항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

무연탄 분말의 사과나무 생산성에 미치는 영향 (1)

宋承達,李容夏,鄭三澤,黃正儀 慶北大學校 1974 論文集 Vol.18 No.-

Effects of coal powder on the apple productivity were investigated from the plant eco-physiological point of view. 1) Light absorption by the dispersion of 10, 30 and 50g/㎡ of 54μ meshed coal powder was 42, 82 and 94% of the incident light, respectively. 2) Leaf area index of the coal treated apple tree on June (nearly maximum) was slightly larger than that of the control plant, i.e., 4.5-5.0 for Jonathan and 5.5-6.0 for Rolls Janet. Relative light intensity under this apple leaf population declined to 3.4-2.4% on June 26, 1974. 3) Application of coal powder on apple tree resulted in an increase of specific leaf area. 4) Assimilation rate measured by the half leaf method showed a decreased rate in the treated leaf. 5) Transpiration rate decreased by 9.6% on the coal powdered leaf. 6) Surplus photosynthesis of the apple leaf population was 31.1-32.7g/㎡/day from the estimation by the formula of Monsi-Saeki. 7) Growth rate of fruit diameter and shoot length showed the obstructive effect of coal treated apple tree. 8) Rate of June drop of the coal treated apple (50g/㎡) increased 11.0-15.7% as compared with that of the control plant.

일 농촌지역의 우울 증상에 관한 역학연구 -위험요인 및 요인구조분석

하양숙,홍진표,김한규,이군희,한경자,조맹제,김용익,송미순,박성애,김창윤 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구목적 : 세계적으로 널리 사용되는 우울증 척도인 the Center for Epidemiologic Studies Depression Scale(CES-D)을 이용하여 지역사회 주민의 우울증상의 정도를 평가하고, 우울증상의 위험요인을 분석하고, 한국인에서 우울증상의 요인구조를 알기 위해 본 연구를 실시하였다. 방 법 : 경기도 일 농촌 지역의 30세 이상 주민에 대해 무작위 군집 집락 추출을 실시하였고, 훈련된 면담원들이 가정 방문을 통하여 면접 및 자기보고 검사인 CES-D를 실시하였다. 총 1,315명에서 응답을 하였고 응답율은 59.3%이었다. 결 과 : CES-D에 의한 우울증 점수는 0∼5점이 57%정도를 차지하였고, 평균 점수는 남자 7.8점 여자 9.5점으로 비교적 낮은 편이었다. ANCOVA 분석 결과 비결혼, 저학력, 여성이라는 위험요인은 독립적으로 우울증상을 악화시키는 요인이었으나 연령은 통계적으로 유의하지 않았다. CES-D 결과를 요인분석을 시행한 결과 4가지 요인이 추출되었는데 우울증상 및 신체증상이 한 개의 요인으로, 다른 나라에서 보고되지 않는 정서적 고통이 별도의 요인으로 추출되었다. 결 론 : 국내 역학 조사에서도 외국과 유사한 우울점수 및 위험요인이 확인되었으나 우울증의 요인에서는 특이한 요인이 추출되었다. 한국인에 독특한 우울 반응에 관한 추가 연구가 필요하다. Objectives :The rates, correlates, and factor structure of depressive symptoms in a Korean rural sample were examined using Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). Methods : Door to door visiting survey was conducted by trained interviewers. A random cluster sample of 1,315 respondents, aged 30 and over completed the CES-D scale along with additional sociodemographic questionnaire. Results : In this sample, mean CES-D score of male and female were 7.8 and 9.5, respectively which were lower than those reported previously. Symptoms of depression were most common among the less educated, non-married and female according to ANCOVA. Age was not a significant risk factor for depressive symptoms. Different factor structures emerged from this sample as compared to other studies using this approach. Somatic symptoms and affective symptoms were combined as one factor and emotional hardship emerged as a separate factor. Conclusion : Symptoms scores and risk factors were similar to the results reported in other countries but unique factor structures were found in this study. Further research is needed about the Korean depressive symptomatology and related areas.

