이뇨제를 사용한 급성 신손상 환자에서 FEUrea의 진단적 유용성

임대훈 ( Dae Hun Lim ),정지민 ( Ji Min Jeong ),오슬현 ( Seul Hyun Oh ),이형철 ( Hyung Chul Lee ),최준석 ( Joon Suk Choi ),김민지 ( Min Jee Kim ),박정우 ( Jeong Woo Park ),배은희 ( Eun Hui Bae ),마성권 ( Seong Kwon Ma ),김남호 ( Na 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3

목적: 임상적으로 FENa가 일과성 신손상 (T-AKI)과 지속성 신손상 (P-AKI)을 감별하는 데 많이 사용되지만 이뇨제를 사용한 환자에서 FENa는 유효 혈류량 결핍 상태에서도 증가하게 되어 진단적 정확성이 떨어진다고 알려져 있다. 본 연구에서는 이뇨제 투여상황에서 FE(Na)와 비교하여 FE(Urea)의 진단적 유용성에 대하여 알아보고자 하였다. 방법: 107명의 급성 신손상 환자를 임상적 특성에 따라 일과성과 지속성 신손상 군으로 나누고 이를 다시 이뇨제 투여 유무에 따라 재분류하였다. ROC 곡선에 따라 계산된 cutoff value에 따라서 일과성 신손상을 정의하였고 이뇨제 투여로 인한 cutoff value의 변화에 따른 민감도와 특이도를 비교하였다. 결과: AKI가 발생한 107명의 모든 환자중 검사 이전에 경험적으로 이뇨제를 사용한 경우가 67명으로 63%를 보였고, 일과성 신손상군의 경우는 52명 중 27명으로 52%를, 지속성 신손상군의 경우는 55명 중 45명으로 73%를 보였다. ROC curve에 따라 cutoff value를 FE(Na)≤1.5 FE(Urea)≤30으로 하였을 때 T-AKI를 진단하는 데 사용된 두 값의 민감도와 특이도는 모든 환자군에서 FE(Na)가 81%, 98%를, FE(Urea) 가 94%, 82%를 보였다. 이뇨제 비투여군에서는 FE(Na)가 96 %, 100%를, FEUrea가 92%, 87%를 보였으며, 이뇨제 투여군에서는 FE(Na)가 63%, 98%를, FE(Urea)가 96%, 83%를 보였다. 결론: 이뇨제를 사용한 경우 P-AKI를 진단하는데 FE(Urea)도 FE(Na) 정도의 진단적 유용성을 가진다. Purpose: Although fractional excretion of sodium (FE(Na)) has been used to distinguish transient-acute kidney injury (T-AKI) from persistent-AKI (P-AKI), the availability of FE(Na) in the diagnosis of T-AKI is reported low in patients with diuretics use. We compared the diagnostic performance of fractional excretion of urea (FE(Urea)) with that of FE(Na) in patients with diuretics use. Methods: One hundred seven AKI patients were classified as having T-AKIor P-AKI according to the clinical context. Each group was again subdivided according to exposure to diuretics. According to the cut off value generated by receiver operating characteristic (ROC) curves, sensitivity and specificity of FE(Na) and FE(Urea) were compared with each other. Results: The numbers of patients administered with diuretics were 67 out of total 107 AKI patients (63%), 27 out of 52 (52%) of T-AKI patients, and 40 out of total (65) 55 (73%) of P-AKI patients. When the cutoff value of T-AKI was defined as FE(Na) ≤1.5 and FE(Urea) ≤30 according to the ROC curves, sensitivity and specificity of FE(Na) were 96% and 100% in non-diuretics group, and 63% and 98% in diuretics group, respectively. Sensitivity and specificity of FE(Urea) were 92% and 87% in non-diuretics group, and 96% and 83% in diuretics group, respectively. Conclusion: FE(Urea) is as good as FE(Na) at distinguishing T-AKI from P-AKI in patients administered with diuretics.

부산지역에서 유행한 계절인플루엔자바이러스의 유전자 특성 및 계통분석(’06~’08 절기)

Yon-Koung Park(박연경),Nam-Ho Kim(김남호),Seung-Hwa Choi(최성화),Mi-Oak Lee(이미옥),Sang-Kee Min(민상기),Seong-Joon Kim(김성준),Kyung-Soon Cho(조경순),Young-Nan Na(나영란) 한국생명과학회 2010 생명과학회지 Vol.20 No.3

