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The Respiratory and Hemodynamic Effect of Prone Position in Patients with ARDS (급성호흡부전증후군에서 Prone Position의 호흡 및 혈류역학적 효과)

  • Lim, Chae-Man;Koh, Youn-Suck;Jung, Bok-Hyun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.5
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    • pp.1105-1113
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    • 1997
  • Background : Prone position improves oxygenation in some patients with ARDS. According to some authors, prone position can also improve the deteriorated hemodynamics induced by PEEP. But these respiratory and hemodynamic effects of prone position has not yet been fully established. Methods : Twentythree consequtive patients with ARDS(M : F= 11 : 12, $62.1{\pm}20.8yrs$) were the subjects for this study. ABGA, static compliance of the respiratory system, mean arterial pressure and pulse rate were obtained in supine position and at 5min, 0.5h and 2h of prone position. Positive respiratory response was defined as 20mmHg or more increase in $PaO_2/FIO_2$ within 2h of prone position. Early of late respiratory responses were defined if the positive response was observed within of after 3 day of ARDS onset, respectively. Positive hemodynamic response was defined as 10mmHg or more increase in mean arterial pressure at 5min of prone position. Results : Fifteen patients (65%) showed positive respiratory response. In the respiratory responders, $PaO_2$ was $69.8{\pm}17.6mmHg$ in supine position, $83.2{\pm}22.6mmHg$ in prone position 0.5h, $96.8{\pm}22.7mmHg$ in prone position 2h(p<0.001), and $PaO_2/FIO_2$ was $108{\pm}41mmHg$, $137{\pm}57mmHg$, $158{\pm}50mmHg$, respectively(p=0.001). Age, sex, cause of ARDS, supine $PaO_2$ and $PaO_2/FIO_2$ were not different between the respiratory responders and the nonresponders. The respiratory responders, however, showed higher mean arterial pressure than the nonresponders($91.1{\pm}13.1mmHg$ vs. $76.0{\pm}18.7mmHg$, p=0.035), and tendency of higher survival rate(9/15 vs. 2/8, p=0.074). Static compliance of the respiratory system was decreased in prone position 0.5h($28.4{\pm}7.9ml/cm$ $H_2O$ vs. $23.8{\pm}7.6ml/cm$ $H_2O$, p=0.007). The overall rate of early response(n=23) and late response(n=11) were similar(14/23 vs. 7/11, p>0.05). But patient without early response showed late response only in 25%(1/4), while patient with early response showed late response in 85.7%(6/7)(p=0.072). Five patients(22%) showed positive hemodynamic response, two of them being respiratory nonresponders. There were no differences in the baseline mean arterial pressure or the level of PEEP applied in supine between the hemodynamic responders and the hemodynamic nonresponders. Conclusions : Prone position either improved oxygenation or increased arterial pressure in significant proportion of patients with ARDS. And the respiratory response to prone position was thought to be determined in the early stage of ARDS.

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An Analysis of the Imported Consumer Goods Distribution Sector of Korea: From a Vertical Structure Viewpoint (수입소비재(輸入消費財) 유통구조(流通構造)의 효율화(效率化) 방안(方案))

