한국인 제1형 당뇨병에서 체도 세포질 항체의 양성률 : 항GAD항체, 항ICA512항체, 항phogrin항체의 조합 측정으로의 대체 가능성 Possible Replacement with Combined Measurement of Anti-GAD, Anti-ICA512, and Anti-phogrin Antibodies

김경아,김동준,정재훈,민용기,이문규,김광원,진동규,고경수,김상진,이명식 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.6

연구배경:최근 당뇨병의 분류를 새로 제정함에 있어 자가항체가 양성이면 임상형에 상관없이 제1형 당뇨병으로 분류하자는 제안이 나옴으로써 자가항체의 중요성은 더욱 커질 것으로 예상된다. 특히 우리나라와 같이 비비만형인 제2형 당뇨병이 많은 나라에서는 당뇨병의 병인 규명에 자가항체가 중요한 위치를 차지할 것으로 사료된다. 자가항체 중에서 전통적으로 측정되어온 췌도 세포질 항체(ICA)는 표준화하기 어렵고 기술적으로 제한점이 많으며 현실적으로도 췌장 공여자가 적은 점 등이 문제로 알려져 있다. ICA의 대응 항원들로는 GAD(glutamic acid decarboxylase), IA­2(islet­associaated antigen­2;ICA512), IA­2β(phogrin)등이 있다. 이러한 대응 항원에 대한 특이적인 자가항체의 측정은 ICA에 비해 표준화되었으며 최근에는 방사면역측정법(radioimmunoassay;RIA)키드까지 등장하여 손쉽고 정확히 이를 측정할 수 있게 되었다. 연구자들은 한국인 제1형 당뇨병에서 측정법이 표준화 되어 있는 항GAD항체 및 항ICA512항체 조합(combimation)의 조합으로 ICA의 측정을 대신할 수 있는지를 조사하였고 더 나아가 항phogrin항체의 조합 측정으로 임상적 유용성이 있는지 보고자 하였다. 방법: ICA는 면역조직화학 염색법을 이용하였다. 항 GAD항체는 상업화 된 키드(RSR??, United Kingdom)를 이용하였다. 항 ICA512항체와 항phogrin항체의 측정은 in vitro transcription&translation한 후 이를 이용해 방사면역 침전법을 이용하였다. 대상 환자로는 전형적 제1형 당뇨병 76명, 지진형 제1형 당뇨병 22명, 제2형 당뇨병 39명이었으며 각 군간의 연령은 각각 22.8±14.0, 37.9±13.9, 45.3±12.3세였다. 결과:1)전형적인 제1형 당뇨병에서는 ICA의 양성률이 30%, RIA조합만의(항GAD항체 또는 항 ICA512항체 또는 항phgrin항체 한가지에라도 양성인 경우)양성률이 57%이었다. 지진형 제1형 당뇨병에서는 각각 18%, 50%이었다. 제2형 당뇨병에서는 각각 7.7%, 5.1%이었다. 2)각 군에서 ICA가 양성인 군에서 RIA조합 양성률을 보면 전형적 제1형 당뇨병에서는 96%, 지진형 제1형 당뇨병에서는 100%에서 양성이었고 제2형 당뇨병에서는 RIA 조합 양성이 없었다. 각 군에서 ICA가 음성인 군에서도 RIA 조합시 전형적 제1형 당뇨병에서는 40%, 지진형 제1형 당뇨병에서는 39%에서 양성이었고, 제2형 당뇨병에서는 5.6%에서 양성이었다. 3)전형적 제1형 당뇨병에서 ICA가 양성인 군(n=23)에서 96%가 RIA조합 양성이었는데 이때 각각의 RIA유형을 보면 항GAD항체 양성이 87%였다. 한편 항 ICA512항체 양성이 48%, 항phogrin항체 양성이 44%이고 항GAD항체 도는 항ICA512항체 양성이 96%를 차지한다. 지진형 제1형 당뇨병에서는 ICA가 양성인 군(n=4)에서는 항 GAD항체 양성이 3명, 항ICA512항체 양성이 1명이었다. 따라서 기존의 ICA를 RIA조합으로 대체할 수 있을 것으로 사료되었는데 이때 항GAD항체와 항ICA512항체의 조합이 도움이 되겠고 항phogrin항체의 추가적인 검사는 일부의 환자에서만 도움이 되리라 사료된다. 4)이환 기간에 따라 ICA와 RIA조합을 비교시 ICA는 차이가 없었으나 RIA조합의 양성률은 지진형 제1형 당뇨병에서 4년 이상의 이환 기간이 지나면 그 이전보다 떨어졌다. 5)발병 연령에 따라 ICA와 RIA조합을 비교시 ICA 양성률이 전형적 제1형 당뇨병에서 15세 이전에 발병한 그룹에서 그 이후에 발병한 그룹보다 유의하게 높았다. 결론:이상의 결과를 요약하면 항GAD항체 및 항ICA512항체 측정의 조합은 ICA보다 민감도가 높아 기존의 ICA를 대체함은 물론 임상적 이용에서 현격한 우월성을 보이며, 성인에서 발병한 비전형적인 당뇨병의 분류에도 도움이 될 것으로 사료되었다. 추가적인 항phogrin항체의 측정은 임상적 유용성이 없었다. Background : Type 1 diabetes includes all forms of autoimmune-mediated and idiopathic beta-cell destruction leading to an absolute insulin deficiency. Evidence of an autoimune pathogenesis was assessed by studying cytoplasmic islet cell antibodies (ICA), antibodies to glutamic acid decarboxylase (GADA), antibodies reacting with an islet tyrosine phosphatase-related molecule referred to as ICA 512 (ICA 512A), or its homologue phogrin (phogrin-A). In comparison with ICA, the best validation to assess the risk of type 1 diabetes, shows that a combination of antibodies to GADA with ICA 512A has the power to detect a majority of ICA and 97 ~ 100% of subjects who progressed to overt diabetes. These findings suggest the possibility of replacing the laborious ICA test in the screening programs to identify subjects at risk of progressing to type 1 diabetes or for classifying the stage of diabetes at the