말기 암환자의 임종 전 48시간 동안의 임상증상

심윤수,김도연,남은미,이순남,Sim, Yun-Su,Kim, Do-Yeun,Nam, Eun-Mi,Lee, Soon-Nam 한국호스피스완화의료학회 2007 한국호스피스.완화의료학회지 Vol.10 No.4

목적: 말기 암환자의 여명을 예측하는 것은 환자와 가족들에게 '평안한 임종'을 맞기 위한 준비를 할 수 있도록 하고, 의료진에게는 적극적 증상완화와 전인간적 돌봄을 가능하게 할 수 있다. 이에 본 연구는 말기 암환자에서 임종 전 48시간 동안의 임상증상을 파악하고 임종을 예측하는 임상증상을 확인하여 환자 가족 및 의료진에게 이 시기에 나타나는 변화들을 이해하여 준비된 평안한 임종을 맞는데 도움이 되고자 한다. 방법: 2003년 7월부터 2006년 3월까지 한 대학병원에 입원하여 사망한 말기 암환자 89명을 대상으로 하여 임종 전 48시간 동안의 임상증상을 조사하였고 입원 시, 임종 48시간-24시간전, 임종 24시간전$\sim$임종시까지 시간대별 증상의 빈도 변화를 분석하였다. 결과: 전체 대상 환자의 중앙 연령은 62세(범위, $16{\sim}97$세)였다. 임종 48시간전 임상증상의 빈도는 의식혼탁(57%)이 가장 흔하였으며 이외 통증(30%), 발열(22%), 호흡곤란(19%)의 순이었다. 원발암에 따른 임종 48시간전 임상증상도 유사한 빈도를 보였으나 담도계암환자에서 발열의 빈도가 다른 암종에 비해 유의하게 높았다(P=0.012). 임종이 임박할수록 입원 시에 호소하던 전신 쇠약감과 식욕부진은 감소한 반면 의식혼탁은 유의하게 증가하였다(P<0.001). 결론: 말기 암환자에서 의식혼탁은 임종이 임박했음을 나타내는 가장 중요한 임상 지표로 생각된다. Purpose: Individual cancer patients often experience many symptoms that impair their quality of life at the end of life. Identifying symptoms at the terminal stage of cancer patients and possible imminent death prediction by using that assessment can assist physicians and patients in preparing the 'peaceful death'. This study examines symptom experience during the last 48 hours of life of terminal cancer patients, and determines whether symptom experience change with proximal to death. Methods: The medical records of 89 patients who died with terminal cancer at a hospital between July 1, 2003 and March 31, 2006 were reviewed. Symptom prevalence at the last 48 hours was analyzed along with the change of symptom experience at the admission, $48{\sim}24$ hours, and $24{\sim}0$ hours before death. Results: Median age of all patients was 62 years old (range $16{\sim}97$). During the last 48 hours, symptom prevalence was described as follows; unclear consciousness (57%), pain (30%), fever (22%), and dyspnea (19%). According to the primary site, unclear consciousness was notified the most frequent symptom, but fever was relatively high prevalence in patients of biliary origin cancer rather than other site cancer (P=0.012). As death was Impending, the prevalence of poor appetite and general weakness were decreased, while that of unclear consciousness was increased, which were all statistically significant (P < 0.05). Conclusion: The presence of unclear consciousness could be regarded as the symptom indicator as imminent death of terminal canter patients.

