65 research outputs found
์ ์ด์ฑ ๋์ข ์ ์น๋ฃ์์ ์์ ์ ์ ์ ์ ์ญํ : 17 ๋ ๊ฐ์ ์ข ๋จ์ฐ๊ตฌ
ํ์๋
ผ๋ฌธ (์์ฌ)-- ์์ธ๋ํ๊ต ๋ํ์ : ์ํ๊ณผ, 2012. 8. ๊น๋๊ท.๋ชฉ์
์ง๋ 10๋
๋์ ์ ์ด์ฑ๋์ข
์์ ์น๋ฃ๋ ๋ฐฉ์ฌ์ ์น๋ฃ, ํญ์์น๋ฃ, ์ ์์ ๋ฐฉ์ฌ์ ์์ (stereotactic radiosurgery [SRS])๋ฑ์ ๋ฐ์ ์ ๋ณด์๋ค. ๊ทธ๋ฌ๋ ์์ ์ ์น๋ฃ๋ ์ฌ์ ํ ์น๋ฃ์ ์ค์ฌ์ด๊ณ ํนํ ์๊ธ ๋๊ฐ์์ ์ด ํ์ํ ๊ฒฝ์ฐ์๋ ๊ฐ์ฅ ์ค์ํ ์น๋ฃ์ด๋ค. ์ด ์ฐ๊ตฌ๋ ์ ์ด์ฑ ๋์ข
์ํ์์ ์น๋ฃ์ ์์ด์ ์์ ์ ์ ์ ์ ์ญํ ์ ์์กด๊ธฐ๊ฐ, ์ฌ๋ฐ, ๊ธฐ๋ฅ์ ๊ฒฐ๊ณผ๋ค์ ๋ฉด์์ ํ๊ฐํ๊ธฐ ์ํจ์ด๋ค.
๋ฐฉ๋ฒ
1995๋
3์๋ถํฐ 2011๋
6์๊น์ง ์ด 194๋ช
์ ์์ ์ ๋ฐ์ ์ ์ด์ฑ๋์ข
์ ํ์๋ค์ ์กฐ์ฌํ์๋ค. ์์ ์ ๋์์กฐ์ ์ด ํ์ํ ํ์, ๋ณ๋ฆฌ์ง๋จ์ด ํ์ํ ํ์, ๋ญ์ฑ๋ณ๋ณ์ด๋ ์ข
์๋ด์ถํ, ์กฐ์ ๋์ง ์๋ ๊ฒฝ๋ จ๋ฐ์, ๊ฑฐ๋์ข
์์ ๊ฒฝ์ฐ์ ์ํ๋์๋ค. ๋ถ๊ฐ์ ์ธ ์น๋ฃ๋ ์์ ์ ์ ์ ์ ์ ๋์ ์ข
์์ ์กฐ์งํ์ ์๊ฒฌ์ ๋ฐ๋ผ ๊ฒฐ์ ๋์๋ค. ์ ๋๋ฐฉ์ฌ์ ์น๋ฃ (whole brain radiation therapy [WBRT])๋ ํต์์ ์ธ 30Gy, 10 fractions ์ ๋ฐฉ๋ฒ์ผ๋ก ์ํ๋์๊ณ SRS๋ ๊ถ๊ณ ์ฌํญ์ ๋ฐ๋ผ 15-24Gy๋ฅผ ์กฐ์ฌํ์๋ค.
์ข
์์ ์น๋ฃ๋ก ์์ ์ ๊ฐ์ฅ ๋จผ์ ์ ํํ ํ์๋ ์ด 157๋ช
์ด์๋ค. ๋๋จธ์ง 37๋ช
์ ์์ ์ ๋ฐฉ์ฌ์ ์น๋ฃ๋ ๋ฐฉ์ฌ์ ์์ ์ ๋ฐ์์ ์ด ์ฐ๊ตฌ์์ ๋ฐฐ์ ๋์๋ค. ์ด 157๋ช
์ค 109๋ช
(69.4%)๋ ์์ ํ ์ ๋๋ฐฉ์ฌ์ ์น๋ฃ(WBRT), 17๋ช
(10.8%)์ ๋ฐฉ์ฌ์ ์์ (SRS)์ ๋ฐ์๋ค. 31๋ช
(19.7%) ์์ ํ ๋ถ๊ฐ์ ์ธ ์น๋ฃ๋ฅผ ๋ฐ์ง ์์๋ค. ์์ ์ ์ ์ ์ ์ ๋๋ ์ ์ ์ (gross total resection)์ ์์ ์ ์ (subtotal resection)๋ก ๋ถ๋ฅํ์๋ค. ์ด์์กด๊ธฐ๊ฐ์ ์ ์ด์์ ์ ์ ํ ์์ ๋ถํฐ ์ฌ๋งํ ๋๊น์ง๋ก ์ ์ํ์๋ค. ์ข
์์กฐ์ ์ ๊ฒฐ๊ณผ๋ ๊ตญ์์ฌ๋ฐ๊ณผ ์๊ฒฉ์ ์ด๋ก ๋ถ๋ฅํ์๋ค. ๊ธฐ๋ฅ์ ์ธ ํ๊ฐ๋ Karnofsky performance status (KPS)์ Recursive Partitional Analysis (RPA)๋ก ์ธก์ ํ์๋ค.