time of diagnosis. Up to now, it is unclear whether these results are applicable to the slowly progressive type 1 diabetes that appears to be more prevalent in Asian than in western countries. The prevalence of combined autoantibody testing (1≥ of GADA, ICA512A, or phogrin-A) was investigated in the patients with type 1 diabetes (typical and slowly progressive) and type 2 diabetes, and compared with that of ICA which is a more laborious and insensitive test. Methods : The ICA assay was performed using immunoenzymatic staining of frozen human (blood group O) pancreatic sections with serial dilutions of serum samples with peroxidase-labeled protein A. For the GADA determination, commercially available GADA radiommunoassay kits utilizing the ^125I-labeled recombinant GAD65 (RSR®, United Kingdom) as an antigen was used. Either ICA512A or phogrin-A were detected by a radioligand-binding assay after in vitro transcription and translation using the clone ICA512bdc or phogrin c DNA. Serum was obtained from 76 patients with type 1 diabetes(mean age 45.3± 12.3 years). Typical and slowly progressive type 1 diabetes patients had the disease for between 4.0±4.6 and 10.1±9.5 years, respectively at the earliest serum sampling. Results: 1) In typicaltype 1 diabetes, 30% of patients tested positive for ICA and 57% for the combined autoantibody test. In type 2 diabetes, 7.7% and 5.1% tested positive, respectively. 2) Ninety-six percent of ICA-positive patients expressed one or more of the 3 auto-antibody specificities in typicaltype 1 diabetes. Among the 53 ICA-negative patients with typicaltype 1 diabetes, 40% had one or more of these auto-antibodies. In the slowly pregressive type 1 diabetes, 100% of the ICA-positive and 39% of the ICA-negative patients expressed one or more of the 3 autoantibody specificities. 3) Of the 23 patients with ICA-positive typical type 1 diabetes patients, 87% had a positive result for GADA, 48% FOR ICA512A, 44% for phogrin-A, and 96% for GADA or ICA512A. Of the 4 patients with ICA-positive slowly progressive type 1 diabetes, three had a positive result for GADA, and 1 for ICA512A. 4) When the prevalence of combined autoantibody testing was analyzed according to the duration of diabetes, the prevalence in patients tested within 4 years after the diagnosis and more than 4 years after the diagnosis was 61% and 52%, respectively in typical type 1 diabetes. Furthermore, that for the ICA was 37% and 21%, respectively. In the slowly progressive type 1 diabetes, the prevalence of combined auto-antibody testing was 88% and 25%, respectively (p<0.05), while that of ICA was 25% and 13%, respectively. 5) In typical type 1 diabetes, ICA were detected more frequently in patients younger than 15 years of age (48%) than in older patients (23%) (p<0.05), while the prevalence of combined auto-antibody testing -was not different according to the onset age(65% vs 53%). Conclusion : Combined autoantibody testing for GADA and ICA512A is more sensitive that ICA in type 1 diabetes. Therefore, it could replace the laborious ICA measurement and may be useful for discriminating the etiology of adult onset a typical diabetes(J Kor Diabetes Asso 25 :430~445, 2001).

