Contribution of Respiratory Viral Infection to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: a 2-year Prospective Study

곽현정,송준석,김웅준,박동원,문지용,김태형,손장원,윤호주,신동호,박성수,김상헌 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Introduction: Acute exacerbation is a characteristic of chronic obstructive pulmonary disease (COPD) and is mostly associated with acute respiratory infection with various viruses and bacteria. However, the contribution of viral infection to the acute exacerbation of COPD is not well established. We investigated the association of viral infection with acute COPD exacerbation and the clinical characteristics of acute exacerbation of COPD associated with viral infection.Methods: Patients with acute exacerbation of COPD who were hospitalized in Hanyang University Hospital, Seoul, Korea, over a 2-year period were prospectively enrolled in the study. Nasopharyngeal swabs were taken and viruses were identified by multiplex PCR. Clinical characteristics and courses were compared between patients with exacerbation associated with viral infection and those with non-viral causes. Results: A total of 278 episodes of acute exacerbation were recorded in 215 patients with COPD. The age range of the patients was 45-92 years; 65.1% were male. Viral infection was detected in 78 episodes (28.1%), with 86 viruses in 64 patients. The most common virus was rhinovirus (39.5%), followed by coronavirus (11.6%), influenza A (10.5%). The frequency of acute exacerbation of COPD associated with viral infection was higher in female subjects, never-smokers and light smokers, patients with cor pulmonale, and patients with a history of admissions due to exacerbation of COPD. Conclusions: These findings suggest that viral infection is a frequent cause of hospitalization for acute exacerbation of COPD, with rhinovirus being the most common etiological agent.

소아에서 후두마스크를 이용한 저유량마취의 유용성

곽현정,임필재,손수창,박영환,김명옥 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6

Background: Low flow anesthesia provides many advantages, including reduced cost, conservation of body heat and airway humidity. This study was performed to compare low flow anesthesia with high flow anesthesia and to investigate whether the advantages of low flow anesthesia during positive pressure ventilation can be combined with the laryngeal mask airway in paralyzed pediatric patients. Methods: Thirty-one pediatric patients of ASA physical status 1 or 2 were studies and divided into two groups according to the fresh gas flow (FGF) in the breathing system; low flow group (FGF ≒ 1 L/min, n=17) or high flow group (FGF ≒ 4 L/min, n=14). Each respiratory parameter was measured when a steady state was reached at 20 min after induction. Results: There were no significant differences of respiratory data between the two groups except that the inspired oxygen concentration was lower in the low flow group than in the high flow group. Hemodynamic changes with the laryngeal mask airway insertion were not statistically significant. Conclusions: A laryngeal mask airway is an effective airway device for low flow anesthesia as well as for high anesthesia in paralyzed pediatric patients. (Korean J Anesthesiol 2002; 43: 723~727)

The Wnt/β-catenin signaling pathway regulates the development of airway remodeling in patients with asthma

곽현정,박동원,서지영,문지용,김태형,손장원,신동호,윤호주,박성수,김상헌 생화학분자생물학회 2015 Experimental and molecular medicine Vol.47 No.-

Airway remodeling is a key characteristic of chronic asthma, particularly in patients with a fixed airflow limitation. The mechanisms underlying airway remodeling are poorly understood, and no therapeutic option is available. The Wnt/β-catenin signaling pathway is involved in various physiological and pathological processes, including fibrosis and smooth muscle hypertrophy. In this study, we investigated the roles of Wnt/β-catenin signaling in airway remodeling in patients with asthma. Wnt7a mRNA expression was prominent in induced sputum from patients with asthma compared with that from healthy controls. Next, we induced a chronic asthma mouse model with airway remodeling features, including subepithelial fibrosis and airway smooth muscle hyperplasia. Higher expression of Wnt family proteins and β-catenin was detected in the lung tissue of mice with chronic asthma compared to control mice. Blocking β-catenin expression with a specific siRNA attenuated airway inflammation and airway remodeling. Decreased subepithelial fibrosis and collagen accumulation in the β-catenin siRNA-treated mice was accompanied by reduced expression of transforming growth factor-β. We further showed that suppressing β-catenin in the chronic asthma model inhibited smooth muscle hyperplasia by downregulating the tenascin C/platelet-derived growth factor receptor pathway. Taken together, these findings demonstrate that the Wnt/β-catenin signaling pathway is highly expressed and regulates the development of airway remodeling in chronic asthma.

