Review : Novel Biomarkers for Cardio-renal Syndrome

( Sul Ra Lee ),( Kyung Hwan Jeong ) 대한전해질학회 2012 Electrolytes & Blood Pressure Vol.10 No.1

Cardio-renal syndrome (CRS) is a frequent and life-threatening syndrome. It is a disorder of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Acute kidney injury (AKI) is strongly associated with increased morbidity and mortality in patients with CRS. Early detection of renal dysfunction is not possible using the traditional marker, serum creatinine, and therefore efforts to explore possible biomarkers for early detection of AKI are being made. Apart from predicting AKI, several biomarker studies also identified predictors for poor prognosis such as the need for renal replacement therapy (RRT) or death. It is possible that biomarkers can become risk factors in an improvement of clinical outcomes of CRS. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with renal dysfunction and the treatment for this disease can be modified based on cardiac biomarkers. In addition to natriuretic peptides, which are established cardiac markers, several new biomarkers have been identified and may play important roles in CRS. In this review, we will briefly summarize the literature on novel renal and cardiac biomarkers and discuss their potential roles in the clinical outcome of CRS.

신기능이 저하된 IgA 신증 환자의 관련 위험 인자

이설라 ( Sul Ra Lee ),송세빈 ( Se Bin Song ),최소영 ( So Young Choi ),정경환 ( Kyung Hwan Jung ),이태원 ( Tae Won Lee ),임천규 ( Chun Kyu Lim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2

Purpose: This study was aimed at finding clinical factors to be associated with a progressive course of IgA nephropathy. Methods: We investigated the association between the prognosis of IgA nephropathy and clinical and laboratory findings including age, sex, hypertension, diabetes mellitus, 24-hour urine protein, macroscopic hematuria, hematuria duration, serum uric acid, serum creatinine, GFR, upper respiratory infection, pathological observation, and treatment protocols. One hundred seventy seven patients were followed up for more than 2 years at Kyung Hee university medical center from January 1997 through December 2006. Kidney size and echogenicity were measured by abdominal ultrasonography. Resistive index was calculated by doppler ultrasonography. Results: Long hematuria duration, increased uric acid, elevated creatinine of chronic renal failure group were distinguished from those of normal and acute renal failure group statistically. Using multivariate analysis, three factors, elevated serum uric acid, decreased GFR, ACE inhibitor or ARB and steroid combination treatment proved to be independent prognostic indicators of acute renal failure of IgA nephropathy. Heavy proteinuria, long hematuria duration, and severe histopathologic findings by Haas` classification were associated with significant risk factors for developing chronic renal failure. Conclusion: At diagnosis of IgA nephropathy, hematuria continuation and histological damage in Haas` classification were related with the reduction of renal function.

신이식 환자에서의 단순포진 바이러스와 대상포진 바이러스 감염에 대한 위험 요소

이설라 ( Sul Ra Lee ),문주영 ( Ju Young Moon ),정경환 ( Kyung Hwan Jung ),이상호 ( Sang Ho Lee ),임천규 ( Chun Kyu Lim ),이태원 ( Tae Won Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