๊ฒฐ๊ณผ
์ด 157๋ช
์ค ์ ์ ์ ๋ 119๋ช
(75.8%) ์ด์๊ณ ์์ ์ ์ ๋ 38๋ช
(24.2%)์ด์๋ค. ์ ๊ฒฝํ์ ์ฌ๋ง์ 25%์์ผ๋ฉฐ, ๋๋จธ์ง 75%๋ ๋น์ ๊ฒฝํ์ ์ฌ๋ง์ด์๋ค. ํ๊ท ์์กด๊ธฐ๊ฐ (median survival)์ 19.3๊ฐ์์ด์๋ค. ํ๊ท ์์กด๊ธฐ๊ฐ์ ์ ์ ์ ๊ตฐ์์ 20.4๊ฐ์์ด์๊ณ ์์ ์ ์ ๊ตฐ์์ 15.1๊ฐ์์ด์๋ค (P=.016). ๋๊ฐ์ธ ์๋ฐ์ข
์์ ์ํ์ ๋ฐ๋ฅธ ํ๊ท ์์กด๊ธฐ๊ฐ์ ์์ ์ ์ธ ์ํ์ธ ๊ฒฝ์ฐ๊ฐ ์๋ฐ์ข
์๊ณผ ์ ์ด๋์ข
์์ด ๋์์ ๋ฐ๊ฒฌ๋ ๊ฒฝ์ฐ๋ณด๋ค ์๋ฏธ์๋ค ๊ธธ์๋ค (P=.032). RPA I ํ์๊ตฐ์ RPA II ํ์๋ค๋ณด๋ค ๋ ์์กด๊ธฐ๊ฐ์ด ๊ธธ์๋ค (P=.047). ์ด ์ฐจ์ด๋ ์์ ์ ์ ๊ตฐ ํ์๋ค๋ณด๋ค ์ ์ ์ ๊ตฐ ํ์๋ค์์ ์๋ฏธ์๋ ์ฐจ์ด๋ฅผ ๋ณด์๋ค (GTR, P=.022STR, P=.075). ๊ทธ์ธ ๋ค๋ฅธ ์ธ์๋ค(๋์ด, ์ฑ๋ณ, ๋ณ์์ ๊ฐ์, ์๋ฐ์ข
์์ ์ข
๋ฅ)์ ๋ฐ๋ผ์๋ ํ๊ท ์์กด๊ธฐ๊ฐ์ ์๋ฏธ์๋ ์ฐจ์ด๋ฅผ ๋ณด์ด์ง ์์๋ค. ๊ตญ์์ฌ๋ฐ์ ์ด 15.7%์์ ๋ฐ์ํ์๋ค. ์ ์ ์ ๊ตฐ์์๋ 14.6%๊ฐ ๋ฐ์ํ์์ผ๋ ์์ ์ ์ ๊ตฐ์์๋ 18.2%๊ฐ ๋ฐ์ํ์๋ค (P=.589). ์๊ฒฉ์ ์ด๋ 43๋ช
์ ํ์ (29.5%)์์ ๋ฐ์ํ์๋ค. ์์ ํ KPS๋ ์ ์ ์ ๊ตฐ์์ 82.3์์ 87.0์ผ๋ก ํธ์ ๋์์ผ๋ ์์ ์ ์ ๊ตฐ์์๋ 79.2์์ 77.1๋ก ์
ํ๋์๋ค (P=.001). ์์ ํ ํฉ๋ณ์ฆ์ 7๋ช
(4.5%) ์์ ๋ฐ์ํ์๊ณ ๊ทธ ์ค ์ฌ๋งํ ํ์๋ 2๋ช
(1.3%)์ผ๋ก ๋ชจ๋ ์์ ์ ์ ๊ตฐ์ ํ์์๋ค. ์ฌ์ธ์ ์กฐ์ ๋์ง ์๋ ๋๋ถ์ข
๊ณผ ๋์ถํ์ด์๋ค.
๊ฒฐ๋ก
์ ์ด์ฑ ๋์ข
์ํ์์ ์น๋ฃ์์ ์์ ์ ์ ์ ๋ ์์กด๊ธฐ๊ฐ๊ณผ ์์์ ๊ฒฐ๊ณผ๋ฉด์์ ์ํธํ ์ฑ์ ์ ๋ณด์๋ค. ์์ ์ ์ ์ ์ ์ ์ฌ๋ถ, RPA ๋ถ๋ฅ, ๋๊ฐ์ธ ์๋ฐ์ข
์์ ์ํ์ ๋ฐ๋ผ ํ๊ท ์์กด๊ธฐ๊ฐ์ด ์๋ฏธ์๋ ์ฐจ์ด๋ฅผ ๋ณด์๋ค. ๋น๋ก ๋ถ๊ฐ์ ์ธ ์น๋ฃ๊ฐ ๋ฐ๋ฌํ๋ค๊ณ ํ ์ง๋ผ๋ ์์ ์ ์ ์ ๋ ์ ์ด์ฑ ๋์ข
์์ ์น๋ฃ์ ์ค์ํ ์ญํ ์ ํ๊ณ ์๋ค.Objective
Advancement during the last decade has yielded several new treatment options for the management of brain metastases such as radiotherapy, chemotherapy, and stereotactic radiosurgery (SRS). However, surgical resection 18 still remains the mainstay and is especially performed in the necessity of cases of decompression. The goal of this study is to evaluate the role of surgical resection for the patients with brain metastases by overall survival, recurrence, and functional outcome.
Methods
Between March 1995 and June 2011, a total of 194 consecutive patients had undergone surgical resection of brain metastases. The indications of surgical resection were to control intracranial pressure, to confirm pathological diagnosis, cystic lesions or intratumoral hemorrhage, intractable seizures, and large metastasis. The postoperative adjuvant treatment was decided by the extent of surgical resection, and histology. Whole brain radiotherapy (WBRT) was usually administered at a conventional dose of 30 Gy in 10 fractions. SRS administered a dose in the range 15โ24 Gy.
Surgical resection as the initial treatment was performed in 157 patients. Remaining 37 patients were excluded in this study because they had undergone other treatments such as SRS and/or radiotherapy before surgical resection. Among 157 patients, 109 (69.4%) and 17 (10.8%) patients underwent WBRT and SRS. Thirty one (19.7%) patients did not undergo adjuvant treatment. The extent of surgical resection was assessed by postoperative magnetic resornance imaging and operation record. Overall survival was defined as the interval from the date of metastasectomy through the date of death. The tumor-control was evaluated by local recurrence and distant metastasis. Functional status was evaluated by change of Karnofsky performance status (KPS) and recursive partitioning analysis (RPA).
Results
In total 157 patients, gross total resection (GTR) and subtotal resection (STR) were achieved in 119 (75.8%) and 38 (24.2%) cases, respectively. Neurogenic death accounted for 25% and non-neurogenic death accounted for 75%. The overall median survival was 19.3 months. Median survival by surgical extent accounted for 20.4 and 15.1 months in the GTR and the STR group, respectively (P=.016). The patients with stable primary extracranial cancer showed significant longer overall survival than in patients of synchronous detection of extracranial cancer (P=.032). The RPA I class showed longer survival than the RPA II class (P=.047). This difference is prominent in the GTR group rather than the STR group (GTR, P=.022STR, P=.075). There were no significant survival differences by clinical characteristics (age, gender, number of lesion, and histology of systemic disease). Overall local recurrence occurred in 15.7% of these patients. The local recurrence rate was 14.6% in GTR and 18.2% in STR (P=.589). Overall distant metastasis was detected in 43 patients (29.5%). The KPS score in the GTR group was changed from 82.3 to 87.0, and that in the STR group changed from 79.2 to 77.1 (P=.001). Postoperative complications occurred in 7 patients (4.5%). Two STR cases (1.3%) expired due to uncontrolled brain swelling and intracerebral hemorrhage.
