전신적 항응고제 사용이 어려운 말기신부전 환자에서 헤파린 결합된 Hemophan 투석기를 사용한 혈액투석 - 7년간의 임상 경험

윤수진 ( Yun Su Jin ),김범 ( Kim Beom ),이현희 ( Lee Hyeon Hui ),이영기 ( Lee Yeong Gi ),강우헌 ( Kang U Heon ),김정아 ( Kim Jeong A ),이방훈 ( Lee Bang Hun ),여호명 ( Yeo Ho Myeong ),임영환 ( Im Yeong Hwan ),백현정 ( Baeg Hyeon 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.4

목 적 : 저자들은 양전하를 띤 N, N-diethyl-aminoethyl group이 부착되어 있는 Hemophan 투석기에 음전하를 떤 헤파린을 결합시키는 Gretz 등의 방법을 수정하여 출혈 위험성이 있는 말기신부전 환자에서 헤파린 결합 Hemophan을 이용한 혈액투석법 (hemodialysis using heparin bound Hemophan, HBH-HD)을 보고한 바 있다. 저자들은 지난 7년 동안 출혈 위험성이 있는 말기신부전증 환자들에서 HBH-HD를 시행하였으며 이에 그간의 결과를 종합하여 HBH-HD의 안전성과 효율성을 보고하고자 한다. 방 법 : 저자들은 1995년 4월부터 2002년 4월까지 출혈 위험성이 있는 만성혈액투석환자 159명에서, 헤파린을 결합시킨 Hemophan 투석기 (GFS plus 11, Gambro)를 사용하여 총 1,057회의 HBH-HD를 시행하였다. 투석기나 혈액관 교체가 필요할 정도의 심한 혈액응고 없이 4시간 동안 혈액투석이 가능하였던 40회 투석에서 혈액투석 전, 투석 시작 후 15분, 60분, 120분과 투석 종료 직전 (240분)에 혈중 헤파린 농도와 activated partial thromboplastin time (aPTT)을 측정하였다. 투석의 효율성을 평가하기 위하여 동일 환자에서 시행한 HBH-HD와 이후 헤파린을 전신적으로 사용한 혈액투석 (routine hemodialysis, R-HD) 간의 혈액구획용적(total blood compartment volume, TBCV) 손실과 투석기요소청소율 (K), Kt/V를 비교하였다 (n=20). 결 과 : 1,057회 투석 중 11회 (1.0%)에서는 투석 후 150분 이내에 투석기와 혈액관에 혈액 응고가 발생하어 투석을 증단하였고, 64회 (6.1%)에서는 투석 후 150분부터 230분 사이에 혈액관에 혈액응고가 발생하여 혈액관 교체가 필요하였다. 투석기나 혈액관의 교체가 필요할 정도의 심한 혈액응고 없이 4시간 동안 혈액투석이 가능하였던 982회 증 40회의 투석에서 측정된 헤파린 농도는 투석전 값 (0.11±0.06 U/mL, 평균±표준편차)에 비하여 투석 후 15분 (0.14±0.06 U/mL)에 경미한 증가를 보인 후 (p<0.05), 60분에 0.11±0.05 U/mL, 120분에 0.08±0.04 U/mL, 투석 종료 후 0.08±0.04 U/mL로 감소하였다. 투석 중 aPTT는 투석 전 (44.3±12.9초)에 비하여 투석 후 15분 (49.8±10.5초)에 증가한 후 (p<0.05), 60분에 40.8十7.1초, 120분에 36.1±5.5초, 투석 종료 후 32.1±5.3초로 감소하였다. 두 투석간의 TBCV 손실은 HBH-HD시 17.2±9.6%, R-HD시 2.8±1.2%로 유의한 차이를 보였다 (p<0.0001). 그러나, HBH-HD시 측정한 K값은 136.9±14.6 mL/min, Kt/V는 1.27±0.21로 R-HD의 137.6±18.4 mL/min와 1.20±0.22와 각각 비교하여 볼 때 유의한 차이가 없었다 (p>0.05). 결 론 : 헤파린을 결합시킨 투석막을 사용한 혈액투석법은 출혈 위험성이 있는 말기신부전증 환자들에서 시행할 수 있는 안전하고 효과적인 투석법이다. 그러나 체외 회로에 심한 혈액응고를 완전히 방지하지는 못하므로 투석 중 투석기와 혈액관에서 혈액응고 발생 여부를 감시해야 한다. Objective : Positively charged N,N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH-HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and effciency of HBH-HD in chronic renal failure patients at risk of bleeding. Methods : During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer : GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250mL/min. To evaluate of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n=40). To evaluate the dialysis effciency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). Results : Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1,057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean±SD, 49.8±10.5 sec) and HC (0.14±0.06 U/㎖) at 15 min, compared to predialysis levels of 44.3±12.9 sec and 0.11±0.06 U/㎖, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean±SD, 17.2±9.6%), compared to R-HD (2.8±1.2%) (p<0.0001). However, K and Kt/V value (mean±SD) were 136.9±14.6 ㎖/min and 1.27±0.21 in HBH-HD and 137.6±18.4 ㎖/min and 1.20±0.22 in R-HD, showing no significant difference (p>0.05). Conclusion : HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed cardfully during HBH-HD. (Korean J Nephrol 2003;22(4):389-396)

