근골격계 질환의 의학적 접근

홍정연(Jung Yeon Hong),구정완(Jung?Wan Koo) 대한인간공학회 2010 大韓人間工學會誌 Vol.29 No.4

For the medical approaches of work-related musculoskeletal diseases, it is important to consider occupational relatedness and occupational fitness. Clinical approach includes physical examination, radiologic tests and other related tests and we should choose proper management which is suitable to workers' status for the prevention of early disease's progression and later disabilities. Also, it suggests that occupational prevention program consultation for work-related musculoskeletal diseases considering workers' variable circumstances should be done via occupational relatedness and occupational fitness.

스티븐스 존슨 증후군 및 독성표피괴사융해증 88예의 임상적 고찰

홍정연 ( Jeong Yeon Hong ),정의현 ( Euy Hyun Chung ),양나경 ( Na Gyeong Yang ),김재윤 ( Jae Yun Kim ),허남훈 ( Nam Hun Heo ),이설희 ( Sul Hee Lee ),김정은 ( Jung Eun Kim ),이성열 ( Sung Yul Lee ) 대한피부과학회 2021 대한피부과학회지 Vol.59 No.8

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal acute hypersensitivity reactions that involve the skin and mucous membranes. Because they are relatively rare diseases, it is difficult to obtain well-organized epidemiological data. The clinicodemographic characteristics, culprit drugs, and factors related to disease prognosis may vary. Objective: To identify the characteristics of SJS/TEN by investigating patient clinicopathological characteristics, laboratory findings, suspected drugs, and mortality through a retrospective study using medical record data. Methods: The clinical records of patients diagnosed with SJS/TEN between February 2009 and February 2019 at three medical institutions of Soonchunhyang University were retrospectively reviewed. Data pertaining to sex, age, history, suspected drugs, latent period, laboratory findings, and mortality were collected, and their correlations were analyzed. Results: We identified SJS/TEN in 88 patients. Among the probable causative agents, antibiotics were the most common (29 cases, 33.0%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) in 20 cases (22.7%). The period between drug administration and symptom onset varied with the causative agent. Patients who died had high SCORTEN scores. In addition, hypertension, diabetes, renal failure, and cardiac disease had a statistically significant association with high SCORTEN. Conclusion: Antibiotics, NSAIDs, antiepileptics and allopurinol were the most commonly implicated drugs in our retrospective study. There was a significant correlation between comorbidities. Because SJS/TEN is a life-threatening condition, early recognition of the suspected drug are important. The results of this study may provide insights that aid in the early diagnosis and prediction of disease outcomes of SJS/TEN in the Korean population. (Korean J Dermatol 2021;59(8):604∼610)

Diclofenac에 의한 다발성 고정약진 2예

이호정 ( Ho Jung Lee ),홍정연 ( Jeong Yeon Hong ),박태흠 ( Tae Heum Park ),이성열 ( Sung Yul Lee ),이종석 ( Jong Suk Lee ),정의현 ( Euy Hyun Chung ),이상훈 ( Sang Hoon Lee ),김정은 ( Jung Eun Kim ) 대한피부과학회 2020 대한피부과학회지 Vol.58 No.6

Fixed drug eruption (FDE) is a drug-induced disorder that may appear as patches or bullae. It recurs at the same sites as those involved in exposure to the same drug (causative drug). We encountered two cases of generalized FDE, and both patients had a history of diclofenac exposure before the onset of skin lesions. In the first case, an 82-year-old female patient presented with multiple erythematous patches on the trunk and lower extremities. In the second case, a 71-year-old male patient developed multiple bullae on violaceous patches on the trunk and extremities. The findings of histopathologic examinations were indicative of the diagnosis of FDEs. Although diclofenac is commonly used as a non-steroidal inflammatory drug, diclofenac-induced generalized FDE occurs rarely and has not been reported in Korea. With reuse of causative drugs, the size and number of lesions tend to increase. Therefore, early diagnosis of FDE is important, and avoidance of repeated exposure to drugs should be educated

답손으로 치료한 포진상 피부염 1예

이호정 ( Ho Jung Lee ),홍정연 ( Jeong Yeon Hong ),정의현 ( Euy Hyun Chung ),김정은 ( Jung Eun Kim ),이종석 ( Jong Suk Lee ),이현주 ( Hyun Ju Lee ),이성열 ( Sung Yul Lee ) 대한피부과학회 2020 대한피부과학회지 Vol.58 No.3

호흡기상피세포 내 Mycoplasma pneumoniae에 의한 혈관내피세포성장인자의 유도

이경은 ( Kyung Eun Lee ),홍정연 ( Jung Yeon Hong ),손명현 ( Myung Hyun Sohn ),김경원 ( Kyung Won Kim ),박인달 ( In Dal Park ),장명웅 ( Myung Woong Chang ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 소아알레르기 및 호흡기학회지 Vol.20 No.2