Conclusion
Surgical resection shows favorable outcome in aspect of survival and clinical outcome. The extent of surgical resection, RPA class, and the status of extracranial condition are important prognostic factors in overall survival. Even in advancement of adjuvant therapies, surgical resection plays a major role in management of brain metastasis.Abstract โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ i
Contents โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ v
List of tables โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ vi
List of figures โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ vii
Introduction โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 1
Materials and Methods โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 4
Results โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 8
Patient characteristics โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 8
Survival and relating factors โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 11
Local recurrence and distant metastasis โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 15
Postoperative complications and functional outcome โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 17
Discussion โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 18
Conclusion โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 24
References โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 25
Abstract in Korean โฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆโฆ. 29Maste
-ํ๊ตญ์์์ ์ ์ฉ ๊ฐ๋ฅ์ฑ์ ์ค์ฌ์ผ๋ก-
ํ์๋
ผ๋ฌธ (๋ฐ์ฌ) -- ์์ธ๋ํ๊ต ๋ํ์ : ๋ฒํ์ ๋ฌธ๋ํ์ ๋ฒํ๊ณผ, 2020. 8. ์๊ดํ.๊ตญ๋ฌธ์ด๋ก
์๊ตญ์์ ์ ๋ํ ์์ก๊ธ์ง๋ช
๋ น(anti-suit injunction)์ ๊ตญ์ ์ ๋ถ์์ ์์ด์ ๋ถ๋นํ ์ธ๊ตญ ์ ์์ ๋ํญํ๊ธฐ ์ํ ์ ๊ทน์ โข์ ์ ์ ๊ตฌ์ ์๋จ์ผ๋ก ์๋ฏธ๋ฒ๊ณ ๊ตญ๊ฐ๋ฅผ ์ค์ฌ์ผ๋ก ๋๋ฆฌ ์ด์ฉ๋์ด ์๋ค. ํนํ ์ต๊ทผ์๋ ๋ค๊ตญ์ IT๊ธฐ์
๋ค ์ฌ์ด์์ ํนํ๋ถ์๊ณผ ๊ทธ์์ ํ์๋ ์์ก๊ธ์ง๋ช
๋ น ์ฌ๊ฑด์ด ์ฆ๊ฐํ๊ณ ์๋ค. ํ๊ตญ ๋น์ฌ์๊ฐ ์ธ๊ตญ๋ฒ์์ผ๋ก๋ถํฐ ์์ก๊ธ์ง๋ช
๋ น์ ๋นํ ์ฌ๋ก๋ ์ฌ๋ฌ ๊ฑด ๋ฐ๊ฒฌ๋๋ค. ๋น๊ต๋ฒ์ ์ผ๋ก๋, ์๋ฏธ๋ฒ๊ณ ๊ตญ๊ฐ๋ค์ ์์ก๊ธ์ง๋ช
๋ น์ ์ ๊ทน์ ์ผ๋ก ํ์ฉํ๋ ๋ฐ๋ฉด, ๋๋ฅ๋ฒ๊ณ ๊ตญ๊ฐ๋ค์ ๋์ฒด๋ก ๋ถ์ ์ ์ธ ์
์ฅ์ด๋ ์ต๊ทผ์๋ ์ ํ์ ์ผ๋ก ์ธ์ ํ๋ ๊ฒฝํฅ๋ ๋ฐ๊ฒฌ๋๋ค.
ํ๊ตญ๋ฒ์๋ ์ธ๊ตญ์์ก์ ๊ธ์งํ๋ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ์ ๋ฐ๋ นํ ์ ์๋๊ฐ? ๋จผ์ ์ด๋ฌํ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ์ ํ์ฉ ๊ฐ๋ฅ์ฑ(์ ๋ฒ์๊ฑด) ์์ฒด๋ฅผ ๋ถ์ ํ๋ ๊ฒฌํด๊ฐ ์์ผ๋ ์ด๋ ํ๋นํ์ง ์๋ค. ์ฌํ๊ถ๋ ์ธ์ ๋๋ค. ๊ตญ์ ์ฌํ๊ดํ ๊ถ ๋ฐ ์ค๊ฑฐ๋ฒ์ ์ฌ์๋ณ๋ก ๋ฐ์ ธ๋ณด์์ผ ํ๋ค. ๊ฐ์ฅ ์ค์ํ ์๊ฑด์ ํผ๋ณด์ ๊ถ๋ฆฌ์ ์กด์ฌ๊ฐ ์ธ์ ๋๋๋์ธ๋ฐ, ์ด๋ ์ ํ๋ณ๋ก ๋๋ ์ ๋ณด์์ผ ํ๋ค.
๋ถ์ํด๊ฒฐํฉ์(์ ์์ ๊ตญ์ ์ฌํ๊ดํ ํฉ์ ๋ฐ ์ค์ฌํฉ์) ์๋ฐ์ ๊ฒฝ์ฐ ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ์ด ๋ฐ์ํ๋์ง๋ ๊ฐ ๋ถ์ํด๊ฒฐํฉ์์ ๋ฒ์ ์ฑ์ง๊ณผ ๊ด๋ จ์ด ์๋ค. ๋ถ์ํด๊ฒฐํฉ์๋ ์์ก๊ณ์ฝ์ ์ธก๋ฉด๊ณผ ์ค์ฒด๊ณ์ฝ์ ์ธก๋ฉด์ด ํผ์ฌํ๋ ํผํฉ๊ณ์ฝ์ด๋ผ๊ณ ํ์
๋๋ค. ๊ทธ์ ๋ฐ๋ผ ๋ถ์ํด๊ฒฐํฉ์ ์๋ฐ ์ ๊ทธ ํจ๋ ฅ์ผ๋ก์ ์์ก๊ธ์ง์๋ฌด ๋ฐ ์ํด๋ฐฐ์์๋ฌด๊ฐ ๋ฐ์ํ๋ค๊ณ ํด์ํจ์ด ํฉ์ ๋น์ฌ์๋ค์ ์์ฌ์ ๋ถํฉํ๋ ํด์์ด๋ค. ๊ทธ ํ๋จ์ ์ค๊ฑฐ๋ฒ์ด ๋ฌด์์ธ์ง๋ฅผ ๊ฒฐ์ ํ๋ ๊ฒ๋ ์ค์ํ๋ฐ ๊ทธ์ ๋ฐ๋ผ ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ์ ์ธ์ ์ฌ๋ถ๊ฐ ๋ฌ๋ผ์ง ์๋ ์๊ธฐ ๋๋ฌธ์ด๋ค.
๋ถ์ํด๊ฒฐํฉ์ ์๋ฐ ์ธ์ ๋ถ๋น ์ธ๊ตญ ์ ์์ ๊ฒฝ์ฐ ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ์ด ๋ฐ์ํ๋์ง๋ ๋ ์ด๋ ค์ด ๋ฌธ์ ์ด๋ค. ๋๋ฅ๋ฒ๊ณ์ ํ ๋ด์์ ๊ทธ ๋ฒ์ ๊ทผ๊ฑฐ์ ๋ํ ์ด๋ก ๊ตฌ์ฑ์ ์๋ํด ๋ณธ ๊ฒฐ๊ณผ, ๋ถ๋ฒํ์์ ๊ธฐํ์ฌ ๊ธ์ง์ฒญ๊ตฌ๊ถ์ ๋์ถํ๋ ์ด๋ก ๊ตฌ์ฑ์ด ๊ฐ๋ฅํ๋ค๊ณ ๋ณธ๋ค. ์ด ๋ ์ค๊ฑฐ๋ฒ์ ๋ถ๋ฒํ์์ ์ค๊ฑฐ๋ฒ ๊ฒฐ์ ์ด๋ก ์ ์ ์ฉํ๋ฉด ๋๋ค.