Stereological Analysis on Migration of Human Neural Stem Cells in the Brain of Rats Bearing Glioma

Kim, Jae-Ho,Lee, Jong-Eun,Kim, Seung U.,Cho, Kyung-Gi Oxford University Press 2010 Neurosurgery Vol.66 No.2

<P>OBJECTIVE: The objective of this study was to determine the rate and pattern of NSC migration in the brain and its time course after NSC transplantation. METHODS: We investigated the tropism of HB1.F3 (F3) immortalized human NSCs in rats bearing U373 human glioma in the brain. Rats received an injection of human U373MG malignant glioma cells into the striatum followed by an injection of F3 cells into the contralateral hemisphere 7 days later. We analyzed the numbers, distribution, and migration rate of NSCs using unbiased stereology. RESULTS: Approximately 10% of the injected NSCs migrated into the tumor region by 50 minutes after NSC injection. The number of NSCs in the tumor region increased slowly up to 5 days post-injection and increased significantly up to 15 days post-injection. Changes in tumor volume showed similar patterns. The rate of NSC migration was approximately 175 microm/min. NSCs increased in number approximately 1.7-fold during day 1 in the absence of tumor cell inoculation in vivo. However, the proliferation of NSCs began to decline after 5 days after injection. CONCLUSION: We identified for the first time the rate and pattern of NSC migration to the tumor mass in vivo. These findings may provide useful information with respect to preclinical research of gene therapy for malignant gliomas.</P>

Effective transduction of osteogenic sarcoma cells by a baculovirus vector

Song, Sun U.,Shin, Seok-Hwan,Kim, Soon-Ki,Choi, Gwang-Seong,Kim, Woo-Chul,Lee, Moon-Hee,Kim, Sei-Joong,Kim, In-Ho,Choi, Mi-Sook,Hong, Young-Jin,Lee, Kwan-Hee Microbiology Society 2003 The Journal of general virology Vol.84 No.3

