단일 2차 기관에서 소아 마이코플라스마 폐렴 환자의 치료를 위한 스테로이드 사용 현황과 효과

유수지 ( Susie Yoo ),최성은 ( Seong Eun Choi ),전지영 ( Jiyoung Chun ),안요한 ( Yo Han Ahn ),조기영 ( Ky Young Cho ),이용주 ( Yong Ju Lee ),성태정 ( Tae Jung Sung ),이건희 ( Kon Hee Lee ) 대한천식알레르기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Purpose: Steroids can be used as an adjuvant therapy in the management of mycoplasma pneumonia, but no definite guidelines for the use of steroids have been established. The purpose of this study was to analyze the current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital in Korea. Methods: We retrospectively reviewed the medical records of 152 patients who were admitted due to mycoplasma pneumonia. The patients were divided into 3 groups as follows: those who did not use steroids (81 patients, 53%), those who used steroids after their fever subsided (42 patients, 28%) and those who used steroids during fever (29 patients, 19%). Results: In decreasing order of values, the duration of fever during hospitalization (60.0±40.2 hours vs. 37.3±28.5 hours vs. 29.7±29.5 hours, P=0.006) and duration of hospitalization (5.9±1.7 days vs. 5.0±1.4 days vs. 4.0±1.5 days, P<0.001) were reported in the group which received steroids during fever, the group which received steroids after the fever subsided and the group which did not receive steroids. In the group which received steroids during fever, patients with early steroid use (within 24 hours) had a shorter fever duration in the hospital (12.0 hours vs. 73.5 hours, P<0.001) and a hospitalization duration (5.0 days vs. 6.5 days, P=0.007) than those with late steroid use (after 24 hours). Conclusion: Steroids were used in 47% of patients with mycoplasma pneumonia. The patients who received early steroids had a shorter fever duration and a shorter hospital stay than those who received late steroids. (Allergy Asthma Respir Dis 2018;6:122-127)

Establishment of a library of fragments for the rapid and reliable determination of anabolic steroids by liquid chromatography-quadrupole time of flight-mass spectrometry

도정아,이상경,노은영,윤순병,최호준,백선영,박성관 한국분석과학회 2017 분석과학 Vol.30 No.1

Anabolic steroids have similar structures to testosterone, both of which promote the growth of muscle mass and increase strength. However, the side effects of anabolic steroid use may lead to heart attacks or strokes. Additionally, the excessive use of steroids inhibits the production of the sex hormones in the body via a negative feedback loop, which results in testicular atrophy in males and amenorrhea in females. Currently, the method of choice used to test for the presence of anabolic steroids is GC-MS. However, GC-MS methods require chemical derivatization of the steroid sample to ensure compatibility with the analytical method; therefore, analysis of many different samples is difficult and time consuming. Unlike GC-MS, the liquid chromatography-quadrupoletime of flight mass spectrometry (LC-Q-TOF-MS) method is suitable for many samples. Twenty-two different anabolic steroids were analyzed by LC-Q-TOF-MS with various collision energies (CE). Accurate mass spectral data were obtained using a Q-TOF-MS equipped with an electro-spray ionization source and operated in the positive MS/MS mode for several classes of steroids that are often the targets of testing. Based on the collected data, fragmentation pathways were carefully elucidated. The high selectivity and sensitivity of the LC-Q-TOF-MS instrument combined with these fragmentation pathways offers a new approach for the rapid and accurate screening of anabolic steroids. The obtained data from the 22 different anabolic steroids will be shared with the scientific community in order to establish a library to aid in the screening of illegal anabolic steroids.

Establishment of a library of fragments for the rapid and reliable determination of anabolic steroids by liquid chromatography-quadrupole time of flight-mass spectrometry

Do, Jung-Ah,Noh, Eunyoung,Yoon, Soon-Byung,Choi, Hojune,Baek, Sun-Young,Park, Sung-Kwan,Lee, Sang-Gyeong The Korean Society of Analytical Science 2017 분석과학 Vol.30 No.1