๋ณด์ ์ ํ์์ฑ ์๊ฑด์ ์ฌ์์ ๋ฐ๋ผ case-by-case๋ก ๋ด์ผ ํ๊ณ ์ด๋ฅผ ์ผ๋ฅ ์ ์ผ๋ก ๋ถ์ ํ ๊ฒ์ ์๋๋ค. ๋ณด์ ์ ํ์์ฑ์ ํ๋จํจ์ ์์ด์๋ ๊ตญ๋ด์ ๋ฒ๋ฆฌ์ ํจ๊ป ์ธ๊ตญ ํ๋ก๋ค์์ ์ถ์ถ๋๋ ํ๋จ์์๋ค๋ ์ฐธ๊ณ ํ ํ์๊ฐ ์๋๋ฐ, ํนํ ๊ตญ์ ์์์ ์์๋ฅผ ์ด ๋จ๊ณ์์ ์ฃผ๋ก ๊ณ ๋ คํ ํ์๊ฐ ์๋ค.
ํ๊ตญ๋ฒ์์ด ์ค์ฌ๊ธ์ง๊ฐ์ฒ๋ถ, ์งํ๊ธ์ง๊ฐ์ฒ๋ถ์ ๋ฐ๋ นํ ์ ์๋์ง๋ ๋ฌธ์ ๋๋, ํํ๋ฒ์ ํด์์ ์ด๋ ๋ถ์ ํจ์ด ํ๋นํ๋ค.
UNCITRAL ๋ชจ๋ธ๋ฒ์ ์์ฉํ ๊ฐ์ ์ค์ฌ๋ฒ์ ๋ฐ๋ผ ํ๊ตญ ์ค์ฌํ์ ๋ถ๋ ์์์ ์ฒ๋ถ์ผ๋ก ์์ก๊ธ์ง๋ช
๋ น์ ๋ฐ๋ นํ ์ ์๊ฒ ๋์๋ค. ๋ง์ผ ํ๊ตญ๋ฒ์์ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ์ ๋ฐ๋ นํ ์ ์๋ค๊ณ ํด์ํ๊ฒ ๋๋ฉด ๊ถํ์ ๋ถ๊ท ํ์ด ์๊ธฐ๋ฏ๋ก ๋ฒ์์ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ ๊ฐ๋ฅ์ฑ๋ ์ ํฅ์ ์ผ๋ก ํด์ํ ์ฌ์ง๊ฐ ์๊ฒผ๋ค.
์ธ๊ตญ๋ฒ์์ด๋ ์ธ๊ตญ์ค์ฌํ์ ๋ถ๊ฐ ๋ด๋ฆฐ ์์ก๊ธ์ง๋ช
๋ น์ ํ๊ตญ์์ ์น์ธ ๋ฐ ์งํ๋์ง ์๋๋ค. ๊ทธ๋ฌ๋ ์์ก๊ธ์ง๋ช
๋ น์ ์คํจ์ฑ์ ์ฃผ๋ก ๊ทธ ๋ฐ๋ น์ง์์์ ๋์ธ์ ํจ๋ ฅ(๋ฒ์ ๋ชจ์์ฃ์ ์ ์ฌ ๋ฑ)๊ณผ ์ฌ์ค์์ ๊ตฌ์๋ ฅ์ ์ํด ํ๋ณด๋๋ ๊ฒฝ์ฐ๊ฐ ๋ง์ผ๋ฏ๋ก, ์ธ๊ตญ์์์ ์น์ธ ๋ฐ ์งํ์ ์ค์ต์ด ํฌ์ง ์๋ค.
์ค๋๋ ๊ธ๋ก๋ฒํ๊ฐ ๊ฐ์๋๋ฉด์ ์ธ๊ตญ๋ฒ์์์ ๋ค๊ตญ์ ์์ก์ ํผ๊ณ ๊ฐ ๋ ๊ฐ๋ฅ์ฑ์ ์ ์ฆํ๋ค. ๊ทธ ๊ณผ์ ์์ ์
์ ํผํด๋ฅผ ๊ณ ๋ คํ๋ฉด ์ธ๊ตญ๋ฒ์์์ ๊ดํ ํญ๋ณ ๋ฑ์ผ๋ก ๋์ํ๋ ๊ฒ์ด๋ ์ฌํ์ ์ํด๋ฐฐ์๋ง์ผ๋ก๋ ๊ถ๋ฆฌ๊ตฌ์ ์๋จ์ผ๋ก ์ถฉ๋ถ์น ์๋ค. ํ๊ตญ๋ฒ์์ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ ๊ฐ๋ฅ์ฑ์ ๊ธ์ ํจ์ ์ต๊ทผ ์ฐ๋ฆฌ๋๋ผ๊ฐ ์ถ์งํ๋ ๊ตญ์ ์์ก ๋ฐ ๊ตญ์ ์ค์ฌ์ ํ๋ธํ์๋ ๋์์ด ๋ ๊ฒ์ด๋ค.The Use of 'Anti-suit Injunction' in Transnational Dispute Resolutions:
Focusing on the Applicability in Korea
Chang Hyun Lee
Department of Law,
The Graduate School,
Seoul National University
The anti-suit injunction originated in the UK has been widely used as a preemptive remedy against abusive foreign proceedings throughout common law countries. These days anti-suit injunctions are increasingly being found particularly in the fields of patent-related disputes between multinational IT companies. In some cases, foreign courts ordered Korean parties to restrain from Korean proceedings. While common law countries generally make good use of the anti-suit injunction, continental law countries are reluctant to it although some changes are being detected recently.
Can Korean courts also issue this anti-suit injunction as a form of a preliminary injunction? Some views deny the admissibility of the application for the anti-suit injunction which I oppose because there is no ground for the denial. Jurisdiction and applicable law should be determined according to relevant factors of each case.
Can Korean courts issue preliminary injunctions that preclude foreign proceedings in support of dispute resolution agreements such as exclusive jurisdiction agreements or arbitration agreements? This issue is to some extent related to the legal nature of those agreements. My view is that those agreements are hybrid contracts which have both procedural and substantive aspect. Thus those agreements can generate the obligation not to sue abroad and the liability for damages.
