흰쥐 작은창자에서 Carbonic Anhydrase 동위효소의 분포에 관한 면역조직화학적 연구

전병조(Byeong Jo Chun),나진희(Jin Hee Na),남광일(Kwang Il Nam),이승원(Seung Won Lee),안규윤(Kyu Youn Ahn),배춘상(Choon Sang Bae),박성식(Sung Sik Park) 대한해부학회 2006 Anatomy & Cell Biology Vol.39 No.1

흰쥐 작은창자에서 부위에 따른 carbonic anhydrase (CA)의 발현 양상을 관찰하고자 샘창자 시작부, 빈창자 시작부, 빈창자-돌창자 경계부, 돌창자 끝부를 대상으로 CAI, CAII, CAIV, CAIX 동위효소에 대한 항체를 사용하여 면역조직화학 염색을 시행하였고, 이들 조직에서 각각의 CA 동위효소 단백 발현을 Western blotting 분석을 시행하여 확인하였다. Western blotting 분석에서 CAI은 빈창자-돌창자 경계부를 제외한 모든 부위에서 강한 발현을 보였고, CAII는 샘창자에서 가장 강한 발현을 보였다. CAIV와 CAIX는 전반적으로 약한 발현을 보였으며, CAIV의 경우는 돌창자 끝부분에서 가장 강한 발현을 보였고 CAIX은 샘창자에서 가장 강하게 발현되었다. 면역조직화학 반응에서 CAI은 혈관을 제외하고는 작은창자 전체에서 음성이었다. CAII는 일반적으로 융모상피의 핵상부 세포질에서 양성이었고 창자샘에서는 음성이었으며 샘창자에서 제일 강하게 염색되고 나머지 부위에서는 약하게 염색되었다. CAIV는 빈창자 끝 부분에서는 강한 반응을 보였으나 나머지 부위는 약한 반응을 보였다. 반응 부위는 주로 융모상피세포의 내강쪽 세포막이었다. CAIX은 작은창자 각 부위에서 융모상피세포 및 창자샘에서 모두 양성 반응을 보였으며 샘창자 점막밑샘세포에서도 강한 양성 반응을 보였다. 반응 부위는 핵상부 세포질이었다. 이상의 관찰로 작은창자 융모상피는 주로 CAII, IV, IX가, 창자샘과 샘창자 점막밑샘세포는 CAIX가 강하게 발현됨을 알 수 있었으며 CAIX는 작은창자 모든 부위에서 산-염기 균형 조절에 관여할 것임을 시사하였다. Carbonic anhydrase catalizes the reversible hydration of carbonic dioxide and participate in various biological processes. There are several isozymes and differ in their kinetic properties, tissue distribution and subcellular localization. The expression of carbonic anhydrase isozymes in digestive tract vary according to animal species and region of the tract. The distribution of carbonic anhydrase (CA) isozymes I, II, IV and IX was investigated in various portions of the rat small intestine using Western blotting analysis and immunohistochemical staining. Western blotting analysis of rat small intestine revealed that CAI was found to be abundantly expressed throughout the small intestine. Expression of CAII in duodenum was much higher than that in jejunum and ileum. Expression of CAIV and IX was found to be weak throughout the small intestine. Immunohistochemical reaction revealed no staining of CAI in all parts of small intestine except blood vessels. CAII was detected at the supranuclear cytoplasm of surface epithelium, but not in intestinal gland. Staining intensity was most strong in the proximal duodenum. CAIV was detected at the apical surface of epithelial cells of villi, and showed most strong staining intensity in the terminal ileum. CAIX was detected at the surfcae epithelium, cells of intestinal gland and Brunner’s gland, and the positive reaction was confined to the supranuclear cytoplasm. CAIX differed from CAII in tissue distribution, but subcellular localization of CAIX and II were the same. These results indicate that the surface epithelium of small intestine express CAII, IV and IX, intestinal gland and Brunner’s gland express CAIX, and suggest that CAIX may somewhat contribute the control of acid-base balance in the small intestine.

자살시도 후 생존 퇴원한 환자에서 지역정신건강센터 등록 요인 분석 - 응급실 기반 자살시도자 관리시스템 자료 중심으로 -

김동기 ( Dong-ki Kim ),전병조 ( Byeong Jo Chun ),문정미 ( Jong Mi Moon ),조용수 ( Yong Soo Cho ),배경열 ( Kyung-yeol Bae ),김현정 ( Hyun Jung Kim ),김미진 ( Mi Jin Kim ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.1

Purpose: This study was conducted to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between January and September 2015 at the academic ED in the tertiary urban hospital. The variables examined included gender, age, address, type of insurance, history of previous psychiatric disease, suicide methods, number of previous attempts, CES-D (The Center for Epidemiologic Studies-Depression Scale), and disposition at ED. Univariate and multivariate logistic regression analysis were conducted to identify factors affecting the registration rate for the community-based post suicidal care program. Results: Overall, 331 suicides were investigated, 61 (18.4%) of which were registered in the post-suicide care program. Factors such as a intervention by psychiatric physician (OR: 3.287, 95%; CI: 1.207-9.624) and levels of depression by CES-D score of 16?24 (OR: 3.635; CI: 1.055-12.526) were significantly correlated with registration for the program. Conclusion: The registration rate for the community-based post suicidal care program was influenced by frequent intervention by a psychiatric physician and levels of depression by CES-D score of 16-24.

