일개 부산지역 3차 병원에서 관찰한 다제내성 결핵의 실태, 2005~2009

윤늘봄 ( Neul Bom Yoon ),이성우 ( Sung Woo Lee ),박수민 ( Su Min Park ),정일환 ( Il Hwan Jeong ),박소영 ( So Young Park ),한송이 ( Song Yee Han ),이유림 ( Yu Rim Lee ),정진규 ( Jin Kyu Jung ),김준모 ( Joon Mo Kim ),김수영 ( Su You 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.2

Background: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. Methods: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. Results: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~ 26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. Conclusion: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.

감염 ; 폐외 결핵 진단에서 2개의 전혈 인터페론 감마 측정법의 유용성 비교

한송이 ( Song Yee Han ),이혁 ( Hyuck Lee ),정동식 ( Dong Sik Jung ),김경희 ( Kyeong Hee Kim ),우수미 ( Su Mi Woo ),박소영 ( So Young Park ),서정민 ( Jeong Min Seo ),정진규 ( Jin Kyu Jung ),윤늘봄 ( Neul Bom Yoon ),이성우 ( Sung W 대한내과학회 2011 대한내과학회지 Vol.81 No.4

목적: QuantiFERON-TB GOLD (QFT-G)와 QuantiFERON-TB GOLD in tube (QFT-IT) 검사는 주로 활동성 폐결핵 또는 잠복결핵의 진단과 관련되어 연구되어져 왔으나, 폐외 결핵의 진단과 유용성은 아직 잘 밝혀지지 않은 상태이다. 본 연구는 폐외 결핵 환자에서 QFT-G와 QFT-IT의 진단적 유용성에 대해 비교 분석하였다. 방법: 2007년 6월부터 2010년 8월까지 임상적으로 폐외결핵이 의심되어 QFT-G, QFT-IT 검사를 한 환자 각각 56명과 48명을 대상으로 하였다. QFT-G와 QFT-IT의 민감도, 특이도, 양성예측도, 음성예측도와 QFT-IT의 cut-off value를 통하여 진단적 유용성을 분석하였다. 결과: 폐외 결핵으로 진단된 환자는 55명(53%)이었고 QFT-IT의 민감도, 특이도, 양성예측도, 음성예측도는 96%, 42%, 62%, 91%이었으며, QFT-G는 81%, 52%, 68%, 68%이었다. 감염부위에 따른 검사 결과 또한 민감도, 음성예측도에서 QFT-IT가 QFT-G보다 더 높은 결과를 보였다. 본 연구에서 cut-off value는 기존에 권고하고 있는 cut-off value의 범위 안에 포함되었다(0.30-0.45 IU/mL, sensitivity 95.8%, specificity 41.7%). 결론: QFT-IT는 M.tuberculosis 감염의 진단에 있어서 QFT-G보다 높은 민감도와 음성예측도를 보이며, 특이도에 있어서는 유사한 결과를 보여 새로운 IGRA방법으로서 폐외결핵의 진단을 더 강화시킬 수 있는 가능성을 보여주었다. Background/Aims: The QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold in tube (QFT-IT) assays have been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. The clinical usefulness of these assays for the detection of active extrapulmonary (EP) TB has not been fully defined. The aim of this study was to compare the diagnostic value of these two interferon-gamma assays for EP-TB. Methods: From June 2007 to August 2010, we evaluated the usefulness of QFT-G (n=56) and QFT-IT (n=48) in patients (n=104) with suspected EP-TB. The diagnostic sensitivity, specificity, postive predictive value (PPV), and negative predictive value (NPV) of QFT-G and QFT-IT, and the cut-off value of QFT-IT were analyzed. Results: EP-TB was diagnosed in 55 (53%) patients. The overall sensitivity, specificity, PPV, and NPV of the QFT-IT assay were 96%, 42%, 62%, and 91%, respectively, and those of the QFT-G test were 81%, 52%, 68%, and 68%, respectively. In subgroup analyses according to infection site, the sensitivity and NPV of QFT-IT were higher than those of QFT-G. Analysis confirmed that the manufacturer`s recommended test cut-off value fell within our cut-off value range (0.30-0.45 IU/mL; 95.8% sensitivity, 41.7% specificity). Conclusions: The QFT-IT assay showed superior sensitivity and NPV, and equivalent specificity, as comparison with the QFT-G test for the detection of Mycobacterium tuberculosis infection. The logistic benefits of the QFT-IT test format should facilitate the diagnosis of EP-TB. (Korean J Med 2011;81:478-486)

Comparison of cell viability, proliferation and cytokine response to NaHCO₃ and NaCl type hot springs in cultured HaCaT cells stimulated with Toll-like receptor 3

( Sang Ho Park ),( Bom Yee Jung ),( Min Ji Kang ),( Soo Young Lee ),( Min Ji Kang ),( Joo Hee Lee ),( Young Bok Lee ),( Dong Soo Yu ),( Kyung Ho Lee ),( Jin-wou Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: It has been known for a long time that hot springs (HS) are effective for a wide range of diseases such as psoriasis and atopic dermatitis. However, the treatment mechanisms of HS treatment are still not well defined. Objectives: The aim of this study is to demonstrate mechanisms for the traditional treatment of atopic dermatitis through hot spring bathing. Methods: HS were classified into two main groups, NaHCO3 and NaCl type HS, and five regions were selected. We investigated the viability and proliferative capacity of hot water in HaCaT cells stimulated with Toll-like receptor 3 (TLR3) by poly I-C and analyzed the cytokine changes by Human Inflammation Antibody Array. Results: The cell viability was 81.1% in NaHCO3 and 94.8% in NaCl type HS. In NaHCO3. The cell proliferation was 85.6% and in NaCl, it was 90.1%. The area of migration cells in NaHCO3 and NaCl had reached 98.6% and 25.3%. When cells were exposed to all type HS, IP-10 and TIMP-2 increased and ICAM-1 and MIP-1 alpha decreased. In different from NaCl, only NaHCO3 increased IL-6, PDGF-BB and decreased IL-12 p40. Conclusion: We compared the cell viability, proliferation and wound healing in HS treated cells. NaHCO3 is more effective for keratinocytes than NaCl type HS. The inflammatory cytokines derived from keratinocytes increased or decreased when exposed to hot spring water. In this study, the effect and mechanism of treatment with hot spring water in sensitive dermatitis could be partially proved.