Anabolic steroids have similar structures to testosterone, both of which promote the growth of muscle mass and increase strength. However, the side effects of anabolic steroid use may lead to heart attacks or strokes. Additionally, the excessive use of steroids inhibits the production of the sex hormones in the body via a negative feedback loop, which results in testicular atrophy in males and amenorrhea in females. Currently, the method of choice used to test for the presence of anabolic steroids is GC-MS. However, GC-MS methods require chemical derivatization of the steroid sample to ensure compatibility with the analytical method; therefore, analysis of many different samples is difficult and time consuming. Unlike GC-MS, the liquid chromatography-quadrupole-time of flight mass spectrometry (LC-Q-TOF-MS) method is suitable for many samples. Twenty-two different anabolic steroids were analyzed by LC-Q-TOF-MS with various collision energies (CE). Accurate mass spectral data were obtained using a Q-TOF-MS equipped with an electro-spray ionization source and operated in the positive MS/MS mode for several classes of steroids that are often the targets of testing. Based on the collected data, fragmentation pathways were carefully elucidated. The high selectivity and sensitivity of the LC-Q-TOF-MS instrument combined with these fragmentation pathways offers a new approach for the rapid and accurate screening of anabolic steroids. The obtained data from the 22 different anabolic steroids will be shared with the scientific community in order to establish a library to aid in the screening of illegal anabolic steroids.

P022 : Topical steroid phobia among parents of children with atopic dermatitis in Korea

( Young Her ),( So Eun Park ),( Jin Yong Lee ),( Soo Jung Shin ),( Chang Sun Yoo ),( Chul Woo Kim ),( Sang Seok Kim ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Topical steroids are effective therapeutic agent for treatment of atopic dermatitis (AD). However, there is a vague phobia when using topical steroids among parents of children with AD due to lacking correct information about this subject. Objectives: The purpose of this study is to assess the current state of steroid phobia and the relationship of these concerns with level of adherence with treatment among parents of atopic children in Korea. Methods: 127 parents of atopic children were interviewed using structural questionnaire. Results: Overall, 67% of the parents were exposed to steroid phobia. There were statistically significant difference of steroid phobia according to awareness of side effects, application of topical steroids and relationship between topical steroid phobia and adherence (p<0.05). The most recognized side effects of topical steroids is skin atrophy and thinning (71.9%). The most prevalent source of information about steroid phobia is internet (49.2%). Degree of AD severity (odds ratio[OR]=5.332(moderate),9.040(severe) vs mild; p=0.001) and awareness of side effects of topical steroids (OR=2.658; p=0.021) were predictive factors for steroid phobia. Conclusion: Our study showed the prevalence of inaccurate information about topical steroids through other sources, not through a doctor, can lead to steroid phobia. Therefore, we emphasized the important role of dermatologists as a provider of appropriate information and education when using topical steroids.

Physician education can minimize inappropriate steroid use in patients with inflammatory bowel disease: the ACTION study

박예현,최창환,김현수,문희석,김도현,김진주,Dennis Teng,박동일 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Background/Aims: Epidemiological data on steroid use in South Korean patients with inflammatory bowel disease (IBD) are limited. We documented the steroid use patterns in these patients, and whether physician education on appropriate steroid use affected these patterns.Methods: ACTION was an observational cohort study conducted in adults (≥19 years) with IBD. A retrospective chart review was performed at baseline (cohort 1) and 1 year after physician training (cohort 2). Eligible cases with excessive or inappropriate steroid use were identified, along with any associated risk factors.Results: Data were collected during May 2018-July 2019 from patients with Crohn’s disease (CD) and ulcerative colitis (UC) in cohort 1 (n=1,685) and cohort 2 (n=1,649). At baseline, 155 patients (9.2%) had received steroids within the previous 12 months, 46 (29.7%) of whom had used steroids excessively, 16 (34.8%) of these having inappropriately used excessive steroids. Although steroid exposure was similar in cohort 1 (9.2%) and cohort 2 (9.7%), the latter comprised fewer excessive steroid users (20.0% vs. 29.7%). Severe disease was associated with excessive steroid use in cases with UC, but not with CD.Conclusions: Although, overall steroid use was relatively low in South Korean patients with IBD, one-third of steroid users used them excessively, and one-third among these used excessive steroids inappropriately. High disease activity was the main risk factor for excessive steroid use which may potentially be reduced by physician education, especially in cases with UC. Active screening to minimize excessive and inappropriate steroid use through physician education should be considered.