It is difficult to formulate a theory to underpin the non-contractual right not to be sued abroad outside the realm of dispute resolution agreements. Arguably, approving the right to prohibit foreign proceedings based on tort would be a feasible theory within the limitation of continental law systems. The applicable law should be the law governing the tort.
Whether the applicant is successful in proving the necessity or urgency for issuing a preliminary injunction should be determined on a case-by-case basis. In doing so, special consideration should be given to the principle of comity.
It is also controversial whether Korean courts can issue preliminary injunctions which preclude foreign enforcement and arbitration procedure. In my opinion, it seems that Korean courts are not allowed to issue such injunctions under current law.
Arbitral tribunals from Korea can issue anti-suit injunctions as a form of interim measures under the Arbitration Act of 2016. This implies the increased possibility and necessity of anti-suit injunctions by courts.
Korean courts cannot recognize and enforce foreign anti-suit injunctions because of the lack of finality and conclusiveness. However, the effectiveness of the foreign anti-suit injunctions is normally guaranteed by the personal punishment of contempt or de facto effect which leads to self-enforcing.
It is expected that there are higher chances for Korean parties to become a defendant before a foreign court in this era of globalization. During the procedure, they might suffer irreparable damages that could have been prevented. In that context, an anti-suit injunction could be a very effective remedy against abusive foreign proceedings. It will also promote the status of Korean courts as an Asian dispute resolutions hub.์ 1 ์ฅ ์ ๋ก 1
์ 1 ์ ์ฐ๊ตฌ์ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์ 1
์ 2 ์ ์์ ๊ฐ๋ฅํ ์์ก๊ธ์ง๋ช
๋ น์ ์ฌ๋ฌ ๋ชจ์ต 6
์ 3 ์ ์ฐ๊ตฌ์ ๋ฐฉ๋ฒ ๋ฐ ๋ฒ์ 8
์ 4 ์ ๋
ผ์ ์์ 10
์ 2 ์ฅ ์์ก๊ธ์ง๋ช
๋ น์ ๊ฐ์ ๋ฐ ๋น๊ต๋ฒ์ ๊ฒํ 11
์ 1 ์ ์ ๋์ ๊ฐ์์ ์ค์ 11
โ
. ๊ฐ๋
๋ฐ ์ฐํ 11
โ
ก. ๊ตญ์ ์ ๋ถ์์์ ๊ฐ์ง๋ ์ค์ ์ ์๋ฏธ ๋ฐ ๊ธฐ๋ฅ 13
1. ๊ตญ์ ์ ๋ถ์์์์ ๋ฒ์ ์ํ ์์์ ์ํ ๊ด๋ฆฌ 13
2. ๊ตญ์ ์ ์์ก๊ฒฝํฉ ์ํฉ๊ณผ ๋์ ๋ฉ์ปค๋์ฆ 16
โ
ข. ํ๊ตญ ๋น์ฌ์๊ฐ ๊ด๋ จ๋ ์ฌ๋ก ์๊ฐ 22
1. China Trade and Development Corp. v. M.V. Choong Yong ์ฌ๊ฑด 23
2. Rationis Enterprises, Inc. of Panama and Mediterranean Shipping Co. S.A. of Geneva v. Hyundai Mipo Dockyard Co. Ltd. ์ฌ๊ฑด(์ ๋ฐ MSC Carla ์นจ๋ชฐ์ฌ๊ฑด) 25
3. ์์ธ์ค์์ง๋ฐฉ๋ฒ์ 2013. 5. 16. 2013๊ฐํฉ7238 ์ฌ๊ฑด 30
4. Samsung v. Huawei ์ฌ๊ฑด 33
5. ๊ธฐํ ์ฌ๊ฑด 35
์ 2 ์ ๋น๊ต๋ฒ์ ๊ฒํ 37
โ
. ์๊ตญ 37
1. ์ธ์ ์ฌ๋ถ ๋ฐ ๊ทผ๊ฑฐ 37
2. ์๊ฑด ๋ฐ ํจ๊ณผ 39
3. ์ ํ๊ณผ ํ์ ๋ฐ ์ ์ฐจ 64
4. ํ๋ก์ ์๊ฐ 67
5. ์๊ตญ ๋ฒ์ ์ ๋ํ ๊ตญ์ ์ ๋ฐ์ 69
โ
ก. ๋ฏธ๊ตญ 71
1. ์ธ์ ์ฌ๋ถ ๋ฐ ๊ทผ๊ฑฐ 71
2. ์๊ฑด ๋ฐ ํจ๊ณผ 74
3. ํ๋ก 81
โ
ข. ์ ๋ฝ์ฐํฉ(EU) 81
โ
ฃ. ๋
์ผ ๋ฐ ํ๋์ค ๋ฑ ์ ๋ฝ๊ตญ๊ฐ๋ค 86
1. ๋
์ผ 86
2. ํ๋์ค 96
3. ๊ธฐํ ์ ๋ฝ๊ตญ๊ฐ๋ค 102
โ
ค. ์ผ๋ณธ 104
โ
ฅ. ๊ธฐํ ์๋ฏธ๋ฒ๊ณ ๊ตญ๊ฐ๋ค ๋ฐ ์์์ ๊ตญ๊ฐ๋ค 105
1. ํธ์ฃผ, ์บ๋๋ค ๋ฑ Commonwealth ๊ตญ๊ฐ๋ค 105
2. ํ์ฝฉ 107
3. ์์ฌ์ 109
โ
ฆ. ๊ตญ์ ๊ท๋ฒ : UNCITRAL ๋ชจ๋ธ๋ฒ, ๊ตญ์ ์ค์ฌ๊ธฐ๊ด(ICC ๋ฑ) 110
โ
ง. ์ดํ 112
์ 3 ์ฅ ํ๊ตญ๋ฒ์์ ๋ฐ๋ น ๊ฐ๋ฅ์ฑ 112