NaHCO₃- and NaCl-Type Hot Springs Enhance the Secretion of Inflammatory Cytokine Induced by Polyinosinic-Polycytidylic Acid in HaCaT Cells

( Sang Ho Park ),( Bom Yee Jung ),( Soo Young Lee ),( Dong Soo Yu ),( So-youn Woo ),( Seong-taek Yun ),( Jong Tae Lee ),( Jin-wou Kim ),( Young Bok Lee ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.5

Background: Hot springs have been traditionally used as an alternative treatment for a wide range of diseases, including rheumatoid arthritis, bronchial asthma, diabetes, hypertension, psoriasis and atopic dermatitis. However, the clinical effects and therapeutic mechanisms associated with hot springs remain poorly defined. Objective: The purpose of this study was to demonstrate the different effects of hot springs on cellular viability and secretion of inflammatory cytokines on keratinocyte in two geographically representative types of hot springs: NaHCO₃-type and NaCl-type, which are the most common types in South Korea. Methods: We performed WST-1, BrdU measurements, human inflammatory cytokine arrays and enzyme-linked immunosorbent assay in HaCaT cells stimulated with toll-like receptor 3 by polyinosinic-polycytidylic acid. Results: The interaction effects of cell viability and cell proliferation were not significantly different regardless of polyinosinic-polycytidylic acid stimulation and cultured hot springs type. Cytokine array and enzyme-linked immunosorbent assay analysis showed increased expression of inflammatory cytokines such as interleukin-6 and granulocyte-macrophage colony-stimulating factor by polyinosinic-polycytidylic acid stimulation, with expression levels differing according to hot springs hydrochemical composition. Cytokine reduction was not significant. Conclusion: The effects and mechanisms of hot springs treatment in keratinocytes were partially elucidated. (Ann Dermatol 33(5) 440∼447, 2021)

산전 진단에서 관찰된 8번과 22번 염색체 사이의 미세 전좌에 의한 8번 염색체 단완 위성체

오아름(Ah Rum Oh),이봄이(Bom Yee Lee),최은영(Ene Yuong Choi),류현미(Hyun Mee Ryu),이승재(Seung Jae Lee),정지예(Ji Ye Jung),박소연(So Yeon Park) 대한의학유전학회 2011 대한의학유전학회지 Vol.8 No.2

초산인 35세 산모가 고령 임신과 모체혈액선별검사 고위험군을 주소로 양수천자를 실시한 결과 8번 염색체의 단완에 위성체가 붙어 있는 것이 발견되었다. 부모 염색체 검사 결과 모두 정상으로 확인되어 태아에게서 관찰된 8ps현상은 de novo로 판단된다. FISH 검사로 좀 더 자세히 분석한 결과, 8번 염색체와 22번 염색체 사이에 미세한 전좌가 관찰되었다. 태아의 염색체 8번과 22번 사이의 de novo 전좌를 갖고 있었지만 절단 부위가 DNA의 단순 반복 부위이므로 표현형에 영향을 미칠 가능성은 높지 않을 것으로 추측되었고, 임신 기간 동안 초음파상 이상 소견은 관찰되지 않았다. 유전상담을 통해 8번 염색체 단완의 미세 결실 가능성이 설명되었고, 부모의 결정에 따라 추가실험 없이 임신은 유지되었다. 그리고 38주에 정상 표현형의 남아가 분만되었다. 본 증례는 산전 진단에서 세포유전학적 검사로 8번 염색체 단완의 위성체만이 발견되었으나, 추가의 분자세포유전학적 진단으로 8번과 22번 염색체 단완 사이의 미세한 전좌를 확인하였다. 이처럼 보다 정확하고 자세한 분자세포 유전학적 분석들이 산전 진단에서는 필요함을 시사한 사례였다. The authors of the present study report the prenatal detection of a chromosomal abnormality with additional satellites on the distal short arm of chromosome 8. A 35-year-old woman was referred for amniocentesis because of her advanced maternal age and positive result for maternal serum screening test. Cytogenetic analysis of cultured amniocytes showed a satellite 8p chromosome. The satellite 8p chromosome was positive for nucleolus organizer region (NOR) staining. The parents’ karyotypes were normal. Fluorescence in situ hybridization (FISH) study for metaphases of fetal amniocytes revealed a cryptic translocation of chromosomes 8p and 22p. The fetal karyotype was described as 46,XY,8ps.ish t(8;22)(p23.3;p11.2) (D8S504-;D8S504+)dn. The parents decided to continue the pregnancy and a phenotypically normal boy was born at 38 weeks of gestation. In case of de novo terminal NORs detected prenatally, more accurate cytogenetic and molecular analysis should be performed in order to rule out cryptic chromosomal rearrangement among other chromosomes.