<P>Efficient gene delivery of a baculovirus-derived vector (BV-p53-lacZ) to a human osteogenic sarcoma cell line, Saos-2, was serendipitously found while evaluating the vector for gene delivery to human p53-null tumour cells in a previous study. Therefore, we investigated other human, rat and mouse osteogenic sarcoma and other types of tumour cell lines for transduction efficiency via baculovirus vectors containing a lacZ reporter gene under the control of either a cytomegalovirus or Rous sarcoma virus promoter. The expression of beta-galactosidase protein, assessed by X-Gal staining and beta-galactosidase ELISA, demonstrated an extremely high level of transduction efficiency in some osteogenic sarcoma cell lines, such as U-2OS, Saos-2 and Saos-LM2. These human osteogenic sarcoma cell lines showed levels of beta-galactosidase expression 5-40 times greater than HepG2 cells, which were previously thought to be the mammalian cells most susceptible to baculovirus-mediated gene delivery. The level of acetylated histone proteins in these tumour lines did not correlate well with the high level of reporter gene expression. These results strongly suggest that some osteogenic sarcoma cells are highly susceptible to baculovirus-mediated gene delivery and that a baculovirus-derived vector is an efficient gene delivery vehicle into human osteogenic sarcoma cells.</P>

Zinc stearate의 첨가가 $UO_{2}$분말의 겉보기밀도, 혼합 및 성형에 미치는 효과

나상호,김시형,이영우,양명승,손동성,Na, Sang-Ho,Kim, Si-Hyeong,Lee, Yeong-U,Yang, Myeong-Seung,Son, Dong-Seong 한국재료학회 1995 한국재료학회지 Vol.5 No.4

윤활제인 zinc stearate의 첨가량 (0~4wt%)을 변화시켜 U$O_{2}$분말의 겉보기밀도, 성형시의 분말입자간 마찰과 입자/다이벽 마찰간의 상관관계를 조사하였다. 소량의 윤활제 첨가시에는 U$O_{2}$분말입자간 박막의 윤활제 도포층이 형성되어 겉보기밀도가 증가한 반면 다량의 윤활제를 첨가한 경우에는 U$O_{2}$ 분말입자에 두꺼운 윤활제 도포층이 형성되고 미혼합된 윤활제가 존재하여 겉보기밀도는 감소하는 경향을 보였다. 윤활제를 첨가혼합한 상태에서 다이벽 윤활도포 유무에 따라 구한 U$O_{2}$ 성형체의 성형압력/성형밀도 자료로부터 분말입자간 마찰, 입자/다이벽 마찰 그리고 성형시 lubrication/inhibition등의 상대적 중요성을 조사하였다. 입자/다이벽 마찰에 의한 압력손실은 입자간 마찰에 의한 압력손실보다 크게 나타났다. 입자/다이벽 마찰에 의한 압력손실은 다이벽 윤활제 도포에 의해 최소화될 수 있지만 상대적으로 바람직하지 않은 성형시의 inhibition이 야기되는 것으로 나타났다.