아침 식사시간의 다른 사람들에서 혈장 그렐린의 변화

이상엽,김윤진,김형회,손한철,전태용,심문섭 대한비만학회 2002 The Korean journal of obesity Vol.11 No.2

연구배경 : 최근 식욕조절인자로 관심이 집중되고 있는 그렐린(ghrelin)은 식사 전후로 독한 일중변동을 보인다. 하지만, 지금까지는 실험적으로 일정한 열량의 표준 음식을 일정한 식사시간에 공급한 이후 그렐린의 농도 변화를 관찰하였다. 저자 등은 평소 아침 식사시간이 각기 다른 사람들에서 아침 식사 전후의 혈장 그렐린 농도 변화를 관찰하여 향후 외래 환경에서도 그렐린 관련 연구가 가능하도록 기초 자료를 제공하고자 하였다. 방법 : 연구에 대한 설명을 듣고 동의한 23.4 ~ 35.5세 사이의 비교적 건강한 동양인 남자 4명을 대상으로 하였다. 신체 계측을 한 후 이중 에너지 방사선 측정법 (Lunar prodigy, GE medical systems, Waukesha, Wisconsis, USA, 이하 DEXA)으로 체지방을 측정하였다. 연구 대상자 모두 평소 아침 식사시간이 일정하였지만 연구 시작 2주전부터 아침 식사시간을 엄격히 고정하도록 하였다. 스트레스가 없는 상태에서 아침 식사를 하지 않는 지원자는 오전 6시 30분부터, 나머지는 아침식사 시간 1시간 전부터 1시간 간격으로 점심 식사 전인 오전 11시 30분까지 채혈하였다. 각각의 검체로 부터 혈장 그렐린은 상업적인 방사선면역측정법 (Phoenix Pharmaceuticals, Inc., Belmont, CA)으로 측정되었다. 랩틴은 Ⅰ-125 표지 랩틴을 이용한 이중항체 방사선면역측정법으로, 혈장 인슐린은 항체 부착관을 이용한 방사선면역측정법으로, 혈당은 포도당산화 효소법에 의해 Synchron LX 20 (Beckman Coulter, Inc, Fullerton, USA)으로 측정하였다. 결과 : 연구 대상자의 체질량지수는 22.9 ~ 27.1 kg/㎡이었고, 허리둘레는 80.3 ~ 93.3 cm이었다. DEXA로 측정한 결과 전체 체지방과 체부지방 비율은 각각 27.1 ~ 31.8%와 32.7 ~ 32.4%이었다. 아침 식사를 하지 않는 자를 제외한 나머지 연구 대상자의 아침 식사 직전의 식후 2시간의 혈장 그렐린 농도는 각각 113.0 ~ 800.0 pg/mL, 78.3 ~ 553.0 pg/mL이었고 랩틴 농도는 각각 4.9 ~ 5.1 ng/mL, 4.4 ~ 4.7 ng/mL 이었다. 혈장 그렐린 랩틴 농도는 아침 식사 직전에 비해 식사 2시간 후 각각 7.2 ~ 30.9%와 7.8 ~ 10.2%감소되었다. 아침식사를 하지 않는 대상자의 경우 인슐린과 혈당치가 변화가 없음에도 불구하고 혈장 그렐린 농도는 오전 7시 30분에 가장 낮았다. 그 외 연구 대상자에서는 각기 다른 시간이더라도 아침 식사 2시간 후의 혈장 그렐린 농도가 가장 낮았다. 결론 : 평소 아침 식사시간이 다른 사람들에게서 혈장 그렐린 농도는 각기 다른 아침 식사 2 시간 후에 가장 낮았다. 아침 식사를 하지 않는 경우에는 혈장 그렐린 농도가 오전 7시 30분에 가장 낮았다. Background : Recently, the particular interest is on ghrelin, the dietary control factor among many scientists and it a toxic diurnal variations has been demonstrated before and after meal. However, the experimental approach has been only to see the changes in the concentration of ghrelin after intake of meals standardized with fixed calories at scheduled meal hours. the authors of this particular experiment have tried to observe and record the changes in concentrations of plasma ghrelin of persons with different breakfast hours. This might help in providing a basis for further possible studies in outpatient setting. Method : A group of four relatively healthy males whose ages between 23.4 and 35.5 with prior agreements were selected for this study. After body measurements, body lipid status was measured based on Lunar prodigy (GE medical systems, Waukesha, Wisconsin, USA) which is also referred to as DEXA. All of the selected persons had somewhat fixed breakfast time; however, they were asked to strictly keep their breakfast time fixed and steady starting two weeks before the beginning of experiment. The bloods of those who skip their breakfast without any particular stress were sampled at 6:30 AM, whereas the rest had different schedule, whose bloods were sampled every hour starting 1 hour before the first meal of the day till just before lunch (11:30 Am). From each blood sample, the level of plasma ghrelin was measured using the commercial radioimmune assay (Phoenix Pharmaceuticals, Inc., Belmont, CA). Leptin was measured with double antibody radioimmune assay using Ⅰ-125 labelled leptin, plasma insulin with radioimmune assay using antibody attachment tube, and blood sugar with Synchron LX20 (Beckman Coulter, Inc, Fullerton, USA) using glucosylation enzyme method. Result : The body mass index of the volunteers was 22.9 ~ 27.1 kg/㎡, with 80.3 ~ 93.3 cm waist circumference. Based on measurements by DEXA, the rates of total body lipid and trunk lipid were each 27.1 ~ 31.8% and 32.7 ~ 32.4%, respectively. The concentrations of plasma ghrelin of those who consume their breakfast before and 2 hour after their breakfast are 113.0 ~ 800.0 pg/mL and 78.3 ~ 553.0 pg/mL. The concentrations of leptin are 4.9 ~ 5.1 ng/mL and 4.4 ~ 4.7 ng/mL. Compared to the concentration of plasma ghrelin and of leptin recorded just before breakfast, it showed 7.2 ~ 30.9% and 7.8 ~ 10.2% decrease, respectively, 2 hours after breakfast. For those who skip their breakfast, the plasma concentration of ghrelin was recorded the lowest at 7:30 AM, even though there was no change in insulin and blood sugar. The rest of the subjects had their lowest plasma ghrelin concentration at 2 hours after breakfast, despite their different meal schedule. Conclusion : The persons with different breakfast hours had their lowest plasma concentration of ghrelin at 2 hours after breakfast. In contrast, the persons who skip their breakfast had their lowest concentration at 7: 30 AM.

