제1형 당뇨병 환자에서 췌도세포 동종이식의 반복시행

양태영,정인경,서인아,오은영,조건영,오승훈,김성주,정재훈,민용기,이명식,이문규,김광원,도영수,주성욱 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.4

연구배경:췌도세포 이식은 시술이 간편하고 안전하기 때문에 반복이식이 가능하여 그 동안 여러 센터에서 반복이식의 성공을 보고한 바 있다. 국내에서도 본 병원을 비롯하여 몇몇 센터에서 췌도세포 이식이 활발히 시도되고 있으나 사람에서의 동종이식 및 동종 이식의 반복시행은 보고된 바 없는 실정이다. 저자 등은 국내 최초로 췌도세포 동종이식을 시행하여, 혈청 C­펩타이드가 증가하고 인슐린 요구량이 감소하였으며, 혈당농도와 당화혈색소의 안정을 보였다. 그러나 이식 70일 후 다시 인슐린 요구량이 증가하고 C­펩타이드가 감소하여 췌도세포 이식을 다시 시행한 바 있다. 2차 이식 후 70여일이 지난 현재 다시 혈청 C­펩타이드가 증가하고, 인슐린 요구량이 더 감소되어 췌도세포 이식에서 반복 시행의 유용성을 보고하는 바이다. 방법:환자는 32세 남자로 17년전 당뇨병 진단 후 인슐린 치료 중이었으며, 3년전 부터는 만성신부전증으로 혈액툭석을 하고있었다. 1999년 12월 25일 신장이식을 하였고 3일 후 췌도이식을 하였으며, 두번째 이식은 70일 후 시행하였다. 췌도분리는 변형된 Recordi방법과 비연속성 자당 농도차(discontinuous density gradient)를 이용하였으며 분리한 췌도는 배양 후 환자의 신장기능이 정상화되고 미생물학 검사에서 음성을 확인한 후 경피경간으로 간문맥을 접근하여 16G 폴리 에틸렌 카테터를 이용하여 간실질에 이식하였다. 결과:1차 췌도이식시 순수분리전 췌도수는 210,000개, 순수분리후 획득한 췌도수는 90,000개, 순도 95%, 세포양 1.0mL 이었고, 2차 췌도이식시 순수분리전 췌도수는 420,000개, 순수분리후 획득한 췌도수는 370,000개, 순도 95%, 세포양 1.5mL 이었다. 1,2차 모두 간문맥을 통해 약 20분에 걸쳐 간실질에 주입하였다. 췌도이식전 인슐린요구량은 75∼75U/일, HbA1e 8∼10%, C­펩타이드 0.6ng/mL 였으며, 1차 췌도이식수 7일째 인슐린 요구량은 40U/일, C­펩타이드 1.5ng/mL, FPS 109mg/mL 였고, 40일 추적관찰 후 인슐린 요구량이 36U/일, C­펩타이드 1.8ng/mL, HbA1e 6.5∼7.0%로 안정되었다. 그러나 이식 50일째부터 인슐린 요구량이 50∼56U/일, C­펩타이드 0.6ng/mL, FPS 130∼200mg/dL로 혈당 조절이 불안정하여 다시 췌도이식을 시행하였다. 2차 이식후 50일이 경과한 현재, 인슐린 요구량은 26U/일, C­펩타이드 1.8ng/mL, FPS 90∼120mg/dL로 다시 안정되었다. 결론:췌도이식은 반복이식이 가능하며, 본 환자의 경우 인슐린요구량 감소, 혈당의 안정화 및 C­펩타이드가 상승하여 이식한 췌도의 기능을 확인할 수 있었고, 향후 스테로이드 등 면역억제가 유지 용량으로 감량되면 인슐린 요구량은 더 감소될 것으로 기대된다. Over the past 20 years, significant advances have been made in human islet transplantation. However, cases of prolonged insulin independence after islet allotransplantation have rarely been reported and over time, a slight, gradual decrease in insulin secretion appears to occur, as suggested by the lower C-peptide. Although preliminary clinical success achieved over the past few years has been considerably higher with whole pancreatic transplant than with isolated islet grafts, both approaches remain experimental. Islet grafts might gain, over time, increasing credibility and might eventually provide an easier alternative in terms of grafting procedures and patient management, as compared with the more "traumatizing" whole-pancreas transplantation. Also, using islet, re-transplantation is possible. But it is not known whether re-transplantation of islet could be suitable for those patients who lost grafted islet function. The aim of the present study was to investigate the benefits of re-transplantation of islet in previously simultaneous islets-kidney transplant (SIK) patient who have lost graft function. Methods : The recipient was a 32 year old male. First islet transplantation was underwent at December 25, 1999. However, the grafted islets lost function after 70 days. So we performed re-transplantation of islets. The isolation of islet was conducted sterilely on a laminarflow hood and isolated by a modified Recordimethod. The islet was injected slowly into the liver via a cannular placed in the potalvein for 20 minutes. Results : Transplanted islets were 90,000 IEq at first islet transplantation, 370,000 IEq at second islet transplantation. The insulin requirement was reduced from 75-85 to 35-40 U/day, the basal C-peptide level was 1.5 ng/mL at 7 days posttransplant Unfortunately, the grafted islets lost function after 70 days. After second transplantation, the insulin requirement was reduced to 26 U/day. Conclusions : Despite the continuous need for exogenous insulin therapy, islet transplantation can prevent wide glucose fluctuations, thus resulting in normalization of glycemic control and improvement in HbAlc, and also, show that islets can be successfully and safely re-transplanted intraportally in patients who have lost previously grafted islet function (J Kor Diabetes Asso 457~466, 2000).