한국대학생의 도덕사태 개념화 및 그 변화과정에 관한 연구(II)

송명자,조용하,설기문,김상윤 東亞大學校 學生生活硏究所 1992 學生硏究 Vol.20 No.-

This study aims to analyze the moral judgmental levels and the conceptions of transgressions of Korean college students in a series of multifacted events and the aspects of change in terms of moral judgmental level and conceptualizastion after with two years' college experience. The study was based on the Kohlberg's cognitive moral development theory and on the domain-distinction model in which children's intuitive abilities are stressed. This study was consisted of two sub-studies done in 1989 and 1991 respectively. The subjects of the 1st year study were 416 college students in four major cities(Seoul, Taegu, Kwangjoo, and Pusan). The subjects of the longitudinal analysis of second year study were 199 college students who could be followed up among the subjects of the 1st year study after two years. The instruments used in this study were Test of Moral Judgmental Development and Test of Conceptualization on Mulifaceted Events developed by the authors on the basis of Kohlberg's and Turiel's theories respectively. The following conclusions were obtained through the basis of the results and discussions of this study. First, Korean college students' false responses to moral issues decrease but the radical and anti-social responses increase after two years, and ther these responses are replaced by the level Ⅲmoral judgmental responses. Second, college students who are on the higher moral judgmental level conceptualize the transgression in social conventional and personal domains less permissible than those on the lower levels do. The students who are on the lower judgmental level reveal the decrese of nonpermissibility in social conventional domain with two years' college experience than those on the higher level do.

大學 新入生의 道德的 事態判斷 水準 및 槪念化 樣相의 分析

宋明子,趙鏞夏,薛耆汶,李京淑 東亞大學校 學生生活硏究所 1988 學生硏究 Vol.17 No.-

This study was conducted in order to analyze freshmen's level of cognitive judgment of moral situations and their conceptions of moral situation in different conceptual domains. The research questions to be answered in this study were as follows : 1) What are freshmen's levels of the judgment in moral situations, and are the levels differentiated according to their sex and majors? 2) What are the justifications in each domain? In other words, how do justifications of nonpermissibility, generality, and rule-independency differ in such domains as moral, conventional, and personal? 3) How are freshmen's conceptions of moral situation characterized? Subjects in this study were 200 freshmen(131 boys and 79 girls) randomly sampled from Dong-a University. The instruments were Kim's(1985) Test of Moral Development Judgment which was translated from Rest's(1979) DIT, and 9 interview situations for moral judgment and justfication developed by the current researchers on the basis of Turiel's theory. Subjeects were presented with six moral dilemas and 9 moral situations by 10 research aides who are seniors of education department of dong-A University, specially trained for this study. Data were analyzed statistically to answer the research questions. The major findings of this study were as follows: 1) More freshmen attained level P in terms of judgment of moral situations, while some other students did levels three and four. Therfore, it is considered that a large amount of freshmen start the principled-stage thinking. 2) Many freshmen showed high degree of transitional phase(4½) as level P according to frequencies in each moral stage. This reflects the apparent regression from the hightest stages to stage 2 during freshmen's campus life. Additionally, this kind of regression is found in arts and physical education students rather than other students. 3) There is no sex difference in the levels of freshmen's moral judgment. 4) Freshmen justified the transgressions in moral situations on permissibility and generality. Therefore, they appear to view moral issues as more legitimately subject to moral domain. In part, they tend to view moral issues as subject to conventional domain in that they justify the affairs related to peers of elders on rule-dependence. 5) Freshmen's domain distinction was apparent in that they justified conventional issues on generality. However, they are also seem to moralize since they partly view conventional issues containing relationships with parents as subject to moral domain. 6) Freshmen justified personal issues on rule-dependence and generality. Therfore, it is concluded that they justify the personal issues as subject to conventional domain. 7) Freshmen are more likely to reason about moral issues as personal obligation and sort them as under moral domain. However, within-domain differences in justifications are apparent in that freshmen treated the moral issues as subject to customs or traditions, or personal choice. 8) A strong moralizing is evident in that freshmen conceived conventional issues in terms of other's welfare rather than conventional reason. 9) The within-domain consistence is obvious in that freshment reasoned about personal issues as personal and sort them as under personal domain. However, it is found freshmen's moral conceptions are dependent on situations because some students justified personal issues on other's welfare or obligation while other sutdents did on moral reasons and conventional sanctions or customs.

구개부에 발생한 다형선종의 처치

하주원,백승,송종운,박충열,이용욱,박홍주,오희균,유선열,김옥준 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

Pleomorphic adenoma of the palate is the most common of all intraoral salivary tumors. It can occur at any age but it presents most commonly in the 40∼60 age group, and there is no significant sex preponderance. It grows slowly and is usually painless, firm, well-circumscribed nodule. Because of high rate of recurrence, extra-capsular excision including the overlying mucosa and margin of normal tissue is recommended. We report 10 cases of palatal pelomorphic adenoma which have been successfully treated by extra-capsular excision. The surgical defects smaller than 3㎝ in diameter were covered with palatal acrylic splint for the secondary healing. The larger defects were repaired using palatal island flap in 3 cases, rotation flap and buccal fat graft in each 1 case. No patient showed any recurrence or malignant change during the mean follow-up period of 4 years and 9 months. These repair methods seem to be simple, reliable and uncomplicated procedures in the palatal surgical defects.