Caerulein과 총담췌장관 결찰에 의한 급성췌장염 모델의 특징

심상수,김현준,이윤혜,박진형,이승준,김창종 중앙대학교 약학연구소 2000 약학 논총 Vol.14 No.-

To investigate the difference in acute pancreatitis experimentally induced by common bile-pancreatic duct (CBPD) ligation and caerulein iv infusion, we measured amylase activity, pancreatic edema and phospholipase A_2 activity in pancreatic tissue and serum. In acute pancreatitis induced by CBPD ligation and caerulein infusion, tissue edema and tissue phospholipase A_2 activity significantly increased as compared with normal group. Also experimental acute pancreatitis significantly increased the levels of serum protein, serum amylase activity and serum phospholipase A_2 activity. In the comparison of two experimental models, the symptom of acute pancreatitis induced by CBPD ligation was more severe than that induced by caerulein infusion. These results indicate that the increase of phospholipase A_2 activity in pancreatic tissue and serum may be one of the parameters for the diagnosis of acute pancreatitis.

부산광역시의 대기질 변화경향 및 특성에 관한 연구

이화운,김유근,원경미,홍정혜,문윤섭,장난심,정우식 부산대학교 환경문제연구소 1997 環境硏究報 Vol.15 No.1

대장에 발생한 샘암종에서 MUC1과 MUC2 점소 발현의 의의

이윤경,이주호,이용,심재영,박정훈,오수섭,박진실,기근홍 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2

Background : Mucins possess the unique function of protecting and lubricating the epithelial surface and other important functions such as call growth, direct implication in the fetal development, the epithelial renewal and differentiation, the epithelial integrity, carcinogenesis, immune regulation, cellular adhesion and metastasis. Purpose : This study was done to provide the significance of alteration of MUC1 and MUC2 expression in colorectal adenocarcinoma, A series of 131 colorectal adenocarcinomas including 11 mucinous carcinomas were screened immunohistochemically for their expression of MUCI and MUC2, Materials and mehtods : Of 131 carcinomas, 76 (58,5%) were MUCI positive and 91 (68, 9%) were MUC2 positive, In normal colonic goblet cells, MUCl was not expressed but MUC2 was expressed in cytoplasm, Conclusion There were up-regulation of MUCI and down-regulation of MUC2 in colorectal carcinomas, The frequency of MUC2 positivity according to differentiation was statistically reliable. (p=0.0001)

외이에 대한 경피신경 전기자극과 레이저가 실험적 피부 통증역치에 미치는 영향

심연주,이미선,이윤주 한국전문물리치료학회 1997 한국전문물리치료학회지 Vol.4 No.1

2004년 3월 $4{\sim}5$일 중부지방 대설 분석

신도식,박윤호,이재원,심기오,Sin, Do-Sik,Park, Yun-Ho,Lee, Jae-Won,Sim, Gi-O 한국방재학회 2004 한국방재학회지 Vol.4 No.4