급성 골수성 백혈병 환자에서 발생한 침습성 아스페르길루스중에 대한 수술적치료 1 예

배영환;어원식;어상민;김승만 김태영;박수영;서영경;정은주;안효정 인제대학교 2011 仁濟醫學 Vol.32 No.-

Invasive pulmonary aspergillosis is known to have a poor prognosis and major cause of morbidity and motality in patients with hematologic disease. Without adequate therapy, invasive pulmonary aspergillosis will almost always progress to fatal pneumonia. Early administration of antifungal agents in patient with invasive pulmonary aspergillosis is most important. And surgical resection of aspergillous-infected tissue may be useful in patients with lesions that are contiguous with great vessel and lesions causing hemoptysis. We reported a rare case of surgical resection as curative treatment for invasive pulmonary aspergillosis patient in 58-year-old man who had the history of acute myeloid leukemia.

Hepatocellular Carcinoma in the Elderly: Clinical Characteristics, Outcomes and Treatment Efficacy, Safety in Older than 75 Years

( Ji Ho Seo ),( Sunmin Kim ),( Eunae Cho ),( Chung Hwan Jun ),( Sun Young Park ),( Sung Bum Cho ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing because the increase in the longevity of the general population. But there is no proper management based on age stratification in elderly patients. We compared clinical characteristics, outcomes and treatment efficacy, safety between oldest-old (aged more than 85 years), middle-old (aged between 80 and 85 years) and young-old (aged between 75 and 80 years) patients with HCC. Methods: We conducted a retrospective cohort study, from January 2010 to December 2016, at Chonnam National University Hospital. A total of 550 elderly patients whose data included demographics, co-morbidity, etiology of liver disease, presence of cirrhosis, staging of HCC, treatment modality and treatment related adverse event were evaluated retrospectively. Also overall survival was assessed in enrolled patient. Results: Fifty one patients (oldest-old; median 87 years old), 153 patients (middle-old; median 82 years old) and 346 patients (young-old; median 77 years old) were diagnosed with HCC. Both oldest- and middle-old patients, compared to young-old patients had significantly lower rate of alcohol-related disease (13.7% vs 20.9% vs 34.1%, P = 0.001). There were no significant difference in underlying sex, body mass index, presence of co-morbidity, hepatitis C-related disease and stage of HCC. The Child-Pugh class (CPT class A 88.9% vs 84.1% vs 83.6%, CPT class B 11.1% vs 15.9% vs 15.0% and CPT class C 0.0% vs 0.0% vs 1.3%, respectively, P = 0.912) and Model for End Stage Liver Disease score (mean MELD score 7.22±3.34 vs 5.88±3.01 vs 5.77±3.14, P = 0.166) were no significant difference between the patients with active treatment. The modified UICC staging (stage I 5.6% vs 17.1% vs 18.6%, stage II 55.6% vs 46.3% vs 47.3%, Stage III 22.2% vs 24.4% vs 24.8%, Stage IV-A 11.1% vs 6.1% vs 4.9% and Stage IV-B 5.6% vs 6.1% vs 4.4%, respectively, P = 0.826) and Barcelona Clinic Liver Cancer staging (stage 0 5.6% vs 9.8% vs 9.3%, stage A 16.7% vs 17.1% vs 22.1%, stage B 27.8% vs 29.3% vs 24.8%, stage C 50.0% vs 43.9% vs 41.2% and stage D 0.0% vs 0.0% vs 2.7%, respectively, P = 0.878) were no significant difference between the patients with active treatment. Furthermore, there were no difference between the age groups in treatment modality (Surgical resection 0.0% vs 3.3% vs 5.2%, P = 0.166; Radiofrequency ablation 2.0% vs 8.5% vs 11.0%, P=0.113; Transcatheter arterial chemoembolization 21.6% vs 34.6% vs 41.6%, P=0.014; Best supportive care 62.7% vs 40.5% vs 29.2%, P < 0.001), adverse event related treatment (P = 0.731) and disease-free survival days (329 .3±309.1 days vs 271.7 ± 414.2 days vs 357.2 ± 511.6 days, P = 0.336). Multivariate analysis showed that age, performance status, CTP class, MELD score, modified UICC staging, presence of portal vein thrombosis and ruptured HCC are risk factors for mortality. Conclusions: Clinician should make an active treatment in elderly patients with HCC not a age but performance status, liver function and disease status of cancer.