์ 1 ์ ๋ฌธ์ ์ ์์ฌ 113
์ 2 ์ ๊ตญ๋ด์ ์ผ๋ฐ์ ๋
ผ์ ํํฉ 114
โ
. ํ์ค์ ํ๋ 115
1. ๊ธ์ ์ค 115
2. ์ ํ์ ๊ธ์ ์ค 116
3. ๋ถ์ ์ค 117
โ
ก. ํ๋ก์ ํ๋ 118
1. ๋๋ฒ์ ํ๋ก 118
2. ํ๊ธ์ฌ ํ๋ก 118
โ
ข. ๊ฒํ ๋ฐ ็ง่ฆ 122
์ 3 ์ ํ๊ตญ๋ฒ์์ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ ๋ฐ๋ น ๊ฐ๋ถ 125
โ
. ์ฌํ๊ถ, ๊ตญ์ ์ฌํ๊ดํ ๊ถ, ์ค๊ฑฐ๋ฒ 127
1. ์ฌํ๊ถ์ ์กด์ฌ 127
2. ๊ตญ์ ์ฌํ๊ดํ ๊ถ์ ์กด์ฌ 129
3. ์ค๊ฑฐ๋ฒ 140
โ
ก. ํผ๋ณด์ ๊ถ๋ฆฌ์ ์กด์ฌ ๋ฐ ๋ณด์ ์ ํ์์ฑ 145
1. ๋ณด์ ์ ํ์์ฑ ์ผ๋ฐ๋ก 145
2. ์ธ์ ์ฌ๋ถ์ ๊ดํ ๊ตญ๋ด์ ๋
ผ์ 148
3. ๊ตฌ์ฒด์ ์๊ฑด ๋ฐ ํ๋จ๊ธฐ์ค ์ ์(์๋ก ) 150
4. ๋จ์ฉ ํต์ ์ฅ์น๋ก์์ ๊ธฐ๋ฅ 152
5. ์ค๊ฑฐ๋ฒ 153
โ
ข. ๋ด๋ณด์ ์ ๊ณต 153
โ
ฃ. ์ธ์ฉ๊ฒฐ์ ์ ๋ฐฉ์(์ฃผ๋ฌธ๋ก):์์ทจํ๋ฅผ ๋ช
ํ๋ ๊ฐ์ฒ๋ถ ๊ฐ๋ถ 154
โ
ค. ํจ๋ ฅ ๋ฐ ์งํ(๊ฐ์ ๊ฐ์ ํฌํจ) 157
1. ํจ๋ ฅ 157
2. ์งํ 159
์ 4 ์ ํผ๋ณด์ ๊ถ๋ฆฌ์ ์กด์ฌ 162
โ
. ์๋ก 162
1. ํผ๋ณด์ ๊ถ๋ฆฌ - '๊ธ์ง์ฒญ๊ตฌ๊ถ'์ ์๋ถ 162
2. ๋ณธ์ ์์ก์ ํํ 165
3. ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ์ ๋ฒ์ ๊ทผ๊ฑฐ 166
โ
ก. ์ ์์ ๊ตญ์ ์ฌํ๊ดํ ํฉ์ ์๋ฐ์ ๊ฒฝ์ฐ 169
1. ์ ์์ ๊ตญ์ ์ฌํ๊ดํ ํฉ์์ ํ๋จ๊ธฐ์ค ๋ฐ ํ์ฉ์๊ฑด 170
2. ์ ์์ ๊ตญ์ ์ฌํ๊ดํ ํฉ์์ ๋ฒ์ ์ฑ์ง 178
3. ์ ์์ ๊ตญ์ ์ฌํ๊ดํ ํฉ์์ ํจ๋ ฅ ์ผ๋ฐ 185
4. ์ํด๋ฐฐ์์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ 187
5. ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ 191
6. ๊ฒํ ๋ฐ ็ง่ฆ 192
7. ์ค๊ฑฐ๋ฒ 202
8. ๊ด๋ จ ๋ฌธ์ : ๊ดํ ํฉ์ ์๋ ์ ์๊ดํ ์๋ฐ์ ๊ฒฝ์ฐ 216
โ
ข. ์ค์ฌํฉ์ ์๋ฐ์ ๊ฒฝ์ฐ 217
1. ์ค์ฌํฉ์์ ๋ฒ์ ์ฑ์ง 218
2. ์ค์ฌํฉ์์ ํจ๋ ฅ ์ผ๋ฐ 222
3. ์ํด๋ฐฐ์์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ 224
4. ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ 226
5. ๊ฒํ ๋ฐ ็ง่ฆ 228
6. ์ค๊ฑฐ๋ฒ 238
7. ๊ด๋ จ ๋ฌธ์ : ์๋น์๊ณ์ฝ์ ๊ฒฝ์ฐ 251
โ
ฃ. ๋ถ์ํด๊ฒฐํฉ์ ์๋ฐ ์ธ์ ๋ถ๋นํ ์ธ๊ตญ ์ ์์ ๊ฒฝ์ฐ 253
1. ์๋ก 253
2. ๊ตญ๋ด์ ๋
ผ์ 255
3. ์ธ๊ตญ์ ๋
ผ์ 256
4. ์ํด๋ฐฐ์์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ 258
5. ์์ก๊ธ์ง์ฒญ๊ตฌ๊ถ ๋ฐ์ ์ฌ๋ถ(์๋ก ) 258
6. ๊ตฌ์ฒด์ ์๊ฑด ๋ฐ ์๋ฒ์ฑ ํ๋จ๊ธฐ์ค ์ ์(์๋ก ) 270
7. ์ค๊ฑฐ๋ฒ 281
โ
ค. ๊ด๋ จ ๋ฌธ์ : ์๋ช
์ฑ
์๊ณผ ์๋ช
์ ๋, ๊ตญ์ ์์, ์ํด๋ฐฐ์์ฒญ๊ตฌ๊ถ๊ณผ์ ๊ด๊ณ 290
1. ์๋ช
์ฑ
์๊ณผ ์๋ช
์ ๋ 290
2. ๊ตญ์ ์์์ ๋ฌธ์ 295
3. ์ํด๋ฐฐ์์ฒญ๊ตฌ๊ถ๊ณผ์ ๊ด๊ณ 301
โ
ฅ. ์๊ฒฐ๋ก 305
์ 5 ์ ํ๊ตญ๋ฒ์์ ์ค์ฌ๊ธ์ง๊ฐ์ฒ๋ถ ๋ฐ๋ น ๊ฐ๋ถ 305
โ
. ๊ตญ๋ด์ธ์ ๋
ผ์ ๊ฐ์ 306
1. ๊ตญ๋ด์ ๋
ผ์ 306
2. ์ธ๊ตญ์ ๋
ผ์ 310
โ
ก. ๊ฒํ ๋ฐ ็ง่ฆ 311
์ 6 ์ ํ๊ตญ๋ฒ์์ ์งํ๊ธ์ง๊ฐ์ฒ๋ถ ๋ฐ๋ น ๊ฐ๋ถ 315
โ
. ์ธ๊ตญ์ ๋
ผ์ 315
โ
ก. ๊ตญ๋ด์ ๋
ผ์ 315
์ 4 ์ฅ ํ๊ตญ ์ค์ฌํ์ ๋ถ์ ๋ฐ๋ น ๊ฐ๋ฅ์ฑ 318
์ 1 ์ ๊ตญ๋ด์ธ์ ๋
ผ์ ๊ฐ์ 318
โ
. ์ธ๊ตญ์ ๋
ผ์ 318
โ
ก. ๊ตญ๋ด์ ๋
ผ์ 320
์ 2 ์ ์ค์ฌ๋ฒ์ ์์ก๊ธ์ง ์์์ ์ฒ๋ถ์ ์ฃผ์ ๋ด์ฉ 321
์ 3 ์ ๋ฒ์์ ์์ก๊ธ์ง๊ฐ์ฒ๋ถ๊ณผ์ ๋น๊ต 330
์ 5 ์ฅ ๋์์ฑ
๋ฐ ์
๋ฒ๋ก 332
์ 1 ์ ๋์์ฑ
332
์ 2 ์ ์
๋ฒ๋ก 334
์ 6 ์ฅ ๊ฒฐ ๋ก 336
์ 1 ์ ๊ตญ์ ์ ๋ํฅ๊ณผ ํ์ค์ โข์ ์ฑ
์ ํ์์ฑ 336
์ 2 ์ ๊ฒฐ๋ก ๋ฐ ์ ์ธ 340
์ฐธ๊ณ ๋ฌธํ 342
Abstract 361Docto
ํธ์ํฐ๋ ์์ ๋คํธ์ํฌ์ธ๊ฐ? - ๋คํธ์ํฌ ๊ตฌ์กฐ์ ์ ๋ณด ์ ํ์ ๊ด์
์ด ์ฐ๊ตฌ์์๋ 4100๋ง๋ช
์ด์์ ํธ์ํฐ ์ฌ์ฉ์ ์ ๋ณด์ 14์ต 7์ฒ๋ง๊ฐ์ ํ๋ก(Follow) ๊ด๊ณ, ๊ทธ๋ฆฌ๊ณ ์ฌ์ฉ์๋ค์ด ๋จ๊ธด 1์ต๊ฐ ์ด์์ ํธ์๋ค์ ์์ง, ๋ถ์ํ์ฌ ํธ์ํฐ ์ฌ์ฉ์ ๋คํธ์ํฌ์ ๊ตฌ์กฐ์ ํน์ฑ๊ณผ ์ ๋ณด ์ ํ์ ํน์ฑ์ ๋ถ์ํ์๋ค. ๋จ๋ฐฉํฅ ํ๋ก ๊ด๊ณ์ ์ํธ์ฑ(Reciprocity)์ ์ผ๋ฐ์ ์ธ ์ฌํ์ ๊ด๊ณ ๋ฐ ์ฌํ ์จ๋ผ์ธ ์์
