Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

( Min Soo Kim ),( Tae Yoon Jeong ),( Yu Seon Cheong ),( Young Wook Jeon ),( So Young Lim ),( Seong Sik Kang ),( In Nam Kim ),( Tsong Bin Chang ),( Hyun Ho Seong ),( Byeong Mun Hwang ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.4

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine. (Korean J Pain 2017; 30: 281-6)

사염화탄소 투여 흰쥐에서 간섬유화 진행에 따른 Propranolol 의 약동학적 지표들의 변화

이민호,강주섭,강문수,윤병철,이오영,함준수,변재원,윤창옥 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2

Background/Aims : This study was designed to determine the effect of hepatic fibrotic severity on pharmacokinetics of propranolol in CC1q - treated rats. Methods - 1 mL/kg of 10% CC14 in olive oil was injected intramuscularly to rats twice weekly for 4, 6, 8 and 10 weeks, respectively (n=6). Control (n=6) was a sham - injected equal dose of olive oil for 10 weeks. After intravenous bolus injection of 2 mg/kg propranolol to rats, the serum propranolol concentrations were analyzed for 4 hours at various time points by a HPLC - fluorimetric system, and pharmacokinetic parameters such as Co, MRT, AUC, Vdss, tl/2(p) and CLp were determined. Then, a small amount of hepatic tissue was obtained and subjected to determination of the hepatic 4 - hydroxyproline content, which confirmed the hepatic fibrotic severity. Results : The serum concentrations of propranolol at 0.5, 1, 2 and 4 hours were significantly increased in CC1q-treated rats (p$lt;0.01). In proportion to the duration of CC4 treatment, Co and AUC were significantly increased, and Vdss and CLp were significantly decreased (p$lt;0.001). But MRT and t1/2(β) were not significantly changed. The hepatic 4 -hydroxyproline content was gradually increased in CC4-treated rats (p$lt;0.001). Conclusion - Gradual changes in pharmacokinetic parameters of propranolol were seen to be dependent on the hepatic fibrotic severity. We suggest that gradual dosage modification, according to their hepatic fibrotic severity, is necessary for many drugs administered to patients with chronic liver disease.(Korean J Hepatol 2001;7:181-188)

강원도지역에서 발생한 발진열과 쯔쯔가무시병

민창홍,장우현,강재승,조수익,최문기,조민기,윤창순,김윤원 대한감염학회 1988 감염 Vol.20 No.2

In Korea, there has been an increasing concern on rickettsiosis as one of most prevailing acute febrile illness, since murine typhus and scrub typhus had not been reported for 2 decades until 1986 and thereafter a few studies were reported on these diseases. A microimmunofluorescence test was used to study antibodies to R. typhi and R. tsutsugamushi in urban and rural inhabitants students, and patiants suspected of leptospirosis or rickettsiosis from 1986 to 1987 in Kangwon-do Korea. 43% of inhabitatnts and 17% of students reacted to R. typhi. Only one inhabitant among inhabitants and students reacted to R. tsutsugamushi. Among 169 patients, 43(25%) reacted to R. typhi, 38(22%) to R. tsutsugamushi and 25(15%) to Leptospira interrogans. Sexual rate(male; female) in murine typhus was 1.7:1, that in scrub typhus was 1:2.2 and that in leptospirosis was 1.5;1. The age ditribution of patients with murine typhus was generally even over 20 years old. But 71% of patients with scrub typhus were over 40 years old. Scrub typhus was most prevailing in female over 40 years old. Murine typhus was relatively more prevailing in Choonchun city than rural area as compared with scrub typhus and leptospirosis. Most of scrub typhus occurred in rural area. Most of each disease occurred between September and November (murine typhus; 93%, scrub typhus; 95%, leptospirosis; 84%) with a peak in October. Scrub typhus considerably occurred not only October(58%) but also November(28%). All patients with scrub typhus were immediately diagnosed by antibody when they visited hospital. 53% of patients with murine typhus were diagnosed when they visited hospital within 7 days after onset of illness, and others were done by second sera obtained 8 days after. The patients in whom IgM was seronegative but antibodies of other class were seropsitive by 20 days after onset of illness, were 14% in murine typhus and 26% in scrub typhus. At least those patients were considered to be infected second. Murine typhus and scrub typhus were suggested to be endemic diseases in Kangwon-do as antibodies of inhabitants and characteristics of patients' sera were considered. By serologic finding of patients with scrub typhus in Kangwon-do, Gilliam was 59'% of etiologic strain of scrub typhus, Karp was 41q% and Kato was none. Most scrub typhus occurred in person to be related to agriculture, but murine typhus was not related to job and occurred more in small city than rural area. Rash was scarcely detected in murine typhus and scrub typhus, and eschar was in 50% of scrub typhus only. Serum transaminase elevated in many patients with scrub typhus and murine typhus. Leukocytosis and abnormal finding in chest X-ray were showed in some patients with scrub typhus but were scarcely in murine typhus.