Supported liquid extraction coupled to gas chromatography-selective mass spectrometric scan modes for serum steroid profiling

Moon, Ju-Yeon,Lee, Hye Suk,Kim, Jun Ho,Lee, Jin Hyup,Choi, Man Ho Elsevier 2018 Analytica chimica acta Vol.1037 No.-

<P><B>Abstract</B></P> <P>Although, steroid profiling is being applied in clinical and biochemical studies, improvement of the technique is still needed for accurate quantification of steroids in case of limited biological sample volumes. To improve analytical sensitivity and selectivity in comparison to that of conventional methods, a method that comprises supported liquid extraction (SLE) and gas chromatography-mass spectrometry with a combination of selected-reaction and selected-ion monitoring modes (GC-SRM/SIM-MS) was developed. Here, this combination of SLE purification with GC-MS method was optimized with 37 different types of steroids and the results were compared to a solid-phase extraction (SPE) method. The devised assay led to an increase in extraction efficiency with the good chromatographic selectivity through a single extraction step. The limits of quantification of the serum steroids, ranged from 0.2 to 5 ng mL<SUP>−1</SUP>, except for cholesterol (0.2 μg mL<SUP>−1</SUP>), and the correlation coefficients for calibration curves were higher than 0.99. The precision and accuracy were 1.4%–10.5% and 82.7%–115.3%, respectively. The overall recoveries of 30 steroids ranged from 62.1% to 104.3%, while that of 7 sterols was 44.7%–75.7%. Then, this validated method was applied to monitor the serum steroid levels of mice, which showed significant sex and age dependent metabolic patterns. This technique can be used to evaluate the metabolic changes occurring in animal models as well as in clinical patients.</P> <P><B>Highlights</B></P> <P> <UL> <LI> GC-MS-based analysis for different types of serum steroids was evaluated. </LI> <LI> All 37 steroids were measured in SIM and SRM simultaneously. </LI> <LI> Supported liquid extraction (SLE) ensured a good chromatographic selectivity. </LI> <LI> The validated method showed sex and age dependent changes of mouse serum steroids. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Improved detectability of sex steroids from frozen sections of breast cancer tissue using GC-triple quadrupole-MS

Moon, Ju-Yeon,McNamara, Keely May,Lee, Jung-Jin,Chung, Bong Chul,Sasano, Hironobu,Choi, Man Ho Elsevier 2018 The Journal of steroid biochemistry and molecular Vol.178 No.-

<P><B>Abstract</B></P> <P>Sex steroids in clinical endocrinology have been mainly investigated with peripheral blood and urine samples, while there is limited information regarding the local levels within tissues. To improve analytical properties of sex steroids from trace amounts of tissue samples, two-phase extractive ethoxycarbonlyation and subsequent pentafluoropropionyl derivatization coupled to gas chromatography–tandem mass spectrometry (GC–MS/MS) was developed. The optimized analytical conditions led to excellent chromatographic separation of 15 estrogens, 6 androgens, and 2 progestins. The quantitative results were calculated based on <I>in-house</I> control samples as the steroid-free tissues, and the precision and accuracy were 4.2%–26.8% and 90.8%–116.4%, respectively. The on-column limit of quantification was from 180 fg to 0.5 pg for androgens and estrogens, and 1.25 pg for progestins, which were found to be linear (<I>r</I> <SUP>2 </SUP>> 0.990). The validated method was then applied to quantify 7 sex steroids from three 100-μm-thick frozen breast tissue slices from postmenopausal patients with breast cancer. This is the first report on the improved GC–MS/MS method for the detection of androgens and pregnenolone from breast cancer tissues, and it can be a useful technique to measure the local levels of sex steroids, thus, enhancing our understanding of the pathophysiological significances of steroidogenesis.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Sex steroids were measured from trace amounts of tissue samples. </LI> <LI> Extractable alkyloxycarbonylation improved chromatographic properties. </LI> <LI> Pentafluroropropionylation produces characteristic ions in mass spectrometry. </LI> <LI> GC–MS/MS resulted in a sensitive detection of sex steroids from frozen breast tissue slices. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Alternative Sample Preparation Techniques in Gas Chromatographic-Mass Spectrometric Analysis of Urinary Androgenic Steroids

Cho, Young-Dae,Choi, Man-Ho Korean Chemical Society 2006 Bulletin of the Korean Chemical Society Vol.27 No.9

