Application of therapeutic plasma exchange in patients having severe fever with thrombocytopenia syndrome

( Jeong Rae Yoo ),( Sun Hyung Kim ),( Young Ree Kim ),( Keun Hwa Lee ),( Won Sup Oh ),( Sang Taek Heo ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. Methods: TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. Results: Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. Conclusions: SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS

Painful erythematous nodules in the left finger pads

( Jeong Rae Yoo ),( Sang Taek Heo ),( Suhyun Oh ),( Seung-jae Joo ),( Ki Yung Boo ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.5

Unusual genotypic distribution of Orientia tsutsugamushi strains causing human infections on Jeju Island.

Yoo, Jeong Rae,Heo, Sang Taek,Koh, Young-Sang,Kim, Sohyun,Kim, Seok Allen Press, etc 2014 The American journal of tropical medicine and hygi Vol.90 No.3

<P>We investigated the clinical characteristics and serologic types of tsutsugamushi disease on the largest island of South Korea. There were 141 patients with tsutsugamushi disease at Jeju National University Hospital and Seogwipo Medical Center between November of 2003 and December of 2012. Median age of patients was 61 years, and 59% were women. The major clinical manifestations were fever (80.5%) and skin rash (55.7%), with eschars evident in 75.8% of the patients. Genotype analysis of Orientia tsutsugamushi was conducted in 33 specimens. The genotype was identified as Boryong type in 17 of 33 patients and Taguchi type in 15 of 33 patients. In our study, although the Taguchi genotype is rarely reported in the endemic area, it was common on Jeju Island. This genotype may be associated with mild and moderate forms of tsutsugamushi disease.</P>

Predictable Factors of Early Colorectal Cancer after Colonoscopic Polypectomy

( Jeong Rae Yoo ),( Hyun Joo Song ),( Jong Wook Beom ),( Soo Young Na ),( Sun Jin Boo ),( Eun Kwang Choi ),( Yoo Kyung Cho ),( Heung Up Kim ),( Byung Cheol Song ),( Chang Lim Hyun ),( Jo Heon Kim ) 대한장연구학회 2013 Intestinal Research Vol.11 No.3

Background/Aims: Colorectal cancer is the third most common cancer and the fourth leading cause of cancer death in Korea. Colonoscopic screening with removal of adenomas is an effective strategy for reducing the incidence and mortality of colorectal cancer. This study was conducted to investigate predictable factors of early colorectal cancer (ECC) in patients with advanced adenoma (AA), tumor in situ (Tis), and submucosal (SM) cancer diagnosed after colonoscopic polypectomy. Methods: Between August 2003 and June 2012, a total of 1,001 patients who underwent colonoscopic polypectomy in Jeju National University Hospital were enrolled in this study. Results: Patients were classified into four groups; non-AA, AA, Tis, and SM cancer. Compared to the AA group, the ECC group (n=50) had large adenoma size (12.2±5.9 mm vs. 15.3±6.5 mm, P<0.01), distal location (39.3% vs. 52.0%, P=0.05) and diabetes mellitus (13.1% vs. 25.0%, P=0.04). However, age, sex, body mass index, the mean number of polyps, and morphological features (polypoid vs. nonpolypoid lesions) were not significantly different between the AA and ECC groups. In multivariate analysis, adenoma size >15 mm (odds ratio [OR], 4.49; 95% confidence interval [CI] 2.40-8.38), distal location (OR, 2.59; 95% CI, 1.33-5.05), and diabetes mellitus (OR, 2.10; 95% CI, 1.07-4.43) were significantly associated with ECC. Of the 12 patients with SM cancer, 5 underwent additional operations and had no remnant carcinoma. Conclusions: Predictable factors of ECC after colonoscopic polypectomy may be adenoma size >15 mm, distal location and diabetes mellitus. (Intest Res 2013;11:169-177)

Poster Session : PS 0394 ; Infectious Disease ; Arteriovenous Fistula Stent Infection Diagnosed with

( Jeong Rae Yoo ),( Sang Taek Heo ),( Miyeon Kim ),( Hyun Woo Kim ),( Jee Won Jang ),( Hee Sung Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

