가축에서 분리된 Vancomycin 내성 장구균의 내성유전자 구조 분석을 통한 분자생물학적 역학 연구

허지영,이선민,이석호,이위교,용동은,이경원,신완식,이동건 대한임상미샐물학회 2003 Annals of clinical microbiology Vol.6 No.2

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

계획에 없던 중환자실 재입실 실태 및 원인

송동현,이순교,김철규,최동주,이상일,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1)The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2)Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3)Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4)The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5)About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6)Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7)Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%)(P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

하시모트 갑상선염과 동반된 갑상선 MALT 림프종(MALToma) 1 예

김영선,이태영,한찬희,유명희,김철희,변동원,진소영,남일송,류은상,홍기영,윤석기,서교일 대한내과학회 2001 대한내과학회지 Vol.61 No.3

Primary thyroid lymphomas constitute of up to 5% of all thyroid malignancies. Recently, mucosa-associated lymphoid tissue (MALT) lymphoma are relatively recognized as a B cell subset of non-Hodgkin's lymphoma. MALT-lymphomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid , which is normally devoid of lymphocytic tissue, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. The clinical presentations include the enlarging of the neck mass, dysphagia, hoarsenes and choking or cold thyroid nodule. We report a case of MALToma of the thyroid accompanied by Hashimoto's thyroiditis with a review of the literature.(Korean J Med 61:281-285, 2001)

Expression of EGFR and follicular dendritic markers in lymphoid follicles from patients with Castleman's disease.

Lee, Juhie,Ban, Ju Yeon,Won, Kyu Yeoun,Kim, Gyo-Yong,Lim, Sung-Jig,Lee, Sun,Kim, Youn Wha,Park, Yong-Koo,Lee, Sang Sook National Hellenic Research Foundation 2008 Oncology reports Vol.20 No.4

<P>This study investigated the useful morphologic and immunophenotypic findings for the diagnosis of Castleman's disease (CD). We focused on the distribution and expression of follicular dendritic cells (FDC) in lymphoid follicles from patients with CD. Eleven CD cases of the hyaline vascular (HV) variant and six cases of the plasma cell (PC) variant were studied using tissue microarray and paraffin resistant monoclonal antibodies CD21, CD35, and EGFR, a new novel marker of FDC, as well as an antibody against human herpes virus 8 (HHV8). Epstein-Barr virus (EBV) was detected by means of in situ hybridization with a fluorescein isothiocyanate-labeled EBV-encoded RNA (EBER) specific oligonucleotide. The FDC network of the PC variant (n=4) was similar to that seen in normal or reactive germinal centers. In contrast, all HV variants and 2 cases of the PC variant were either expanded, disrupted, or exhibited multiple tight collections of FDC both in germinal centers and in mantle zone lymphocytes. The expanded mantle zone lymphocytes were CD20+, Bcl2+, PAX5+, and MUM1- with less number of CD3+ T cells admixed. Other features of the HV variant included follicular regression and vascular ingrowth of the germinal centers, whereas features of the PC variant were follicular hyperplasia and interfollicular plasmacytosis. In addition, EBV infection was positive in three CD cases, and one case had co-expression of HHV8 and EBV infection. Taken together, we found immunophenotypic differences of mantle zone lymphocytes and FDC network patterns of lymphoid follicles in CD. Thus, we conclude that these differences are relevant for the differential diagnosis of the two histopathologic variants of CD.</P>

Purification and characterization of recombinant human erythropoietin from milk of transgenic pigs

Lee, Eun Gyo,Lee, Seung Hui,Park, Kyung Mi,Baek, Jung Eun,Yeon, Sun Hee,Park, Jin-Ki,Chang, Won-Kyong,Jung, Joon-Ki,Chung, Bong Hyun John Wiley Sons, Ltd. 2009 Journal of chemical technology and biotechnology Vol.84 No.5