재발성 눈꺼풀 종괴로 발현된 사르코이드증 1예

고동아 ( Dong Ah Ko ) , 김병진 ( Byoung Jin Kim ) 대한안과학회 2004 대한안과학회지 Vol.45 No.9

재발성 눈꺼풀 종괴로 발현된 사르코이드증 1예

고동아 ( Dong Ah Ko ),김병진 ( Byoung Jin Kim ) 대한안과학회 2004 대한안과학회지 Vol.45 No.9

Dosimetric evaluation of magnetic resonance imaging-guided adaptive radiation therapy in pancreatic cancer by extent of re-contouring of organs-at-risk

Jun Yeong Song(Jun Yeong Song),Eui Kyu Chie(Eui Kyu Chie),Seong-Hee Kang(Seong-Hee Kang),Yeon-Jun Jeon(Yeon-Jun Jeon),Yoon-Ah Ko(Yoon-Ah Ko),Dong-Yun Kim(Dong-Yun Kim),Hyun-Cheol Kang(Hyun-Cheol Kang) 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.4

Purpose: The safety of online contouring and planning for adaptive radiotherapy is unknown. This study aimed to evaluate the dosimetric difference of the organ-at-risk (OAR) according to the extent of contouring in stereotactic magnetic resonance image-guided adaptive RT (SMART) for pancreatic cancer. Materials and Methods: We reviewed the treatment plan data used for SMART in patients with pancreatic cancer. For the online contouring and planning, OARs within 2 cm from the planning target volume (PTV) in the craniocaudal direction were re-controlled daily at the attending physician's discretion. The entire OARs were re-contoured retrospectively for data analysis. We termed the two contouring methods the Rough OAR and the Full OAR, respectively. The proportion of dose constraint violation and other dosimetric parameters was analyzed. Results: Nineteen patients with 94 fractions of SMART were included in the analysis. The dose constraint was violated in 10.6% and 43.6% of the fractions in Rough OAR and Full OAR methods, respectively (p = 0.075). Patients with a large tumor, a short distance from gross tumor volume (GTV) to OAR, and a tumor in the body or tail were associated with more occult dose constraint violations—large tumor (p = 0.027), short distance from GTV to OAR (p = 0.061), tumor in body or tail (p = 0.054). No dose constraint violation occurred outside 2 cm from the PTV. Conclusion: More occult dose constraint violations can be found by the Full OAR method in patients with pancreatic cancer with some clinical factors in the online re-planning for SMART. Re-contouring all the OARs would be helpful to detect occult dose constraint violations in SMART planning. Since the dosimetric profile of SMART cannot be represented by a single fraction, patient selection for the Full OAR method should be weighted between the clinical usefulness and the time and workforce required.

Impact of high MIC of fluconazole on outcomes of <i>Candida glabrata</i> bloodstream infection: a retrospective multicenter cohort study

Ko, Jae-Hoon,Peck, Kyong Ran,Jung, Dong Sik,Lee, Ji Yeon,Kim, Hyun Ah,Ryu, Seong Yeol,Jung, Sook-In,Joo, Eun-Jeong,Cheon, Shinhye,Kim, Yeon-Sook,Kim, Shin-Woo,Cho, Sun Young,Ha, Young Eun,Kang, Cheol- Elsevier 2018 Diagnostic microbiology and infectious disease Vol.92 No.2

<P><B>Abstract</B></P> <P>To evaluate the impacts of fluconazole minimum inhibitory concentration (MIC) according to primary antifungal agents on <I>Candida glabrata</I> bloodstream infection (BSI), a multicenter retrospective cohort study was conducted in Korea, concerning the time period from January 2010 to February 2016. A total of 197 adult patients with <I>C. glabrata</I> BSI were included in the study, and neutropenia (<I>P</I> = 0.026), APACHE II score (<I>P</I> = 0.004), and fluconazole resistance (HR 3.960, 95% CI 1.395-11.246, <I>P</I> = 0.010) were associated with 30-day mortality in multivariate analysis. In subgroup analysis, fluconazole MIC = 32 μg/mL in the azole-treated group (HR 6.691, 95% CI 1.569-28.542, <I>P</I> = 0.010) and fluconazole MIC ≥ 64 μg/mL in the non-azole-treated group (HR 3.337, 95% CI 1.183-9.411, <I>P</I> = 0.023) showed the highest hazard ratio (HR) for 30-day mortality. Increased fluconazole MIC was associated with poor outcome both in azole- and non-azole-treated patients with <I>C. glabrata</I> BSI.</P> <P><B>Highlights</B></P> <P> <UL> <LI> A multicenter cohort study was conducted for <I>C. glabrata</I> BSI. </LI> <LI> Neutropenia, APACHE II, and fluconazole resistance were associated with mortality. </LI> <LI> Fluconazole resistance was associated with mortality even in non-azole treated group. </LI> <LI> Types of antifungal agents were not associated with outcome. </LI> </UL> </P>