๋คํธ์ํฌ์์ ๊ด์ฐฐ๋๋ ์ํธ์ฑ๋ณด๋ค ์๋นํ ๋ฎ์ 22.1%๋ก ๊ด์ฐฐ๋์์ผ๋ฉฐ ์ด๋ ํธ์ํฐ์์์ ํ๋ก ๊ด๊ณ๊ฐ ์น๋ฐํ ์ฌํ์ ๊ด๊ณ์ ๊ธฐ๋ฐํ๊ณ ์์ง๋ง์ ์๋ค๋ ๊ฒ์ ๋ณด์ฌ์ค๋ค. ํธ์ํฐ์ ์ฌ์ฉ์๋ค์ ์คํ๋ผ์ธ์์์ ์ด์์ ๊ด๋ จ๋ ํธ์๋ค์ ํ๋ฐํ ๊ธฐ๋กํ๋ฉฐ, ๋ง์ ํ๋ก์ด๋ฅผ ๊ฐ๋ ํ๋ธ(Hub) ์ฌ์ฉ์๋ค์ด ํ๋ถํ๊ฒ ์กด์ฌํ๊ณ , ํ๋ก์ด๋ฅผ ๋ง์ด ๊ฐ์ง ๋ชปํ ์ฌ์ฉ์๋ค๋ ๋ฆฌํธ์์ ํตํด ์ ๋ณด๋ฅผ ๋น ๋ฅด๊ณ ๋๊ฒ ํผ๋จ๋ฆด ์ ์๋ค๋ ๊ฒ์ ์ ๋์ ์ผ๋ก ๋ฐํ๋ค. ๊ด๊ณ์ ๋จ๋ฐฉํฅ์ฑ๊ณผ ๋ฎ์ ์ํธ์ฑ, ๊ทธ๋ฆฌ๊ณ ๋น ๋ฅด๊ณ ๋์ ์ ๋ณด ์ ํ๋ ๋ค๋ฅธ ์์
๋คํธ์ํฌ ์๋น์ค์์๋ ์ฐพ์๋ณผ ์ ์๋ ํธ์ํฐ์ ๊ณ ์ ํ ํน์ฑ์ผ๋ก์, ์๋ก์ด ์ ๋ณด ์ ํ ๋งค์ฒด๋ก์์ ๊ฐ๋ฅ์ฑ์ ๋ณด์ฌ์ค๋ค
Low High-Sensitivity C-Reactive Protein Level in Korean Patients With Chronic Kidney Disease and Its Predictive Significance for Cardiovascular Events, Mortality, and Adverse Kidney Outcomes: Results From KNOW-CKD
Background Inflammation levels are lower in East Asians than in Western people. We studied the association between high-sensitivity hs-CRP (C-reactive protein) and adverse outcomes in Korean patients with chronic kidney disease. Methods and Results We included 2018 participants from the KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) between April 2011 and February 2016. The primary outcome was a composite of extended major cardiovascular events (eMACE) or all-cause mortality. The secondary end points were separate outcomes of eMACE, all-cause death, and adverse kidney outcome. We also evaluated predictive ability of hs-CRP for the primary outcome. The median hs-CRP level was 0.60 mg/L. During the mean follow-up of 3.9 years, there were 125 (6.2%) eMACEs and 80 (4.0%) deaths. In multivariable Cox analysis after adjustment of confounders, there was a graded association of hs-CRP with the primary outcome. The hazard ratios for hs-CRPs of 1.0 to 2.99 and โฅ3.0 mg/L were 1.33 (95% CI, 0.87-2.03) and 2.08 (95% CI, 1.30-3.33) compared with the hs-CRP of <1.0 mg/L. In secondary outcomes, this association was consistent for eMACE and all-cause death; however, hs-CRP was not associated with adverse kidney outcomes. Finally, prediction models failed to show improvement of predictive performance of hs-CRP compared with conventional factors. Conclusions In Korean patients with chronic kidney disease, the hs-CRP level was low and significantly associated with higher risks of eMACEs and mortality. However, hs-CRP did not associate with adverse kidney outcome, and the predictive performance of hs-CRP was not strong. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT01630486.ope
Framingham risk score and risk of incident chronic kidney disease: A community-based prospective cohort study
Background: Cardiovascular disease and chronic kidney disease share several common risk factors. The Framingham risk score is hypothesized to predict chronic kidney disease development. We determined if the Framingham risk scoring system can correctly predict incident chronic kidney disease in the general population.
Methods: This study included 9,080 subjects who participated in the Korean Genome and Epidemiology Study between 2001 and 2014 and had normal renal function. The subjects were classified into low- ( 20%) risk groups based on baseline Framingham risk scores. The primary endpoint was de novo chronic kidney disease development (estimated glomerular filtration rate [eGFR], < 60 mL/min/1.73 m2).