2006년 10월부터 2008년 6월까지 총 인플루엔자 의사 환자 1,822건의 인후도찰물 및 비인후도찰물에서 277건의 인플루엔자바이러스를 분리했다. 절기별로는 2006~2007 절기의 1,154검체 중 52건(4.5%), 2007~2008절기의 668검체 중 210건(31.4%)에서 인플루엔자바이러스를 분리하였다. 인플루엔자바이러스 A/H1N1의 HA 유전자의 경우, 2008~2009 절기의 백신주인 A/Brisbane/59/2007과는 96.7%~97.7%, A/Solomon Islands/3/2006 96.5%~97.3%, A/New Caledonia/20/99와는 95.6%~96.6%의 유사성을 나타냈으며, NA 유전자의 경우, A/Brisbane/59/2007과는 97.8%~98.5%, A/Solomon Islands/3/2006과는 96.7%~97.6%, A/New Caledonia/20/99와는 96.8%~97.7%의 유사성을 보여 2008~2009절기의 백신주인 A/Brisbane/59/07과 가장 유사성이 컸다. 인플루엔자바이러스 A/H3N2의 분리주 중 1주를 제외한 모든 분리주가 HA 유전자에서 2008~2009 절기 백신주인 A/Brisbane/10/2007과는 98.4%~99.7%의 유사성을 보였고, A/Wisconsin/67/2005와는 96.5%~97.5%의 유사성을 보였으며, NA 유전자에서는 A/Brisbane/10/2007과는 98.9%~99.4%, A/Wisconsin/67/2005와는 98.0%~98.6%, A/California/7/2004와는 98.3%~98.9%의 유사성을 보였다. 인플루엔자바이러스 B의 HA 유전자의 경우는 2주를 제외하고는 2008~2009 절기의 백신주인 B/Florida/4/2006과는 96.5%~99.7%의 유사성을 보였으며, B/Malaysia/2506/2004와는 86.7%~87.7%의 유사성을 보여 B/Florida/4/2006과의 유사성이 크게 나타났다. NA 유전자의 경우는 reassortant분리주가 96.7%와 97.3%의 유사성을 나타내는 것을 제외하고는 B/Florida/4/2006에 98.9%~100%의 유사성을 나타냈으며, 분리주 유행시기의 백신주인 B/Malaysia/2506/2004와는 94.5%~96.7%의 유사성을 나타내어 2008~2009 절기의 백신주와 더 큰 유사성을 보였다. HA 유전자에서는 conserverd receptor binding site는 아미노산의 치환 없이 모든 분리주에서 잘 보존되어 있었으며, N-linked glycosylation site도 인플루엔자바이러스 A/H1 1주, A/H3 1주를 제외하고는 모두 같은 수의 N-linked glycosylation sites를 가졌으며, 인플루엔자바이러스 B의 경우는 2008~2009 절기의 백신주보다 1개가 많은 4개의 N-linked glycosylation sites를 가지고 있었다. Antigenic sites의 경우는 인플루엔자바이러스 A/H1의 Sb의 3개의 아미노산에서 백신주들과 다른 아미노산을 가지고 있으며, A/H3에서는 A, B, E 부위에서는 아미노산의 변화가 나타났고, C, D 부위에서는 변화가 없었다. 인플루엔자바이러스 B의 4개의 분리주에서는 150 loop와 160 loop에서 B/Florida/4/2006과 비교하여 1개의 아미노산에서 치환이 나타났으며, 190 helix에서 모든 분리주가 B/Florida/4/2006과 비교하여 1개의 아미노산에서 치환이 나타났다. To monitor newly emerged influenza virus variants and to investigate the prevalence pattern, our laboratory performed isolation of the viruses from surveillance sentinel hospitals. In the present study, we analysed influenza A/H1N1, A/H3N2, B viruses isolated in Busan during the 2006/07 and 2007/08 seasons by sequence analysis of the hemagglutinin (HA1 subunit) and neuraminidase (NA) genes. The isolates studied here were selected by the stratified random sample method from a total of 277 isolates, in which 15 were A/H1N1, 16 were A/H3N2 and 29 were B. Based on the phylogenetic tree, the HA1 gene showed that A/H1N1 isolates had a 96.7% to 97.7% homology with the A/Brisbane/59/2007, A/H3N2 isolates had a 98.4% to 99.7% homology with the A/Brisbane/10/2007, and B isolates had a 96.5% to 99.7% homology with the B/Florida/4/2006(Yamagata lineage), which are all the vaccine strains for the Northern Hemisphere in 2008~2009 season. In the case of the NA gene, A/H1N1 isolates had 97.8% to 98.5% homologies, A/H3N2 isolates had 98.9% to 99.4% homologies, and B isolates had 98.9% to 100% homologies with each vaccine strain in the 2008~2009 season, respectively. Characterization of the hemagglutinin gene revealed that amino acids at the receptor-binding site and N-linked glycosylation site were highly conserved. These results provide useful information for the control of influenza viruses in Busan and for a better understanding of vaccine strain selection.