목적: 면역 억제는 신이식의 성공을 위해 불가피하나 이로 인한 감염이 신이식의 실패와 사망의 주요 위험 요인이 되어 있다. 이에 저자들은 감염 후 발생하는 바이러스 감염의 주요 원인인 단순포진 바이러스와 대상포진 바이러스의 위험요소를 알아보고자 하였다. 방법: 1987년 1월부터 2008년 3월까지 경희대학교 부속 경희의료원에서 시행된 344예의 신이식 환자 중 단순포진 바이러스와 대상포진 바이러스 감염으로 진단된 78예에서 유병율에 영향을 미치는 위험 요소를 비교 분석하였다. 결과: 신이식 후 단순포진 바이러스와 대상포진 바이러스의 발현율은 23.6%로 높게 나타났다. 감염 발현시기는 평균 37.8개월 (이식 후 5일에서 15년)이었으며 이식 후 6개월까지 42%의 감염율을 보여 감염 초기에 높은 감염률을 보였다. 이식 당시 나이, 성별, 초급성 거부 반응과 급성거부 반응의 발생 여부, 당뇨, 이식신의 차이, 면역 도입요법 사용 유무를 조사하였다. 당뇨 환자군과 초급성과 급성 거부 반응이 있던 군에서 발현율의 유의한 차이를 보였다. 나이, 성별, 급성 거부반응, 면역억제제 (cyclosporine, mycophenolate mofetil, azathioprine, tacrolimus)와 도입 면역요법은 감염의 발현에 위험 요소로서 통계적 의미를 보이지 않았고, 다만 당뇨만이 통계적으로 유의하게 영향을 주는 것으로 보였다 (hazard ratio=2.568 CI 95% p=0.022). 결론: 본 연구의 결과는 당뇨환자에서 단순포진 바이러스와 대상포진 바이러스에 대한 위험성을 높으므로 이에 대한 임상적 주의가 필요함을 시사하고 있다. Purpose: Enhanced immunosuppression for preventing acute rejection, But infection is an inevitable complication. This study was performed to evaluate the risk factors of herpes simplex virus (HSV) and varicella zoster virus (VZV) infection which are frequent and serious complication of renal transplant recipients. Method: We evaluated the incidence and risk factors for post-transplant HSV and VZV infection in three hundred and twenty three adult renal transplant recipients. Results: The averaged period of infection was 37.8 months and 42% of infection occurred within six month after transplantation. Prevalence of HSV and VZV infection in diabetes patients are higher than that of non-diabetes patients (p=0.01). The other factors such as age, sex, acute rejection and immunosuppressive regimens, antibody induction didnt affect HSV and VZV infections in renal transplant recipients. Conclusion: As diabetic condition suggested more susceptibility to HSV and VZV infections, it is necessary to evaluate the possible occurrence of HSV and VZV infections carefully in transplant recipients with diabetes.

Renal outcomes and clinical course of nondiabetic renal diseases in patients with type 2 diabetes

( Ja Min Byun ),( Cheol Hyun Lee ),( Sul Ra Lee ),( Ju Young Moon ),( Sang Ho Lee ),( Tae Won Lee ),( Chun Gyoo Ihm ),( Kyung Hwan Jeong ) 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.5

Background/Aims: In several recent studies, renal biopsies in patients with type 2 diabetes and renal disease have revealed a heterogeneous group of disease entities. Our aim was to study the prognosis and clinical course of nondiabetic renal disease (NDRD) and to determine risk factors for NDRD in patients with type 2 diabetes. Methods: Renal biopsy reports of 110 patients with type 2 diabetes who were seen at Kyung Hee University Medical Center and Kyung Hee University Hospital at Gangdong, Seoul, Korea between January 2000 and December 2011 were retrospectively analyzed. Results: Of 110 patients with type 2 diabetes, 41 (37.3%) had diabetic nephropathy (DN), 59 (53.6%) had NDRD, and 10 (9.1%) had NDRD superimposed on DN. Immunoglobulin A nephropathy (43.5%) was the most common NDRD. Patients with NDRD had a shorter duration of diabetes, lower frequency of diabetic retinopathy, and better renal outcomes, which might have resulted from the use of aggressive disease-specific treatments such as steroids and immunosuppressants in patients with NDRD. Conclusions: Compared with DN, NDRD was associated with better renal outcomes in patients with type 2 diabetes, as evidenced by a higher cumulative renal survival rate and lower rate of end-stage renal disease (ESRD). Shorter duration of diabetes and absence of retinopathy were independent predictors of NDRD in patients with type 2 diabetes and renal involvement. Renal biopsy is recommended for patients with type 2 diabetes and risk factors for NDRD, to obtain an accurate diagnosis, prompt initiation of disease-specific treatment, and ultimately better renal outcomes with the avoidance of ESRD.