목적: Mycoplasma pneumoniae는 세포 외 병원균으로 기도점막에 부착하여 기관지상피세포들을 공격한다고 알려져 있다. 혈관내피세포성장인자(VEGF) 는 혈관계의 형성 및 기능을 담당하는 매우 중요한 혈관형성인자이다. 본 연구에서는 기관지 상피세포에 M. pneumoniae항원을 자극하여 VEGF가 유도되는지를 확인하였고 이 과정에서 MAPK 신호전달경로가 관여하는지를 살펴보았다. 방법: 기관지 상피세포주인 세포에 H292 M. pneumo-niae 항원을 농도별 시간별로 변화를 주어 자극한 후 그 상층액 및 RNA를 분리하여 각각 VEGF 단백생성 및 mRNA 발현정도를 측정하였다. 그리고 신호전달물질의 활성을 특이적으로 억제할 수 있는 화학물질들을 사용하여 그 연관성을 확인하였다. 결과: 기관지 상피세포에 M. pneumoniae 항원을 노출시켰을 때 항원의 농도 및 반응시간을 증가시킴에 따라 VEGF 단백 및 mRNA 합성이 증가하는 것을 관찰할 수 있었다. 또한, MAPK 신호전달물질 중 ERK와 p38의 억제제인 U0126 SB202190을 각각 전처치한 후 항원과 반응시켰을 때 -85%까지 단백생성이 감소하는 것을 확인할 수 있었으며 JNK의 억제제인 JNK inhibitor II를 처리한 경우에는 VEGF 단백합성이 57% 줄어드는 것을 관찰할 수 있었다. 결론: M. pneumoniae 항원은 기관지 상피세포에서 VEGF 발현을 유도하며 그 과정에서 MAPK 신호전달경로가 중요한 역할을 담당하고 있는 것으로 생각된다. Purpose: Mycoplasma pneumoniae is an extracellular pathogen that attaches to and destroys the ciliated epithelial cells of the respiratory tract. The vascular endothelial growth factor (VEGF) is a critical angiogenic factor that manages the formation and function of vascular networks. Thus, we examined whether M. pneumoniae lysate (MPL) induces VEGF and MPL-induced VEGF expression is regulated by the activation of mitogen-activated protein kinase (MAPK) pathways in airway epithelial cells. Methods: Cells were treated with MPL in dose and time dependent manners or pretreated with chemical inhibitors of MAPK signaling molecules before the addition of MPL. The supernatants were measured by a specific human VEGF enzyme-linked immunosorbent assay (ELISA). The RNAs were extracted and synthesized into cDNAs for VEGF gene expression by polymerase chain reaction. Results: MPL considerably increased VEGF mRNA 2 hours after treatment, which was gradually reduced thereafter. On the other hand, VEGF protein was continuously amplified for 12 hours after both 5 and 10 g/mL MPL treatment. Pretreatment with U0126 (a specific extracellular signal-regu μ - lated kinase inhibitor) and SB202190 (a specific p38 inhibitor) abolished MPL-stimulated VEGF protein close to basal level (-85%), whereas JNK inhibitor II (a specific c-Jun N-terminal kinase inhibitor) partially decreased VEGF protein (57%). Conclusion: We concluded that MPL induces VEGF expression through the activation of MAPK signaling molecules (ERK, p38 and JNK) in airway epithelial cells. [Pediatr Allergy Respir Dis

조리방법에 따른 참깨의 알레르기 항원성 비교

이경은 ( Kyung Eun Lee ),홍정연 ( Jung Yeon Hong ),손선미 ( Sun Mi Son ),박선희 ( Sun Hee Park ),이상일 ( Sang Il Lee ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ),김경원 ( Kyung Won Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.1