벤조디아제핀 수용체 영상용 양전자 방출 핵종 표지 플루마제닐 유도체 [F-18](3-(2-Fluoro)flumazenil의 합성과 생체 내 분포

장영수,이숙자,강삼식,홍성현,이명철,이동수,정준기,정재민,조정혁 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.6

Purpose: Radiotracers that bind to the central benzodiazepine receptor are useful for the investigation of various neurological and psychiatric diseases. [C-11]Flumazenil, a benzodiazepine antagonist, is the most widely used radioligand for central benzodiazepine receptor imaging by PET. We synthesized 3-(2-[F- 18]fluoro)flumazenil, a new fluorine-18 (t1/2=110 min) labeled analogue of benzodiazepine receptor imaging agent, and evaluated in vivo for biodistribution in mice. Materials and Methods: Flumazenil (Ro 15-1788) was synthesized by a modification of the reported method. Precursor of 3-(2-[F-18]fluoro)flumazenil, the tosylated flumazenil derivative was prepared by the tosylation of the ethyl ester by ditosylethane. [F-18] labeling of tosyl substitued flumazenil precursor was performed by adding F-18 ion at 85℃ in the hot cell for 20 min. The reaction mixture was trapped by C18 cartridge, washed with 10% ethanol, and eluted by 40% ethanol. Bidistribution in mice was determined after intravenous injection Results: The total chemical yield of tosylated flumazenil derivative was ∼40%. The efficiency of labeling 3-(2-[F-18]fluoro)flumazenil was 66% with a total synthesis time of 50 min. Brain uptakes of 3-(2-[F-18]fluoro)flumazenil at 10, 30, 60 min after injection, were 2.5±0.37, 2.2±0.26, 2.1±0.11 and blood activities were 3.7±0.43, 3.3±0.07, 3.3±0.09%ID/g, respectively. Conclusion: We synthesized a tosylated flumazenil derivative which was successfully labeled with no-carrier-added F-18 by nucleophilic substitution.

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

Involvement of serine phosphorylation of spinal cord NR-2B subunit of the N-methyl-D-aspartate receptor following electroacupuncture stimulation

Kang Byeol-Rim,Choi Byung-Tae,Yoon Hyun-Min,Min Young-Kwang,Ahn Chang-Beohm 대한침구의학회 2007 대한침구의학회지 Vol.24 No.2

Objective : This study was to examine the low frequency EA is associated with NMDAR and phosphorylation of NMDAR NR-2B subunits in the spinal cordMethods : We investigated that only those rats without overt signs of spinal cord or root damage such as paralysis or lameness were used for experimentation. The NMDA antagonist, D-2-amino-5-phosphonopentanoic acid dissolved in sterile saline and injected intrathecally. Two stainless-steel needles were inserted in each hind leg at those acupoints corresponding to Zusanli(S36) and Sanyinjiao(Sp6) in man and wereconnected to an electric stimulator The EA wit 2 ㎐ stimulation started immediately after AP-5 injection for 30 min. Results : EA analgesia was slightly reduced by intrathecal injection of NMDAR antagonist AP-5, but analgesic effects of EA still showed at 60 minutes after termination of stimulation in all EA-treated group. In the Western blot analysis, the levels of NMDAR NR-2B and phospho-NR-2B were slightly induced by EA stimulation in the spinal cord. These expressions were significantly inhibited by spinal blockage of AP-5. As for regional reaction of NMDAR NR-2B and phospho-NR-2B, immunoreactions were observed throughout all laminae of the dorsal horn of spinal cord and weaker ones showed in the neck region. The mean IOD of phospho-NR-2B in the superficial laminae and nucleus proprius of EA-treated rats were significantly increased compared with normal ones, these expressions were decreased in EA-treated with AP-5 groupsConclusion : It is concluded that EA stimulation may be involved NMDAR activation through phosphorylation of spinal NMDAR NR-2B subunit. 목적 : 저주파에 해당하는 2 Hz 전침 자극이 척수 N-methyl-D-aspartate receptor (NMDAR)의 NR-2B subunit의 발현 및 인산화에 미치는 영향을 조사하였다. 방법 : Sprague-Dawley계 흰쥐를 Størkson 등의 방법에 의해 척수막의 지주막하강에 catheter를 삽입하는 수술을 행한 후 마비 등의 척수 손상을 나타내지 않는 개체를 대상으로 하였다. N-methyl-D-aspartate (NMDA) antagonist인 D-2-amino-5- phosphonopentanoic acid (AP-5)를 투여한 후 족삼리와 삼음교에 해당하는 부위에 30분간 전침 자극하였다. 무통각 여부는 hot plate test를 시행하였으며 NMDAR NR-2 subunit 발현과 인산화 여부는 Western blot과 면역조직화학적으로 살펴보았다. 결과 : 전침 무통각은 전침 자극 후 180분 후까지 지속되었으며 NMDA antagonist인 AP-5를 투여하였을 때 전침 무통각이 저하되었으나 유의성은 나타내지 않았다. Western blot 분석으로 보아 NMDAR NR-2B 및 인산화 NR-2B의 발현은 전침자극에 의해 미약한 증가를 보이나 AP-5투여에 의해 현저한 저해를 보였다. 면역조직화학에 의한 척수배각 구역별 발현을 보면 NMDAR NR-2B 및 인산화 NR-2B는 전 배각에 걸쳐 관찰되나 경부 (층판 Ⅴ-Ⅵ)에서 약한 반응을 보였다. 전침 자극에 의한 각 군별 NR-2B 발현은 유의한 차이를 보여 주지 않았으나 인산화 NR-2B는 천층 (층판 Ⅰ-Ⅱ)및 고유핵 (층판 Ⅲ-Ⅳ)에서 유의성 있는 증가를 보였다. 전침 자극시 AP-5 투여는 유의성은 보이지 않았으나 인산화 NR-2B발현을 저해하였다. 결론 : 저주파 2 Hz 전침에 의한 무통각은 NMDA antagonist인 AP-5 투여에 의해 저해될 뿐아니라 NMDAR NR-2B subunit의 인산화를 저해하는 것으로 보아 전침 무통각의 과정에 NMDAR 및 NMDAR NR-2B의 인산화가 관여함을 알 수 있다.

