류마티스관절염 환자에서 잠복결핵 진단을 위한 투베르쿨린 검사와 T-SPOT.TB 사이의 일치율에 관한 연구

허지안 ( Ji An Hur ),서수홍 ( Soo Hong Seo ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Objective: To evaluate concordance rate between tuberculin skin test (TST) and T-SPOT. TB (T-SPOT) for detecting latent tuberculosis in patients with rheumatoid arthritis (RA) received disease modifying antirheumatic drugs (DMARDs) and/or immunosuppressant. Methods: Fifty four patients with RA refractory to conventional DMARDs and planned ahead to be received tumor necrosis factor-α (TNF-α) blockade were enrolled in this study. The TST was performed by Mantoux method. Over 10 mm induration size was considered to be positive in the TST. The peripheral blood were collected from all patients and used for the T-SPOT. Results: Only six patients (11.11%) had a positive TST, and 48 patients (88.89%) had a negative TST. The mean TST values were 13.51±3.51 mm (range: 10~19 mm) in TST (+) group and 2.50±3.12 mm (range: 0~9 mm) in TST (-) group, respectively. T-SPOT was indeterminate in 7 patients (12.96%). Twenty-five patients (53.19%) had a positive result, and 22 patients (46.81%) had a negative result in 47 patients determinated with T-SPOT. There was poor overall agreement between results of TST and T-SPOT (p=0.194). Conclusion: There was no concordance between TST and T-SPOT in patients with RA received DMARDs and/or immunosuppressant. Therefore, the results of TST should be interpreted with caution, taking into consideration of the result of T-SPOT in patients with RA who are Drone to having false negative of TST.

류마티스관절염 동물모델에서 관절염 치료에 따른 통증수용체의 발현

방지혜 ( Ji Hye Bang ),하은영 ( Eun Young Ha ),허지안 ( Ji An Hur ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.2

Objective. Rheumatoid arthritis, the most common form of arthritis, is typically characterized by induced inflammatory pain in joints. Recent studies have reported on the expression of pain receptors such as transient receptor potential vanilloid 1 (TRPV1) and acid sensing ion channel 3 (ASIC3), which are related to pain induction and regulation. This study was conducted to investigate the expression of TRPV1 and ASIC3 in response to the analgesic effect of an arthritis treatment in a collagen-induced arthritis (CIA). Methods. Mice were divided into 3 groups: Control, CIA, and CIA with arthritis treatment. Mice received intraperitoneal injection with 10 mg/kg infliximab and 10 mg/kg meloxicam five times per week for 3 weeks. Mechanical hyperalgesia, histologic examination of the feet, serum levels of inflammatory cytokine such as interleukin-6 (IL-6), and interleukin-17 (IL-17), TRPV1 and ASIC3 expression were investigated. Results. The serum levels of IL-6 and IL-17 were lower in the treatment group (73.77±10.11 pg/mL and 26.75±7.17 pg/mL, respectively) compared to the CIA group (p<0.001). Histological analysis showed decreased synovial cell proliferation, leukocyte infiltration, and cartilage destruction in the treatment group compared with the CIA group. The CIA group that underwent arthritis treatment showed a significantly increased withdrawal threshold of mechanical nociception on the hind paw and increased expression of TRPV1 and ASIC3 compared to the CIA group. Conclusion. Arthritis treatment resulted in an anti-inflammatory and analgesic effect through upregulation of the activity of TRPV1 and ASIC3 in CIA mice. (J Rheum Dis 2015;22:85-92)

레이노현상으로 발현하여 무작위 관자동맥 생검으로 진단된 비전형적 거대세포동맥염

서정우 ( Jong Woo Seo ),허지안 ( Ji An Hur ),김현옥 ( Hyun Ok Kim ),전대홍 ( Dae Hong Jeon ),백종하 ( Jong Ha Back ),김재희 ( Jae Hee Kim ),이상일 ( Sang Il Lee ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.3