만성신질환 단계에 따른 경동맥 내막-중간막 두께

송세빈 ( Se Bin Song ),김양균 ( Yang Gyun Kim ),이설라 ( Sul Ra Lee ),이동영 ( Dong Young Lee ),정경환 ( Kyung Hwan Jeong ),문주영 ( Ju Young Moon ),이상호 ( Sang Ho Lee ),임천규 ( Chun Gyoo Ihm ),이태원 ( Tae Won Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

목적: 경동맥의 내막-중간막 두께(carotid artery-intima-media thickness, cIMT)는 혈액 및 복막 투석을 받고 있는 만성 신부전 환자에서 심혈관 질환과 관련된 사망의 예측인자임은 이미 알려져 있으나 투석 전 만성신질환 환자에 대한 연구 결과는 부족하였다. 이에 만성신질환 환자들의 신기능 단계에 따른 경동맥의 내막-중간막 두께 변화를 확인하고자 본 연구를 계획하였다. 방법: 2005년 1월1일부터 2009년4월30일까지 경희대학교 부속병원에 내원한 사구체 여과율 60 ml/min/1.73m2 미만의 만성신질환 환자 중 고해상도 B모드 경동맥 초음파를 시행한 환자 88명 (남:여=49:39)을 대상으로 정상 신기능의 대조군 30명 (남:여=13:17)과 경동맥 내막-중간막 두께를 비교하였다. 결과: 경동맥의 평균 내막-중간막 두께는 사구체여과율의 감소에 따른 만성신질환의 단계가 증가될수록 통계적으로 유의하게 증가하였는데 그 두께는 만성신질환 단계가 3, 4, 5단계로 악화되면서 각각 0.82±0.19 mm, 0.93±0.13 mm, 그리고 1.04±0.27 mm로 증가하였다. 또한 정상 성인과 비교하여 모든 만성신질환 단계에서 경동맥 내막-중간막 두께가 통계적으로 유의하게 증가된 상태임을 확인하였다. (p=0.002). 당뇨성 신질환의 경우 비당뇨성 신질환에 비해 그 두께는 증가하였으나 통계적으로 유의하지 않았다. (0.96±0.32 vs. 0.92±0.20, p=0.142). 다중회귀분석에서는 나이와 사구체여과율, 만성신질환 단계가 경동맥 내막-중간막 두께와 유의한 상관성을 보였다. 결론: 만성신질환 환자에서 투석전 초기 신기능 저하 단계에서부터, 경동맥의 동맥경화는 진행되어 있었으며 경동맥의 내막-중간막 두께는 나이 및 사구체여과율 만성신질환 단계와 상관관계가 있었다. Purpose: Carotid artery intima-media thickness (cIMT) has been reported as the predictive factor of mortality of cardiovascular disease in dialysis patients but only a few reports are available on the patients with earlier stages. We compared cIMT according to the stage of chronic kidney disease, and analyzed the data in association with cardiovascular risk factors. Methods: Study subjects were 88 patients with chronic kidney disease less than 60 ml/min/1.73m2 of glomerular filtration rate. cIMT was measured by means of high- resolution B-mode ultrasonography. Cardiovascular risk factors and cIMT were analyzed and compared with 30 subjects with normal renal function. Results: cIMT was significantly increased with the stage of chronic kidney disease. When the stage was increased from 3 to 5, cIMT was increased (p=002). cIMT was further increased in all stages of chronic kidney disease than in patients with normal kidney function. But association of diabetic chronic kidney disease with non-diabetic chronic kidney disease was not significant (p=0.127). Multiple regression analysis showed that cIMT in patients with chronic kidney disease was significantly correlated to age, glomerular filtration rate, and the stage of chronic kidney disease. Conclusion: We suggest that carotid atherosclerosis could increase in no dialysis patients with early stage of chronic kidney disease. Carotid artery intima-media thickness was correlated with age, glomerular filtration rate, and the stage of chronic kidney disease.

