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만성신부전 환자에서 혈액투석 전후의 P300 인지유발전위 검사
배재천,이상무 대한임상신경생리학회 2001 Annals of Clinical Neurophysiology Vol.3 No.2
Background : Nervous system dysfunction is a major complication of end stage renal disease. Although severe neurologic symptoms are partially or complete reversed by adequate hemodialysis, even optimally dialyzed patients will usually not return to normal neurocognitive function. To investigate the influence of chronic renal failure and hemodialysis on higher cognitive function electrophysiologically, we studied auditory P300 event-related potentials in 14 hemodialysis patients and 14 age- and sex-matched normal healthy controls. Methods : The subjects consisted of 14 patients(M:6, F:8) with chronic renal failure(CRF) for 1 to 10 years and 14 age-and sex-matched healthy controls(M:5. F:9). For the reliability of study, patients with diabetes mellitus, abnormal brain CT findings, or low mini-mental state score(below 20) were excluded. Event related potentials(ERPs) for hemodialysis patients were performed at pre-and post-hemodialysis. To obtain ERPs, subjects underwent 2-tone auditory discrimination test(oddball paradigm). Results : Although the age(control: 48.79?0.31 years, CRF: 51.21?.61 years) and mini-mental state score(control: 27.00?.71 points, predialysis CRF: 25.07?.58 points) were not different in normal control and CRF groups significantly(P>0.05), P300 latencies at Cz(controls: 288.11?7.36 msec, predialysis CRF: 332.35?2.34 msec) were significantly delayed(P<0.05) and the duration of Trail making test A was significantly prolonged(control: 64.2?4.2 sec, CRF: 118.9?01 sec) in CRF group, P300 latencies between pre-and post-hemodialysis CRF patients(predialysis CRF: 332.35?2.34 msec, postdialysis CRF: 325.82?8.69 msec) were not significantly different. The P300 latency was not related with the duration of CRF(Spearman's correlation test, r=0.25, p>0.05) and tthe frequency of hemodialysis(Spearman's correlation test, r=0.28, P>0.05). Conclusions : From these results, we suggest that P300 latency is valuable in evaluating cognitive brain dysfunction in patients with CRF and hemodialysis does not have a significant effect on cognitive brain dysfunction in patients with CRF.
말초조직염증 혹은 신경손상 후 흰쥐 등쪽뿌리신경절에서 mitogen-activated protein kinase의 활성화
배재천(Jae-Chun Bae),이혜림(Hye-Lim Lee),이경민(Kyung-Min Lee),황성헌(Sung-Hun Hwang),손선주(Sun-Ju Sohn),김동선(Dong-Sun Kim),조희중(Hee-Jung Cho) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.3
Mitogen-activated protein kinase (MAPK)계열에는 extracellular signal-regulated kinase (ERK), p38 MAPK와 c-Jun Nterminal kinase (JNK) 등이 이에 속한다. 그리고 이러한 MAPK전달계는 세포 외부로부터의 자극을 전달하여 세포내 반응을 일으키는데 있어서 매우 중요한 역할을 하는 것으로 보고되어져 있다. ERK는 성장인자, 산화 스트레스, 세포내 칼슘 증가 혹은 glutamate 수용체의 자극 등에 의하여, p38 MAPK 및 JNK는 cytokine, 열쇼크, 자외선 및 허혈 등에 의하여 활성화되는 것으로 알려져 있다. 한편 말초조직에 염증을 유발시키거나 말초신경의 손상 후 축삭이 퇴행을 일으키면 이곳으로부터 cytokine, 성장인자 및 기타 물질들이 생성되어 등쪽뿌리신경절(DRG)로 역행성이동을 하여 동통과민화를 야기하게 된다. 본 연구에서는 말초조직염증이나 신경손상 후 DRG에서 MAPK이 어떻게 활성화되는지를 알아보기 위하여 면역조직염색 법으로 관찰하여 다음의 결과를 얻을 수 있었다. 1. 말초조직염증을 유발시키면 동측의 L5 DRG에서 phosphorylated (P)-ERK, P-p38 MAPK 및 P-JNK 면역반응신경세포수 의 유의한 증가가 관찰되었다. 2. 좌골신경절단의 경우 동측의 DRG에서 P-ERK 혹은 P-p38 MAPK 면역반응성 신경세포수의 유의한 감소와 P-JNK 면 역반응성 신경세포수의 유의한 증가를 볼 수 있었다. 3. 좌골신경의 만성협착손상(chronic constriction injury, CCI)시 DRG에서 MAPK의 활성화는 말초조직염증유발시의 그것 과 유사하였다. 4. 말초조직염증이나 CCI 후의 ERK, p38 MAPK 및 JNK의 활성화는 작은직경의 신경세포에서, 좌골신경절단 후의 JNK 의 활성화는 모든 직경 신경세포에서 관찰되었다. 