Microspheres: Synthesis of Monodispersed Microspheres from Laplace Pressure Induced Droplets in Micromolds (Adv. Mater. 37/2012)

Choi, Chang‐,Hyung,Jeong, Jae‐,Min,Kang, Sung‐,Min,Lee, Chang‐,Soo,Lee, Jinkee WILEY‐VCH Verlag 2012 ADVANCED MATERIALS Vol.24 No.37

<P>A novel synthesis method for microspheres using micromolds based on the Laplace pressure difference is presented by Jinkee Lee, Chang‐Soo Lee, and co‐workers on page 5078. This simple micromolding technique makes it possible to synthesize highly monodispersed microspheres with the flexibility of various reaction schemes, such as photopolymerization, sol‐gel reactions, and colloidal assembly. This method is promising for the mass production of various sizes of monodispersed microspheres without the need for complicated control of fluids. </P>

TPL을 이용한 일단위 실거래 가격지수 산정방법에 관한 연구

류강민(Kang-Min Ryu),한제선(Je-Sun Han),정상준(Sang-Jun Jung),이창무(Chang-Moo Lee) 한국주택학회 2017 주택연구 Vol.25 No.2

2009년 국내에 아파트 실거래가 지수가 공표된 이후, 2016년에는 연립다세대 실거래가 지수가 추가로 공개되었다. 이들 지수의 특징 중 하나는 국내에서 표준화되어 대량 으로 공급된 공동주택을 대상으로 하여 거래쌍을 구성하기 쉽고, 개별특성 또한 파악하기 쉬워 지수를 산정하기에 용이하다는 것이다. 그러나 단독다가구 주택은 표준화되어 공급되지 않아 개별특성을 파악하기가 쉽지 않다. 또한 국내의 경우 아파트 위주로 공급되기 때문에 지수를 만들기 위한 표본이 상당히 부족한 실정이다. 또한 주택가격지수와 연관된 이슈 중의 하나는 주택가격지수가 주식과 같은 금융상품의 기초자산으로 역할을 할 수 있느냐는 것이다. 그러나 주택가격지수가 코스피 지수와 같이 금융상품의 기초자산이 되기 위해서는 투자자나 헷지를 원하는 시장참여자가 시장 변화에 민감하게 대처할 수 있도록 일별 지수가 산정되어야 한다. 그러나 지금까지의 주택가격지수는 자료의 한계로 인해 월별로만 산정되고 있다. 본 연구는 이러한 한계를 극복하고자 자료에 한계가 있을 때 지수를 산정할 수 있고, 일별로도 중위수를 이용하여 지수를 산정할 수 있는 방법인 Radar Logic사의 TPL 방법을 제시하고자 한다. Since the apartment sales price index using repeated sale data was introduced in 2009, the multi-family house price index was released in 2016. The two-type houses have good characteristics for making indices. For example they have lots of transaction data and lots of stock with standardized type for quality control. However, detached houses in Korea are not supplied in a standardized form and it is difficult to identify individual housing characteristics. Apart from this there is a lack of transaction data to generate sale price index of a detached house since the domestic housing market has been dominated by apartment. The other issue associated with the housing price index is whether the price index could reflect an underlying demand of financial asset such as a stock market. In order to estimate an underlying asset of capital market like the KOSPI index, a daily index should be considered so that the property investors who desire to hedge their investment can timely respond on the market change. Unfortunately, the house price index has been calculated in a monthly base due to a lack of transaction data. This study proposes the ‘TPL method’ of Radar Logic company, which calculates indices even when data exists in a small number and produces the index on a daily basis.