일산화탄소 중독에서 초기 젖산의 측정은 카복시헤모글로빈 측정과 비교하여 어떤 임상적 의의를 가지는가?

진상찬,진상찬,최우익,전재천,김태권 대한응급의학회 2017 대한응급의학회지 Vol.28 No.5

Purpose: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. Methods: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. Results: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). Conclusion: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.

다발성 벌 자상에 의한 길랑 바레 증후군 1례

진상찬,Jin, Sang-Chan 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.1

Severe systemic responses including neurologic complications such as myasthenia gravis, myeloradiculopathy, optic neuropathy, parkinsonism, stroke and Guillain-$barr{\acute{e}}$ syndrome can occur after bee stings. This case describes a 78-year-old female who presented with symptoms of acute progressive bilateral symmetrical weakness in both lower legs after multiple bee stings. Nerve conduction study findings were consistent with acute sensorimotor axonal neuropathy and recovered by treatment with intravenous immunoglobulin. This case highlights that bee stings can result in acute onset Guillain-$barr{\acute{e}}$ syndrome, although the pathophysiologies of bee venoms need to be investigated accurately.

폐 선암의 첫 증상으로 발생한 악성 심장막 삼출액으로 인한 심장눌림증 1례

진상찬,손유동,최우익 대한응급의학회 2006 大韓應急醫學會誌 Vol.17 No.4

독사 교상 환자에서 전신 증상 및 합병증 발생에 연관된 인자에 대한 연구

진상찬,이제원,양승준,주명돈,최우익 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6

Purpose: Venomous snakebite is an important medical emergency in Korea, but the factors affecting outcomes are unclear. Methods: We conducted an 8-year retrospective study of 169 snake bite patients who visited the emergency departments of Keimyung University at Dongsan Medical Center between January, 2000, and December, 2007. Patients were divided by systemic symptoms and complications (group 1) or local symptoms only (group 2). We compared the general characteristics and clinical and laboratory findings of the two groups. Results: The male to female ratio was 1.19. The most common systemic symptom was dizziness (7.6%), and the most common complication was rhabdomyolysis (23.6%). Distal bite sites (finger, toe) in group 1 occurred in 20 (35.7%) cases, and proximal (hand, foot, ankle, arm, calf, perianal area) in 36 (64.3%) cases (p<0.05). The median interval from envenomation to hospital visit was 6.0 (0.3- 96.0) h in group 1, which was longer than group 2 (p<0.05). Among 33 (19.5%) patients with local effect scores of 9~16, 25 (75.8%) patients had systemic symptoms and complications. The local effect scores and the interval from bite to antivenin treatment in the hospital were significant risk factors for systemic symptoms and complications in logistic regression analysis. Conclusion: Snakebite poisoning is an emergency and we must evaluate risk factors to prevent the development of serious complications.

Fluoropolymer Fume 흡입으로 인한 급성 호흡곤란 증후군 1예

진상찬,최우익 대한응급의학회 2013 대한응급의학회지 Vol.24 No.3

Fluoropolymer compounds (polytetrafluoroethylene-PTFE,Teflon ) can produce a clinical syndrome, polymer fume fever, when the products from their thermal decomposition are inhaled. Polymer fume fever is characterized by fever,dyspnea, a non-productive cough, and headaches after exposure to the pyrolytic products. We report a case of acute respiratory distress syndrome after the inhalation of fumes produced from overheated fluoropolymer compounds. A 60-year-old male came to the emergency department complaining of severe dyspnea, nausea, coughing. Just one day ago, he worked in a fluoropolymer-processing factory without any protective mask device. Initial arterial blood gas analysis showed a composition of pH 7.4, arterial partial oxygen pressure 46.0 mmHg and oxygen saturation 79% of room air. Chest computerized tomography revealed a bilateral diffuse consolidation and ground glass appearance. Polymer fume fever and acute respiratory distress syndrome was suspected by the symptoms, history of exposure,and radiologic findings. The patient received ventilatory support with a mechanical ventilator, intravenous corticosteroids,and intravenous N-acetylcysteine. His symptoms and oxygen saturation completely resolved over 6 days. In summary, when fluoropolymers compounds are heated the fumes generated can cause polymer fume fever with severe toxic effects, such as acute respiratory distress syndrome,pulmonary edema, and pneumonitis. The clinical presentation, radiologic findings, and the management of polymer fume fever are reviewed here.

