거대적아구성빈혈의 임상적 고찰

곽승근,천재민,박남숙,박상은,박수진,윤환중,김삼용,조덕연 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Megaloblastic anemias are disorders caused by impaired DNA synthesis and chara-cterized by the presence of megaloblastic cells. Clinical data on these disorders in Korea are limited. The aim of this study was to analyze clinical characteristics of megaloblastic anemias caused by vitamin B12 deficiency. We identified 40 cases who were diagnosed as megaloblastic anemia from January 1993 to December 2002 in a retrospective study on the basis of chart review. We investigated the annual distribution of diagnosed patients, clinical manifestations and response to treatment. 19 cases were complicated with a previous total gastrectomy(gastrectomy group) and 21 cases had no history of surgical operation(non-gastrectomy group). The most common presenting complaint was generalized weakness. The median age at diagnosis was 7(range: 38-79) years in non-gastrectomy group. The mean pos-toperative duration was 7(range: 4-25)years in group of total gastrectomy and mean level of serum vitamin B12 was lower than 100 pg/mL in both group. Peripheral blood revealed thrombocy-topenia, macrocytic anemia and hypersegmented neutrophil in all cases. After treatment of pareliteral vitamin B12, Their clinical symptoms and hematologic findings improved except two patients who had bone marrow with lower cellularity. Cobalamin replacement after total gastrectomy is still missing. Diagnoses are made too late in a population of patients, resulting in irreversible neurological sequale, and we suggest that Pernicious anemia seems not to be very rare in Korea.

이동 애드 혹 네트워크에서의 환경적응형 QoS AODV 라우팅 프로토콜에 관한 연구

裵振勝,宋東勳,吳世德,鄭燦赫,金玄郁,李光培,文泰洙,郭承郁,河載承 明知大學校 産業技術硏究所 2004 産業技術硏究所論文集 Vol.23 No.-

In this paper, we propose a bidirectional mobile Ad Hoc routing protocol based on AODV(ad-hoc on-demand distance vector routing) with QoS(quality of service) support. At presence, wireless mobile communication focuses on how to efficiently support mobility of users more than QoS guarantee. However, in order to satisfy requirement of various applications which have been or will be served, QoS guarantee between end points is a very important issue. The existing AODV routing protocol is implemented to use only BE (Best Effort) service. However, actual wireless mobile environment requires to reduce a waste of communication resources and meet with the real-time change of data paths by setting up routes with QoS support, considering available communication resources at each node in advance. Therefore, in this thesis, we propose an adaptive QoS support method using hello message in order to rapidly meet with the change of available communication resources and to smoothly perform route maintenance. For performance evaluation, we analyzed the average data reception rate. At that time, we used evaluation parameters such as node's mobility-stop time, hello message period, and packet priority, considering the node's mobility and the number of best effort/QoS data flows. As results, we found that with our proposed method the average data reception rate was increased 16.293%, 15.914%, 17.238% for 300 mobility-stop second case and 4.809%, 4.264%, 2.956% for 300 mobility-stop second case.