목적: 본 연구에서는 참깨 알레르겐의 구성단백을 알아보고 조리방법에 따른 항원성의 변화를 비교하고자 하였으며, 참깨 특이 IgE 항체 수치가 높은 환자들의 혈청을 이용하여 IgE와 결합하는 알레르겐 내 구성단백들을 조사하고자 하였다. 방법: 참깨를 다양한 방법(볶기, 식물성 기름과 볶기, 삶기)으로 조리한 후 각각의 조항원을 제조하고 SDS-PAGE를 통해 그 단백분포를 비교하였다. 그리고 알레르기 환자를 대상으로 시행한 CAP test를 기초로 참깨 알레르겐에 감작된 환자의 혈청을 수집하고 immunoblot 분석을 시행하여 특이 IgE 결합능을 비교해 보았다. 결과: 조리하지 않은 참깨의 경우 SDS-PAGE상에서 6-115 kD 크기에 해당하는 많은 단백 띠들이 관찰되었다. 이 중에서도 중요 참깨 알레르겐들로 알려져 있는 7, 9, 12, 15, 17 kD 단백 띠들이 존재함을 관찰할 수 있었다. 각각의 조리한 참깨들을 비교해 본 결과, 볶거나 식물성 기름과 함께 볶은 경우 거의 대부분의 단백 띠들이 소실되었으나 삶은 경우에는 보다 선명한 다양한 크기의 단백 띠들이 재구성됨을 알 수 있었다. 또한 참깨를 삶은 후 분리한 상층액에서도 특징적으로 6 kD부근에 단백 띠들이 관찰되었다. 참깨에 특이적인 환자혈청들을 사용하여 IgE immunoblot 분석을 실시한 결과 조리하지 않은 참깨는 삶거나 식물성 기름과 볶은 참깨와 함께 공통적으로 7 kD 또는 37 kD에 특이적으로 결합한 IgE 단백띠를 형성하였다. 결론: 참깨의 경우 조리방법에 따라 항원성의 변화가 있으며, 특히 조리하지 않거나 또는 삶은 경우에 참깨 특이 IgE 항체 반응은 다른 조리방법들보다 상대적으로 강하게 나타났으며 이와 같은 강한 항원성은 참깨에 대한 감작률을 높일 수 있다고 생각된다. Purpose: There has been a significant increase in the number on reports of hypersensitivity to sesame, probably because of its use in international fast-food and bakery products. Thus, we have investigated whether various cooking methods affect the allergenicity of sesame. Methods: Sesame seeds were roasted, boiled or fried with vegetable oil, and then their proteins were each extracted. The proteins were separated by sodium dodecyl sulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and detection of immunoglobulin (Ig) E specific to sesame seed proteins was performed with Western blotting using 6 sera. Results: SDS-PAGE of raw sesame proteins showed various-sized bands including 7, 9, 12, 15 and 17 kD known as major allergens. While only few protein bands remained in roasted or fried sesame seeds, some protein bands sized under 15 kD were observed in the boiled sesame seeds and their soup. The pooled sera yielded IgE-specific reaction with 7 kD in raw and boiled, and 37 kD in fried and boiled sesame proteins. Conclusion: These findings suggest that the cooking methods may change the allergenicity of sesame seed proteins. [Pediatr Allergy Respir Dis(Korea) 2009;19:56-62]

Group B β-hemolytic Streptococcus에 의한 소아 감염증의 임상상

김윤경,곽영호,김예진,정혜선,홍정연,이환종,Kim, Yun Kyung,Kwak, Young Ho,Kim, Yae Jean,Jung, Hye Sun,Hong, Jung Yeon,Lee, Hoan Jong 대한소아감염학회 1999 Pediatric Infection and Vaccine Vol.6 No.2

목 적 : 이전까지는 국내에서 발생 증례가 적었던 GBS 감염증이 최근에는 자주 접하게 되었다. 이에 최근 수년간의 발생 증례에 대한 고찰을 하여 그 임상적, 역학적 특성을 고찰하고자 하였다. 방 법 : 1985년 6월부터 1999년 6월까지 서울대학교 병원 소아과에서 균이 증명된 GBS 감염증 환아들을 대상으로 하였다. 이들의 의무 기록을 후향적으로 검토하였고, 분려된 일부 균주의 혈청형과 항균제 감수성을 경시하였다. 결 과 : 기간 별 증례 수를 비교해 보면, 1990년대 후반에 그 이전보다 증례가 많았다. 총 27례중 25례가 신생아 감염증이었고, 지발형이면서 뇌막염인 증례가 많았다. 혈청형은 III(6균주), Ib(6), Ia(1)와 II(1)였다. 검사된 10개의 항균제에 대하여 모든 균주가 감수성을 보였다. 결 론 : 국내에서 신생아 GBS 감염증은 증가하고 있는 추세이므로, 신생아 패혈증 또는 뇌막염의 원인균으로서 GBS의 가능성을 고려하여야 하며, 향후 빈도가 더욱 증가하면 산모에게 산전 검사와 예방적 항생제 요법 등을 고려해야 할 것으로 사료된다. Background : Group B ${\beta}$-hemolytic Streptococcus(GBS) has been the major pathogen of neonatal sepsis in western country. In contrast, GBS has played little role in neonatal sepsis in Korea. But recently, neonatal GBS infections are encountered more frequently. It is important to characterize the clinical and epidemiological features of GBS infection in Korean children. Methods: We reviewed retrospectively the medical records of twenty-seven infants and children with GBS infection experienced at the Seoul National University Children's Hospital during 14 year-period from June, 1985 to June, 1999. Fourteen strains isolated from blood and cerebrospinal fluid were serotyped. Minimum inhibitory concentrations of 10 strains were determined by agar dilution method for penicillin, ampicillin, ampicillin with sulbactam, cefarolin, cefuroxime, and cefuiaxone. Results: The numbers of cases with GBS infection increased in 1990s. Among twenty seven cases, twenty-five cases were under three months of age and both of two cases with underlying disease occurred at three years of age. All neonatal infections were late-onset type and meningitis predominated. Serotypes were III(6 strain), Ib(4), Ia(l) and V(2). All of the strain were susceptible to all of the antibiotics tested. Conclusion: GBS infections in infants were increasingly recognized. GBS should be considered as an etiological agent of neonatal sepsis or meningitis in Korea. Maternal screening and prophylactic antibiotic therapy may be considered.

