• Tuberculosis and Respiratory Diseases
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• 제79권4호
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• pp.307-311
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• 2016

Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.

• 대한유전성대사질환학회지
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• 제14권2호
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• pp.195-199
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• 2014

X 연관 부신백질이영양증(adrenoleukodystrophy, X-ALD)는 성염색체 Xq28에 위치한 ABCD1 유전자의 돌연변이에 의해 발생하며, 매우 긴 사슬 지방산(saturated very long chain fatty acids, VLCFA) 운반의 장애로 뇌와 척수의 백질과 부신 피질을 포함한 모든 조직에 VLCFA가 쌓이게 되어 중추와 말초 신경 조직 내에 탈수초(demyelination)가 진행되고, 부신 피질의 기능 저하가 나타나게 된다. X-ALD의 임상적 증상은 매우 다양하나, 크게 3가지 표현형으로 나누어 대뇌 부신백질형성 장애(cerebral ALD), 부신 척수 신경병증(adrenomyeloneuropathy), 부신 피질 기능 저하 즉 애디슨병(Addison's disease only ALD)으로 나눌 수 있다2). 부신 피질 기능 저하 증세만을 보이는 Addison's disease only ALD의 경우 주로 2세에서 7.5세에 발생하며, 증세는 구토, 위약, 혼수, ACTH 분비 증가에 따른 색소 과다 침착(hyperpigmentation)으로 나타나고 발생 당시에는 신경학적 증세가 동반되지 않는다. 저자들은 구역, 구토, 탈수, 저혈당 및 저혈압 등의 증상 없이 색소 과다 침착이 부신 피질 기능 저하의 유일한 증세였던 환아를 혈장 VLCFA 검사를 통해 X-ALD로 진단하였고, ABCD1 유전자 분석 검사에서 c.1992-2A>G 변이를 확인하였다. 국내에서 색소 과다 침착만을 보이는 환아가 X-ALD로 진단받은 보고는 찾을 수 없었으며, 국내에서 보고되지 않은 돌연변이로 이를 보고하는 바이다. X-ALD 환아의 장기적인 예후 예측과 자세한 상담을 위해서 유전자형과 표현형의 상관관계에 대한 더 많은 연구가 필요하며, 이를 위해 유전자형에 따른 증상과 예후에 대한 자료가 공유되어야 할 것이다.

• 한국임상수의학회지
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• 제29권5호
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• pp.400-403
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• 2012

10년령의 수컷 푸들이 복부팽만, 등쪽 몸통 부위 탈모, 간비대와 혈청 알칼리인산분해효소의 지속적인 상승으로 전북대학교 수의과대학 동물병원에 내원하였다. 간 생검 및 미세침흡인세포 검사법과 PAS 염색을 실시한 결과 공포성 간병증 및 간세포에 글리코겐이 침착된 것을 확인 하였다. ACTH 자극 시험 실시 전 후 코티솔 및 부신과 관련된 성 호르몬의 농도를 측정하였다. 측정결과 안드로스텐디온, 프로게스테론 및 수산화 프로게스테론의 상승을 관찰할 수 있었으며 코티솔농도는 정상 범위내에 존재하였다. 진단은 성호르몬과 관련된 비정형의 부신피질 기능 항진증으로 내렸으며 치료는 트릴로스탄으로 하였다. 치료 8주 후 등 부위의 탈모를 포함한 임상증상들이 개선되었다.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.149-155
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• 2012

Background: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). Methods: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. Results: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). Conclusion: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.

• The Korean Journal of Pain
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• 제33권2호
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• pp.192-198
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• 2020

Background: Previous studies have shown varying results between lumbosacral transforaminal epidural steroid injections (TFESIs) performed with particulate versus non-particulate corticosteroids. The purpose of this study was to investigate the difference in pain relief and functional improvement between particulate and nonparticulate lumbosacral TFESIs in patients who had undergone both injections, sequentially. Methods: This was a self-controlled, retrospective study of 20 patients who underwent both a methylprednisolone and a dexamethasone TFESI to the same vertebral level and side. Primary outcomes included pain relief according to the visual analogue scale (VAS) and functional improvement determined by a yes/no answer to questions regarding mobility and the activities of daily living. Post-injection data was recorded at 2, 3, and 6 months. Results: A decrease in VAS scores of -3.4 ± 3.0 (mean ± standard deviation), -3.1 ± 3.1, and -2.8 ± 3.4 was seen for the methylprednisolone group at 2, 3, and 6 months, respectively. Similar decreases of -3.9 ± 3.5, -3.4 ± 2.8, and -2.3 ± 3.4 were seen in the dexamethasone group. There was no significant difference in pain relief at any point between the two medications. The percentage of subjects who reported improved function at 2, 3, and 6 months was 65%, 51%, and 41%, respectively, for the methylprednisolone group and 75%, 53%, and 42% for the dexamethasone group. Conclusions: These findings support the use of non-particulate corticosteroids for lumbosacral TFESIs in the context of documented safety concerns with particulate corticosteroids.