Dry Pituitary Powder에 對하여

朴勝淑,吳淑子,郭賢玉,裵炯珍,李仙浩 梨花女子大學校 藥學硏究所 1960 梨花藥學硏究 Vol.- No.2

미만성 대형 B-세포 림프종에서의 예후인자에 관한 연구

김삼용,곽승근,박상은,윤환중,조덕연,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

미만성 대형 B-세포 림프종은 가장 흔한 악성 림프종의 한 종류로서 우리나라에서는 전체 비호지킨 림프종의 50%를 차지한다. 비호지킨 림프종에서 병기는 호지킨병과는 달리 예후 인자로서의 유용성이 적다. 따라서 병기만을 예후 인자로서 평가하는 한계를 극복하기 위해 국제예후지표(International Prognostic Index)가 도입되었다. 특정 환자에서 IPI 점수와 함께 그 환자의 림프종의 생물학적 특성을 분석한다면 예후 예측에서 정확도가 높아질 것이다. 본 연구에서는 미만성 대형 B-세포 림프종에서 국제예후지표의 유용성을 확인하고자 하였으며, 각종 생물학적 지표의 면역화학염색을 통하여 이들을 배세포 중심 아형(germinal center subgroup : 이하 GC양 아형으로 약함)과 활성화 B-세포 아형(post-germinal center subgroup; 이후 pGC양 아형으로 약함)으로 분류하고 이들의 예후 예측에 대한 적절성을 평가하였다. 결과는 다음과 같다. 1. 연령분포는 37세에서 69세로 중앙치는 56세이었으며, 남자는 17예(65.4%), 여자가 9예(34.6%)였다. 병기는 Ⅰ, Ⅱ, Ⅲ, Ⅳ기가 각각 2예(7.7%), 11예 (42.3%), 5예(19.2%), 8예(30.8%)였다. 'B'증상은 5예(19.2%)에서 양성이었다. 진단 당시 혈청 LDH치가 상승한 경우가 11예(42.3%)였고, 거대종양(직경이 10㎝이상)을 갖는 경우가 5예(19.2%)이었다. ECOG 수행등급은 0이 2예(7.7%), 1이 18예(69.2%), 2가 5예(19.2%), 3이 1예(3.8%)이었다. 2. 면역조직화학염색 상 bcl-2의 양성은 17예(65.4%), bcl-6의 양성이 20예(76.9%)이었다. CD10이 양성인 경우가 5예(19.2%)이었다. IRF-4가 양성인 경우는 8예(30.8%)였다. 26명의 환자에서 bcl-6, CD10과 IRF-4를 이용하여 GC양 아형과 pGC양 아형으로 분류 하였는데, GC양 아형은 14예(53.8%)이었고, pGC양 아형은 7예(26.9%), 분류가 되지 않는 경우가 5예(19.3%)이었다. 3. 평균 48개월 동안 추적한 결과 중앙생존기간은 44개월이었고 생존기간은 1~100+개월에 분포하였다. Kaplan-Meier법에 의한 5년 누적 생존률은 32%이었다. 4. 병기, 'B' 증상, 혈청 LDH 농도, ECOG 수행등급, 거대종양유무가 통계학적으로 의미있는 임상적 예후 인자였다. 5. 면연조직화학염색에서는 bcl-2만이 통계학적으로 유의한 예후인자였다. 6. GC양 아형은 pGC양 아형에 비해 생존기간은 좋았으나, 통계학적 유의성은 없었다. 7. 다변량 분석결과 bcl-2 발현과 혈청 LDH치만이 예후에 영향을 미쳤다. Clinical Significanceof Expression of Biomarkers in Patients with Diffuse Large B-cell Lymphoma Diffuse large B-cell lymphoma(DLBL) is the most common type of lymphoma in Korea, representing about 50% of non-Hodgkin's Lymphomas. Although DLBL is usually considered as a specific category, the diversity in clinical presentation, morphology, genetic and molecular alterations strongly suggest that these tumors represent a heterogeneous group of neoplasia rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embraces patients with heterogeneous prognoses. It is likely that the prognostic assessment of patients with DLBL might be improved by using biological features. During the last decade, most studies dealing with the heterogeneity of DLBL have focused on individual protein expression and molecular alterations. The expression of individual antigens related to different stages of B-cell differentiation, including CD10, bcl-6, and IRF-4, may help to define groups of tumors with different clinical and pathological characteristics. To determine the clinical significance and prognostic value of individual biomarker expression and the biomarker expression patterns according to germinal center subgroup or post-germinal center subgroup of DLBL as defined by a relatively small number of single antigens, we studied 26 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for CD10, bcl-6, IRF-4, bcl-2 antigens. Two immunophenotyping profiles were distinguished according to the pattern of differentiation; germinal center(GC;CD10/Bcl-6+/IRF-4-) subgroup or postgerminal center (pGC ; CD10/bcl-6/IRF4+) subgroup. The results are as follows; 1) Baseline characteristics of patients were ; median age of patients was 56(range ; 37-69). 17 patients(65.4%) were male. 5 patients(l9.2%) had 'B' symptoms. Stages were as follows ; stage Ⅰ2 patients(7.7%), stage Ⅱ 11 patients(42.3%), stage Ⅲ 5 patients(l9.2%), stage Ⅳ 8 patients(30.8%). 11 patients (42.3%) had elevated LDH levels. 25 patients(96.2%) had ECOG performance grade 0-Ⅱ and 1 patient had grade Ⅲ. 5 patients(l9.2%) bad bulky disease. 2) The results of immunohistochemical study were as follows ; positive bcl-2 staining in 17 patients(65.4%), positive bcl-6 in 20 patients(76.1%), positive CD10 in 5 patients(l9.2%), positive IRF-4 staining in 8 patients (30.8%). 3) After a median follow up duration of 48 months, the median survival duration was 44 months with a range of survival of 1-100+ months. 5-year overall survival rate was 32% by Kaplan-Meier method. 4) The clinical factors affecting survival were elevated serum LDH level, B symptoms, bulky disease, stage at diagnosis and ECOG performance status 5) Among the biomarkers, only bcl-2 expression affected survival of DLBL patients 6) The germinal center like subgroup had superior survival than post-germinal center like subgroup but had no statistical significance. 7) Multivariate analysis showed that bcl-2 and serum LDH level had siginificance on survival Conclusion In addition to the known clinical prognostic factors, immunohistochemically defined characteristics such as bcl-2 expressionin DLBL is important and subgroups(germinal center or post-germinal center subgroup) of DLBL may have importance in predicting prognosis of DLBL patients