Giant cell arteritis (GCA) is a chronic vasculitis that mainly involves the cranial branches of arteries, and typically it presents with a cephalic sign such as a new headache, jaw claudication and/or visual symptoms. Although the tender, swollen or beaded arteries are adequate sites for biopsy, random temporal artery biopsy should be performed in all the patients suspected of suffering with GCA and even if cephalic signs are not present. Several cases of typical GCA have been reported in Korea, but so far there have been no reports of an atypical case presenting with Raynaud`s phenomenon, and the patient was diagnosed by random temporal artery biopsy. Here we describe a case that showed the typical pathological findings of GCA in an asymptomatic temporal artery. The patient complained of only Raynaud`s phnomenon and the patient was without any cephalic symptoms.

간호사의 감염예방 표준주의지침 지식, 태도 및 준수 정도

이경희 ( Kyoung Hee Lee ),최주옥 ( Joo Ok Choi ),이경수 ( Kyeong Soo Lee ),허지안 ( Ji An Hur ),황태윤 ( Tae Yoon Hwang ) 한국병원경영학회 2014 병원경영학회지 Vol.19 No.2

This study was conducted to investigate the degree of nurses. knowledge, attitudes, and compliance with hospital infection standard precautions. The study subjects were nurses in a university hospital in Daegu, South Korea, and a self-administered survey was carried out using a standardized questionnaire from 1st to 15th August, 2012. A total of 187 questionnaires were used for analysis. Those who were injured by a syringe needle for the last year accounted for 29.96%, and those exposed to patients. blood or body fluid on their damaged skin/mucous membranes accounted for 26.2%. There were statistically significant differences in attitude and compliance according to safety environment for hospital infection standard precautions. The knowledge score of the subjects about standard precautions was 15.30±1.51 on a 19 point scale and had significant difference according to the subjects. education level. The attitude score was 2.86±0.49 on a 4 point scale and had significant difference depending on how experienced they were on the career. The compliance score was 3.41±0.38 on a 4 point scale and had significant difference depending on their age and their experience on the career. In conclusion, it can be said that systematic and continuous practical training is required to improve compliance with standard precautions. Particularly, it is needed to provide less experienced nurses with educational opportunities along with their supervisors. ongoing attention and position personnel appropriately.

염증성 근육병증에 동반된 폐침범의 임상적 특징

김현숙 ( Hyun Sook Kim ),서수홍 ( Soo Hong Seo ),허지안 ( Ji An Hur ),곽승기 ( Seung Ki Kwok ),주지현 ( Ji Hyeon Ju ),윤종현 ( Chong Hyeon Yoon ),김완욱 ( Wan Uk Kim ),홍연식 ( Yeon Sik Hong ),조철수 ( Chul Soo Cho ),김호연 ( Ho Y 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.1

Objective: To investigate the clinical manifestation and prognostic factors of interstitial lung disease (ILD) in Korean patients with idiopathic inflammatory myopathies include with polymyositis (PM) and dermatomyositis (DM). Methods: Clinical and laboratory data of 110 patients with PM/DM in our rheumatology clinic were investigated. Clinical data including history, medication, pulmonary function tests (PFT) findings, radiologic findings, and labaratory findings were obtained from medical records at the first diagnosis of ILD with PM/DM. ILD was diagnosed on the basis of the imaging abnormalities defined above on definite findings of chest X-rays and high resolution computed tomography (HRCT), restrictive changes on PFT with respiratory symptoms. During the course of treatment, we assessed chest radiograph and HRCT findings. Results: Forty-two PM/DM patients (38.2%) developed ILD. Anti-extracellular nuclear antigen (ENA) antibody, anti-Jo-1 antibody and ground glass opacity in HRCT were significantly high in PM-ILD. However honeycoomb appearance (53%:22%) and fibrosis (41%:6%) in HRCT were significantly high in DM-ILD. Interest in aspects of prognosis including initial steroid treatment response in HRCT were favorable in PM-ILD. There were statistically significant association between normal level of CPK and usual interstitial pneumonia (UIP) pattern in HRCT in DM-ILD. Such cases had resistance to steroid therapy. Overall interval between steroid and immunosuppressant therapy was significantly shorter in those with DM-ILD. Conclusion: The clinical manifestations between PM-ILD and DM-ILD in Korean patients were not significant different from those of other populations. DM-ILD is more refractory to steroid treatment, expecting in poor prognosis compared with PM-ILD. So immediate intensive immunosuppressive therapy should be considered in DM-ILD.