Nanogenerators: Fully Rollable Transparent Nanogenerators Based on Graphene Electrodes (Adv. Mater. 19/2010)

Choi, Dukhyun,Choi, Min-Yeol,Choi, Won Mook,Shin, Hyeon-Jin,Park, Hyun-Kyu,Seo, Ju-Seok,Park, Jongbong,Yoon, Seon-Mi,Chae, Seung Jin,Lee, Young Hee,Kim, Sang-Woo,Choi, Jae-Young,Lee, Sang Yoon,Kim, Jo WILEY-VCH Verlag 2010 ADVANCED MATERIALS Vol.22 No.19

<B>Graphic Abstract</B> <P>The cover shows an image of fully rollable transparent nanogenerators synthesized using chemical vapor deposition grown large-scale graphene sheets as transparent electrodes and piezoelectric ZnO nanorod arrays. Sang-Woo Kim, Jae-Young Choi, and co-workers report on p. 2187 the electrical and structural stability of the nanogenerators, with excellent charge scavenging performance under external mechanical loads such as bending and rolling. This study shows that graphene-based nanogenerators are very promising for self-powered rollable transparent device applications. <img src='wiley_img_2010/09359648-2010-22-19-ADMA201090066-content.gif' alt='wiley_img_2010/09359648-2010-22-19-ADMA201090066-content'> </P>

안근성 중증근무력증이 동반된 갑상선 기능항진증의 임상상 : Report of Six Cases

서지영,김두만,김현규,최철수,임성희,유재명,최문기,유형준,박성우,김형철,송홍기,김덕환 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

CMP 공정의 재현성 확보를 위한 공정제어 범위의 결정

서용진,정소영,김철복,박성우,이경진,김기욱,박창준 대불대학교 2002 大佛大學校大學院 硏究論文集 Vol.- No.1

To achieve the ULSI goals of higher density and greater performance, STI(shallow trench isolation)-CMP(chemical mechanical polishing) process has been attracted. Recently, the direct STI-CMP process without the conventional complex reverse moat etch process has established by using slurry additive with the high selectivity between SiO2 and Si3N4 films for the purpose of process simplification and in-situ EPD(end point detection). However, STI-CMP process has various defects such as nitride residue, torn oxide and demage of silicon active region. Also, it was difficult to assure the suitable process margin in the STI-CMP process. To solve these problems, in this paper, we discussed to determine the control limit of process, which can entirely remove the oxide on nitride film from the most area of high density as reducing the damage of dense moat area and minimizing dishing effect in the large field area. We, also, evaluated the wafer-to-wafer thickness variation and the day-by-day reproducibility of STI-CMP process after repeatable tests.