지하구내에 설치된 변압기의 극간 거리에 따른 연면방전 특성

박하용,임윤희,심낙순,이상교,송우창 三陟大學校 産業科學技術硏究院 2005 産業科學技術硏究論文集 Vol.10 No.-

The electric equipment of the recently building is established in underground of the building, it is the actual condition where the immediacy countermeasure preparation which is special regarding an electric equipment is deficient. The dissertation which it sees the case where the mold transformer which is established in the underground enclosure will be flooded minimizes the damage regarding the 1st disaster it could occur and a 2nd disaster in the test Book of Psalms to select the mold transformer which at fundamental phase of the research for is established on th actual underground enclosure, it analyzed the surface discharge voltage which it follows in distance and the electric current corrugated back. It appears with the fact that the recording surface discharge voltage where the analysis result electrode for interval will become larger increases, peek of discharge current highly there is a possibility of knowing the burden. Also, it caused by with increase of the surface discharge hour and the recording discharge hour when the interval of electrode for will become larger to increase also the insulation scandal damage will be augmented with the fact that it is thought.

Rhizopus suinus의 原形質體 融合에 關하여

이영하,김무송,최영길 충남대학교 자연과학연구소 1984 忠南科學硏究誌 Vol.11 No.2

The protoplast fusion of Rhizopus suinus was studied to develope a new method for strain improvement in Rhizopus species. High yields of protoplasts from 12hr-age of germlings were obtained by using an enzyme system containing Bacillus HD 2 chitosanase and commercial Driselase with 0.5M mannitol as osmotic stabilizer. The optimum temperature for mycelium digestion was 25℃ and the optimum pH was 6.0. The reversion frequency of these protoplasts on minimal and complete agar medium was 0.39 and 0.45%, respectively. In the presence of polyethylene glycol (PEG), intraspecific hybrids were aquired by the protoplast fusion between protoplasts of UV induced auxotrophs. Thirty percent of PEG (pH 6.0) was found to be most effective and the efficiency of PEG was enhanced by the addition of 10-50 mM CaCl_2. The average fusion frequency under optimum condition was 0.42%.

상아질 결합제의 종류와 처리방법에 따른 전단결합강도와 상아질-레진 결합계면 미세구조에 관한 연구

임창하,이용렬,정영화,송호준,박영준 大韓齒科器材學會 2003 대한치과재료학회지 Vol.30 No.1

The purpose of this study was to evaluate the dentin bonding agents (DBA) with the variations of the bonding system generations (4^th, 5^th and 6^th) and application methods by comparing the shear bond strengths (SBS) which were determined 24 h after application and dentin-adhesive interface microstructure. It was also aimed to suggest the theoretical clues for the adequate use of each bonding systems. The parameters were 1) generation of bonding systems (one product of 4^th, eight products of 5^th, and three products of 6^th generation), 2) moisture condition of the dentin surface after acid conditioning (moist group vs. dry group), 3) solvent type of the primers (three acetone-based, one acetone/ethanol-based, two water/ethanol-based, four water-based, one ethanol-based, one water/acetone-based), and 4) type of etchants (seven with phosphoric acid, three with self-etching primer, and one with 10-3 etchant). The results were as follows; One-bottle adhesives had comparable shear bond strengths compared to multiple component bonding agents, and some showed even higher results. Single Bond had the highest SBS value (20.6 ㎫) in the moist subgroup. For 4th and 5th generation DBAs, except for Mac Bond Ⅱ, all bonding systems showed lower SBS when dentin became desiccated after the conditioning-rinsing step, and generally shorter resin tags were produced in dry condition. Acetone-based adhesives generally showed better penetrability into dentinal tubules, and tended to be more sensitive to the degree of dentin dampness compared to those of the ethanol- or water-based adhesives. With Mac Bond Ⅱ which uses a self-etching primer, even though the hybrid layer was thin with a thickness of 1∼2 μ m, SBS was comparatively high. In the case of 6^th generation DBAs, Prompt L-Pop showed significantly lower SBS to dentin (7.4 ㎫) compared to those of AQ bond (13.3 ㎫) and One-Up Bond F (13.1 ㎫)(p<0.05). The hybrid layer was thin with a thickness of about 1μ m. In the case of AQ bond and One-Up Bond F, dentinal tubules were relatively well sealed. In the case of Prompt L-Pop, on the other hand, some of the dentinal tubules were not completely sealed, and fractured resin tags and separation between the hybrid layer and composite resin were observed. In the case of AQ bond, about 15μ m-thick resin layer was formed and many of the adhesive resin tags could not penetrate deep into the dentinal tubules. In the case of One-Up Bond F, many resin tags which are more than 50μ m-long were formed, but short penetration was also seen in some tubules. It is concluded that even though resin tag formation contributes in some extent for the bond strength, sufficient penetration of the adhesive resin to the exposed collagen meshwork and complete curing there in, and having sufficient strength to withstand the stress caused by the polymerization shrinkage during the light curing is essential for the success of the bonding procedure.