한국에서 독일어 : 과거와 현재

홍명순,정시호,이광숙,이성만,하수권,Ammon, Ulrich 한국독일어교육학회 2002 외국어로서의 독일어 Vol.10 No.-

Es handelt sich bei dieser Arbeit um die Frage, welche Rolle die deutsche Sprache und Kultur in der koreanischen Gesellschaft bis heute gespielt haben und noch in Zukunft spielen werden, wobei die folgenden verschiedenen Bereiche in Betrachtung genommen wurden: Wissenschaft, Kunst, Wirtschaft und Werbesprache. Außerdem wurde einen U¨berblick u¨ber die Geschichte der Fremdsprachenausbildung in Korea gegeben. Bis in die 1950er war die deutsche Sprache in Korea in denmeisten wissenschaftlichen Bereichen von großer Bedeutung vor allem in der Philosophie, Sozialwissenschaft, Rechtswissenschaft, Medizin und Musik. Danach verlor die deutsche Sprache allma¨hlich ihre Bedeutung, wa¨hrend Englisch und Japanisch eine zunehmend dominierende Rolle spielten. Die deutsche Medizin und die deutsche Sprache haben zur entwicklung der westlichen Medizin in Korea einen großen Beitrag geleistet. Zum Beispiel hat Deutsch in den Curricula der Soul und der Kyungpook Medizinschule bis 1945 fast eine gleich starke Stellung wie Englisch oder zeitweise noch sta¨rkere Stellung gehabt. Aber das Jahr 1945, besonders der Korea Krieg(1950-1953) war ein entscheidender Wendepunkt. Seitdem sind die deutsche Medizin und Deutsch verdra¨ngt worden. Es hat heute vo¨llig an Boden verloren. Und um die Beeinflußung der deutschen Musik in Korea fest zustellen, wurden in Korea erschienene Musiklehrbu¨cher und wissenschaftliche Bescha¨ftgung in der Musikwissenschaft untersucht. Nach der Analyse der Musiklehrbu¨cher ist folgendes zubemerken: Im ersten Schuljahr werden u¨berwiegend Komponisten aus dem deutschsprachigen Raum behandelt. Auf dem Hochschulbereich u¨ben sie einen gro¨ßeren Einfluss aua. Bei der Untersuchung der Magisterarbeiten auf dem Gebiet Vokal-, Klavier-, Kammer- und Instrumentalmusik zwischen 1958 und 1987 fa¨llt auf, dass ca. 60-70% der arbeiten Komponisten des deutschsprachigen Raums behandeln. Anders als in den oben erwa¨hnten Bereichen ist die Einstellung koreanischer Firmen zur deutschen Sprache extrem negativ. Seitens der koreanischen Firmen wird der deutschen Sprache fu¨r ihre gescha¨ftlichen Aktivita¨ten keinerlei Bedeutung beigemessen, in vielen Fa¨llen wurde auch das negative Image der deutschen Sprache erwa¨hnt. So kommt es nicht von ungefa¨hr, wenn Absolventen eines Studienganges in Germanistik ihre deutsche Sprachkenntnis in Bewerbungsschreiben erst gar nicht erwa¨hnen, sondern stattdessen nur ihre in den Englischzertifikaten TOEIC und TOEFL erlangten Punktzahlen angeben. Neben solchen Bereichen wurde in dieser Arbeit auch die Frage untersucht, ob und welche Bezeichnungen von Gescha¨ften und Geba¨uden aus der deutschen Sprache und Kultur stammen. Auch in diesem Untersuchungsbereich dominiert Englisch und wird Deutsch selten verwendet. Allerdings sind bei Kaffee-, Bierha¨usern und Konditoreien deutsche Benennungen nicht selten zu beobachten. Viele Kaffeeha¨user tragen die Namen der in Korea beliebten Komponisten aus dem deutschsprachigen Raum : Mozart, Schubert, Brahms und Beethoven, oder auch ihrer Werke. Fu¨r Bierha¨user beborzugt man Stadt- bzw. Ortsbezeichnungen wie Mu¨nchen, Bern, Berlin, Heidelberg, Schwabing und Mosel. Außer solchen Gesichtspunkten wurde hier auch die geschichtliche Entwicklung der Fremdsprachenausblidung in Korea untersucht. Diese Entwicklungsgeschichte hat eine enge Beziehung mit der politischen Geschichte. Chinesisch galt bis Ende des 19. Jahr hunderts als Bildungssprache, und zwar nur fu¨r ho¨here Schichten der Bevo¨lkerung. Der Fremdsprachenunterricht als allgemeine Bildung an Schulen hat seinen Ursprung in den spezifischen Fremdsprachenschulen, die Ende des 19. Jahrhundert gegru¨ndet wurden, in dem der Modernisierungsprozess Koreas begann: Englisch, Deutsch, Franzo¨sisch, Russisch, Chinesisch und Japanisch konnte man dort bei Muttersprachlern lernen. In der koreanischen Fremdsprachenausbildung haven aber heutzutage Englisch und Japanisch erste Priorita¨t vor allen anderen Sprachen. Deutsch wird zwar an den Schulen unterrichtet, findet aber daru¨ber hinaus, etwa im Berufsleben, so gut wie keine praktische Verwendung. Die Untersuchung zeigt auch in anderen Bereichen einen Wandel, na¨mlich bei der Benennung der Fremdsprachen, der Zahl der Fremdsprachen und den Unterrichtsinstitutionen. Es ist dabei festzustellen, dass die Unterrichtsmethoden und Lerngewohnheiten am wenigsten mobil sind. Wenn man solche Untersuchungsergebnisse zur Rechnung tra¨gt, scheint der Ru¨ckgang des Bedarfs der deutschen Sprache in Korea unvermeidbar sowohl in der Schule und als auch in der Universita¨t zu sein, obwohl auch in Zukunft Koreaner Interesse and de Kultur der deutschsprachigen La¨nder-im großen Abstand nach den USA, Japan und China-zeigen werden. Das ko¨nnte eine negative Kettenreaktion auslo¨sen : die Anzahl von Deutsch Experten geht zuru¨ck, ihre Berufschanchen verschlechtern sich weiter, viele Institutionen mu¨ssen zwangsweise geschlossen, Forschungaktivita¨ten beschra¨nkt werden usew. Wie vorher festgestellt, gru¨ndet sich das bestehende Lehrangebot an Deutsch in Korea weniger auf einem wirklich existierenden gesellschaftlichen Bedarf, sondem auf der Macht, u¨ber die Institutionen und Strukturen verfu¨gen. Eine am Anbieter orientierte Schulpolitik hat lange Zeit den Bedarf an Deutsch in Schulen und Universita¨ten garantiert. Mit dem nun stattfindenden Wandel hin zu einer nachfrageorientierten Schulpolitik verliert das Schulfach Deutsch sein bisheriges Fundament. Quantitativ gesehen hat der Markt fu¨r Deutsch als Fremdsprache in Korea eine Phase des Wachstums hinter sich und erlebt nun einen vielerorts deutlichen Abschwung. Die Krise, in der sich Deutsch als Frmdsprache in Korea zur Zeit befindet, wird sich vermutlich angesichts der gesellschaftlichen Bedingungen, des herrschenden Zeitgeists und der ungu¨nstigen Schulpolitik fu¨s Erste fortsetzen. Geht man von einem Ungleichgewicht zwischen Angebot und Nachfrage aus, wird dieser Abwa¨rtstrenderst zum Stillstand kommen, wenn ein Gleichgewicht hergestellt ist. Selbstversta¨ndlich sind solche Tendenzen im Zusammenhang mit der umfassenden Restrukturierung zu sehen, in der sich die koreanische Gesellschaft momentan befindet.