Brain Death in a Near-Term Infant: A Case Report

( Dong Jun Lee ),( Hyun Ah Choi ),( Yeon Kyung Lee ),( Sun Young Ko ),( Son Moon Shin ) 대한주산의학회 2016 Perinatology Vol.27 No.4

Brain death is defined as the complete and irreversible loss of cerebral and brainstem function while the heart continues to beat. Unlike cardiac death, brain death is associated with medical, legal, and ethical issues. Common causes of neonatal brain death are perinatal asphyxia, birth trauma, cerebral infection, malformations, severe intracranial hemorrhage, and metabolic diseases. Although a diagnosis of brain death is usually based on clinical criteria, it is not well defined in neonates, especially in preterm babies. Furthermore, there are no guidelines on life expectancy, prolonging life care, or discontinuation of life support in brain dead newborns in Korea. We report a case of brain death due to hypoxic ischemic encephalopathy in a near-term newborn, present the need to establish guidelines for brain death in newborns based on national standards, and discuss further directions about end of life treatment after brain death.

증례 : 소화기 ; 과형성 용종으로 발현된 용종성 낭종성 위염 1예

고동훈 ( Dong Hoon Ko ),김태호 ( Tae Ho Kim ),이석주 ( Seok Ju Lee ),김정아 ( Jeong Ah Kim ),서경진 ( Kyung Jin Seo ),김창환 ( Chang Whan Kim ),한석원 ( Sok Won Han ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

용종성 낭종성 위염(GCP)은 드문 질환으로 흔히 위 점막과 점막하층에서 다발성 낭성 종물로 나타난다. 주로 과거에 위절제술을 시행받은 사람에서 발병되며 드물게 수술병력 없이 위에서 발병되기도 한다. 육안적으로 점막하 종양, 유경성 또는 무경성 용종, 거대 점막 주름 등 다양한 형태로 나타난다. 최근 저자들은 위절제술의 과거력이 없는 환자에게서 우연히 실시한 상부위장관 내시경 생검결과 과형성 용종을 진단하여 내시경적 점막절제술을 통해 용종성 낭종성 위염으로 확진하여 치료한 증례를 경험하였다. 따라서 위용종 생검에서 과형성 용종으로 진단되더라도 용종성 낭종성 위염의 가능성을 염두에 두어야 하겠다. Gastritis cystica polyposa (GCP) is a rare lesion characterized by hyperplastic and cystic dilatation of the gastric mucosal glands infiltrating into the underlying submucosa. In most cases, it develops in patients who have undergone a gastroenterectomy, but can occasionally be found in an unoperated stomach. GCP may present as a submucosal tumor or polyp, and rarely as a giant gastric mucosal fold. We experienced a case of GCP that presented as a hyperplastic polyp, and it was unrelated to any gastric surgery. Upper endoscopy revealed the presence of a subpedunculated polyp in the posterior wall of the antrum. The lesion was successfully removed by endoscopic mucosal resection and diagnosed as a GCP. (Korean J Med 2011;80:S83-S86)

Graduate Colloquium 1 : Tumor-derived Exosome as a Vehicle of Immunogens

( Jung Ah Cho ),( Dong Jun Yeo ),( Dae Sun Jung ),( Hye Yun Son ),( Jae Kyun Ko ),( Min Jung Lee ),( Sun Hee Cho ),( Chul Woo Kim ) 한국생화학분자생물학회 (구 한국생화학회) 2002 추계학술대회집 Vol.2002 No.-

한의학 교의 사업의 유효성에 관한 연구

김동수(Dong Su Kim),이혜림(Hye Lim Lee),성현경(Hyun Kyung Sung),박선주(Sun Ju Park),이주아(Ju Ah Lee),고재언(Jae-un Ko),박재만(Jae-Man Park),최석훈(Suk-Hoon Choi),김효선(Hyo-Sun Kim),고호연(Ho-Yeon Go) 대한한의학회 2017 대한한의학회지 Vol.38 No.3

IGZO Thin-Film Transistor with Bottom Gate Coplanar Structure Using Parylene-C Substrate and Gate Dielectric

Yoojeong Ko(고유정),Ah-Hyun Hong(홍아현),Yoon Kim(김윤),Dong-Wook Park(박동욱) 대한전자공학회 2023 대한전자공학회 학술대회 Vol.2023 No.6