  • Nam, Il-chong
    • KDI Journal of Economic Policy
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    • v.13 no.1
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    • pp.3-33
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    • 1991
  • Since the early 1980's, the Korean government has gradually been widening the Korean market to foreign consumer goods. This, combined with the increased purchasing power of the Korean consumers resulting from the continued economic growth of the country, has sparked a spectacular influx of foreign consumer goods into Korea, ranging from BMW's to chopsticks. Import of foreign consumer goods amounted to more than 6 billion dollars in 1989 and is continuing to grow at a rapid rate. The increased import of foreign consumer goods doubtlessly improved the overall welfare of the Korean consumers by providing them with a wider range of options to choose from, by lowering the prices of some of the consumer goods domestically produced, and also by forcing the producers of some Korean goods to face competition with better foreign goods, thus giving them an incentive to raise the quality of their products. However, it is agreed by most economists that this increase in general welfare has been much smaller than what they had expected at the outset. Consumer prices of most imported consumer goods are easily double the import price, and in some cases, more than treble the import prices. Further, there has not been a noticeable drop in the prices of domestically produced consumer goods. Much of the blame has been attributed to the distribution sector of Korea. The objective of this paper is to analyze the imported consumer goods distribution sector of Korea, focusing on the possible sources of the poor performance of that sector, and to make policy suggestions that could potentially increase the welfare. This paper differs from all the previous research by others on this subject in that it analyzes the imported consumer goods distribution sector of Korea as a vertical structure. The distribution sector of an imported consumer good is a vertical structure since it consists of an international market, an import stage, and domestic wholesale and retail markets, in that order vertically. Our study naturally includes the analysis of the vertical restraints as well as the analysis of the industrial organization of each horizontal stage in the vertical structure. Each horizontal component of the imported consumer goods distribution sector is basically a monopolistically competitive market differentiated by characteristics of goods and by the locations and the services of firms. Further, restrictive dealership and resale price maintenance are found to be widely in use. Our main findings are the follwing; First, most consumer goods are imported monopolistically or oligopolistically through restrictive dealership contracts between foreign producers and domestic importers. Such restrictive dealership gives importers market power in the domestic market and explains many of the large discrepancies betwen the consumer prices and the import prices of many goods. Korean anti - trust law does not cover the issues arising from the market power of an importer resulting from a restrictive dealership contract. Second, some major producers of Korean goods are also importers of foreign goods that are substitutes of their products. The import of substitutes by major domestic producers is anti - competitive because it tends to raise the prices of both domestic goods and foreign goods, and also because it reduces the incentive of the domestic producers to raise the quality of their products. Third, wholesalers and retailers widely use resale price maintenance as a price fixing mechanism, and while this is against the anti- trust law, it seldom gets noticed. Fourth, the high level of rents of real estate for commercial use works as an entry barrier to the distribution sector and results in reduced competition by the firms in that sector. Finally, there are information problems. Consumers have inferior information to firms about the quality of a foreign consumer good that they have not tried before. Such information asymmetry often enables firms to raise prices. In addition, information asymmetry between importers frequently delays the import of cheaper substitutes. In order to alleviate the problems indentified above, we suggest the following policy changes. The government should strengthen the anti - trust law and its enforcement to regulate restrictive import contracts, import of competing goods by major domestic producers, and RPM by wholesalers and retailers that is aimed at price fixing. In addition, the government should loosen its tight real estate policy to encourage investment in the distribution sector. Finally, we suggest that the import price revelation policy that has been in use for some items since 1990 be expanded to most imported consumer goods that are introduced for the first time to give consumer better information and be used only for the period of time needed to inform sufficient number of consumers.

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Experimental Investigation of Stannite-Sphalerite System In Relation to Ores (황석석일섬아연석계(黃錫石一閃亞鉛石系)의 실험연구(實驗硏究)와 천연건물(天然鍵物)에의 활용(活用))

  • Lee, Jae Yeong
    • Economic and Environmental Geology
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    • v.8 no.1
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    • pp.1-23
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    • 1975
  • The subject of this study deals with phase relations between stannite ($Cu_2FeSnS_4$) and sphalerite (${\beta}-ZnS$)/wurtzite (${\alpha}-ZnS$). The phase relations were systematically investigated from liquidus temperature to $400^{\circ}C$ under controlled conditions. ${\beta}-stannite$ (tetragonal) is stable up to $706{\pm}5^{\circ}C$, where it inverts to a high-temperature polymorph ${\alpha}-stannite$ (cubic) melting congruently at $867{\pm}5^{\circ}C$. Sphalerite (cubic, ${\beta}-ZnS$) inverts at $1013{\pm}3^{\circ}C$ to wurtzite, which is the hexagonal hightemperature polymorph of ZnS. Between ${\alpha}-stannite$ and sphalerite a complete solid solution series exists above approximately $870^{\circ}C$ up to solidus temperature. The melting temperature of ${\alpha}-stannite$ rises towards sphalerite and reaches a maximum at $1074{\pm}3^{\circ}C$, which is the peritectic with the composition of 91 wt. % sphalerite and 9 wt. % ${\alpha}-stannite$. At this temperature, wurtzite takes only 5wt. % ${\alpha}-stannite$ in solid solution which decreases with increasing temperature. The inverson temperature of ${\alpha}/{\beta}-stannite$ is lowered with increasing amounts of sphalerite in solid solution down to $614{\pm}7^{\circ}C$, which is the eutectoid with the composition of 13 wt. % sphalerite and 87 wt. % ${\alpha}-stannite$. Here, ${\beta}-stannite$ contains only 10wt. % sphalerite in solid solution. With decreasing temperature, the ranges of the solid solution on both sides of the system narrow. The phase relations in the above pure system changed due to the FeS impurities in the sphalerite solid solution. The eutectoid increased from $614{\pm}7^{\circ}C$ up to $695{\pm}5^{\circ}C$ (5 wt. % FeS) and $700{\pm}5^{\circ}C$ (10wt. % FeS), while the peritectic decreased from $1074{\pm}3^{\circ}C$ down to $1036{\pm}3^{\circ}C$ (wt. %FeS) and $987{\pm}3^{\circ}C$ (10wt. %FeS). A most notable change is the appearance of non-binary regions. An important feature is the combination of this study system with the experimental results reported by Sprinfer (1972). If a stannite-kesterite solid solution is used in the place of stannite as a bulk composition, the inversion temperature is lowered to less than $400^{\circ}C$ which belongs to temperatures of the hydrothermal region.