Results: During a mean follow-up duration of 8.9 ยฑ 4.3 years, 312 (5.3%), 217 (10.8%), and 205 (16.9%) subjects developed chronic kidney disease in the low, intermediate, and high risk groups, respectively (P < 0.001). Multivariable analysis after adjustment for confounding factors showed the hazard ratios for the high- and intermediate risk groups were 2.674 (95% confidence interval [CI], 2.197-3.255) and 1.734 (95% CI, 1.447-2.078), respectively. This association was consistently observed irrespective of proteinuria, age, sex, obesity, or hypertension. The predictive power of this scoring system was lower than that of renal parameters, such as eGFR and proteinuria, but increased when both were included in the prediction model.
Conclusion: The Framingham risk score predicted incident chronic kidney disease and enhanced risk stratification in conjunction with traditional renal parameters in the general population with normal renal function.ope
Association Between Serum High-Density Lipoprotein Cholesterol Levels and Progression of Chronic Kidney Disease: Results From the KNOW-CKD
Background High-density lipoprotein cholesterol ( HDL -C) levels are generally decreased in patients with chronic kidney disease ( CKD ). However, studies on the relationship between HDL -C and CKD progression are scarce. Methods and Results We studied the association between serum HDL -C levels and the risk of CKD progression in 2168 participants of the KNOW - CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). The primary outcome was the composite of a 50% decline in estimated glomerular filtration rate from baseline or end-stage renal disease. The secondary outcome was the onset of end-stage renal disease. During a median follow-up of 3.1 (interquartile range, 1.6-4.5) years, the primary outcome occurred in 335 patients (15.5%). In a fully adjusted Cox model, the lowest category with HDL -C of <30 mg/dL (hazard ratio, 2.21; 95% CI, 1.30-3.77) and the highest category with HDL -C of โฅ60 mg/dL (hazard ratio, 2.05; 95% CI , 1.35-3.10) were associated with a significantly higher risk of the composite renal outcome, compared with the reference category with HDL -C of 50 to 59 mg/dL. This association remained unaltered in a time-varying Cox analysis. In addition, a fully adjusted cubic spline model with HDL -C being treated as a continuous variable yielded similar results. Furthermore, consistent findings were obtained in a secondary outcome analysis for the development of end-stage renal disease. Conclusions A U-shaped association was observed between serum HDL -C levels and adverse renal outcomes in this large cohort of patients with CKD . Our findings suggest that both low and high serum HDL -C levels may be detrimental to patients with nondialysis CKD .ope
Snoring and incident chronic kidney disease: a community-based prospective cohort study
OBJECTIVES: Previous studies have shown that symptoms of sleep-disordered breathing are associated with metabolic derangements and vascular disease development. However, the relationship between snoring and renal function is not well investigated. The association between snoring and the development of incident chronic kidney disease (CKD) in subjects with normal renal function was evaluated.
DESIGN: Prospective cohort study.
SETTING: Ansung (rural community) and Ansan (urban community) cities.
PARTICIPANTS: Community-based cohort participants aged 40-69 years.
METHODS: A total of 9062 participants in the Ansung-Ansan cohort study were prospectively followed up from 2001 to 2014. The participants were classified into three groups: non-snorer, <1โday/week and โฅ1โday/week. The main outcome was incident CKD, which was defined as an estimated glomerular filtration rate of <60โmL/min/1.73โm2 during the follow-up period.
PRIMARY OUTCOME: Incident CKD.
RESULTS: The mean subject age was 52.0ยฑ8.9 years, and 4372 (48.2%) subjects were male. The non-snorer,<1โday/week and โฅ1โday/week groups included 3493 (38.5%), 3749 (41.4%), and 1820 (20.1%) subjects, respectively. Metabolic syndrome was more prevalent in the snoring groups than in the non-snoring group. Snoring frequency showed a significant positive relationship with age, waist:hip ratio, fasting glucose, total cholesterol (Tchol) and low-density lipoprotein cholesterol. During a mean follow-up of 8.9 years, 764 (8.4%) subjects developed CKD. Cox proportional hazards model analysis revealed that the risk of CKD development was significantly higher in subjects who snored โฅ1โday/week than in non-snorers, even after adjustments for confounding factors (HR 1.23, 95% CI 1.09 to 1.38, p<0.01).
CONCLUSION: Snoring may increase the risk of CKD development in subjects with normal renal function.ope
Prediction of welding deformation of ship hull panel blocks using equivalent loading method based on inherent strain
ํ์๋
ผ๋ฌธ(๋ฐ์ฌ)--์์ธ๋ํ๊ต ๋ํ์ :์กฐ์ ํด์๊ณตํ๊ณผ,2002.Docto
์ก๊ฒฌ์์ ํํก์ถฉ์ฆ์ ์ฐ์์ ์ธ ์ปดํจํฐ ๋จ์ธต์ดฌ์์๊ฒฌ๊ณผ ์ถฉ๋ญ์ Micro-CT ์๊ฒฌ
Thesis(doctor`s)--์์ธ๋ํ๊ต ๋ํ์ :์ํ๊ณผ ๋ฐฉ์ฌ์ ํ ์ ๊ณต,2006.Abstract
Purpose: To investigate serial CT findings in P. westermani infected dogs and microscopic structures of the worm cyst using Micro-CT.
Materials and Methods: Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until 6 months for radiologic-pathologic correlation. Three dogs were sacrificed at 1, 3 and 6 months. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for the worm cysts.
Results: The initial findings were pleural effusion (26.7%) and/or subpleural ground-glass opacities (20%) or linear opacities (20%) at 10 days. At day 30, subpleural (100%) and peribronchial nodules (100%) appeared with pleural effusion (26.7%), pneumothorax (93.3%), and abdominal or chest wall air bubbles (93.3%). Cavitary change (6.7%) began to be seen at day 30 and with mediastinal lymphadenopathy (64.2%) and bronchial dilatation (50%) at day 60 on CT scan. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, migrating features of the subpleural or peribronchial nodules were seen in all serial CT scans. Micro-CT showed that the cyst wall contains dilated interconnected tubular structures which have communications with the cyst cavity and adjacent distal bronchus.
Conclusion: The CT findings of paragonimiasis depend on the stage of migration of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and adjacent distal bronchus.Docto
๊ณ ์ ๋ณํ๋๋ฒ์ ์ด์ฉํ ๋ณด๊ฐํ์ ์ฉ์ ๋ณํ ์์ธก์ ๊ดํ ์ฐ๊ตฌ
ํ์๋
ผ๋ฌธ(์์ฌ)--์์ธๅคงๅญธๆ ก ๅคงๅญธ้ข :้ ่นๆตทๆดๅทฅๅญธ็ง,1997.Maste
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