99mTc-Hexamethyl-propyleneamine oxime (HMPAO)-labeled leukocyte scintigraphy (WBC scan) is a useful technique in the diagnosis of vascular prosthetic (or graft) infection, regardless of the type of prosthesis and the stage of infection. However, it is seldom known to physician about reliability of WBC scan in the diagnosis of vascular or vascular prosthetic, particularly arteriovenous fi stula (AVF) stent infection. Specially, because a prosthetic related infection is associated with morbidity and the success of surgical treatment is dependent on early diagnosis, other diagnostic tool is necessary. WBC scan has advantage more sensitive and specifi city than standard diagnostic tool, it can be useful in the early diagnosis of vascular stent infection. Herein, we report a fi rst case that AVF stent infection was diagnosed using WBC scan and treated appropriately. A 62-year-old man with end-stage renal disease referred for prolonged fever. We performed a WBC scan following fever of unknown origin work up. A focal uptake on the left forearm compatible AVF stent insertion site is showed. He was successfully treated with stent removal surgery and antibiotics therapy. We followed the patient with good health condition without any problems for four months. This is to our knowledge the fi rst reported case of AVF stent infection diagnosed using WBC scan. The WBC scan would be suitable method of assessing vascular stent infection in lowgrade stage or occult fever.

Coinfection of Severe Fever With Thrombocytopenia Syndrome Virus and Coxiella burnetii in Developmental Stage of Hard Ticks in Subtropical Region of Korea

Yoo Jeong Rae,Heo Sang Taek,Kim Misun,Kim Miyeon,Kang Myeong Jin,Kim Eui Tae,Kang Su Yeon,Lee Keun Hwa 대한의학회 2023 Journal of Korean medical science Vol.38 No.20

Background: Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea. Methods: Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species. Results: Haemaphysalis longicornis was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSVinfected H. longicornis ticks. C. burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November. Conclusion: Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

Single-nucleotide polymorphisms in prion protein gene of the Korean subspecies of Chinese water deer

Jeong, Hyun-Jeong,Lee, Joong-Bok,Park, Seung-Yong,Song, Chang-Seon,Kim, Bo-Sook,Rho, Jung-Rae,Yoo, Mi-Hyun,Jeong, Byung-Hoon,Kim, Yong-Sun,Choi, In-Soo The Korean Society of Veterinary Science 2009 大韓獸醫學會誌 Vol.49 No.1

Susceptibility to chronic wasting disease (CWD) in cervid species has been associated with polymorphisms in the prion protein gene (PRNP). The single nucleotide polymorphisms (SNPs) were found in the PRNP of the Korean subspecies of Chinese water deer via analyses of the DNA sequences obtained from 34 individual deer. Two SNPs were detected at codons 77 and 100. One SNP at codon 77 encoding Glycine was determined to be a silent mutation but the other SNP detected at codon 100 induced an amino acid change, from Asparagine to Serine. The prion protein (PrP) amino acid sequence of the water deer showed 98.8-99.2% homology with those of American elk, white-tailed deer and mule deer. The PrP of the water deer contained amino acid residues closely related with CWD-susceptibility. This study is the first to describe genetic variations in the PRNP of the Korean subspecies of Chinese water deer.

Proven Nasal and Pulmonary Aspergillosis in Patient with Severe Fever with Thrombocytopenia Syndrome

Yoo Jeong Rae,Chang Lim Hyun,Chang Suk Won,Gil Myeong Seong 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.3

Evaluation of the early fluconazole treatment of candidemia protocol with automated short message service alerts: a before-and-after study

( Jeong Rae Yoo ),( Bo Ra Shin ),( Sujin Jo ),( Sang Taek Heo ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.3