2001년 연수강좌 : 저나트륨 혈증

김수완 ( Kim Su Wan ),염충호 ( Yeom Chung Ho ),나명윤 ( Na Myeong Yun ),김남호 ( Kim Nam Ho ),최기철 ( Choe Gi Cheol ) 대한신장학회 2001 대한신장학회지 부록 Vol.20 No.3

Effectiveness of Aspiration in Treating Cardiac Implantable Electronic Device-Induced Pocket Hematoma and Characteristics of Patients with Pocket Hematoma

Lee Hye Mi,Park Jin Woo,Young Cheon Na,윤치선,Jong Hwan Kim,김남호 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.1

Background: Pocket hematoma is the most common complication after procedures involving cardiac implantable electronic devices (CIEDs). Furthermore, pocket hematomas increase the risk of device infection. Unless severe, a pocket hematoma is usually managed conservatively because specific treatment is unavailable. Aspiration is not recommended as it can cause infection. This study explored whether lowering the risk of infection by aseptically removing the hematoma at an early stage would be possible through aspiration, investigated the effectiveness of treatment with aspiration for pocket hematoma, and analyzed the characteristics of patients with pocket hematoma. Methods: Via chart review, we retrospectively analyzed 570 patients who underwent CIED implantation or replacement between January 2011 and January 2021. Aspiration was performed only on grade 2 and 3 hematomas. Results: Pocket hematomas were identified in 80 patients (14%). Of these 80 patients, 52 (65%) were treated with aspiration only; six (7.5%), with aspiration plus surgical procedure; five (6.25%), with the surgical procedure only; and 17 (21.25%), with conservative treatment. Out of 58 patients treated with aspiration only and aspiration plus surgical procedure, 52 (89.65%) were treated with aspiration only, while six (10.34%) required more procedures (e.g., hematoma evacuation, Barovac insertion, or device reposition with flap surgery). However, none of these six patients exhibited an infection symptom possibly caused by aspiration. Conclusion: Out of 80 patients with hematoma, 58 were treated with aspiration, and none showed infection symptoms that could be caused by aspiration. This suggests that aspiration can be an effective treatment if performed aseptically.

이불화제논 기상 식각에 의한 실리콘 기판의 표면 텍스쳐링 특성

김선훈(Seon Hoon Kim),기현철(Hyun Chul Ki),김두근(Doo Gun Kim),나용범(Yong Beom Na),김남호(Nam Ho Kim),김회종(Hwe Jong Kim) 대한전기학회 2010 전기학회논문지 Vol.59 No.4

We investigated the haze and the surface roughness of textured Si substrates etched by XeF₂ etching system with the etching parameters of XeF₂ pressure, etching time, and etching cycle, Here, the haze was obtained as a function of wavelength from the measured reflectance, The haze of textured Si substrates was strongly affected by the etching parameter of etching cycle. The surface coughness of textured Si substrates was calculated with the haze and the scalar scattering theory at the wavel ngth of BDD ㎚. Then, the surface coughness was compared with that measured by atomic force microscope, The surface coughness5 obtained by two methods was changed with the similar tendency in terms of XeF₂ etching conditions.

항혈소판제와 병합요법에 따른 Probucol의 관상동맥 스텐트 시술환자에서 임상적 효과

김남호,정명호,김관,김용록,이승욱,김건형,조장현,박종철,앙영근,나국주,조정관,안병희,박종춘,강정채 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.7

혈액투석 환자에서 혈청 마그네슘과 부갑상선호르몬 치의 관계

박미정,김남호,강영준,김정기,박병석,김수완,나명윤,마성권,염충호,최기철 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.6

The important factors involved in the regulation of PTH are calcium, vitamin D, and phosphorus. However, recent studies have suggested that magnesium may also play a significant role in the modulation of PTH. The aims of this study was to analyze the relationship between serum magnesium and PTH levels in the hemodialysis patients. We studied 66 stable patients under maintenance hemodialysis for more than 6 months. Calcium carbonate was used as a phosphate binder in all patients. No patient had been previously treated with vitamin D and aluminum hydroxide. Biochemical parameters were evaluated 3 times during 7 months, and the mean values were computed. The mean serum magnesium level was 2.7±0.4 mEq/L. Hypermagnesemia(defined as serum Mg$gt;2.2 mEq/L) was found in 60 patients(90.1%). Serum magnesiurn levels were inversely correlated with senum iPTH levels(r=-0.579; p$lt;0.001). Serum total and ionized calcium levels were inversely correlated with serum iPTH levels(r=-0.743; p$lt;0.001, r=-0.699; p$lt;0.001, respectively).Serum alkaline phosphatase levels positively correlated with serum iPTH levels (r=0.364; p=0.003). In lower iPTH group(serum iPTH120pg/mL), serum magnesium, total calcium, and ionized calcium levels were significantly higher. Alkaline phosphatase level was significantly lower in lower PTH group. After controlling for the effect of the other variables, serum magnesium and iPTH levels were inversely correlated(r=-0.53; p$lt;0.001). A stepwise multiple regression analysis showed that serum magnesium level was the most predictive variable(R²=0.72; p$lt;0.001). Hypermagnesemia is frequent in hemodialysis patients. There is a significant inverse relationship between serum magnesium and PTH levels. In addition, serum magnesium concentration has an important influence on PTH regulation. These results suggest that hypermagnesemia may have a suppressive effect on PTH regulation in hemodialysis patients.

한국인에서 관상동맥 질환에 대한 만성 감염 및 염증의 역할

김계훈,정명호,신종희,주신배,김원,이승욱,김건형,김남호,조장현,박종철,안영근,나국주,조정관,안병희,박종춘,강정채 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.9