Additional Genomic Aberrations Identified by Single Nucleotide Polymorphism Array-Based Karyotyping in an Acute Myeloid Leukemia Case with Isolated del(20q) Abnormality

함초롱,문영철,성주명,정화순,허정원 대한진단검사의학회 2012 Annals of Laboratory Medicine Vol.32 No.6

Prognosis is known to be better in cases with isolated chromosomal abnormalities than in those with complex karyotypes. Accordingly, del(20q) as an isolated abnormality must be distinguished from cases in which it is associated with other chromosomal rearrangements for a better stratification of prognosis. We report a case of an isolated del(20q) abnormality with additional genomic aberrations identified using whole-genome single nucleotide polymorphism array (SNP-A)-based karyotyping. A 39-yr-old man was diagnosed with AML without maturation. Metaphase cytogenetic analysis (MC) revealed del(20)(q11.2) as the isolated abnormality in 100% of metaphase cells analyzed, and FISH analysis using D20S108 confirmed the 20q deletion in 99% of interphase cells. Using FISH, other rearrangements such as BCR/ABL1, RUNX1/RUNX1T1, PML/RARA, CBFB/MYH11, and MLL were found to be negative. SNP-A identified an additional copy neutral loss of heterozygosity (CN-LOH) in the 11q13.1-q25 region. Furthermore, SNP-A allowed for a more precise definition of the breakpoints of the 20q deletion (20q11.22-q13.31). Unexpectedly, the terminal regions showed gain on chromosome 20q. The patient did not achieve complete remission; 8 months later, he died from complications of leukemic cell infiltrations into the central nervous system. This study suggests that a presumably isolated chromosomal abnormality by MC may have additional genomic aberrations, including CN-LOH, which could be associated with a poor prognosis. SNP-A-based karyotyping may be helpful for distinguishing true isolated cases from cases in combination with additional genomic aberrations not detected by MC.

결핵균과 비결핵 항산균 검출을 위한 AdvanSure TB/NTM Plus Real-Time PCR의 평가

함초롱,이미애,소민경,정혜선 대한임상미생물학회 2020 Annals of clinical microbiology Vol.23 No.2

Background: The AdvanSure TB/NTM plus real-time PCR (AdvanSure plus PCR; LG Chem., Korea) assay has been developed to increase the diagnostic sensitivity of nontuberculous mycobacteria (NTM) compared with the currently used the AdvanSure TB/NTM real-time PCR (AdvanSure PCR; LG Chem., Korea) assay. In this study, we aimed to evaluate the performance of the AdvanSure plus PCR comparing the results with mycobacterial culture and the AdvanSure PCR. Methods: Patients (n=199) with suspected NTM or Mycobacterium tuberculosis complex (MTC) were tested using AdvanSure plus PCR, AdvanSure PCR, acid-fast bacilli staining, and mycobacteria culture. Additionally, 200 DNA samples (n=100, MTC and n=100, NTM) were obtained from positive MTC or NTM cultures for evaluation using the AdvanSure plus PCR assay. Results: The two real-time PCR systems showed a 94.0% (n=187/199) concordance rate (Kappa=0.94). Based on culture results, the sensitivity and specificity for the detection of MTC were 100% (45/45) and 83.8% (129/154) using AdvanSure plus PCR, and 100.0% (45/45) and 99.3% (153/154) using AdvanSure PCR, respectively. The sensitivity and specificity for NTM detection were 68.0% (n=17/25) and 90.2% (n=157/174), respectively, with AdvanSure plus PCR, and 64.0% (n=16/25) and 95.4% (n=166/174), respectively, using AdvanSure PCR. With culturepositive samples, AdvanSure plus PCR tested positive for 100% of both the MTC and NTM specimens. Seven (out of 200) culture-positive samples tested positive for both MTC and NTM using the AdvanSure plus PCR. Conclusion: AdvanSure plus PCR had increased sensitivity but decreased specificity compared with AdvanSure PCR for the detection of NTM. The AdvanSure plus PCR assay can be used for the simultaneous detection of MTC and NTM in direct specimen and culture.