외상 후 발생한 조기 폐색전증 2례

진상찬,최우익 대한응급의학회 2014 대한응급의학회지 Vol.25 No.3

Pulmonary embolism (PE) is generally thought to occur between days 5 to 7 after acute injury. However, PE can occur early after injury and the features of early PE after injury have not been well studied. We report on two cases of acute PE within two days after thoracic and lower extremity injury. First, a 39-year-old female presented to the emergency department complaining of chest pain and dyspnea. Fifteen hours earlier, she had fallen from a 1 m height drawer at home. She had a history of idiopathic pulmonary arterial hypertension. Initial blood pressure was normal; however, oxygen saturation was 83% on room air. Chest computerized tomography (CT) showed a low density filling defect in the left main pulmonary artery. However, no deep vein thrombus was observed on low extremity CT angiogram. Second, a 21-year-old male was transferred from a local clinic to the emergency department. He had pelvic ramus, right femur shaft and ankle fracture from a motorcycle accident, which had occurred 36 hours ago. Initial vital signs were stable and he had no symptoms related to PE, except leg pain. We performed CT scan in order to rule out injury associated with pelvic bone fracture. CT scan showed filling defects in the segmental pulmonary artery of the left lower lobe. We did not find deep vein thrombus on low extremity CT angiogram. PE related to trauma can occur in early days after injury and is not commonly associated with deep vein thrombus. Emergency physicians should consider PE in the differential for patients with unexplained dyspnea, even early after injury.

동적 QoS 속성을 고려한 단일 웹서비스의 교환을 지원하는 프레임워크

진상찬(Sang-Chan Jin),이은주(Eun-Joo Lee) 한국컴퓨터정보학회 2009 韓國컴퓨터情報學會論文誌 Vol.14 No.4

현재 웹 어플리케이션을 구축하는데 있어 웹서비스는 중요한 역할을 담당하게 되었다. 웹서비스의 수와 종류가 많아짐에 따라, QoS는 웹서비스의 선택과 조합에서 중요한 기준이 되었다. 하지만 웹서비스의 QoS요소는 실행환경에 따라 동적으로 변하고, 이로 인해 선택된 웹서비스가 요청자의 QoS요구사항에 부합하지 않는 웹서비스가 되기도 한다. 본 논문에서는 요청자의 QoS요구사항에 적합한 웹서비스를 찾고 웹서비스의 QoS에 기반하여 웹서비스를 동적으로 변경하는 프레임워크를 제안하였다. 그리고 웹서비스 변경 시 발생하는 웹서비스의 인터페이스적응문제와 수행중인 작업의 보장문제에 대한 해결방법도 함께 제시한다. At present, Web services become main means to construct web applications. As the number of web services grows and various kind of web services have been produced, QoS properties of web services are one of important criteria to select more appropriate web services. However, the selected web services may become inappropriate for the Requester's requirements, because QoS is kind of dynamic properties. this paper proposes a framework that proposed that finds an appropriate web service for Requester's QoS requirements, and dynamically replaces an inappropriate web service with right one. The problems which happen in substitution step are also identified and the solutions are described with an illustrative example.

QoS 기반 웹서비스 동적 교환 지원 프레임워크

진상찬(Sang-Ghan Jin),송유진(Yu-Jin Song),이은주(Eun-Joo Lee) 한국컴퓨터정보학회 2008 한국컴퓨터정보학회 학술발표논문집 Vol.16 No.1