우유단백 항원의 열처리 및 가수분해에 따른 단백의 분포와 항원성 변화

이희선 ( Hee Seon Lee ),김미나 ( Mi Na Kim ),홍정연 ( Jung Yeon Hong ),허원일 ( Won Il Heo ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ),이경은 ( Kyung Eun Lee ),박중원 ( Jung Won Park ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.4

Purpose: Cow`s milk protein is one of the most common and strongest food allergen. We investigated the effects of heat treatment on the distribution and antigenicities of major allergens from cow`s milk. We also compared the protein distribution and antigenicities among cow`s milk formula and its substitutes. Methods: We heated α-casen, β-lactoglobulin (BLG), α-lactalbumin (ALA), and crude extract of cow`s milk in 100°C boiling water for 1 hour. We prepared crude extracts from cow`s milk formula, partially hydrolyzed milk formula (pHF) and extensively hydrolyzed milk formula (eHF). The protein compositions of all the samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The antigenicities were determined by IgE immunoblotting with pooled serum collected from 11 patients with milk allergy. Results: After heating, no significant alteration was found in casein, and the aggregates of ALA and BLG were detected with molecular weights of about 30 and 45 kDa, respectively. The antigenicities of newly detected aggregates were increased. The new aggregates of BLG with increased antigenicities were also found in heated milk total protein. Major milk allergens were not found in pHF, and residual components with a molecular weight below 10 KDa did not show IgE-binding activity. We failed to observe the residual components and antigenicities of eHF. Conclusion: Changes in protein distribution and antigenicity of milk total protein induced by heat treatment may not be significantly different from those of each major allergen. The residual components of pHF could have little IgE-binding capacity, and there may be few or no antigenic components in eHF.

2세 남아에서 발견된 들깨 알레르기 1례

송지은 ( Ji Eun Song ),이재랑 ( Jae Rang Lee ),박여훈 ( Yeo Hoon Park ),홍정연 ( Jung Yeon Hong ),손선미 ( Sun Mi Son ),김경원 ( Kyung Won Kim ),고홍 ( Hong Koh ),정기섭 ( Ki Sup Chung ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Ea 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.1

저자들은 아토피 피부염이 있으며 난백, 땅콩 등에 알레르기가 있는 유아에서 이유기에 처음으로 섭취한 들깨에 의해 심한 소화기 증상이 발생했던 들깨 알레르기 환아 1례를 경험하였기에 들깨 단백분석 및 환아 혈청 내 특이 IgE와의 immunoblot 분석과 함께 보고하는 바이다. Even though perilla is one of the most commonly consumed grain in Asia including Korea, perilla allergy is rare. A 2 year-old boy had erythematous popular urticaria on his whole body, as well as vomiting and diarrhea after ingestion of boiled perilla. On the second day of admission, old blood clots in the vomitus and blood tinged stool were shown. He underwent an esophago gastro duodenoscopy which showed a large duonenal ulcer. After treatment, his general condition improved. We report a case of perilla allergy with brief review of related literature. [Pediatr Allergy Respir Dis(Korea) 2009;19:78-83]

계란 알레르기에서 열처리한 계란을 이용한 피부단자시험의 진단적 유용성

전진 ( Jin Jhon ),이경은 ( Kyung Eun Lee ),김미나 ( Mi Na Kim ),홍정연 ( Jung Yeon Hong ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),박현빈 ( Hyun Bin Park ),한윤기 ( Yoon Ki Han ),이희선 ( Hee Seon Lee ),김경원 ( Kyung Won 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Purpose: Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy. Methods: We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA. Results: Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0.14.6] vs. 4.2 [0.0.5.6], P<0.001) and OVM (9.6 [7.3.13.8] vs. 5.6 [0.0.7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE. Conclusion: Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.