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IR Study on the Adsorption of Carbon Monoxide on Silica Supported Ruthenium-Nickel Alloy (실리카 지지 루테늄-니켈 합금에 있어서 일산화탄소의 흡착에 관한 IR 연구)

  • Park, Sang-Youn;Yoon, Dong-Wook
    • Applied Chemistry for Engineering
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    • v.17 no.4
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    • pp.349-356
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    • 2006
  • We have investigated adsorption and desorption properties of CO adsorption on silica supported Ru/Ni alloys at various Ru/Ni mole content ratio as well as CO partial pressures using Fourier transform infrared spectrometer (FT-IR). For Ru-$SiO_{2}$ sample, four bands were observed at $2080.0cm^{-1}$, $2021.0{\sim}2030.7cm^{-1}$, $1778.9{\sim}1799.3cm^{-1}$, $1623.8cm^{-1}$ on adsorption and three bands were observed at $2138.7cm^{-1}$, $2069.3cm^{-1}$, $1988.3{\sim}2030.7cm^{-1}$ on vacumn desorption. For Ni-$SiO_{2}$ sample, four bands were observed at $2057.7cm^{-1}$, $2019.1{\sim}2040.3cm^{-1}$, $1862.9{\sim}1868.7cm^{-1}$, $1625.7cm^{-1}$ on adsorption and two bands were observed at $2009.5{\sim}2040.3cm^{-1}$, $1828.4{\sim}1868.7cm^{-1}$ on vacumn desorption. These absorption bands correspond with those of the previous reports approximately. For Ru/Ni(9/1, 8/2, 7/3, 6/4, 5/5; mole content ratio)-$SiO_{2}$ samples, three bands were observed at $2001.8{\sim}2057.7cm^{-1}$, $1812.8{\sim}1926.5cm^{-1}$, $1623.8{\sim}1625.7cm^{-1}$ on adsorption and three bands were observed at $2140.6cm^{-1}$, $2073.1cm^{-1}$, $1969.0{\sim}2057.7cm^{-1}$ on vacumn desorption. The spectrum pattern observed for Ru/Ni-$SiO_{2}$ sample at 9/1 Ru/Ni mole content ratio on CO adsorption and on vacumn desorption is almost like the spectrum pattern observed for Ru-$SiO_{2}$ sample. But the spectrum patterns observed for Ru/Ni-$SiO_{2}$ samples under 8/2 Ru/Ni mole content ratio on CO adsorption and vacumn desorption are almost like the pattern observed for $Ni-SiO_{2}$ sample. It may be suggested surfaces of alloy clusters on the Ru/Ni-$SiO_{2}$ samples contain more Ni components than the mole content ratio of the sample considering the above phenomena. With Ru/Ni-$SiO_{2}$ samples the absorption band shifts may be ascribed to variations of surface concentration, strain variation due to atomic size difference, variation of bonding energy and electronic densities, and changes of surface geometries according to surface concentration variation. Studies for CO adsorption on Ru/Ni alloy cluster surface by LEED and Auger spectroscopy, interation between Ru/Ni alloy cluster and $SiO_{2}$, and MO calculation for the system would be needed to look into the phenomena.