<P>BACKGROUND: Human erythropoietin (hEPO), a hydrophobic acidic glycoprotein responsible for the regulation of red blood cell production in mammals, is used for the treatment of anemia. In general, the purification of transgenic animal-derived therapeutic proteins is not easy due to their low titer concentrations and abundant contaminant proteins. For the first time, here the purification and characterization of rhEPO from the milk of transgenic pigs are described.</P><P>RESULTS: The rhEPO was purified by heparin chromatography, reverse-phase chromatography, and gel filtration chromatography, resulting in a 16.5% yield and > 98% purity. The rhEPO purified from the milk of transgenic pigs contained less acidic isoforms and was underglycosylated in contrast to CHO-derived rhEPO. Cell proliferation of the F-36/EPO-dependent cell line was proportional to the dose of transgenic pig-derived rhEPO.</P><P>CONCLUSION: Transgenic pig-derived rhEPO with high purity was achieved after three-step chromatography following two-step precipitation. The transgenic pig-derived rhEPO was demonstrated to have comparable potency with CHO-derived rhEPO. Transgenic pig-derived rhEPO may not be therapeutically feasible because of different glycosylation, and thus further studies are required to elucidate the effect of this aberrant glycosylation on the biological activity and stability in vivo. Copyright © 2008 Society of Chemical Industry</P>

Copy number variations of chromosome 17p13.1 might be linked to high risk of lung cancer in heavy smokers

Lee, Minhyeok,Lee, Yeiwon,Cho, Hyun-Jung,Hong, Jeeyoung,Kwon, Sun-Jung,Park, Chang-Gyo,Lee, Hoi-Young,Son, Ji-Woong,Kang, Jaeku Springer-Verlag 2011 MOLECULAR BIOLOGY REPORTS Vol.38 No.8

Coffee-Driven Green Activation of Cellulose and Its Use for All-Paper Flexible Supercapacitors

Lee, Donggue,Cho, Yoon-Gyo,Song, Hyun-Kon,Chun, Sang-Jin,Park, Sang-Bum,Choi, Don-Ha,Lee, Sun-Young,Yoo, JongTae,Lee, Sang-Young American Chemical Society 2017 ACS APPLIED MATERIALS & INTERFACES Vol.9 No.27

<P>Cellulose, which is one of the most-abundant and-renewable natural resources, has been extensively explored as an alternative substance for electrode materials such as activated carbons. Here, we demonstrate a new class of coffee-mediated green activation of cellulose as a new environmentally benign chemical-activation strategy and its potential use for all-paper flexible supercapacitors. A piece of paper towel is soaked in espresso coffee (acting as a natural activating agent) and then pyrolyzed to yield paper-derived activated carbons (denoted as 'EK-ACs'). Potassium ions (K+), a core ingredient of espresso, play a viable role in facilitating pyrolysis kinetics and also in achieving a well-developed microporous structure in the EK-ACs. As a result, the EK-ACs show significant improvement in specific capacitance (131 F g(-1) at a scan rate of 1.0 mV s(-1)) over control ACs (64 F g(-1)) obtained from the carbonization of a pristine paper towel. All-paper flexible supercapacitors are fabricated by assembling EKACs/carbon nanotube mixture-embedded paper towels (as electrodes), poly(vinyl alcohol)/KOH mixture-impregnated paper towels (as electrolytes), and polydimethylsiloxane-infiltrated paper towels (as packaging substances). The introduction of the EKACs (as an electrode material) and the paper towel (as a deformable and compliant substrate) enables the resulting all-paper supercapacitor to provide reliable and sustainable cell perforinance as well as exceptional mechanical flexibility. Notably, no appreciable loss in the cell capacitance is observed after repeated bending (over 5000 cycles) or multiple folding. The coffee mediated green activation of cellulose and the resultant all-paper flexible supercapacitors open new material and system opportunities for eco-friendly high-performance flexible power sources.</P>

Comparative analysis of the transcriptomes and primary metabolite profiles of adventitious roots of five Panax ginseng cultivars

Lee, Yun Sun,Park, Hyun-Seung,Lee, Dong-Kyu,Jayakodi, Murukarthick,Kim, Nam-Hoon,Lee, Sang-Choon,Kundu, Atreyee,Lee, Dong-Yup,Kim, Young Chang,In, Jun Gyo,Kwon, Sung Won,Yang, Tae-Jin The Korean Society of Ginseng 2017 Journal of Ginseng Research Vol.41 No.1