원형탈모증의 임상양상 및 기술역학적 연구

이용호,하헌용,이동초,김미경,서필승,김남송 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

본 연구는 2004년 1월부터 2008년 10월까지 원광대학교 병원 피부과에 내원한 원형 탈모증 환자 126명중 치료 결과를 확인 할 수 있었던 95명을 대상으로 인구학적 특성 및 치료 방법에 따른 치료 효과의 차이를 알아보고자 빈도 분석 및 교차분석을 통하여 유의성을 검정하였다. 탈모반면적은 성별에서 남자와 여자가 각각 26-50%일 때 53.5%, 71.4%로 가장 많았으나 유의한 차이는 없었고, 연령별로는 20대 이하와 30대, 40대 이상이 각각 26-50%일 때 54.1%, 51.9%, 58.6%로 가장 많았으나 유의한 차이는 없었다. 치료방법은 성별에서 남자와 여자 각각 부신피질호르몬 국소방법을 94.3%, 85.7%로 가장 많았으나 유의한 차이는 없었고, 연령별로는 20대 이하, 30대, 40대 이상이 각각 스테로이드 국소 주사요법을 89.7%, 100%, 93.1%로 가장 많았으나 유의한 차이는 없었다. 치료효과는 성별에서 남자와 여자 각각 완치하였다가 64.8%, 71.4%로 가장 많았으나 유의한 차이가 없었고, 연령별로는 20대 이하와 30대의 경우 완치되는 경우가 각각 71.8%, 85.2%로 가장 많았고, 40대 이상은 부분반응 하는 경우가 58.6%로 가장 많았으며 통계적으로 유의한 차이를 보였다(p<0.05) 치료방법에 따른 치료효과에는 유의한 차이가 있었다(p=0.003). 스테로이드 pulse therapy를 사용한 경우 완치가 100%, DPCP 요법은 완치가 77.8%, minoxidil 국소요법은 완치가 73.8%, 스테로이드 pulse therapy의 경우 완치가 100%로 가장 많았다. Background: We embarked on this research in order to gain fundamental information and knowledge on the key differences in the effectiveness of various treatments and factors, such as key clinical conditions and demographic traits through the descriptive research-based procedures, on patients with alopecia areata. Methods: Based on the comprehensive data of 95 patients with verifiable treatment records out of 126 alopecia areata patients who have visited the department of dermatology of Wonkwang University Hospital from January 2004 to October 2008, We examined the significance tests through the analysis of frequency and range of the differences in the effectiveness of various treatments using demographic traits and medical treatments. Results: In terms of the treatment effectiveness, 64.8% of the male patients and 71.4% of the female patients showed the full recovery, with virtually no significant clinical data difference. In terms of the age group variations, 71.8% of the patients in 20's and under and 85.2% of the patients in 30's showed the full recovery, and 58.6% of 40's showed only partial recovery, rendering this difference quite significant.(p<0.05). There was a noticeable difference in effectiveness of various treatments.(p<0.01). Through the steroid pulse therapy, 100% of the patients fully recovered, 77.8% through the DPCP(Diphencyprone) method, 73.8% through the minoxidil application treatment, 65.2% through the steroid injection treatment, and finally 33.3% of the steroid application treatment fully recovering from the hair loss. Conclusion: In terms of the effectiveness, the steroid pulse therapy were most dominant and clear treatment, followed by DPCP treatment, the minoxidil application treatment, the steroid injection treatment, and the steroid application treatment in this order. In terms of the distribution of the gender factor of the observed patients, the number of female patients was far smaller than that of male patients, and tremendous barriers and challenges lie in the quest to make a conclusive finding through the use of the raw data of hospital patients. As such, a variety of rigorous and dynamic clinical research endeavors and the large sample of patients are necessary and strongly recommended at this point.