폐 샘편평세포암의 첫 증상으로 발현된 피부 백혈구파괴혈관염

김현옥 ( Hyun Ok Kim ),김호철 ( Ho Cheol Kim ),고경혁 ( Gyung Hyuck Ko ),장인석 ( In Seok Jang ),강민규 ( Min Gyu Kang ),박현오 ( Hyun Oh Park ),허지안 ( Ji An Hur ),이상일 ( Sang Il Lee ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.3

Leukocytoclastic vasculitis (LV) is a systemic inflammatory disorder involving the small vessels. The exact cause of LV remains unknown, yet malignancy has been considered as a causative factor for LV. We experienced a 60-year-old male with purpura on his extremities. Computed tomography of the chest showed a mass lesion that was suspected to be a non-small-cell lung cancer and the biopsy revealed an adenosquamous carcinoma. There has been no report of LV associated with adenosquamous carcinoma of the lung in Korea. Thus, we report here on this case along with a review of the relevant articles.

알부민이 첨가된 시험관내 약역학 감염모델을 이용한 폐렴알균 치료에서 Ceftriaxone 일일 1회 요법

허지안,전혜선,박선희,최수미,김시현,이동건,최정현,유진홍,신완식 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

배경 : Penicillin 내성 폐렴알균이 증가하는 지역에서 대안 중의 하나로 사용되는 ceftriaxone (CTR)의 적절한 용법, 용량을 파악하는 것이 중요하다. 본 연구는 임상에서 분리된 폐렴알균을 대상으로 시험관내 약역학 감염모델을 이용하여 알부민이 첨가된 경우와 첨가되지 않은 경우 CTR의 일일 1회 요법의 효과를 비교해 보고자 하였다. 재료 및 방법 : Penicillin 감수성(SM24), 중간내성(SM47), 내성(SM60)주를 대상으로 2-구획 시험관내 약역학 감염모델을 적용하였다. CTR 주입은 2 g씩 24시간마다로 사람의 약동학을 모의하였다. 알부민은 모델에서 4g/ dL가 유지되도록 하였다. 살균효과는 0, 2, 4, 6, 24, 30, 48시간째 집락수 변화로 측정하였다. 결과 : 모든 균주에서 알부민이 첨가되지 않은 경우 6시간 이내에 살균력이 관찰되었다. 최저억제농도 및 알부민 첨가유무에 관계없이 3주 모두 24시간째 살균력이 관찰되었고, 48시간째는 모두 측정한계 이하의 집락수로 감소하였다. 전 실험과정에서 CTR에 대한 내성주는 출현하지 않았다. 결론 : CTR의 일일 1회 요법은 알부민이 첨가되었을 때, 감수성, 중간내성, 내성주 모두에서 살균력 발현이 지연되었으나 최종효과는 알부민이 없을 때와 다르지 않았다. 앞으로 알부민 결합효과와 관련된 기초적인 추가 연구가 필요할 것으로 생각된다. Background : During the era of increasing penicillin resistant Streptococcus pneumoniae, it is important to have knowledge about adequate dosage and dosing interval of ceftriaxone (CTR). We examined efficacies of once-daily CTR and compared results in an in vitro pharmacodynamic infection model (IVPDIM) supplemented with albumin and those without albumin. Methods : Using three clinically isolated S. pneumoniae that were susceptible (SM24), intermediate (SM47) and resistant (SM60) against CTR, we utilized a two-compartment IVPDIM. CTR 2 g was administered intravenously every 24 h. Human albumin was added with concentration of 4 g/dL. Samples were removed at multiple time points over a 48-h period to determine the colony counts. Results : In SM24 and SM60, bactericidal effects were observed within 6 hours in groups without albumin. The number of colonies during 1st 6 hours were more decreased in albumin-free groups than in albumin-supplemented groups (P<0.05). In SM47, similar results were found during 1st 6 hours (P=0.03). But, regrowth was observed in albumin supplemented group at 30 h. Irrespective of results of minimal inhibitory concentrations and albumin supplementation, bactericidal effects were shown at 24 h in all 3 strains. All groups were decreased below the detection limit at 48 h. Development of resistance was not detected throughout the entire study period in either strain. Conclusions : Although extents of killing in albumin supplemented broth of once-daily CTR dosing were delayed in all 3 strains compared with those of albumin free broth, final efficacies were not different between the two groups.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