The following study describes the gas chromatography-mass spectrometry (GC-MS) based screening and confirmation analysis of urinary androgenic steroids. Four commercially available solid-phase extraction (SPE) cartridges, Serdolit PAD-1, Sep-pak $C_{18}$, amino-propyl, and Oasis HLB, and three different extractive organic solvents, diethyl ether, methyl tert-butyl ether (MTBE), and n-pentane, were tested for sample preparation. Overall, Oasis HLB combined with MTBE extraction provided the highest recoveries in 39 of 46 total androgenic steroids examined and it showed a good extraction yield (>82.1%) for polar steroids, such as metabolites of fluoxymesterone, oxandrolone, and stanozolol, which gave a poor recovery in both n-pentane (9.2-64.3%) and diethyl ether (22.2-73.6%) extractions. All SPE sorbents tested showed potential, because they were efficient in extraction for most or selective steroids. When applied to positive urine samples based on the results obtained, the present method allowed selective and sensitive analysis for detection of urinary androgenic steroids. The experiments showed that the high-resolution MS method is clearly more efficient than the low-resolution MS technique for the detection of many urinary steroids. However, comprehensive sample clean-up procedures also might be needed especially in confirmation analysis to increase detectability.

Alternative Sample Preparation Techniques in Gas Chromatographic-Mass Spectrometric Analysis of Urinary Androgenic Steroids

Young-Dae Cho,최만호 대한화학회 2006 Bulletin of the Korean Chemical Society Vol.27 No.9

The following study describes the gas chromatography-mass spectrometry (GC-MS) based screening and confirmation analysis of urinary androgenic steroids. Four commercially available solid-phase extraction (SPE) cartridges, Serdolit PAD-1, Sep-pak C18, amino-propyl, and Oasis HLB, and three different extractive organic solvents, diethyl ether, methyl tert-butyl ether (MTBE), and n-pentane, were tested for sample preparation. Overall, Oasis HLB combined with MTBE extraction provided the highest recoveries in 39 of 46 total androgenic steroids examined and it showed a good extraction yield (>82.1%) for polar steroids, such as metabolites of fluoxymesterone, oxandrolone, and stanozolol, which gave a poor recovery in both n-pentane (9.2-64.3%) and diethyl ether (22.2-73.6%) extractions. All SPE sorbents tested showed potential, because they were efficient in extraction for most or selective steroids. When applied to positive urine samples based on the results obtained, the present method allowed selective and sensitive analysis for detection of urinary androgenic steroids. The experiments showed that the high-resolution MS method is clearly more efficient than the low-resolution MS technique for the detection of many urinary steroids. However, comprehensive sample clean-up procedures also might be needed especially in confirmation analysis to increase detectability.

Efficacy and Safety of a Steroid-Free Immunosuppressive Regimen after Liver Transplantation for Hepatocellular Carcinoma

Qiang Wei,Xiao Xu,Chao Wang,Runzhou Zhuang,Li Zhuang,Lin Zhou,Haiyang Xie,Jian Wu,Min Zhang,Yan Shen,Weilin Wang,Shusen Zheng 거트앤리버 소화기연관학회협의회 2016 Gut and Liver Vol.10 No.4

Background/Aims: We aimed to evaluate the efficacy and safety of an immunosuppressive regimen without steroids after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods: Sixty-six HCC patients who underwent an immunosuppressive regimen without steroids after LT were enrolled in the steroid-free group. The preoperative characteristics and postoperative outcomes of these patients were compared with those of 132 HCC recipients who were placed on an immunosuppressive regimen using steroids (steroid group). The incidence of acute rejection, HBV recurrence, infection, and new-onset diabetes mellitus and the overall and tumor-free survival rates were compared between the two groups. Results: Differences were not observed in the 1-year (83.3% vs 97.0%, p=0.067), 3-year (65.4% vs 75.8%, p=0.067) or 5-year (56.3% vs 70.7%, p=0.067) patient survival rates or in the 1-year (62.1% vs 72.7%, p=0.067), 3-year (49.8% vs 63.6%, p=0.067) or 5-year (48.6% vs 63.6%, p=0.067) tumor-free survival rates between the two groups, respectively. In the steroid-free group, the patients who fulfilled the Milan criteria had higher overall and tumor-free survival rates than those in the steroid group (p<0.001). The prevalence of HBV recurrence (3.0% vs 13.6%, p=0.02) was significantly lower in the steroid-free group compared with the steroid group. Conclusions: After LT, an immunosuppressive regimen without steroids could be a safe and feasible treatment for HBVrelated HCC patients, thus resulting in the reduction of HBV recurrence. Based on the observed survival rates, patients who fulfill the Milan criteria may derive benefits from steroidfree immunosuppression.