복어 섭취 후 발생한 급성 테트로도톡신 중독 환자의 임상적 특징과 예후 인자 분석

조용수 ( Yong Soo Jo ),전병조 ( Byeong Jo Chun ),문정미 ( Jeong Mi Moon ),류현호 ( Hyun Ho Ryu ),정용훈 ( Yong Hun Jung ),이성민 ( Sung Min Lee ),송경환 ( Kyung Hwan Song ),류진호 ( Jin Ho Ryu ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. Methods: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. Results: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), PaCO2<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and PaCO2<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). Conclusion: Overall, dizziness, time interval between onset of symptoms and ingestion, DBP and PaCO2<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and PaCO2<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans

문종구,문정미,이미진,전병조,Mun, Jong Gu,Moon, Jeong Mi,Lee, Mi Jin,Chun, Byeong Jo Korean society of Clincal Toxicology 2018 대한임상독성학회지 Vol.16 No.1

Purpose: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. Methods: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. Results: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. Conclusion: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.

유기인계 중독환자에서 내원시 혈당과 예후와의 연관성

이성도 ( Sung Do Lee ),문정미 ( Jeong Mi Moon ),전병조 ( Byeong Jo Chun ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. Methods: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. Results: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. Conclusion: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level>233 mg/dl at presentation after ingestion of OP.

2016년 응급실 손상환자 심층조사 자료를 이용한 중독 환자의 분석

정성필 ( Sung Phil Chung ),이미진 ( Mi Jin Lee ),강형구 ( Hyunggoo Kang ),오범진 ( Bum Jin Oh ),김김현 ( Hyun Kim ),김양원 ( Yang Weon Kim ),전병조 ( Byeong Jo Chun ),김경환 ( Kyung Hwan Kim ) 대한임상독성학회 2017 대한임상독성학회지 Vol.15 No.2

Purpose: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. Methods: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. Results: A total of 7,820 poisoning patients presented to 23 EDs. Adults ≥20 years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. Conclusion: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.

응급실 손상환자 심층조사 자료를 이용한 2017-2018년 중독 환자의 분석

고지윤 ( Jiyoon Koh ),전우찬 ( Woochan Jeon ),강형구 ( Hyunggoo Kang ),김양원 ( Yang Weon Kim ),김현 ( Hyun Kim ),오범진 ( Bum Jin Oh ),이미진 ( Mi Jin Lee ),전병조 ( Byeong Jo Chun ),정성필 ( Sung Phil Chung ),김경환 ( Kyung Hwa 대한임상독성학회 2020 대한임상독성학회지 Vol.18 No.2

Purpose: The annual statistics for poisoning are reported based on the data from poison control centers in many advanced countries. In 2016 a study was conducted to analyze the 2016 Korea Poisoning status. This study was conducted to make a better annual report for poisoning statistics in Korea from a 2017-2018 national representative database. Methods: This study was a retrospective analysis of poisoning patients based on the data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2017-2018. Bite or sting injuries were not included. Results: A total of 17714 patients presented to 23 EDs because of poisoning. Adults above 20 years old age accounted for 84.6% of the population, while the proportion of intentional poisoning was 60.8%. The poisoning substance presented in the ED were therapeutic drugs (51.2%), gas (20.3%), pesticides (16.4%), and artificial substances (11.4%). Overall, 35% of patients were admitted for further treatment. The mortality was 2.4% (422 cases), and the most common fatal substances in order were carbon monoxide, other herbicides, and paraquat. Conclusion: This study showed the 2017-2018 status of poisoning in Korea. The prognosis is different from the cause of poisoning and the initial mental state of the patient. Therefore, appropriate methods for preventing poisoning and therapeutic plans in specific situations are needed.

유기인계농약 음독환자에서 내원시 혈장 Cholinesterase 활성도의 의의

전병조,문정미,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: Plasma cholinesterase is a sensitive measure determining the severity of organophosphate intoxication. The author evaluated the usefulness of the plasma cholinesterase level as a prognostic indicator of the severity of organophosphate intoxication. Methods: From June 1999 to May 2001, 55 patients presented with organophoshate insecticide intoxication to the Emergency Medical Center of the Chonnam National University Hospital, and these were enrolled in this study. The plasma cholinesterase activities of these 55 patients were determined at the time of presentation. The relationships between the plasma cholinesterase level and the clinical variables of organophosphate toxicity, quantity of ingested poison, elapsed time to gastric lavage, and the APACHE score at the time of hospitalization were analyzed. Results: The plasma cholinesterase activity significantly decreased in association with the degree of toxicity of the poison (p<0.001), elapsed time to gastric lavage (p<0.001), and the quantity of organophoshate ingested (p=0.013). In the 55 patients, lower plasma values of cholinesterase were observed in patients with longer durations of mechanical ventilation (r= 0.717, p<0.001) and in patients who developed pneumonia during treatment (r=-0.538, p<0.001). Also, decreased cholinesterase activity correlated with a higher APACHE score(r=-0.672, (p<0.001). Conclusion: These results suggest that immediate determination of the plasma cholinesterase level at the time of hospitalization may be useful as a prognostic indicator in patients with organophosphate intoxication.

발작성 상실성 빈맥 환자의 응급실 내 치료 결과 및 재발 인자에 관한 분석

전병조,문정미,위준선,정경운,김현창,정승태,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. Methods: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. Results: The treatments were vagal maneuver (5 pts, 7.5%), adenosine 6 ㎎ (37 pts, 55.2%), adenosine 12 ㎎ (14 pts, 20.9%), verapamil 5 ㎎ (9 pts, 13.4%), and cardioversion (2 pts, 3.0%). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3%. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. Conclusion: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration ere factors predicting recurrence.

저혈당증과 동반된 고정 증후군 1례

문정미,전병조,이병국,염경인,허탁,민용일,서정진 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65∼75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.