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.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

현행 중등학교 과학 실험 , 실습 교육 실태 조사 및 그 운영 진단 (Ⅱ) : 고등학교 과학 실험 , 실습 교육을 중심으로

김영호,이윤종,정원우,강용희,양승영,윤성효,안병호,윤일희,권용주,임성규,오철한,기우항,전명남,김중욱 한국과학교육학회 1998 한국과학교육학회지 Vol.18 No.3

본 연구는 96년도에 실시한 우리 나라 중학교 과학 실험·실습 교육의 실태 조사 연구에 따른 계속 연구의 일환으로 고등학교 과학 실험·실습 교육의 실태를 조사하기 위한 것이다. 연구내용은 고등학교 과학 교과서의 분석, 실험·실습 실시 현황 분석, 현행 실험·실습 교육의 문제점 분석, 현행 학교 구성원들의 실험·실습 교육 운영 실태 조사 및 현행 실험·실습 교육의 개선을 위한 연구과제 도출을 주요 연구내용으로 다루었다. 연구방법은 전국의 고등학교 80개교를 대상으로 이들 학교의 학생 1,977명, 교사 165명, 학교장 80명에게 적용하였다. 본 연구에서 밝혀진 결과를 중심으로 우리 나라 고등학교 과학 실험 실습 교육의 정상화를 위한 실험 내적인 연구과제를 제시하면 다음과 같다. (1)교재 개발에 대한 연구, (2)실험 킷트 개발에 대한 연구, (3)교사교육 및 재교육 프로그램 개발에 대한 연구, (4)교실 밖 실험·실습 활동 프로그램 개발에 대한 연구, (5)과학 실험·실습 소재의 개발에 대한 연구. This study was accomplished to analysis and survey on the experimental and practical science education of high school in korea for the consecutive study of the an analysis and survey on the experimental and practical science education of middle school in korea(Lee, Yoon-Jong et al., 1997). The status of facilities, management for the experiment, practices, teaching methods in high schools have been investigated. The present status and reasonable management of the high school science education have been grasped from the questionaires. To do this 165 high school science teachers, 1977 students and 80 principals of high schools in Korea are administered questionaires of Science Education Research Institute of Kyungpook National University(1997). The results of this study are as follows : The reasonable management for experiments and practices of science education were scanty in the high school around the urban and rural school owing to the shortage of facilities and equipments, crowded class, excessive class works for teacher, excessive contents of present textbooks and insufficiency of the administrative supports etc. The current teaching method of high school science has emphasized knowledge. This fact does not satisfy the objective of learning due to lack of the teaching method. Desirable directions for the improvement of present status of high school science education were proposed in this paper.

강원도 화천군 수달(Lutra lutra) 서식지의 식생 구조

서형수 ( Hyung Soo Seo ),신영섭 ( Young Seob Shin ),이경은 ( Kyung Eun Lee ),김윤미 ( Yoon Mi Kim ),전미나 ( Mina Jeon ),남택우 ( Taek Woo Nam ),한성용 ( Sung Yong Han ),정연숙 ( Yeonsook Choung ) 한국하천호수학회 2014 생태와 환경 Vol.47 No.special

In order to determine whether vegetation would be one of the factors for the selection of otter home range, vegetation structure and other potential factors were studied in Hwacheon, Korea. Thirteen sites, otter’s activity found and not found, were investigated in North Han River and connected tributary streams of Hwacheon-gun. Three types of vegetation were classified by cluster analysis, which is short grass, tall grass and shrub type. Vegetation zone of each channel is composed of either one type, or mosaic of tall grass and shrub type. Short grass type is common in Lake Paro and upper North Han-river where water level is highly variable throughout a year. Therefore, annual species such as Persicaria nodosa, Fimbristylis dichotomam and Chenopodium ficifolium are the most dominant. Shrub type is common at the downstream sites of Jichon stream and along mainstream of North Han River down Lake Paro. A shrub species, Salix koreensis, is the most common. Tall grass type is dominant occupying the most vegetation zone of the tributary channels. Phragmites japonica is absolutely dominant. Due to its dense cover, a few plant species are co-existed. Otter activity was found in all three vegetation types and no marked activity was found at some sites of tall grass type. There is no difference in species composition and physiognomy between tall grass sites with and without otter activity, while it shows significant difference in fish availability between two groups. Overall we found that home range of otters in the region is along the mainstream and downstream of tributary streams with high fish availability in all vegetation types and in various human activity levels.

외상성 신동맥 색전증 1례

한병규,김욱현,문기혁,송윤섭,박영호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Renal artery thrombosis may result from external trauma of a blunt nature. Such injury is induced by rapid deceleration resulting in the stretching of the renal vasculature, disruption of the arterial intima-the least elastic layer of the arterial wall and eventual thrombosis. The treatment of renal artery thrombosis is controversial, with physician's options divided between prompt surgical exploration with vascular repair and clinical observation. We experienced 1 case of traumatic renal artery thrombosis and report that with a brief review of the literature.