태반에 부착된 amniotic sheet에 대한 임상적 고찰

이성종,김사진,안현영,이귀세라,신종철,김수평,설재웅 대한산부인과초음파학회 2002 대한산부인과초음파학회지 Vol.4 No.2

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

( Hee Jeong Lee ),( Mi Ra You ),( Woo Ram Moon ),( Hyoung Sul ),( Choon Hae Chung ),( Chi Young Park ),( Sang Gon Park ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.4

Background/Aims: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. Methods: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. Results: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). Conclusions: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

Roll-to-roll redox-welding and embedding for silver nanowire network electrodes

Kim, Yeontae,Sul, Yeong Eun,Kang, Hyungseok,Choi, Yongsuk,Lim, Ho Sun,Lee, Sungjoo,Pu, Lyongsun,Yi, Gi-Ra,Cho, Sung Min,Cho, Jeong Ho The Royal Society of Chemistry 2018 Nanoscale Vol.10 No.39

<P>We developed a continuous roll-to-roll redox-welding and embedding method for the fabrication of electrodes of silver nanowire (AgNWs) networks. The roll-to-roll welding method involved a sequence of oxidation and reduction reactions in an aqueous solution. The redox-welding significantly decreased the sheet resistance of the AgNW film owing to the strong fusion and interlocking at the nanowire junction, while the optical transmittance was maintained. The first oxidation step using HNO3 generated ionized silver (Ag<SUP>+</SUP>) which got re-deposited onto the nanowire junctions <I>via</I> an autocatalytic reaction. The oxide layers, which formed on the nanowire surface by both air exposure and the first step of oxidation, were removed by the second reduction step using NaBH4. The redox-welded AgNW electrodes exhibited a sheet resistance of 11.3 Ω sq<SUP>−1</SUP> at the optical transmittance of 90.5% at 550 nm. Furthermore, redox-welding of the AgNWs significantly enhanced their mechanical robustness compared to that of the as-coated AgNWs. The redox-welded AgNWs embedded in a UV curable resin, using a roll-to-roll embedding process, were successfully applied as anode electrodes for large-area and flexible organic light emitting diodes (OLEDs). The device performance is superior to that of a device based on the as-coated AgNW electrode, and is also comparable to that of a device using commercial ITO as the electrode. The redox-welding and embedding processes provide a facile and reliable method for fabricating large-area transparent flexible electrodes for next-generation flexible optoelectronic devices.</P>

Culture-independent Identification of Bacterial Contamination in Inhaler Devices Used for One Month by Patients with Airway Diseases

( Jiyeon Baek ),( Ok Joo Sul ),( Jimi Oh ),( Hayoung Choi ),( Hyun Lee ),( Yeon-mok Oh ),( Byungsuk Kwon ),( Kwang Won Seo ),( Yangjin Jegal ),( Seung Won Ra ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Metered-dose inhaler (MDI) and RESPIMAT devices, in liquid drug formulations, are widely used and monthly based for patients with airway diseases. Bacterial contaminations in the inhaler devices have been examined by culture-based method which cannot detect dead or unculturable bacteria. This study aimed to investigate the contamination of inhaler canisters after a month of use with 16s rRNA gene-based sequencing and the difference of bacterial composition between MDI and RESPIMAT devices. Methods Twelve inhalers (6 MDI and 6 RESPIMAT) used for 30 days by 10 patients (2 patients used both inhalers) were collected as the experimental group; new inhalers were the control (11 MDI and 9 RESPIMAT). DNA was extracted from the remaining liquid formulations in the dismantled devices; absolute quantitative PCR was performed using 16S rRNA to measure the total bacterial load. Microbiome taxonomic profiling based on 16S rRNA sequencing analysis was used to determine the microbial community composition using an Ezbiocloud database. Results The total bacterial load in both inhaler types increased significantly after one month of use (p=0.004), suggesting inhaler contamination; there was no difference in bacterial load increase between MDI and RESPIMAT. Diversity analyses of the inhaler microbiomes showed no significant differences. There were more prevalent large-sized bacilli in MDI than RESPIMAT, whereas small-sized symbiotic cocci contaminated both devices after a month of use. We were able to replicate the findings in patients using both inhalers: MDI showed higher percentages of large-sized bacilli versus RESPIMAT devices (Haemophilus, 34.6% vs. 14.6%; Pseudomonas, 11.94% vs. <1%), whereas the percentage of small-sized cocci was comparable (6.7% vs. 8.2%) Conclusions The bacterial load identified through culture-independent 16s rRNA gene-based sequencing revealed that inhalers used for a month were contaminated. The two devices showed different bacterial compositions, possibly due to differences in the drug pathway pore size in RESPIMAT devices.