웹서비스는 XML기반의 표준인 SOAP, WSDL, UDDI를 이용하여 인터넷을 통해 기능을 제공해 주는 서비스 기반 아키텍처의 대표적 기술이다. 웹서비스의 개수가 많아지고 종류가 다양해 짐에 따라, 요청자의 요구사항에 맞는 웹서비스를 선택하는 것이 중요하게 되었으며, 여기서 웹서비스의 선택 시 QoS(Quality of Service)는 중요한 기준이 된다. 하지만 웹서비스의 QoS는 동적으로 변하고, 이로 인해 요청자의 QoS요구사항에 만족하지 않는 웹서비스가 되기도 한다. 본 논문에서는 요청자의 QoS요구사항에 적합한 웹서비스를 찾고, 웹서비스의 QoS변화로 인하여 웹서비스를 동적으로 변경하는 프레임워크를 제안한다. 그리고 웹서비스를 동적으로 변경하는 경우에 필요한, 각 웹서비스의 인터페이스 적응 및 기존 작업의 보장에 대한 해결방법도 함께 제시한다.

Nrf2 활성화를 통한 익위승양탕(益胃升陽湯)의 간세포 보호 효과

진효정,박상미,김은옥,김상찬,Jin, Hyo Jeong,Park, Sang Mi,Kim, Eun Ok,Kim, Sang Chan 대한한의학방제학회 2021 大韓韓醫學方劑學會誌 Vol.29 No.4

Objectives : Oxidative stress is a important cause of liver disease, and regulation of oxidative stress is essential to maintain the normal metabolic function of the liver. Until a recent date, there has been no studies on the hepatoprotective effect of Ikwiseungyang-tang (IWSYT). Therefore, this study aims to demonstrate the hepatoprotective effect of IWSYT and its related molecular mechanisms on arachidonic acid (AA) + iron induced oxidative stress model in HepG2 cells. Methods : To determine the cytoprotective effect of IWSYT against AA + iron-induced oxidative stress, cell viability, apoptosis-related proteins, intracellular reactive oxygen species (ROS), GSH, and mitochondrial membrane potential (MMP) were measured. Nuclear factor erythroid 2-related factor 2 (Nrf2) activation was analyzed by immunoblot analysis. In addition, Nrf2 transcription activation through ARE binding was measured by reporter gene assays, and the expression of the Nrf2 target antioxidant genes were confirmed by immunoblot analysis. Results : IWSYT increased cell viability from cell death induced by AA + Iron, and inhibited apoptosis by regulating apoptosis-related proteins. Furthermore, IWSYT protected cells by inhibiting intracellular ROS production, GSH depletion, and MMP degradation. Nrf2 activation was increased by IWSYT, and Nrf2 target genes were activated by IWSYT too. Conclusions : These results suggest that IWSYT can protect hepatocytes from oxidative stress through Nrf2 activation and can be potentially applied in the prevention and treatment of liver damage.

NF-κB와 MAPK억제를 통한 시호소간탕(柴胡疏肝湯)의 항염증효과

진효정,박상미,김예림,변성희,김상찬,Hyo Jeong Jin,Sang Mi Park,Ye Lim Kim,Sung Hui Byun,Sang Chan Kim 대한한의학방제학회 2023 大韓韓醫學方劑學會誌 Vol.31 No.2

Objectives : Sihosogan-tang (SST) is one of the traditional herbal formula and also one of the Korean medical insurance medicines. It commonly used in the treatment of hepatitis, chronic gastritis, intercostal neuralgia, pleurisy, and depression in East Asia. In the present study, we have demonstrated the anti-inflammatory effects of SST in macrophage cell line. Methods : To investigate mechanism of the anti-inflammatory effect of SST, we examined the productions of nitric oxide (NO) and pro-inflammatory cytokines, and the expressions of inducible NO synthase (iNOS), nuclear factor-κ B (NF-κB) and mitogen-activated protein kinase (MAPK) on RAW 264.7 cells activated by LPS. Results : SST significantly inhibited the expression of iNOS increased by LPS, and also significantly inhibited the production of NO. In addition, SST significantly inhibited pro-inflammatory cytokines such as TNF- α and interleukines. SST inhibited the expression of NF-κB and MAPK activation. Conclusions : These results suggest that SST ameliorates inflammatory response in LPS-activated RAW 264.7 cells through the inhibition of the NF-κB and MAPK pathway. Therefore, this study supplies objective evidence for the anti-inflammatory effect of SST.