감성돔, Acanthopagrus schlegeli의 종묘생산 및 성분화에 미치는 영향

한종석,김용구,라성주,윤호섭,이원교,김정,최상덕 國立 麗水大學校 環境問題硏究所 2002 環境硏究論文集 Vol.5 No.-

This study was carried out to produce the seeding of the larvae and juvenile of black sea bream, Acanthopagrus schlegeli in terms of artificial hatching, feeding behavior and growth rate in each factor. Total length of black sea bream larvae hatched was 2.57±0.35mm and after 50 days, total length was 22.08±3.74mm, 49.7% in survival rate. This research was conduced to confirm the effect of tributyltin and 2,4-dinitrophenol on the sex differentiation in Black Sea bream, Acanthopagrus schlegeli. Fish were reared of oral administration of tributyltin at 0.05, 0.5, 5㎍/g and 2,4-dinitrophenol at nominak concentration of 0.05, 0.5, 5, 50㎍/g diet from 156 days to 185 days after hatching. In the process of the differentiation until 156 days after hatching, gonads were composed testis. In contrast, 185 days after hatching, testis were composed of a number of spermatogonia and sperm duct. The female in the control in which sex differentiation of Acanthopagrus schlegeil was normally conducted was 100%. The experimental unit of estradiol-17β, it was 100% in 0.05㎍/g diet concentration, which was similar to the sex ratio of the control. And it was 100% in 0.5㎍/g diet concentration. In each experimental unit with 5, 50㎍/g diet concentrations, every individuals of them differentiated to males. About the experimental unit of tributyltin, the females were 100%, 100%, 100%, 100% and 100% in 0.05㎍/g, 0.5,㎍/g, 5㎍/g and 50㎍/g diet concentrations, respectively. About the experimental unit of 2,4-dinitrophenol, the males were 100% tn 0.05, 0.5, 5, 50㎍/g diet concentrations, respectively.

녹지조건에 따른 상대습도의 변화

윤용한,송태갑 建國大學校 自然科學硏究所 2002 建國自然科學硏究誌 Vol.13 No.2

This reseach sought to measure the relative humidity in the green belt on clear days aimed at indentifying the relevancy of relative humidity with landcover status and the height of forest. Based on this measurement data, it used regresssion analysis and interpreted the relevancy of the relative humdity in the green belt with the landcover ratio and with the height of woody plants. As a result, high wet areas are formed in the forest land and near the water surface, while low wet areas are formed on the paved surface and bare ground. Taking a look at the relevancy between the landcover ratio and the relative humidity, the increase in forestland and grassland is ??ective in raising the relative humidity. Also, the increase in number of trees, regarless of the height of trees, is effective in raising the relative humdity, and the efficiency is big in the order of arbores and small arbores.

녹지에 의한 기상환경개선 효과에 관한 실증적 연구

윤용한 건국대학교 자연과학연구소 1999 建國自然科學硏究誌 Vol.10 No.2

In this study we investigate meteorological and humidity distribution reelection on meteorological environment in open space. And revolution analysis interpret related to air temperature, humidity distribution, land coverage, air temperature, number of trees, green volume and air temperature surrounding in open space. As the result, lower temperature zone inside forest zone and higher temperature zone, bare ground observed. It is confirmed that the maximum and minimum temperature was lowered by the observed green space. Low temperature was around vegetation particularly in the area of tall trees.

관상동맥내 스텐트 시술시 Aspirin과 Cilostazol 2개월 병합요법

윤명호,탁승제,염철훈,장혁재,최소연,유상용,안성균,고종훈,신준한,김한수,최병일 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

한국 재래 산양에서 Leptospira spp.에 대한 혈청역학적 연구

한동운,권용국,문진산,윤소라,위성환,장환,탁동섭,이태욱,강문일 한국수의공중보건학회 2003 예방수의학회지 Vol.27 No.3

Between January 1999 and September 2001, 948 sera (120 from each province except 108 from Chungbuk) from 8 provinces were sampled from Korean goats. All the samples were serologically tested for Leptospira spp. By the microscopic agglutination test against four L. interrogans serovars including canicola, icterohaemorrhagiae, pomona and hardjo, 948 Korean goats were confirmed as 11 seropositives (1.2%) only infected with L. icterohemorrhagiae. All positive sera were collected from Gyeonggi (5), Gangwon (4) and Chungbuk (2). Titration of them were classified as 1:100 of 10 sera except one case with 1:200 from Gyeonggi. It was meaningful that the pathogen in Korean goats was mainly distributed in the northen part of the country. Consequently, the results in the study were confirmed and analyzed the recent status of infection of leptospirosisas zoonotic agentsome in Korean goats.