Characteristics and Yield of Recommended Cultivars by Imported Forage Crop Regional Yield Trials in 2002 III. Mid-late Maturing, Good Quality, and High Yield of Forage Corn Hybrid "DK 7545", “Garst 8285” and “GW 737” (2002년 사료작물 수입적응성 인증품종의 생육특성 및 수양성 III. 중만숙 양질 다수성 사료작물 옥수수 교잡종 “DK 7545”, “Garst 8285” 및 “GW 737”)

  • Sung, B.R.;Choi, G.J.;Kim, K.Y.;Lim, K.B.;Park, K.J.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.22 no.4
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    • pp.259-264
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    • 2002
  • DK 754S, a forage corn hybrid is bred by Dekalb plant Genetics Co.. Garst 8255 by Garst Seeds Co., and GW 737 by Crosbyton Co. in US, respectively. These have been tested in Suwon and Chonan for 3 years to test their regional yield trial. In result, we were able to confirm the excellence of above cultivars and these were selected as new recommended cultivars April of 2002 by NACF. The characteristics of these cultivars are as follows ; 1. DK 7545 a. This cultivar is mid-late maturing, high quality, high yielding forage corn hybrid. Its mean tasseling date is the 11th of July. It takes 78 days from emergence to tasseling date, which is almost same with Kwanganok. The culm length and the ear height are 231 cm and 127 cm. It is relatively strong to lodging. b. The color of ear is yellow, the number of ear row is nineteen. DK 7545 shows strength to H maydis and MBSDV has occurred between 0% and 4.1% in Chonan test area but it still does not affect yielding at all. It is relatively resistant to corn borer and its stay green is almost same level comparing to a check hybrid, Kwanganok. c. Dry matter yield of this cultivar is 19.6 tons, TDN is 13.4 tons per a ha, therefore these hybrids are increased by from 6 to 9% comparing to Kwanganok. The percent ear among total dry matters yield is 43.7%. 2. Garst 8255 a. This hybrid is mid-late maturing, high quality, high yielding forage corn like as Kwanganok. Its the mean tasseling date and the period from emergence to tasseling date are almost same with a check hybrid, Kwanganok. The Culm length and the ear height are 259 cm, and 146 cm which are tall. It resists to lodging and shows excellence of stay green. b. Garst 8285 resists to H maydis, and MBSDV, and corn borer as much as Kwanganok has. c. Dry matter yield of this cultivar is 21,735 kg. TDN is 14,627 kg per a ha, therefore this is increased by 21%, 16%, respectively, comparing to a check hybrid, Kwanganok. The percent ear among total dry matters yield is 44.2%. 3. GW 737 a. This hybrid is mid-late maturing, high quality, high yielding forage com hybrid like as Kwanganok. Its mean tasseling date is 13th of July which is 2 days late comparing with a check hybrid, Kwanganok and the period from emergence to tasseling date is 80 days. b. The culm length and the ear height are 274 cm and 150 cm, which are tall. It resists to lodging moderately and shows excellence of stay green. c. GW 737 resists to H maydis and MBSDV very well, corn borer moderately resistance. d. Dry matter yield of this cultivar is 18,025kg, TDN 15,164kg per a ha, therefore this hybrid remarkably increased by 26%, 20%, respectively, comparing to a check hybrid, Kwanganok.

The Evaluation of Attenuation Difference and SUV According to Arm Position in Whole Body PET/CT (전신 PET/CT 검사에서 팔의 위치에 따른 감약 정도와 SUV 변화 평가)