F-93 : Free Paper Presentation ; The Role of WNT Signaling in Chronic Murine Asthma Model

곽현정,이성자,박동원,문지용,김태형,손장원,윤호주,신동호,박성수,김상헌 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Background: Airway remodeling is a main pathogenesis of impaired lung function of asthmatic patients and it is presented as subepithlial fibrosis and hypertrophy of smooth muscle. WNT signaling pathway might be suggested as a critical determinant of airway remodeling in asthmatic patients but there were few reports about direct association between asthma and WNT signal. Thus, we made a murine chronic asthma model and aimed to find out relationship between WNT signaling pathway and airway remodeling in pathogenesis of asthma. Methods: BALB/c mice, after intraperitoneal ovalbumin (OVA) sensitization on days 0 and 7, received intranasal OVA periodically days 14-94. Samples of murine lung tissue for histology and quantitative real-time PCR of WNT family, TNF-β, SMA, PDGFR, Tenscin C and SM22α, and β-catenin were obtained. Using SiRNA for β-catenin, we blocked the canonical pathway and review the tissue and samples of chronic murine asthma model. Results: The OVA-treated mice developed an extensive eosinophil and mononuclear cell inflammatory response, subendothelial fibrosis and hypertrophy of airway smooth muscle in the chronic murine asthma group. The real-time PCR and immunohistochemistry revealed that β-catenin, WNT5a, WNT7a, TNF-β, SMA, PDGFR, Tenscin C and SM22α were up-regulated in chronic asthma group and lower uptake level of them were shown in SiRNA-treated groups. Conclusion: These findings suggest that WNT/β-catenin signaling may be a contributor of airway remodeling in chronic asthma via both pathways of fibrosis and hypertrophy of smooth muscle.Background: Airway remodeling is a main pathogenesis of impaired lung function of asthmatic patients and it is presented as subepithlial fibrosis and hypertrophy of smooth muscle. WNT signaling pathway might be suggested as a critical determinant of airway remodeling in asthmatic patients but there were few reports about direct association between asthma and WNT signal. Thus, we made a murine chronic asthma model and aimed to find out relationship between WNT signaling pathway and airway remodeling in pathogenesis of asthma. Methods: BALB/c mice, after intraperitoneal ovalbumin (OVA) sensitization on days 0 and 7, received intranasal OVA periodically days 14-94. Samples of murine lung tissue for histology and quantitative real-time PCR of WNT family, TNF-β, SMA, PDGFR, Tenscin C and SM22α, and β-catenin were obtained. Using SiRNA for β-catenin, we blocked the canonical pathway and review the tissue and samples of chronic murine asthma model. Results: The OVA-treated mice developed an extensive eosinophil and mononuclear cell inflammatory response, subendothelial fibrosis and hypertrophy of airway smooth muscle in the chronic murine asthma group. The real-time PCR and immunohistochemistry revealed that β-catenin, WNT5a, WNT7a, TNF-β, SMA, PDGFR, Tenscin C and SM22α were up-regulated in chronic asthma group and lower uptake level of them were shown in SiRNA-treated groups. Conclusion: These findings suggest that WNT/β-catenin signaling may be a contributor of airway remodeling in chronic asthma via both pathways of fibrosis and hypertrophy of smooth muscle.

Comparison of the effects of sevoflurane and propofol on core body temperature during laparoscopic abdominal surgery

곽현정,민상기,In-Kyong Yi,장영진,김종엽 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.2

Background: A decrease in core body temperature caused by heat distribution depends on the anesthetic agent used. The purpose of this study is to investigate the effects of sevoflurane and propofol on core temperature during laparoscopic major abdominal surgery requiring pneumoperitoneum of more than 90 min. Methods: Fifty adult patients undergoing laparoscopic major abdominal surgery were randomly assigned to either a sevoflurane group (n = 25) or a propofol group (n = 25). In the sevoflurane group, anesthesia was induced with propofol 2 mg/kg, remifentanil 1.0 μg/kg, and maintained with 0.8-2.0 vol% sevoflurane and 0.1-0.2 μg/kg/min remifentanil. In the propofol group, anesthesia was induced with the effect-site concentration of propofol of 5.0 μg/ml and remifentanil 4 ng/ml, and maintained with the effect-site concentration of propofol of 2-3.5 μg/ml and remifentanil 3-5 ng/ml. Core body temperature was measured with an esophageal stethoscope with a temperature sensor after the start of the pneumoperitoneum (baseline) and at 15-min intervals until completion of surgery. Results: During the study period, core temperature was comparable between the two groups. When compared with baseline values, core temperatures in both groups were significantly decreased 45 min after pneumoperitoneum. Conclusions: This study demonstrated that in patients undergoing prolonged laparoscopic surgery, a decrease in core body temperature during sevoflurane-remifentanil anesthesia was not different than propofol-remifentanil anesthesia, and the incidence of hypothermia of the two groups did not differ.