Background/Aims: We introduced the Early Fluconazole Treatment in Candidemia (EFTC) protocol in August 2015 to improve the outcomes of patients with candidemia. This study evaluated the effectiveness of the EFTC protocol. Methods: We conducted a retrospective before-and-after study among patients in the intensive care units and Hemato-Oncology and General Surgery wards of our hospital between January 2013 and December 2018. The EFTC protocol entailed sending an automatic notification by short message service, feedback to the responsible healthcare worker, and regular standardized education of medical staff. On receiving a notification, physicians prescribed empirical fluconazole immediately. The effectiveness of the EFTC protocol was evaluated by multivariate analysis of risk factors for 30-day mortality. Results: Of 103 patients with candidemia, 50 were admitted before (pre-EFTC group) and 53 were admitted after (post-EFTC group) the introduction of the EFTC protocol. Patients’ mean age ± SD was 67.1 ± 18.6 years, and 55 (53.4%) were male. The mean ± SD time from Candida isolation to antifungal drug administration in the pre-EFTC and post-EFTC groups was 89.1 ± 73.6 and -9.8 ± 63.9 minutes, respectively (p = 0.01). The 30-day mortality in the pre-EFTC and post-EFTC groups was 54.5% (95% confidence interval [CI], 42.3 to 66.7), and 37.6% (95% CI, 26.1 to 49.1), respectively (p = 0.05). In the multivariate analysis, implementation of the EFTC protocol was independently associated with a reduction in 30-day mortality (odds ratio, 0.27; 95% CI, 0.12 to 0.63; p = 0.01). Conclusions: The early f luconazole treatment, monitoring, and education were effective in reducing mortality in patients with candidemia.

호냉성 균주 유래 재조합 티로시나아제 효소, tyrosinase-CNK의 반응 안정성 연구

최유래(Yoo Rae Choi),도현수(Hyunsu Do),정다원(Dawon Jeong),박준태(Junetae Park),최유성(Yoo Seong Choi) 한국청정기술학회 2016 청정기술 Vol.22 No.3

본 연구에서는, 저온 및 약산성 조건에서 높은 활성을 보이는 티로시나아제인 tyrosinase-CNK의 반응 안정성을 조사하였다. Tyrosinase-CNK는 지금까지 알려진 중온성(mesophilic) 및 호열성(thermophilic) 환경 유래의 티로시나아제 보다는 열 안정성이 낮았으나 0 ℃에서 효소 안정성이 매우 뛰어났고, 반복적인 동결-해동(freeze-thaw) 과정에서도 효소 활성을 안정적으로 유지하였다. 또한, 물과 ethanol 및 acetonitrile이 혼합된 유기용매 환경에서 초기 상대 활성 값의 변화가 관찰되었으나 유기용매 농도의 증가로 인한 추가적인 활성 저하를 유발하지 않고 활성을 일정하게 유지하였다. 한편, 효소 반응의 염(salt)에 대한 저해는 chaotropic 특성이 많이 나타나는 염일수록 적게 나타났다. 결과적으로, tyrosinase-CNK는 통상의 티로시나아제를 이용하여 반응을 수행하기 어려운 환경에서도 원하지 않는 반응을 억제하고 효소 불활성화를 최소화면서 반응을 촉매할 것으로 기대된다. Tyrosinases catalyze the hydroxylation of a monophenol (monophenolase activity) and the conversion of an o-diphenol to o-quinone (diphenolase activity), which are mainly involved in the modification of tyrosine residues into 3,4-dihydroxyphenyl-alanine (DOPA) and DOPA/DOPAquinone-derived intermolecular cross-linking. Previously, we obtained a slightly acidic and cold-active tyrosinase, tyrosinase-CNK, by our recombinant protein approach. The enzyme showed optimal activity at pH 6.0 and 20 ℃ with an abnormally high monophenolase/diphenolase activity ratio and still had approximately 50% activity compared with the highest activity even in ice water. Here, we investigated reaction stability of the recombinant tyrosinase-CNK as a psychrophilic enzyme. The enzyme showed remarkable thermal stability at 0 ℃ and the activity was well conserved in repeated freeze-thaw cycles. Although water-miscible organic solvent as reaction media caused the activity decrease of tyrosinase-CNK as expected, the enzyme activity was not additionally decreased with increased concentration in organic solvents such as ethanol and acetonitrile. Also, the enzyme showed high salt tolerance in chaotropic salts. It was remarkably considered that 2+ metal ions might inhibit the incorporation of Cu<SUP>2+</SUP> into the active site. We expect that these results could be used to design tyrosinase-mediated enzymatic reaction at low temperature for the production of catechols through minimizing unwanted self-oxidation and enzyme inactivation.