  • Kwak, In-Suk;Lee, Hyuk;Choi, Sung-Wook;Suk, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.21-25
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    • 2010
  • Purpose: For better PET imaging with accuracy the transmission scanning is inevitably required for attenuation correction. The attenuation is affected by condition of acquisition and patient position, consequently quantitative accuracy may be decreased in emission scan imaging. In this paper, the present study aims at providing the measurement for attenuation varying with the positions of the patient's arm in whole body PET/CT, further performing the comparative analysis over its SUV changes. Materials and Methods: NEMA 1994 PET phantom was filled with $^{18}F$-FDG and the concentration ratio of insert cylinder and background water fit to 4:1. Phantom images were acquired through emission scanning for 4min after conducting transmission scanning by using CT. In an attempt to acquire image at the state that the arm of the patient was positioned at the lower of ahead, image was acquired in away that two pieces of Teflon inserts were used additionally by fixing phantoms at both sides of phantom. The acquired imaged at a were reconstructed by applying the iterative reconstruction method (iteration: 2, subset: 28) as well as attenuation correction using the CT, and then VOI was drawn on each image plane so as to measure CT number and SUV and comparatively analyze axial uniformity (A.U=Standard deviation/Average SUV) of PET images. Results: It was found from the above phantom test that, when comparing two cases of whether Teflon insert was fixed or removed, the CT number of cylinder increased from -5.76 HU to 0 HU, while SUV decreased from 24.64 to 24.29 and A.U from 0.064 to 0.052. And the CT number of background water was identified to increase from -6.14 HU to -0.43 HU, whereas SUV decreased from 6.3 to 5.6 and A.U also decreased from 0.12 to 0.10. In addition, as for the patient image, CT number was verified to increase from 53.09 HU to 58.31 HU and SUV decreased from 24.96 to 21.81 when the patient's arm was positioned over the head rather than when it was lowered. Conclusion: When arms up protocol was applied, the SUV of phantom and patient image was decreased by 1.4% and 9.2% respectively. With the present study it was concluded that in case of PET/CT scanning against the whole body of a patient the position of patient's arm was not so much significant. Especially, the scanning under the condition that the arm is raised over to the head gives rise to more probability that the patient is likely to move due to long scanning time that causes the increase of uptake of $^{18}F$-FDG of brown fat at the shoulder part together with increased pain imposing to the shoulder and discomfort to a patient. As regarding consideration all of such factors, it could be rationally drawn that PET/CT scanning could be made with the arm of the subject lowered.

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Evaluation of Standardized Uptake Value and Metabolic Tumor Volume between Reconstructed data and Re-sliced data in PET Study (PET 검사 시 Reconstructed data와 Re-sliced data의 표준섭취계수와 Metabolic Tumor Volume의 비교 평가)

  • Do, Yong Ho;Lee, Hong Jae;Kim, Jin Eui
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.2
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    • pp.3-8
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    • 2016
  • Purpose SUV is one of the parameters that assist diagnosis in origin, metastasis and staging of cancer. Specially, it is important to compare SUV before and after chemo or radiation therapy to find out effectiveness of treatment. Storing PET data which has no quantitative change is needed for SUV comparison. However, there is a possibility to loss the data in external hard drive or MINIpacs that are managed by department of nuclear medicine. The aim of this study is to evaluate SUV and metabolic tumor volume (MTV) among reconstructed data (R-D) in workstation, R-D and re-sliced data (S-D) in PACS. Materials and Methods Data of 20 patients (aged $60.5{\pm}8.3y$) underwent $^{18}F-FDG$ PET (Biograph truepoint 40, mCT 40, mCT 64, mMR, Siemens) study were analysed. $SUV_{max}$, $SUV_{peak}$ and MTV were measured in liver, aorta and tumor after sending R-D in workstation, R-D and S-D in PACS to syngo.via software. Results R-D of workstation and PACS showed the same value as mean $SUV_{max}$ in liver, aorta and tumor were $2.95{\pm}0.59$, $2.35{\pm}0.61$, $10.36{\pm}6.15$ and $SUV_{peak}$ were $2.70{\pm}0.51$, $2.07{\pm}0.43$, $7.67{\pm}3.73$(p>0.05) respectively. Mean $SUV_{max}$ of S-D in PACS were decreased by 5.18%, 7.22%, 12.11% and $SUV_{peak}$ 2.61%, 3.63%, 10.07%(p<0.05). Correlation between R-D and S-D were $SUV_{max}$ 0.99, 0.96, 0.99 and $SUV_{peak}$ 0.99, 0.99, 0.99. And 2SD in balnd-altman analysis were $SUV_{max}$ 0.125, 0.290, 1.864 and $SUV_{peak}$ 0.053, 0.103, 0.826. MTV of R-D in workstation and PACS show the same value as $14.21{\pm}12.72cm^3$(p>0.05). MTV in PACS was decreased by 0.12% compared to R-D(p>0.05). Correlation and 2SD between R-D and S-D were 0.99 and 2.243. Conclusion $SUV_{max}$, $SUV_{peak}$, MTV showed the same value in both of R-D in workstation and PACS. However, there was statistically difference in $SUV_{max}$, $SUV_{peak}$ of S-D compare to R-D despite of high correlation. It is possible to analyse reliable pre and post SUV if storing R-D in main hospital PACS system.