Anti-oxidative and Photo-protective Effects of Coumarins Isolated from Fraxinus chinensis

Lee, Bum-Chun,Lee, So-Yong,Lee, Hwa-Jeong,Sim, Gwan-Sub,Kim, Jin-Hui,Kim, Jin-Hwa,Cho, Young-Ho,Lee, Dong-Hwan,Pyo, Hyeong-Bae,Choe, Tae-Boo,Moon, Dong-Cheul,Yun, Yeo-Pyo,Hong, Jin-Tae 대한약학회 2007 Archives of Pharmacal Research Vol.30 No.10

Free radicals and reactive oxygen species (ROS), which are generated by UV irradiation, may cause serious injury to skin cell membranes, DNA and functional proteins. In addition, these agents stimulate the expressions of matrix metalloproteinases (MMPs), which can degrade most components of the extracellular matrix (ECM), including collagen. In order to develop new anti-photoaging agents, five major components from the extract of Fraxinus chinensis extract (FCE) were identified. Two of the major components of FCE were found to be esculin (11.2%) and esculetin (1.9%). FCE ($IC_{50}:\;50.0{\mu}g/mL$ 1, 1-diphenyl-2-picrylhydrazyl (DPPH); $19.8{\mu}g/mL$, superoxide anion radical) and esculetin ($IC_{50}:\;2.1{\mu}g/mL$ DPPH; $0.6{\mu}g/mL$, superoxide anion radical) showed strong antioxidative activities. Of the compounds tested, esculetin showed the strongest scavenging activity against DPPH radicals, followed by superoxide anions from the xanthine/xanthine oxidase system. The intracellular ROS scavenging activity showed that oxidation of 5-(6-)-chloromethyl-2', 7'-dichlorodihydrofluorescein diacetate ($CM-H_2DCFDA$) was effectively inhibited by esculetin, with potent free radical scavenging activity was also shown in UVB-irradiated human dermal fibroblasts (HDFs). Moreover, treatment of UVA-irradiated HDFs with esculetin resulted in dose-dependent decreases in the expression levels of MMP-1 mRNA and protein. From these results, FCE and one of its components, esculetin, were predicted to be potentially useful as ingredients in cosmetics for protecting against photoaging.

Cytotoxic Psammaplysin Analogues from a <i>Suberea</i> sp. Marine Sponge and the Role of the Spirooxepinisoxazoline in Their Activity

Lee, Yeon-Ju,Han, Saem,Lee, Hyi-Seung,Kang, Jong Soon,Yun, Jieun,Sim, Chung J.,Shin, Hee Jae,Lee, Jong Seok American Chemical Society and American Society of 2013 Journal of natural products Vol.76 No.9

<P>Seventeen bromotyrosine-derived metabolites, including eight new compounds, were isolated from a Micronesian sponge of the genus <I>Suberea</I>. Four of the new compounds were psammaplysin derivatives (<B>10</B>–<B>13</B>), and the other four were ceratinamine derivatives (<B>14</B>–<B>17</B>). Of the compounds obtained, the psammaplysins exhibited cytotoxicity against human cancer cell lines (GI<SUB>50</SUB> values down to 0.8 μM), while the ceratinamine and moloka’iamine analogues showed almost no activity. These results suggest that the spirooxepinisoxazoline ring system is a requirement for cytotoxicity and, therefore, may serve as an attractive molecular scaffold for the development of a potent anticancer agent.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jnprdf/2013/jnprdf.2013.76.issue-9/np400448y/production/images/medium/np-2013-00448y_0005.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/np400448y'>ACS Electronic Supporting Info</A></P>

In vitro and in vivo anti-allergic actions of Arecae semen

Choi Wahn Soo,Lee Jun Ho,Park Yun Sim,Seo Jin Young,Ko Na Young,Chang Sung Ho,Lee Hoi Young,Lee Hyang Woo,Han Jeung Whan,Her Erk,Kim Young Mi 대한약학회 2004 大韓藥學會 總會 및 學術大會 Vol.2004 No.1