허혈성 뇌졸중의 위험 인자로서의 아포지방단백 B/A1 비

함초롱,홍기숙 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.1

Objectives: According to current knowledge, apolipoprotein B/A1 (apoB/A1) ratio is like to be risk factor in coronary artery disease. There is evidence form case-control studies that apoB/A1 ratio may be a superior to LDL and HDL cholesterol in discriminating coronary artery disease case subject from control subject. However, relationship between apoB/A1 ratio and cerebral ischemic stroke is undefined. The main object of this study is to determine whether the risk of cerebral ischemic stroke is related to levels of apoB/A1. Methods: The study group included 643 patients (Men, 372; Women, 271) who diagnosed cerebral ischemic stroke between January 2008 to December 2010. The control groups were composed of 378 patients (Men, 139; Women, 239) who diagnosed other neurological disease. The correlation between lipid profiles and odds ratio of 10 preliminary risk factors (total cholesterol, triglyceride, LDL, HDL, apoA1, apoB, apoB/A1 ratio, non HDL, total cholesterol/HDL ratio, LDL/HDL ratio) for stroke were analyzed. Results: ApoB/A1 ratio was significantly increased in case patients compared with control subjects. Multivariate logistic regression analysis identified decrease of apoB/A1 ratio (odds ratio [OR], 1.583; 95% confidence intercal [CI], 1.105∼2.269) as significantly associated with stroke. Individual apoA1 (OR, 1.303; 95% CI, 0.967∼1.755) and apoB (OR, 1.397; 95% CI, 0.773∼2.523) were also not significantly associated with cerebral ischemic stroke. Conclusion: Increase of apoB/A1 ratio is associated with an increase risk of cerebral ischemic stroke. Use of apoB/A1 ratio is efficient as conventional lipids, for the identification of subjects at increased risk of stroke. So apoB/A1 ratio to standard lipid profile testing could improve the evaluation of risk factors of cerebral ischemic stroke.

F-66 국내 COPD 경제적 부담

유광하,윤형규,임성용,이진국,이진화,김유일,박창한,함초롱,김성경,이상학,박용범,김진우,이영목,신제현,김윤희 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0

배경: COPD 질환의 중요성을 알리고 국가 정책에 활용하며 가시적인 관리 목표를 가질 수 있도록 국내 COPD의 경제적 부담 에 대해 2년에 걸쳐 조사함. 방법: COPD 환자를 대표할 수 있도록 1차, 2차, 3차 병원의 COPD 환자를 조사하였으며 COPD의 모든 중증도가 포함될 수 있도록 환자를 모집함. 경제적 부담 분석에 포함된 항목은 1) 양 한방 보험 의료 비용, 비 보험 의료 비용 2) 비공식 의료 비용 - COPD 치료를 위한 일반 의약품, 건강기능식품, 의료기기, 보장구 등 3) 간병비, 교통비 4) 생산성 손실 비용 - COPD로 인한 생산성 손실 비용, 조기 사망에 따른 손실 비용이다. 비보험 의료비용 및 간병비, 생산성 소실을 확인 하기 위해 1, 2, 3차 병원에서 표본 환자의 중증도별 COPD 관련 1년간 전체 의료 비용 영수증 조사 및 설문지를 이용하여 직 접 조사함 결과: 본 연구에 사용된 COPD 환자 수는 2009년 발표된 국내 자료를 사용하였으며 약 19만명이었다. 1)양 한방 보험 의료 비용: 2,340억 1,400원 2) 비공식 의료 비용: 499억 7,500만원 3) 간병비- 5,624억 6,400만원, 교통비- 48억 2,100만원 4) 생산성 손실 비용 5,701억 9,900 만원 (생산성 소실 4,611억 8,900만원, 조기사망비용 1,090억 1,000 만원) 등 총 국내 COPD 경제적 부담 비용은 1초 4천 214억이다. 이중 직접 의료 비용이 20%를 차지 하였고 간병비용이 40%로 가장 높은 비율을 차지하였다. 그외 질환에 의한 이환 비용이 32%로 높았다. 환자 1인당 경 제 부담은 7백 47만원으로 혈혈성심질환 2백 56만원, 당뇨1백 37만원보다 높았고 천식 1백 24만원보다 높아 COPD는 국내 만성질환 중 가장 높은 개인당 경제 부담을 주었다. 고찰: 본 연구는 이제까지 국내에 없던 자료로 향후 국가 정책, 연구등에 활용이 되겠다.