Clinical Factors associated with Repeated Exacerbation of Chronic Obstructive Pulmonary Disease

곽현정,송준석,김웅준,박동원,김태형,김상헌,손장원,윤호주,신동호,박성수 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Introduction: Acute exacerbation is a natural course of chronic obstructive pulmonary disease (COPD) and repeated exacerbations are associated with decline of lung function, quality of life and mortality. However, the factors related with repeated exacerbations are not well determined. We investigated the associated factors in repeated exacerbation of COPD. Methods: Hospitalized patients with acute exacerbation of COPD were enrolled for three years (2009.01.01-2011.12.31) in a university hospital, Seoul, Korea. The rates of exacerbation were estimated during observational periods in patient with AECOPD. Clinical characteristics and courses were compared between patients with repeated exacerbations and those with not. Results: A total of 475 episodes of acute exacerbation were recorded in 208 patients with COPD (aged 69.4±10.8 years, male 64.4%). 105 patients (50.5%) had repeated episodes of exacerbations as 372 cases (2-10 per patient) from January 2009 to December 2011. Repeated exacerbations are related with characteristics of subjects like intensity of smoking, use of tiotropium, lung function and in-hospital deaths. In 52 patients had frequent exacerbations (≥ 3 exacerbations within 12months during observational periods) and these subjects had a higher prevalence of bronchiectasis, never-smoker, higher use of tiotropium and systemic steroids. Conclusions: Repeated exacerbations are relatively frequent features of patients with COPD. They are related with many clinical factors of subjects and also independently associated with in-hospital mortality.

COPD Assessment Test (CAT) and Declines of Lung Function in COPD Patients

곽현정,김사일,김상헌,김태형,손장원,윤호주,신동호,박성수 대한결핵 및 호흡기학회 2011 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.112 No.-

W^(sh)/W^(sh) 마우스 고환에서 Protein Kinase C(PKC)와 c-kit의 발현 양상

곽현정,최병민,서기석,임정식,정헌택 大韓免疫學會 1996 大韓免疫學會誌 Vol.18 No.3

Protein kinase C (PKC) is a multigene family of at least nine serine/threonine kinases that are central to many signal transduction pathways. And the expression of PKC gene is strictly con-trolled by developmental stage. Mutation of the W (c kit) gene, which encodes a transmembrane tyrosine kinase receptor, affect the development and differentiation stem cells. Most homozygous W mutant mice are sterile, due to a lack of germ cells arising during embryonic development, but one of notable exception is W */Wh mice, which are fully fertile in both sexes. In order to elucidate the biological functions of PKC S and c-kit in the testes, we have examined the expression of PKC b mRNA and c-kit mRNA in While mouse testes by means of Northern blotting. North-em blot results was demonstrated that only PKC 8, 4, 8 mRNA can be detected in normal mouse testes. PKC, 8 mRNA was weakly expressed in 7 and 8-week-old mice and highly ex-pressed by 12 weeks. The PKC 8 mRNA and the c-kit mRNA was detectable in the testes of Whl Wh mouse. These results indicated that the function of the PKC a gene is necessary for the development and the W (c-kit) gene is important for the transmission of signal in testes.

The Extended Rapid Response System: 1-Year Experience in a University Hospital

곽현정,윤인아,김상헌,손장원,신동호,윤호주,김근호,Tchun Young Lee,박성수,임영효 대한의학회 2014 Journal of Korean medical science Vol.29 No.3

The rapid response system (RRS) is an innovative system designed for in-hospital, at-riskpatients but underutilization of the RRS generally results in unexpected cardiopulmonaryarrests. We implemented an extended RRS (E-RRS) that was triggered by actively screeningat-risk patients prior to calls from primary medical attendants. These patients wereidentified from laboratory data, emergency consults, and step-down units. A fourmemberrapid response team was assembled that included an ICU staff, and the teamvisited the patients more than twice per day for evaluation, triage, and treatment of thepatients with evidence of acute physiological decline. The goal was to provide thistreatment before the team received a call from the patient’s primary physician. We soughtto describe the effectiveness of the E-RRS at preventing sudden and unexpected arrestsand in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screenedby the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRSactivations of simple consultations for invasive procedures. After E-RRS implementation,the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality ratewas reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with areduction in the in-hospital code and mortality rates.

유양돌기절제술 중 예기치 않게 발생한 폐혈전색전증

곽현정,박희연,김홍순,이경천,최성호 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.3

We report on a 45-year-old patient who sustained an intra-operative pulmonary thromboembolism during elective mastoidectomy under general anesthesia. At the end of surgery, the patient developed hemodynamic compromise and exhibited T wave inversion on electrocardiogram. Echocardiography showed an echogenic mass in the right pulmonary artery and pulmonary hypertension. Pulmonary thromboembolism is rare in the field of otolaryngology and head and neck surgery; however, it may develop, resulting in a fatal outcome. It is thus important to establish the diagnosis early and prevent such serious complications.