ACTH 분비 뇌하수체 선암에 의한 쿠싱병

이문호,이정교,이기업,송영기,박중열,김기수,조원경,최기영 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.2

Primary carcinoma of the pituitary is only rarely reported. About half of the reported cases are nonfunctional. It is generally agreed that the presence of distant metastasis is required to clearly establish the diagnosis of pituitary carcinoma. We have experienced a case of ACTH-producing pituitary carcinoma causing Cushing's syndrome which could be diagnosed by histologic features only without evidence of distant metastasis. A 35-year-old female with Cushingoid appearance was diagnosed as Cushing's disease after biochemical and neuroradiological evaluation. Near total removal of the pituitary tumor was performed. By histopathologic examination, the tumor revealed evidences of histological malignancy such as prominent nuclear pleomorphism, frequent mitoses and extensive tumor necrosis. Pseudosarcomatous components were also noted. By immunohistochemical studies, the tumor cells expressed ACTH. However, there was no evidence of distant metastasis at the initial operation. She was diagnosed as having ACTH producing pituitary carcinoma by histologic feature only. One month later, she complained progressive nausea and vomiting, and follow-up brain MRI revealed regrowing pituitary mass. She was reoperated and near total tumor bulk was removed again followed by radiotherapy with 5580 rads. Four month after the second operation, she developed generalized tonic clonic seizure. Brain CT showed multiple enhancing nodules on left temporal and frontal lobes, and around falx cerebri. She refused further treatment and was managed only with anticonvalsants. About month after discharge she died at home(J Kor Soc Endocrinol 9:136-140, 1994).