Background: Various Panax ginseng cultivars exhibit a range of diversity for morphological and physiological traits. However, there are few studies on diversity of metabolic profiles and genetic background to understand the complex metabolic pathway in ginseng. Methods: To understand the complex metabolic pathway and related genes in ginseng, we tried to conduct integrated analysis of primary metabolite profiles and related gene expression using five ginseng cultivars showing different morphology. We investigated primary metabolite profiles via gas chromatography-mass spectrometry (GC-MS) and analyzed transcriptomes by Illumina sequencing using adventitious roots grown under the same conditions to elucidate the differences in metabolism underlying such genetic diversity. Results: GC-MS analysis revealed that primary metabolite profiling allowed us to classify the five cultivars into three independent groups and the grouping was also explained by eight major primary metabolites as biomarkers. We selected three cultivars (Chunpoong, Cheongsun, and Sunhyang) to represent each group and analyzed their transcriptomes. We inspected 100 unigenes involved in seven primary metabolite biosynthesis pathways and found that 21 unigenes encoding 15 enzymes were differentially expressed among the three cultivars. Integrated analysis of transcriptomes and metabolomes revealed that the ginseng cultivars differ in primary metabolites as well as in the putative genes involved in the complex process of primary metabolic pathways. Conclusion: Our data derived from this integrated analysis provide insights into the underlying complexity of genes and metabolites that co-regulate flux through these pathways in ginseng.

Infiltrative Type HCC Has Prognostic Impact in Patients with Hepatocellular Carcinoma: Comparison of Modified AJCC Staging System versus Latest AJCC Staging System

( Sun Young Yim ),( Chung Gyo Seo ),( Yoo Jin Lee ),( Jihwan Lim ),( Tae Hyung Kim ),( Young Sun Lee ),( Na Yeon Han ),( Yeon Seok Seo ),( Ji Hoon Kim ),( Hyung Joon Yim ),( Young Dong Yu ),( Dong Sik 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: The American Joint Committee on Cancer (AJCC) 8th edition staging manual introduced several significant changes to the staging system for hepatocellular carcinoma (HCC). However, the revised staging system still does not consider tumor gross morphology when staging, which is considered to be an important predictive factor of survival in HCC patients as previously reported. Firstly, we aimed to compare the diagnostic efficacy of 8th edition of AJCC staging system to 7th edition. Secondly we evaluated the impact of infiltrative type HCC and propose new staging system to improve the diagnostic efficacy of current staging system. Methods: We retrospectively reviewed database of 992 patients with pathologically confirmed HCC between year 2004 and 2016 from three institutes. The infiltrative type HCC was defined as a mass with foci varying in size which fuse to form a larger foci without a distinct margin or a mass with a permeative appearance which blends into the background of the cirrhotic liver with an indistinct margin. Overall survival analysis (OS) were performed using Kaplan-Meier method and compared using log-rank tests. The Harrell concordance index (c index) and Akaike information criterion (AIC) were calculated to compare prognostic powers. Results: A total of 774 patients who had undergone hepatic resection were available for the analysis. The cohort was comprised of T1 (55.6%), T2 (32.8%), T3a (5%), T3b (4.7%) and T4 (1.9%) stages according to AJCC 7^th staging system while T1a (21.4%), T1b (37%), T2 (30%), T3 (5%) T4 (6.6%) stages according to AJCC 8^th staging system (Fig. 1). The OS did not differ between the advanced stages (T3a vs T3b; T3b vs T4 in AJCC 7^th edition similarly between T2 vs T3; T3 vs T4 in 8^th edition). Among all patients, 56 patients had infiltrative type HCC and OS analysis was performed after reclassifying the infiltrative type HCC separately. The OS of the patients with infiltrative type HCC was similar to OS of T4. After excluding infiltrative type HCC, sub-analysis was performed according to tumor sizes (≤2cm, >2-4cm, >4cm) for single and multiple tumors respectively as survival rate did not differ between the stages as shown above. Since the OS rate differed significantly among tumors with different sizes, we modified the T-stages as shown in Table 1. The modified AJCC T-staging system efficiently stratified patients according to survival as shown in Fig.1. Furthermore, modified staging system showed highest diagnostic performance followed by AJCC 8^th edition and AJCC 7^th edition (AIC 3074.4 vs 3087.8 vs 3103.4 and C-index 0.701 vs 0.67 vs 0.65, all P<0.01). Conclusions: The AJCC 8^th T-staging system showed improved prognostic efficacy compared to 7^th edition. However, modified AJCC staging system presented finer stratification of patients compared to previous staging systems by reclassifying sizes within single or multiple tumors and reassigning infiltrative type HCC to T4. The AJCC staging system requires surgical specimen for analysis and this study includes a large number of patients who undergone hepatectomy which is believed to have clinical impact with further validation in other cohorts.