일 동안 복용하였다. 양파즙은 시중에서 쉽게 구할 수 있는 FDA 공인을 받은 업체의 제품을 임의로 선정하여 구입하였다. 양파즙 투여 전후에 혈압, 중심 동맥압, 심전도, 맥파 속도, 파형증가 지수, 콜레스테롤 수치, 당화혈색소 수치를 측정하였다. 결과: 전체 대상자의 평균 연령은 62±10.9세이며, 남성은 60±12.1세, 여성은 64±9.4세였다. 연구시작 초기 수축기 평균 혈압은 137±14.1mmHg, 이완기 평균 혈압은 81±10.2 mmHg이었으며, 총콜레스테롤은 174±31.8 mg/dL, 당화혈색소는 6±0.8%이었다. 4주간의 양파즙 섭취 후 수축기 혈압은 6.3±15.5 mmHg(p=0.003), 이완기 혈압은4.6±8.3 mmHg(p=0.000), 중심 동맥압은 8.7±18.0 mmHg(p=0.001)감소하였다. 파형증가 지수는 6.0±14.4(p=0.002)감소하였다. 총콜레스테롤은1.5±27.0(p=0.657), 고밀도지질단백질은 1.1±6.9(p=0.235), 저밀도지질단백질은 4.4±28.2(p=0.236)감소하였으나 중성지방은 19.8±71.8(p=0.040)증가하였다. 당화혈색소는 0.1±0.3(p=0.003)감소하였다. 결론: 양파즙 복용 후 혈압 및 파형증가 지수에서 유의한 감소를 보였다. 특히 중심동맥압의 감소가 말초 동맥압의 감소보다 두드러지게 나타났으며, 65세 이하, 여성에서 그 효과는 두드러졌다. 이와 같은 양파즙의 혈압 강하효과는 양파의 겉껍질에 함유되어 있는 flavonoid계 색소의 일종인 quercetin의 항산화 효과로 인한 결과로 생각된다. 다만 지금까지 알려진양파의 혈청 지질 강하 효과는 본 연구에서는 관찰할 수 없었다. 이는 4주간의 짧은 복용 기간, 사용한 시료의 종류, quercetin 용량의 차이 등에 의한 영향으로 생각된다. 향 후 양파즙의 복용이 실제 심혈관 질환 감소라는 임상적인 결과에도 긍정적인 영향을 미칠 수 있는지, 소수의 국외 연구에서 보고된 양파의 혈소판 응집 저해 및 혈전 용해 활성에 대한 유효성을 검증하고, 단편적인 효능 검색을 넘어 활성물질의 분리 및 동정, 작용기전을 밝히기 위해 보다 장기적인 임상연구가 시행되어야 할 것이다.