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Preparation of Pure CO2 Standard Gas from Calcium Carbonate for Stable Isotope Analysis (탄산칼슘을 이용한 이산화탄소 안정동위원소 표준시료 제작에 대한 연구)

  • Park, Mi-Kyung;Park, Sunyoung;Kang, Dong-Jin;Li, Shanlan;Kim, Jae-Yeon;Jo, Chun Ok;Kim, Jooil;Kim, Kyung-Ryul
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.18 no.1
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    • pp.40-46
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    • 2013
  • The isotope ratios of $^{13}C/^{12}C$ and $^{18}O/^{16}O$ for a sample in a mass spectrometer are measured relative to those of a pure $CO_2$ reference gas (i.e., laboratory working standard). Thus, the calibration of a laboratory working standard gas to the international isotope scales (Pee Dee Belemnite (PDB) for ${\delta}^{13}C$ and Vienna Standard Mean Ocean Water (V-SMOW) for ${\delta}^{18}O$) is essential for comparisons between data sets obtained by other groups on other mass spectrometers. However, one often finds difficulties in getting well-calibrated standard gases, because of their production time and high price. Additional difficulty is that fractionation processes can occur inside the gas cylinder most likely due to pressure drop in long-term use. Therefore, studies on laboratory production of pure $CO_2$ isotope standard gas from stable solid calcium carbonate standard materials, have been performed. For this study, we propose a method to extract pure $CO_2$ gas without isotope fractionation from a solid calcium carbonate material. The method is similar to that suggested by Coplen et al., (1983), but is better optimized particularly to make a large amount of pure $CO_2$ gas from calcium carbonate material. The $CaCO_3$ releases $CO_2$ in reaction with 100% pure phosphoric acid at $25^{\circ}C$ in a custom designed, evacuated reaction vessel. Here we introduce optimal procedure, reaction conditions, and samples/reactants size for calcium carbonate-phosphoric acid reaction and also provide the details for extracting, purifying and collecting $CO_2$ gas out of the reaction vessel. The measurements for ${\delta}^{18}O$ and ${\delta}^{13}C$ of $CO_2$ were performed at Seoul National University using a stable isotope ratio mass spectrometer (VG Isotech, SIRA Series II) operated in dual-inlet mode. The entire analysis precisions for ${\delta}^{18}O$ and ${\delta}^{13}C$ were evaluated based on the standard deviations of multiple measurements on 15 separate samples of purified $CO_2$. The pure $CO_2$ samples were taken from 100-mg aliquots of a solid calcium carbonate (Solenhofen-ori $CaCO_3$) during 8-day experimental period. The multiple measurements yielded the $1{\sigma}$ precisions of ${\pm}0.01$‰ for ${\delta}^{13}C$ and ${\pm}0.05$‰ for ${\delta}^{18}O$, comparable to the internal instrumental precisions of SIRA. Therefore, we conclude the method proposed in this study can serve as a way to produce an accurate secondary and/or laboratory $CO_2$ standard gas. We hope this study helps resolve difficulties in placing a laboratory working standard onto the international isotope scales and does make accurate comparisons with other data sets from other groups.

Incidence of Chronic Pathologic Nephrotoxicity of Cyclosporine A in Pediatric Nephrotic Syndrome (소아 신증후군에서 Cyclosporine A에 의한 만성 조직학적 신독성의 발현빈도에 대한 연구)