冷凍冷藏倉庫 前室部 侵氣防止裝置의 適用에 關한 硏究

석호태,곽현철,송승영,송진규,이영욱 대한건축학회 2003 대한건축학회논문집 Vol.19 No.4

This study aims to evaluate the economic performance of infiltration prevention devices for the refrigerated warehouse. It is showed that the cooling loads of refrigerated warehouses is changed by assembling of infiltration prevention devices in a previous study. Space loads and cooling energy costs according to the types of the infiltration prevention devices are analyzed by the DOE-2.1E simulation. Based on the Life Cycle Costs considered the costs of initial construction, repair·replace, cooling energy and operating energy, the probability of reducing energy consumption and application of infiltration prevent devices in vestibule of refrigerated warehouse is founded.

혈관중심성 T세포/자연살상세포 림프종의 임상적 고찰

이정찬,박수진,박상은,곽승근,신현영,김성은,이정호,윤환중,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Although the Working Formulation is commonly used to classify NHL in Korea, it has been recognized as imperfect for primary extranodal lymphoma, expecially for patients with nasal, paranasal disease because of their histological characteristics. Angiocentric T/NK cell lymphoma remains rare clinical presentation in North America and Europe but is more common in Asia and Latin America. The optimal mode of treatment has also not been decided on, probably because of their rarity and limited understanding of its natural course. The aim of this study was to analyze our experience with 14 patients with angiocentric lymphoma seen at the Chungnam Natioanl University Hospital over the last 5 years. We reviewed the records of 14 patients who were treated at the Chungnam National University Hospital between January, 1996 and December, 2000. The angiocentric T/NK cell lymphoma accounted for about 8.2% of NHL. The median age was 52.5 (range 36-71) years. Sex ratio was equal. According to the Ann Arbor staging system, disease was classified as stage Ⅰin 3 patients, stage Ⅱ in 8 patients and stage Ⅳ in 3 patients. Systemic B symptoms were present in only four patients in only four patients. All patients has extranodal involvement. The most frequently involved extranodal sites were nasal cavity followed by paranasal sinuses and orpharynx. The most common presenting symptoms were nasal obstruction with purupent rhinorrhea followed by dysphagia. According to the International prognostic index (IPI), most patients was in low-risk group (11 patients). Nine patients responded completely. Seven patients were received combination chemotherapy and 2 patients had radiation therapy as a initial treatment. Five patients were relapsed. After a median follow-up of 660.5 days, the overall survival and disease-free survival rates at 3 years was 56.8% and 42.9% respectively. The median survival time was not yet reached. The median overall survival time was 1338.5 (range 1212-1564) days for non-relapsed and 733.4 (range 302-1008) days for relapsed patients. The median time from CR to relapse was 100.5 (range, 39-159) days. There were limitations to know enough about the characteristics of angiocentric T/NK cell lymphoma because of a small number of patients. In the future, multicenter trials will be neccesary to identify clinical characteristics, optimal treatment mordalities and their responses, and prognostic factors.

동일한 국제예후지표(International Prognostic Index)를 나타내는 미만성 대형 B-세포 림프종에서 Bcl-2와 p16의 임상적 중요성

박상은,박수진,곽승근,박남숙,천재민,윤환중,조덕연,김삼용,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