활성탄 종류별 메틸렌블루 흡착특성 비교

라덕관 ( Deog-gwan Ra ),김이슬 ( E-sul Kim ),정정조 ( Cheong-jo Cheong ),정상철 ( Sang-chul Jung ),이경동 ( Gyeong-dong Lee ) 한국환경기술학회 2008 한국환경기술학회지 Vol.9 No.1

활성탄 종류에 따른 메틸렌 블루의 흡착성능을 파악하기 위하여 흡착실험을 수행하였다. 메틸렌 블루 수용액의 농도 100mg/L에 활성탄을 62.5㎎/L 첨가하였을 때, 활성탄(A)는 21.4%, (B)는 14.2%, (C)는 17.7% 흡착하였고, 활성탄을 125㎎/L을 첨가하였을 때, 활성탄(A)는 48.6%, (B)는 41.7%, (C)는 46.4%, 활성탄 250㎎/L을 첨가하였을 때, 활성탄(A)는 60.9%, (B)는 53.6%, (C)는 55.1%의 흡착률을 나타냈다. 따라서 활성탄의 첨가량이 증가할수록 흡착률은 증가하는 경향을 나타내었으며, 흡착평형에 도달되는 시간은 10분으로 나타났다. 활성탄 첨가량 250mg/L의 경우 메틸렌 블루 수용액의 농도 100㎎/L에서 활성탄(A)는 38.9%, (B)는 33.1%, (C)는 34.0%, 수용액의 농도 200㎎/L에서 활성탄 (A)는 38.9%, (B)는 33.1%, (C)는 34.0%, 수용액의 농도 300mg/L에서 활성탄 (A)는 38.9%, (B)는 33.1%, (C)는 34.0% 흡착되었다. 석탄계(A), 식물계(B), 석유계(C) 활성탄 중 석탄계 활성탄이 가장 높은 흡착효율을 보였으며, 흡착등온식은 Langmuir식 보다는 Freundlich식이 더 적합하였다. Adsorption experiments were performed to find out the adsorption capacity of methylene blue on activated carbons from coal(A), coconut(B) and oil carbon(C). When 100mg/L of methylene blue adopted to 62.5mg/L of each activated carbon, adsorption efficiency were achieved as 21.4%(A), 14.2%(B) and 17.7%(C). On the case of 125mg/L and 250mg/L for activated carbon dosage, it was changed 48.6% to 60.9%(A), 41.7% to 53.6%(B) and 46.4% to 55.1%(C). Therefore, some tendency was shown that the increasing of adsorption rate was proportioned to the addition amount of activated carbon. And the adsorption equilibrium time was measured by 10minutes. In the meantime, on the various case of changing 100mg/L, 200mg/L and 300mg/L of methylene blue solution concentration on dosage of activated carbon as 250mg/L, the adsorption efficiency were discovered that 38.9%, 33.9% and 38.9% on activated carbon(A), 33.1%, 33.1% and 33.1% on activated carbon(B), 34.0%, 34.0% and 34.0% on activated carbon(C). Activated carbon(C) was shown the highest adsorption efficiency, comparing to activated carbon(A) and (B). The adsorption isotherm were well fitted with the Langmuir equation rather than with that of Freundlich.