• 한국발생생물학회지:발생과생식
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• 제6권2호
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• pp.105-110
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• 2002

포유동물의 생식을 조절하는 다수의 호르몬 가운데 가장 중요한 것들로 난소로부터의 estrogen과 progesterone을 들 수 있다. 반면 다양한 스트레스 인자들은 암컷의 성 반응 행동과 번식을 억제함이 잘 알려졌다. 이러한 스트레스가 가해지는 동안 부신에서는 카테콜아민(catecholamine)이 다량 분비되어 위기 상황에 대처하며 이 과정에서 생식 현상의 억제가 일어나는 것으로 추정된다. 본 연구에서는 생식호르몬 분비와 성 행동 양식에 광범위한 영향을 미침이 알려진 카테콜아민 중 특히 부신의 norepinephrine(NE)과 epinephrine(E) 합성ㆍ분비 양상과 발정주기 간의 상관관계를 조사하였다. 이를 위해 HPLC-ECD를 사용하여 주기 중인 흰쥐 부신 수질내 NE와 E함량과 체외 배양한 부신으로부터의 분비를 조사하였다. NE 함량은 proestrus에서 증가하기 시작하여 diestrus I에서 최고에 도달하였고, diestrus II에 최소치로 감소하였다. 부신 내 E 함량의 최고치는 proestrus, 그리고 최저치는 diestrus II에서 관찰되었다. 흰쥐 부신 내 NE : E ratio는 diestrus I에서 1 : 4.81로 가장 낮았고 기타 시기에는 1 : 6.13～7.02였다. 체외 배양한 흰쥐 부신으로부터의 NE 분비는 diestrus II에서 가장 낮았으며 estrus에서 최고에 도달하였고, proestrus에서의 분비 역시 diestrus II 때보다 유의성있게 높았다. E분비의 최고치는 estrus에서, 그리고 최저치는 diestrus 떼서 II 관찰되었다. 한편 배양액 중 Ne : E ratio는 estrus에서 1 : 3.32로 가장 높았고 기타 시기에는 1 : 2.34～2.65였다. 본 연구 결과는 (1) 흰쥐 부신에서 카테콜아민 생성과 분비 양상이 발정주기 중 역동적으로 변화하며, (2) NE로부터 E로의 전환이 발정주기 중 stage-specific하게 일어남을 나타내는 것으로서, 이는 카테콜아민 합성율을 결정하는 rate limiting enzyme인 tyrosine hydroxylase(TH)와 NE에서 E로의 전환 과정을 매개하는 phenylethanolamine-N-methyltransferase(PNMT)의 발현과 활성이 중추신경계에서와 유사하게 생식호르몬, 특히 estrogen and/or progesterone의 영향을 받음을 시사한다.

• 한국가축번식학회지
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• 제19권4호
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• pp.307-322
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• 1996

The corpus luteum (CL) is formed by the action of a surge of luteinizing hormone (LH) on the pre-ovulatory follicle. Luteal cells derived from granulosa and theca interna cells continue to secrete progesterone for about two weeks. LH in domestic animals is essential for the normal secretion of progesterone at all stages of the luteal phase. For this process in the rodents, 20$\alpha$-hydroxysteroid dehydrogenase (20$\alpha$-HSD) is indispensable. 20$\alpha$-HSD is an enzyme to be a biologically inactive steroid. This enzyme plays a critical role in the regulation of the rat luteal function and reported to be present in steroid-producing tissues such as the testis and adrenal gland. We have purified 20$\alpha$-HSD and found two distinct 20$\alpha$-HSD molecules (HSD-1 and HSD-2). Their molecular weights are both estimated to be 33kd.The amino acid compositions of HSD-1 and HSD-2 are mostly similar, but there is a slight difference in the content of lysine. We demonstrated that 1) CL of previous generations contribute more to whole ovarian 20$\alpha$-HSD activity, 2) newly formed corpora lutea contain only 20$\alpha$-HSD-1 activity, and 3) old CL express activities of each HSD isozyme as shown in the luteal tissue of cycling rats on the day of diestrus where only degenerating old CL exist. The increase in 20$\alpha$-HSD activity identified seems to be related to the increase in the numbers of 20$\alpha$-HSD-positive cells. Interestingly, 20$\alpha$-HSD-1 activities were strongly found in the follicle fluids and theca interna cells by immunohistochemical study. Thus, the activity of 20$\alpha$-HSD may be related to a survival mechanism of those luteal cells and follicles remaining in the ovaries. Luteal cells arise from two sources. The small luteal cells are all of theca cell origin, while the large luteal cells are mainly of granulosa cell origin. CL of Korean Native Cattle, as those of other animal species, contains two morphologycally and functionally distinct luteal cell populations, such as small and large luteal cells as well as nonluteal cells. In all reproductive states except in the late luteal phase, the bovine CL also contained more small luteal cells than large luteal cells. Luteal tissue secretes a variety of growth factors (proteins) and the pattern of secretion changes during all stages of the luteal phase. These growth factors could be important in regulating the function of the bovine corpus luteum and may act in a potential endocrine autocrine and paracrine mechanisms. Therefore, further work has to be done to elucidate the role of growth factors in the ovary, especially in the corpus luterum. Interest should be focussed on interaction of these growth factors in the regulation of luteal cell and the localization of cytokine synthesis in differnet luteal cells.