In Korea, malignant lymphoma is a common cancer, comprising about 2.7% of all malignant neoplasm. Diffuse large B cell lymphoma is the most common lymphoma, representing about 50% of all Non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma is usually considered as heterogeneous group of neoplasms rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embrace patients with heterogeneous prognoses. But International Prognostic Index scoring system is not sufficiently predict the prognosis. It is likely that the prognostic assessment of patients with diffuse large B-cell lymphomamight be improved by using biological features. Bcl-2 protein and p16 protein expression is recognized as useful biologic markers predicting the prognosis of patients with diffuse large B-cell lymphoma. To determine the clinical significance and prognostic value of bcl-2 and p16 proteins expression patterns, we studied 18 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for bcl-2, p16. The results are as follows; 1) The median age was 54(rage : 37-69). There were 12 male patients(66.7%) and 6 female patients(33.3%) The 'B' symptom was abscentin all patients. The stages were as follows : Ⅰ, 2 patient(11.1%), Ⅱ, 10 patient(55.6%), Ⅲ, 4patient(22.2%) and Ⅳ, 2patient(11.1%). 3 patients(16.8%) had the elevated LDH level, 14 patients(77.8%) had the normal LDH level and 1 patients(5.6%) was not identified the LDH level. 2 patients(11.1%) had the bulky disease and 16 patients(88.7%) had no bulky diease. The distribution of ECOG status were O, 2 patients(11.1%c), 1, 14patients(77.8%) and 2, 2patients(11.1%). 2) Theimmunohistochemistry results are as follows bcl-2:+,10 patients(55.6%), bcl-2:-, 8patinets(44.4%), p16:+,3 patients(16.7%), p16:-, 15patients(83.3%) 3) After a median follow UP durations of 67 months, the median survival time was 57 months with a rage of 7-100+ months. 5-years overall survival rates was 44% by Kaplan-Meier method. 4) Reduced overall survival was demonstrated in the patients who expressed bcl-2 protein(P=0.0174). 5-year overall survivial rate was 12%(bcl-2 expression) versus 88%(no bcl-2 expression) 5) Among diffuse large B-cell lymphoma patients with IPI score 0-1, reduced overall survival was demonstrated with bcl-2 expression(P=0.023). 5-year overall survival rate was 18%(bcl-2 expression group) versus 100%(no bcl-2 expressiongroup) 6) Median survival durtation of diffuse large B-cell lymphoma patients negative for p16 expression was 57 months whereas p16 postive patients' median survival duration was not reached(P=0.4478). In diffuse large B-cell lymphoma patients with identical IPI scores, bcl-2 expression had additional prognostic value.

무선 애드 혹 기반 액티브네트워크상에서 QoS지원에 관한 연구

李基源,裵振勝,丁燦赫,金玄郁,李光培,姜景仁,朴京培,文泰洙,郭承郁,河載承 明知大學校 産業技術硏究所 2003 産業技術硏究所論文集 Vol.22 No.-

Abstract - In this thesis, we propose a QoS supporting method on wireless ad hoc-based active network for improving reliability. On the loss of route path, the existing DSR routing protocol has several problems with wireless network communication because of decease of data reception rate and increase of network load. The proposed method improves reliability of data transfer by using functions of active network. That is, by using functions of active nodes and active packets, the proposed method supports QoS with reservation transfer method that saves data packets on transfer at intermediate nodes with lost path and then re-transmit the packets after route reconfiguration.

광주광역시 치매의 유병률과 위험인자의 도시-농촌 지역 비교

신일선,김재민,윤진상,김석재,양수진,김웅장,이승현,강순아,곽지영,이형영 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.6