이러한 연구결과들로 미루어 보아 말초조직염증이나 좌골신경의 CCI 후 생성되는 cytokine이나 성장인자들이 DRG에서 의 P-ERK, P-p38 MAPK 및 P-JNK의 발현에 관여할 것이며 이러한 MAPK계열들은 동통과민화에 중요한 역할을 할 것으 로 생각된다. The mitogen-activated protein kinase (MAPK) family has three members: the extracellular signal-regulated kinase (ERK), p38 MAPK and c-Jun N-terminal kinase (JNK). There is substantial evidence indicating that the MAPK cascade plays a pivotal role in transducing extracellular stimuli into intracellular responses in all cells. The ERK is activated in response to growth factors, oxidative stress, increases in intracellular calcium levels, or glutamate receptor stimulation. The p38 MAPK and JNK are activated by stress signals such as inflammtory cytokines, heat shock, ultraviolet light, and ischemia. It has been shown that cytokines, growth factors, or other agents released and are retrograde-transported to the dorsal root ganglia (DRG) as a result of peripheral tissue inflammation or the degeneration of axons following peripheral nerve injuries which cause hyperalgesia. In the present study, we investigated the activation of MAPKs in rat DRG by means of immunohistochemistry following peripheral inflammation or nerve injuries. The results obtained were as follows; 1. Peripheral tissue inflammation induced significant increase in the percentage of phosphorylated (P)-ERK, P-p38 or P-JNK immunoreactive neurons in the ipsilateral L5 DRG. 2. Following axotomy, the percentage of P-ERK or P-p38 MAPK immunoreactive neurons decreased significantly and that of P-JNK showed significant increase in the ipsilateral side. 3. Chronic constriction injury of the sciatic nerve (CCI) induced similar changes with those following peripheral inflammation in the activation of MAPKs in the DRG neurons. 4. The activation of ERK, p38 MAPK and JNK following inflammation and CCI was observed primarily in small neurons, while that of JNK following axotomy was found in neurons of all sizes. These results suggest that cytokines or growth factors released as a result of peripheral inflammation or CCI of the sciatic nerve may modulate expression of P-ERK, P-p38 MAPK and P-JNK in the DRG and that MAPKs may play an important roles in pain hypersensitivity.
이상무,배재천 대한임상신경생리학회 2002 Annals of Clinical Neurophysiology Vol.4 No.1
Background : Changes in firing pattern and in the recruitment order of single motor unit(MU) have been claimed to be characteristic of central motor lesions, and a reduced firing rate was found in upper motor neuron lesions. But these findings have been rarely studied before in Korea, so we studied initial MU recruitment pattern in stroke patients with hemiparesis. Methods : We studied six patients(3 men and 3 women) whose mean age was 60.6±7.4 years. A mean 20.6±16.2 months had elapsed since the stroke. To compare the initial MU activation patterns in proximal and distal segments of paretic limb with their contalateral unaffected counterparts, we studied the onset and recruitment intervals in biceps brachii(BB) and first dorsal interossei(FDI) muscles in paretic and healthy arms. In a single muscle we examined from 5 to 10 individual MUs. And in a single motor unit, both the onset interval and the recruitment interval was examined. Results : The mean onset interval in paretic limb was significantly(p<0.05) longer than unaffected limb at proximal and distal location: BB 118.5±17.8 msec vs 96.1±8.3 msec(n=58); FDI 125.8±16.7 msec vs 101.5±17.2 msec(n=38). The mean recruitment interval in paretic limb was also significantly(p<0.05) longer than unaffected limb: BB 87.7± 14.9 msec vs 73.4 ±11.5 msec(n=53); FDI 96.3±16.4 msec vs 87.7±14.1 msec(n=38). Conclusion : The first recruited MU had a lower baseline firing rate and the second recruited motor unit potential appeared earlier in paretic than in healthy muscles. And these findings may explain one of the reasons for paresis in patients with stroke.