Adriamycin에 의해 유발된 가역적인 심근병증 1례

장용석,조주연,허지안,도영록,송홍석 啓明大學校 醫科大學 2002 계명의대학술지 Vol.21 No.1

Adriamycin을 투여한 환자에서 약제 투여 5년 후에 발생한 심근병증을 경험하였으며, 심근생검으로 adriamycin에 의해 발생한 심근병증으로 진단하였고, 적극적인 치료로 임상적인 호전을 보인 1례를 문헌고찰과 함께 보고하는 바이다. Adriamycin is a chemotherapeutic agent highly effective against a wide range of neoplasms. A primary limiting factor to the administration of this drug is a cardiotoxicity, which frequently develops when the cumulative dose exceeds 500 ㎎/㎡. Cardiomyopathy, which may develop even after a year of discontinuation of adriamycin therapy, is though to be rapidly progressive and unresponsive to standard cardiac therapy. We experienced a case of adriamycin-induced cardiomyopathy. A 53-year-old male patient who received 337 ㎎/㎡ of adriamycin experienced congestive heart failure at 5 years since the completion of the therapy. Endomyocardial biopsy showed vacuolization of myocytes and focal fibrotic areas. The patient responded to diuretics, inotrophic agents, and an angiotensin converting enzyme inhibitors, and resolution of left ventricular dysfunction was verified by plain chest radiography and echocardiography.

A Case of Perianal Abscess due to Panton-Valentine Leukocidin Positive Community-Associated Methicillin-Resistant Stapnylococcus aureus : Report in Korea and Literature Review from the Far East

Park, Chulmin,Lee, Dong-Gun,Choi, Su-Mi,Park, Sun Hee,Choi, Jung-Hyun,Yoo, Jin-Hong,Hur, Ji An,Shin, Wan-Shik 대한감염학회 2008 감염과 화학요법 Vol.40 No.2

최근 Panton-Valentine leukocidin (PVL) 유전자 양성인 지역사회관련 메티실린내성 포도알균이 전세계적으로 보고되고 있지만 국내에서는 아직 드물다. 저자들은 76세 여자환자에서 PVL양성 지역사회관련 메티실린 내성 포도알균에 의한 광범위한 항문주위 농양을 진단하고 성공적으로 치료하였다. 분자역학연구를 통해 본 균주는 미국에서 유행하는 USA300주와 매우 유사하고, staphylococcal cassette chromosome mec mec (SCCmec) type IV, multilocus Sequence typing ST8, spa type type 1, accessory gene regulator locus (agr) group I이 관련되어있었다. 문헌조사 결과 동아시아에서 보고된 PVL 양성 지역사회관련 메티실린 내성 포도알균은 분자역학적 특성이 다양하고, 미국 및 유럽 증례와 비교해 PVL 유전자가 비교적 드물었다. Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) genes have recently emerged worldwide, but infections due to PVL carrying CA-MRSA strains have never been reported in Korea. We report a case of extensive perianal abscess due to PVLU CA-MRSA in a 76-year-o1d Korean female patient, of which genetic background was very close to USA300. It belonged to staphylococcal cassette chromosome mec element (SCCmec) type IV, ST8 of multilocus sequence typing (MLST), type 1 spa type, and accessory gene regulator locus (agr) group I. Comprehensive literature reviews from the Far East showed molecular characteristics were diverse and PVL genes were infrequently found than in western countries.