  • Kim Ji-Hong;Jeong Hyun-Ju;Choi In-Jun;Kim Pyung-Kil
    • Childhood Kidney Diseases
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    • v.3 no.2
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    • pp.130-144
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    • 1999
  • Purpose : Long-term use of Cyclosporine(CsA) reduce renal blood flow by afferent arteriolar vasoconstriction and lead to chronic pathologic changes of CsA nephrotoxicity - 1) interstitial nephritis(IN); tubular atrophy (TA) and/or interstitial fibrosis(IF),2) arteriolopathy(AP). The Object of this study is to estimate the incidence of chronic pathologic CsA nephrotoxicity by duration of treatment and type of renal disease, relationship between histologic and clinical nephrotoxicity, and optimal duration of CsA therapy. Methods : 102 children with steroid resistant or dependent nephrotic syndrome confirmed by renal biopsy and treated with CsA from 1986 to 1997 were enrolled in this study(58 MCNS, 10 FSGS, 10 MGN, 15 $Henoch-Sch\"{o}nlein$ purpura nephritis with nephrotic syndrome (HSPN) and 9 IgA nephropathy with nephrotic syndrome(IgAN)). CsA was administered for 1yr, 1.5yr, 2yr in 24, 12, 22 MCNS patients and 2, 2, 6 FSGS patients respectively, 1yr, 2yr in MGN and 1yr in HSPN and IgAN. Sequential biopsies were done in all 102 patients after CsA treatment for evaluation of pathologic nephrotoxicity. Results : Complete remission rate was 92.2% (100% in MCNS and MGN, 80% in FSGS, 86.6% in HSPN and 55.5% in IgAN). Incidence of relapse during 6months after CsA treatment was significantly decreased compaed with relapsing spisodes during 6months before CsA treatment in MCNS(P<0.0001) and FSGS(P<0.0001). According to pathologic changes, 71 patients(69.6%) showed no pathological change, 24 patients(23.5%) showed IN and 7 patients(6.8%) showed AP. IN was 16.6%, 33.3%, 27.2% in 1, 1.5, 2 year of CsA treatment group in MCNS. AP was 0%, 16.6%, 9% in 1, 1.5, 2 year of CsA treatment group in MCNS. 14 out of 58 MCNS(24.1%) showed IN and 4 out of 58 MCNS(6.8%) showed AP. Incidence of pathologic change was significantly lower in CsA therapy of <1yr than >1yr(P=0.03). There were no significant difference of incidence of pathologic change in original renal disease, age and sex. Conclusion : Duration of CsA treatment was significant risk factor for nephrotoxicity and optimal duration seemed to be 1 year. Pathologic change due to nephrotoxicity did not correlate with deterioration of renal function and only detectable by renal biopsy.

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Comparative growth and development of the metacercariae of Fibricola seorszensis (Trematoda: Diplostomidae) in vitro, in vivo and on the chick chorioallantois (Fibricolu seoulensis (Trematoda: Diplostomidae) 피낭유충의 in vitro, in vivo 및 닭 장뇨막 상에서의 생존 및 발육 성장 비교)

  • 서병설
    • Parasites, Hosts and Diseases
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    • v.27 no.4
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    • pp.231-248
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    • 1989
  • The growth and development of the metacercariae of F. seoulensis cultivated in vitro or on the chick chorioallantois were assessed by comparison with the optimum process of maturation in albino rats and new born chickens. The process of maturation was divided for convenience into six stages: Stage 1 ; cell multiplication, Stage 2; body shaping, Stage 3; separation of genital anlagen, Stage :1 organogeny, Stage 5; gametogony, and Stage 6: oviposition. In Hank's and Tyrode's .solutions, the metacercariae were alive up to 200 days or more at $4^{\circ}C$ without any development. The in vivo maturation process in rats or chicks was as follows: stage 1 from 6 hours; stage 2 from 24 hours; stage 3 from 48 to 72 hours; stage 4 from 3 to 4 days; stage 5 from 4 to 5 days; and stage 6 from 5 to 8 days. Despite unsuccessful infection of the metacercariae to 12 day old chicks, fully mature worms of stage 5 or 6 were recovered from new born chicks (1 to 2 days old), The metacercariae of F. seoulensis grown in vitro were up to stage 3 and no further maturation was observed. Of various media employed, the medium NCTC 109 (Gibco) or NCTC 135(Gibco) supplemented with 20% egg yolk or 20% whole egg macerate or 0.5% yeast was basically required for the earlier development of the fluke. It took 16.1 days(in average) to reach the stage 3 after cultivation. The metacercariae cultivated on the chorioallantoic membranes of 6∼13 day old chick embryo at 37∼38℃ showed their full development up to stage 5 or 6. However, the worms were in general remarkably retarded, compared with those grown in rats or chickens. In the experiments of worm transplant, although the transfer was failed from in vitro culture to in vivo of rats(Per os), the transplants from in vitro culture to the chorioallantois and from the choriollantois to in vivo of rat host were successful with or without development of the transferred worms. In the present study, it was observed that the metacercariae of F, seoulensis can be maintained in vitro media with poor development as well as fully matured in 1 to 2 day-old chicks or on the chorioallantois at a very low rate.

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