연구목적 : 본 연구의 목적은 광주광역시의 도시 및 농촌 지역에 거주하는 노인에서 치매의 유병률과 위험인자를 조사하고자 하였다. 부가적으로 이 두 지역간에 치매의 유병률과 위험인자를 비교하고자 하였다. 방 법 : 광주광역시의 전형적인 도시와 농촌지역의 65세 이상의 노인(N=1,598)을 대상으로, 2단계의 역학연구를 수행하였다. 1차 선별 단계에서는 38명의 훈련된 연구보조원이 대상노인을 면담하여, 사회인구학적 특징을 조사하고 한국판 간이정신상태검사(Korean version of Mini-Mental State Examination ; MMSE-K)로 평가하였다. 2차 임상 진단 단계에서는 1차 단계에서 MMSE-K 점수가 24점 이하인 노인(N=431)을 대상으로, 전문연구팀의 임상적 평가를 통해 치매를 진단하고 원인질환별로 알쯔하이머병(Alzheimer's disease ; AD), 혈관성 치매(vascular dementia ; VaD) 및 기타 치매로 분류하였다. 대상노인에서 치매의 유병률을 측정한 후, 광주광역시 전체 노인의 연령보정 유병률을 산출하였다. 전체 대상에서 AD의 위험인자를 조사한 후, 도시와 농촌군으로 나누어 분석을 다시 시행하였다. 결 과 : 1차 및 2차 단계의 참가율은 각각 71.0%(N=1,134) 및 83.2%(N=410) 였다. 연구 참여 노인(N=1,134)에서 전체 치매, AD 및 VaD의 유병률은 최소 각각 9.7%, 5.2%, 1.8%였다. 광주광역시 전체 노인의 연령 보정 유병률은 각각 10.7%, 5.7%, 1.9%인 것으로 산출되었다. AD의 독립 위험인자는 고령, 여성, 무학이었다. 도시와 농촌에 따른 유병률의 차이는 파악되지 않았다. 그러나 AD의 위험인자는 지역에 따라 차이가 있었다. 도시 노인에게는 무학만이, 농촌 노인에게는 고령과 여성인 경우가 독립 위험인자였다. 결 론 : 광주광역시 노인에서 치매의 유병률은 높았고, 이는 국내 다른 지역에서 수행된 선행연구 결과와 유사하였다. 알쯔하이머형 치매의 위험인자는 도시와 농촌에 따라 다른 결과를 보였다. 본 연구 결과는 한국에서의 치매의 실태를 반영하며, 치매의 적절한 관리와 예방을 위해서는 지역성 특성이 고려되어야 함을 시사한다. Objectives : The purpose of this study was to investigate the prevalence rate and risk factors of dementia in an urban and a rural sample of older persons in the metropolitan Kwangju area, Republic of Korea. In addition, the prevalence rate and risk factors of dementia between the two samples were compared. Methods : A two-phase epidemiological study of residents aged 65 or over(N=1,598) was conducted in a highly developed, urban and a non-contiguous, poorly developed, rural area of metropolitan Kwangju. In the first(screening) phase, 38 trained research assistants collectively peformed in-home interviews for all participants. Detailed sociodemographic characteristics were gathered and the Korean version of Mini-Mental State Examination (MMSE-K) was administered. In the second (diagnosing) phase, diagnosis of dementia was established for those scoring 24 or less on the MMSE-K in the screening phase(N=431), and etiological types of dementia were classified to Alzheimer's disease(AD), vascular dementia(VaD) or miscellanous type by two teams of experts. Prevalence rate of dementia was determined in the participants, and age-standardized prevalence rate adjusted by age distribution in metropolitan Kwangju was estimated. For AD, the risk factors were investigated in all participants, and analyses were repeated for the urban and rural samples separately. Results : The participating rates in the first and second phases were 71.0%(N=1,134) and 83.2%(N=410), respectively. In the participants, the prevalence rates of dementia(all types), AD and VaD were 9.7%, 5.2% and 1.8%, respectively. The age-standardized prevalence rates were 10.7%, 5.7% and 1.9%, respectively. Aging, female gender and no education(complete lack of formal education) were identified as independent risk factors for AD. No difference between the urban and rural samples was observed in the prevalence rates of dementia(all types), AD and YaD. However, risk factors for AD differed between these areas. In the urban sample, no education was the only significant factor ; whereas, aging and female gender were identified as risk factors in the rural sample. Conclusion : A high prevalence rate of dementia was observed among old persons in metropolitan Kwangju, consistent with previous studies conducted in other Korean areas. The risk factor profi1es for AD differed between urban and rural settings. The results of this study reflect the current status of dementia in Korea and suggests that appropriate management and prevention strategies for dementia should be tailored toward the geographic settings.

서울의 PPNG 발생 빈도(1991-1992)

김재홍,윤기범,박평원,김영진,전경민,김영태,김중환,곽호,구상완,송민석,유옥,지혜구,김동원,문상은,박영립,정승호,성범진,성순제,엄주용,황정열,이기홍,이주협,전태진 대한화학요법학회 1994 대한화학요법학회지 Vol.12 No.1

The prevalence of PPNG among pretreated gonorrhea cases isolated at the STD clinic of Choong-Ku Public Health Center in Seoul has been studied and reported annually since 1981. In 1991, 123 strains of N.gonorrhoeae were isolated, among which 58(47.1%) were PPNG. In 1992, 98 starains of N.gonorrhoeae were isolated, among which 51(52.0%) were PPNG. In all, 109(49.3%) strains were found to be PPNG among 221 strains isolated between 1991-1992. The prevalence of PPNG in Seoul showed increased tendency till 1989, thereafter, it has been stationary or slightly decreasing.