有限要素法에 의한 슬래브를 가지는 3次元 骨造構造物의 靜·動的 解析에 관한 硏究

서상근,허택영,장병순 釜山大學校生産技術硏究所 1995 生産技術硏究所論文集 Vol.49 No.-

슬래브를 가지는 3차원 골조구조물에 진동을 유발하는 기계하중이 재하되면, 동적 거동을 고려하여 구조물을 설계할 필요가 있다. 구조물의 정.동적 해석에서 보다 정확한 해를 얻기위해 기하학적 형상, 재료특성, 경계조건 및 하중조건 등을 실제 구조물에 근접하도록 이상화시켜야 한다. 본 연구에서는 구조물 해석에 유한요소법을 사용하였으며, 본 연구의 목적은 동적 하중을 받는 건축구조물에 대한 동적 운동방정식의 정식화 및 구조물 해석에 적용할 수 있는 프로그램의 개발이며 이 프로그램으로 슬래브 임의 위치에서 진동하는 기계가 재하될 때 구조물의 동적 거동을 해석하는 것이다. When dynamic force such as mechanical load which create vibration is applied to the three-dimensional framed structure with slab, dynamic analysis is an essential part of the design work. In order to obtain the accurate result of either static or dynamic analysis, idealization of geometrical shape, material properties, boundary conditions and loading conditions have to be as close to the actuality. The aim of this study is formulation of the equation for dynamic motion and development of finite element program which can be accommodated to analysis of dynamic behavior of building structures.

적응제어기법을 이용한 유도전동기 속도 센서리스 벡터제어

서영수,이춘상 명지대학교 산업기술연구소 2001 産業技術硏究所論文集 Vol.20 No.-

When the vector control, which does not need a speed signal from a mechanical speed sensor, it is possible to reduce the cost of the control equipment and to improve the control performance in many industrial application. This paper describes a rotor speed identification method of induction motor based on the theory of flux model reference adaptive system. The estimator execute the rotor speed identification so that the vector control of the induction motor may be achieved. The improved auxiliary variable of the two model are introduced to perfrom accurate rotor speed estimation. This method is verified by computer simulation using SIMULINK in MATLAB.

Korean English Teacher's Disempowerment in English-only Classes

Sung-Sam Hwang,Hyo-Sun Seo,Tae-Young Kim 한국사회언어학회 2010 사회언어학 Vol.18 No.1

Hwang, Sung-Sam, SeD, Hyo-Sun, Kim, Tae-Young. 2010. Korean English Teacher's Disempowerment in English-only Classes: A Case Study Focusing on Korea-specific Cultural Aspects. The Sociolinguistic journal of Korea 18(1). In this case study, we have focused on the disempowerment of a Korean English teacher (KET) in English-only classrooms. Six English as a foreign language (EFL) classrooms in a Korean high school were observed and analyzed by using interpretive discourse analysis. Out of the six classes, three representative classrooms were both video- and audio-taped. The results show that the English-only classes could weaken the KETs' power via three mechanisms: (a) calling the KETs' last name for choral greetings at the beginning of the class, (b) students' group solidarity and peer pressure between classmates, and (c) the students' excessively collaborative approach to peer assistance. It is argued that the exclusive English-only instruction disempowers the KETs' status and dismantles their vocational identity. In order to remedy the current situation, within a scaffolding supported by the eclectic use of first language where necessary for effective class management, KETs are empowered and overcome constraints imposed by the limited L2 oral competence of some non-native English teachers.

PSPICE를 이용한 전력전자회로의 시뮬레이션 모델링

서영수,이상봉 명지대학교 대학원 1997 대학원논문집 Vol.1 No.-

PSPICE is not offered a library of mechanical factor like DC Motor, Induction Motor which is needed in Power Electronics field. Therefore, Induction Motor was made library by Equibalent circuit in this study. This model is applied in Voltage-Type inverter and is investigated its characteristics. IGBT is tested by two methods of Macro and Micro Modeling as semiconductor. PWM signal is used of pulse signal. Voltage and current, speed, torque was simulated for assurance of model.