간호사의 감정노동, 자아존중감과 직무태도에 관한 연구

홍상회;박상미;이은경;이윤주;우영화;김효진;최민선;김혜민;장혜윤;최경진;함초롱 중앙대학교 의과대학 간호학과 간호과학연구소 2008 중앙간호논문집 Vol.12 No.-

The purpose of this study is to explore the effect of nurses' emotional labor. self-esteem and job attitude This study was conduded by 192 nurses who attend the general hospital The collected data was analyzed by the SPSS WIN 12.0 program The result of the study is as follow: The job attitude at the total of 11 questions and 55 perfect score appeared with average 35(±6.23). Among the rest the job satisfadion in 30 perfect scores 20.10(is ±5.60) points. 'When completing a task, feels accomplishing feel' : this item was 3.88(±1.01) with was highest. The organized immersion item in 25 perfect scores 16.460(is±4.22) points. ‘Our hospitals the possibility of doing a best in business accomplishment in order to be. make an aspiration have and they make do as a favor and an item there is. 3.62(±.96) with was highest. The self-esteem and job attitude(r=.190 and p=.001) appeared with the fact that is a positive relationship, the self-esteem and emotional labor( r = -.151 and p = .05) appeared with the fact that is relationship of inverse correlation. In the above. selecting and arranging nursed to be, there will be needed both positioning in the appropriate station with the strong intention reflected by one's opinion that multiplies the self-esteem and the continuous education and training in order to control and manage oneself.

포스터 전시 발표 : 소화기 ; 상부위장관 출혈로 환인된 hemosuccus pancreaticus 1예

손현배,함초롱,이석현,류웅,김경아,양전호,이준성,문영수 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

Colistin 내성 Acinetobacter baumannii 감염의 위험인자

정혜선,함초롱,이미애 대한임상미생물학회 2023 Annals of clinical microbiology Vol.26 No.2

Acinetobacter baumannii는 의료관련 감염의 중요한 원인균이며, 거의 모든 약제에 내성을 보이며, 최근에는 colsitin에도 내성인 균주가 보고되고 있다. 본 연구에서는 colistin 내성과 감수성 A. baumannii 감염 환자군의 비교를 통해 colistin 내성 A. baumannii 감염의 위험인자를 파악하고자 하였다. Colistin 내성 A. baumannii가 분리된 51예와 colistin 감수성 A. baumannii 균주가 분리된 환자 100예를 대상으로 후향적으로 의무기록을 검토하였다. 단변량 분석에서는 호흡기계 질환의 기왕력(P = 0.017), 균 분리전 재원 기간(P = 0.004), 중환자실 입원력(P = 0.020), 이전의 기계 호흡(P =0.003), 기관절개술(P = 0.043), 혈액투석(P = 0.002), colistin 사용력(P = 0.000), carbapenem 계열 항균제 사용력(P = 0.000), teicoplanin 사용력(P = 0.004), 중복 감염(P = 0.035)이 colistin 내성군과 감수성군에서 차이에서 차이를 보였다. 다중회귀분석에서는 teicoplanin 사용력(Odds ratio [OR], 3.140; 95% confidence interval [CI], 0.529-18.650; P = 0.208), 이전의 혈액투석(OR, 2.722; 95% CI, 0.851-8.709), 호흡기계 질환의 기왕력(OR, 2.286; 95% CI, 0.998-5.283), carbapenem 계열 항균제 사용력(OR, 0.199; 95% CI, 0.863-5.603), 중복 감염(OR, 1.706; 95% CI, 0.746-3.898), 이전의 기계 호흡(OR, 1.614; 95% CI, 0.684-3.809), 중환자실 입원력(OR, 1.387; 95% CI, 0.560-3.435), 이전의 기관절개술(OR, 1.102; 95% CI, 0.344-3.527)이 colistin 내성군에서 위험도가 높았으나, 모두 통계학적으로 유의하지는 않았다. Colistin 사용력의 경우 다중회귀분석에서 증명할 수 없었지만, 위험인자일 가능성을 배제할 수 없다. Acinetobacter baumannii is an important cause of healthcare-associated infections and is resistant to almost all antimicrobial agents, with strains recently reported to be resistant to colsitin. In this study, we aimed to identify the risk factors associated with colistin-resistant A. baumannii infections by comparing colistin-resistant and -susceptible A. baumannii isolates. We retrospectively reviewed the medical records of 51 and 100 cases in which colistinresistant and -susceptible A. baumannii were isolated, respectively. Univariate analysis showed that compared with patients with colistin-sensitive infections, patients with colistinresistant A. baumanni infections had a combined pulmonary disease (P = 0.017), were admitted to intensive care unit (P = 0.020), and had prior mechanical ventilation (P = 0.003), tracheostomy (P = 0.043), percutaneous drainage (P = 0.070), hemodialysis (P = 0.002); use of colistin (P = 0.000), carbapenem (P = 0.000), and teicoplanin (P = 0.004); and co-infection (P = 0.035). Multivariate analysis indicated that eight variables were related to the likelihood of colistin-resistant A. baumanni infections: use of teicoplanin (Odds ratio [OR]: 3.140, 95% confidence interval [CI]: 0.529–18.650), prior hemodialysis (OR: 2.722, 95% CI: 0.851–8.709), combined pulmonary disease (OR: 2.286, 95% CI: 0.998–5.283), prior use of carbapenem (OR: 0.199, 95% CI: 0.863–5.603), co-infection (OR: 1.706, 95% CI: 0.746–3.898), prior mechanical ventilation (OR: 1.614, 95% CI, 0.684–3.809), intensive care unit admission (OR: 1.387, 95% CI: 0.560–3.435), and prior tracheostomy (OR: 1.102, 95% CI: 0.344–3.527); however, no statistical differences were observed. Although colistin use could not be proven in multivariate analysis, the possibility of being a risk factor cannot be ruled out.