• Journal of Genetic Medicine
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• 제1권1호
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• pp.27-31
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• 1997

Steroid 21 hydroxylase deficiency is a major cause of congenital adrenal hyperplasia (CAH) and is caused by genetic impairment of the gene (CYP21B). In the human genome, CYP21B is located within the MHC class III region on the short arm of chromosome 6. Most of the genes in this region are highly polymorphic and crowded. Also the CYP21B gene is accompanied by its pseudogene (CYP21A) and tandemly arranged with two genes of fourth component of complement. This highly complex gene cluster in this area may predispose genetic instability of CYP21, i.e. mutations. In this study, tried to investigate the frequency of duplication and deletion of CYP21 and patterns of the genetic alterations of these genes.We also compared the genetic alteration in normal subjects with those of the CAH patients. The results showed that 15% of the normal korean population have duplication or deletion of CYP21. There was one normal subject with heterozygous deletion of CYP21B. Of the 5 CAH patients examined, 2 were found to show abnormal patterns. One was a large-scale gene conversion and the other a gene conversion associated with deletion involving both CYP21B and C4 locus II gene. Through this study, we carne to the conclusion that the duplication or even deletion of CYP21 and C4 might be quite a common event in the Korean population and these rearrangements must be regarded as polymorphisms. It could contribute to a high incidencs of CAH by providing a genetic pool of instable CYP21.

• The Korean Journal of Pain
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• 제18권1호
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• pp.15-18
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• 2005

Background: Epidural steroid injections (ESI) have been used widely for the treatment of back and radiating extremity pain. Although its effects on the metabolic and endocrine system have been studied, the effects following repeated injections remain to be determined. We studied the effects of three repeated caudal epidural injections of low dose triamcinolone. Methods: the subject were 10 elderly women with spinal stenosis. Caudal epidural injections were performed biweekly. Triamcinolone (20 mg), mixed with 15 ml of 0.25% lidocaine, was used as the ESI injectate. The procedures were performed with the patient in the prone position. Blood sampling was performed just before the first injection, and used as the baseline, and then just before each injection on the same day of the 2nd and 4th weeks, with the last samples taken 2 weeks after the third injection. Results: The blood glucose concentrations showed no significant changes. The blood cortisol and ACTH concentrations were significantly decreased after the first injection, but there were no further decreases after each of the subsequent injections. The cortisol concentrations were maintained within the normal range. Conclusion: Caudal epidural injections, with low dose triamcinolone, suppressed the hypothalamus-pituitary-adrenal (HPA) axis, but no further suppression followed the subsequent repeated injections. Three consecutive caudal injections at 2 week intervals seems to be a safe procedure.

• Environmental Analysis Health and Toxicology
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• 제31권
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• pp.10.1-10.8
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• 2016

Objectives Aromatase inhibitors that block estrogen synthesis are a proven first-line hormonal therapy for postmenopausal breast cancer. Although it is known that standardized extract of Ginkgo biloba (EGb761) induces anti-carcinogenic effects like the aromatase inhibitors, the effects of EGb761 on steroidogenesis have not been studied yet. Therefore, the effects of EGb761 on steroidogenesis and aromatase activity was studied using a H295R cell model, which was a good in vitro model to predict effects on human adrenal steroidogenesis. Methods Cortisol, aldosterone, testosterone, and $17{\beta}$-estradiol were evaluated in the H295R cells by competitive enzyme-linked immunospecific assay after exposure to EGb761. Real-time polymerase chain reaction were performed to evaluate effects on critical genes in steroid hormone production, specifically cytochrome P450 (CYP11/ 17/19/21) and the hydroxysteroid dehydrogenases ($3{\beta}$-HSD2 and $17{\beta}$-HSD1/4). Finally, aromatase activities were measured with a tritiated water-release assay and by western blotting analysis. Results H295R cells exposed to EGb761 (10 and $100{\mu}g/mL$) showed a significant decrease in $17{\beta}$-estradiol and testosterone, but no change in aldosterone or cortisol. Genes (CYP19 and $17{\beta}$-HSD1) related to the estrogen steroidogenesis were significantly decreased by EGb761. EGb761 treatment of H295R cells resulted in a significant decrease of aromatase activity as measured by the direct and indirect assays. The coding sequence/Exon PII of CYP19 gene transcript and protein level of CYP19 were significantly decreased by EGb761. Conclusions These results suggest that EGb761 could regulate steroidogenesis-related genes such as CYP19 and $17{\beta}$-HSD1, and lead to a decrease in $17{\beta}$-estradiol and testosterone. The present study provides good information on potential therapeutic effects of EGb761 on estrogen dependent breast cancer.