현행 중학교 과학 실험·실습교육에 대한 교사들의 견해와 개선방안

이윤종,기우항,김영호,정원우,양승영,강용희,안병호,임성규,윤일희,김중욱,강동진 경북대학교 과학교육연구소 1996 科學敎育硏究誌 Vol.20 No.-

The status of facilities, management of the experiment, practices, and Science education teaching method in middle school have been investigated. The present status and reasonable management of middle school science education have been grasped from the questionaires. The results are as follows : The reasonable management for expeiments and practices of science education were scanty in the middle school around the urban and rural schools owing to the shortage of facilities and equipments, crowded class, excessive classes, work for teachers, excessive contents of present textbook and insufficience of administrative support etc. The current teaching method of middle school science has emphasized knowledge. This fact does not satisfy the objective of learning due to lack of teaching method. Desirable directions for the improvement of present status of middle school science education were proposed in this paper.

하시모토갑상선염에 동반된 골수를 침범한 ( 병기 4E 기 ) 원발성 갑상선 림프종 1 예

이기업,송영기,박중열,김기수,김상희,공경엽,조재근,추윤호,엄완식,지현숙 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.4

Primary lymphoma of the thyroid is a relatively rare malignant tumor of the thyroid. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, a few cases of primary lymphoma of the thyroid have been reported and most of these cases were in the stage I E or II E. Recently, we experienced a case of the primary thyroid lymphoma, stage IV E associated with Hashimoto's thyroiditis in a 70-year-old woman who presented with dysphagia and dyspnea due to rapidly enlarging neck mass. She was treated with combination chemotherapy(cyclophosphamide, adriamycin, vincristine and methylprednisolone) and local radiotherapy and achieved partial response with resolution of dysphagia and dyspnea(J Kor Soc Endocrinol 9: 390-394, 1994).

문화취향이 정보 불평등에 미치는 영향

서우석,이호영 한국정보사회진흥원 2006 정보화정책 Vol.13 No.3

인터넷을 이용한 문화콘텐츠 소비가 증가함에 따라 정보화 과정에서 문화취향이 중요한 요인으로 작용하게 되었다. 이 연구는 정보 불평등에 대한 문화취향의 영향을 이론적으로 규명하고 경험적 자료의 분석을 통해 실증하고자 하였다. 이론적인 논의에서는 정보부자와 정보빈자 사이의 간극에 대한 관심으로부터 출발하였던 정보격차의 문제가 정보화의 진전에 따라 다차원적인 양상을 갖게 되면서 사용격차가 갖는 의미가 커졌음을 제시하였다. 또한 인터넷 사용에 대한 기대편익과 충족감의 순환구조를 통해 인터넷의 사용격차가 구조화될 때 문화취향에 따른 네트워크 효과가 중요한 변수로 작용할 수 있음을 논의하였다. 서울시민을 대상으로 수집한 경험적 자료를 이용하여 분석한 결과 문화취향은 인터넷 이용정도, 인터넷 글쓰기, 인터넷 기대편익에 모두 유의미한 영향을 미치는 것으로 나타났다. 이러한 결과는 정보 불평등을 해소하기 위해서 소외 계층이 정보화로 얻을 수 있는 만족과 기대 수준을 높이는 방향으로 정책이 추진되어야 하며 이를 위해서 소외 계층의 문화취향을 고려한 부처간 협력사업이 필요함을 시사한다.

현행 중학 수학 교과서의 비교 분석

기우항,김영호,이윤종,정원우,김민숙 경북대학교 과학교육연구소 1997 科學敎育硏究誌 Vol.21 No.-

The purpose of this study is to compare and analyze the eight current mathematics textbooks in order to them effectively in the course of instruction according to the result. Basically the study has been carried out to compare and analyze what is the difference between the current curriculum and the last one, and the development of the teaching procedure, the difference of the quality and contents in the eight kind of text books.