검체 운송 시스템의 온도 유지 기능 평가

이상곤,권애린,박승만,서소연,김영진,심효은,함초롱,김재석 대한진단검사의학회 2020 Laboratory Medicine Online Vol.10 No.2

Background: Clinical specimens are valuable materials that require a traceable management system. Maintenance of temperature and loss prevention during transport are important for the reliability of the clinical test results. Current transportation systems can suffer from temperature changes and agitation. Quality improvement in this pre-analytic phase is required. This study acquired preliminary data from a newly developed specimen transportation system adopting a real-time temperature monitoring during transportation using temperature sensor and global positioning system to establish appropriate guidelines. Methods: Temperature preservation performance was compared between two transportation boxes (newly developed one [A] and conventional one [B]) at exterior temperatures of 35°C and -18°C, reflecting the extreme temperature range in Korea. Influences of the temperatures on analytical results of whole blood, serum, plasma, and urine specimens were investigated, as were the effects of vibration. Results: The interior temperature of box A measured at multiple sites was maintained within 1.0-9.0°C at both exterior temperatures. The interior temperature of box B was outside of this range. The analyzed parameters varied comparably with the variations occurring at the recommended and published storage temperature. Vibration affected nonspecific enolase and lactate dehydrogenase. Conclusions: Temperature preservation and real-time monitoring during specimen transportation are important. The present data highlight the importance of transportation conditions and indicate that laboratories should know the characteristics of temperature changes in their transportation system. 배경: 임상 검체는 정확한 검사를 위해 전체 운반 과정의 엄격한 이력관리가 필요하다. 진단검사의 신뢰성을 위해서는 검체 운송과정 중 운송 온도 유지와 분실 방지가 중요하다. 검체 운송 시스템 현황은 이를 지키기 어려운 경우가 많으므로, 앞으로 지속적인검체 품질관리 수준 향상이 요구되고 있다. 본 연구는 온도센서와위성항법장치가 적용된 검체 운송 시스템에 대해 검체 운송 상자의 온도 유지 능력 및 검사결과에 미치는 영향을 조사하여 평가 모델을 제시하고자 하였다. 방법: 검체 운반시 온도 유지 성능을 신형 검체 운송 상자(A)와 구형 검체 운송 상자(B)로 평가하였다. 외기 온도 상온 35˚C와 영하18˚C에서 새로운 축냉제로 검체 운송 상자의 온도 변화를 관찰하였다. 온도 변화에 따른 검사결과 변화를 확인하고자 하고자 전혈,혈청, 혈장 및 뇨를 대상으로 검체를 실온 및 냉장 보관하여 검사결과를 비교하였다. 또한, 진동에 의한 영향도 평가하였다. 결과: 외기 온도 상온 35˚C와 영하 18˚C에서의 검체 운송 상자(A)의 내부 온도를 측정한 결과, 1.0-9.0˚C였다. 18시간 후 검체 운송상자(B)의 내부 온도는 이 범위를 벗어났다. 전혈, 혈청, 혈장을 이용한 검체 보관조건이 검사결과에 미치는 영향에서는 즉시 분석한 결과와 차이를 보였지만 대부분 분석 정밀도 이내의 결과값을보여주었다. 진동에 의한 결과값 변화에서는 신경 특이 에놀라제,젖산 탈수소 효소 등에서 편차를 보여주었다. 결론: 검체 운송 시스템의 핵심은 검체 운송 상자의 온도 유지와실시간 온도감시이다. 검체 운송 조건의 중요성에 초점을 맞춘 본연구는 검체 운송 과정에서 온도 변화에 미치는 요소들을 파악하여 적절한 온도 유지를 위한 관리 지표를 마련하는 데 활용될 수있을 것이다.