• Tuberculosis and Respiratory Diseases
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• v.79 no.3
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• pp.111-120
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• 2016

Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

• Tuberculosis and Respiratory Diseases
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• v.73 no.6
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• pp.303-311
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• 2012

Background: This study was designed to analyze the efficacy of gefitinib as a second-line therapy, according to the clinical characteristics in Korean patients with non-small-cell lung cancer (NSCLC). Methods: In this Phase IV observational study, we recruited patients, previously failed first-line chemotherapy, who had locally advanced or metastatic NSCLC, and who were found to be either epidermal growth factor receptor (EGFR) mutation-positive or satisfied 2 or more of the 3 characteristics: adenocarcinoma, female, and non-smoker. These patients were administered with gefitinib 250 mg/day, orally. The primary endpoints were to evaluate the objective response rate (ORR) and to determine the relationship of ORRs, depending on each patient's characteristics of modified intent-to-treat population. Results: A total of 138 patients participated in this study. One subject achieved complete response, and 42 subjects achieved partial response (ORR, 31.2%). The subgroup analysis demonstrated that the ORR was significantly higher in patients with EGFR mutation-positive, compared to that of EGFR mutation-negative (45.8% vs. 14.0%, p=0.0004). In a secondary efficacy variable, the median progression-free survival (PFS) was 5.7 months (95% confidence interval, 3.9~8.4 months) and the 6-month PFS and overall survival were 49.6% and 87.9%, respectively. The most common reported adverse events were rash (34.4%), diarrhea (26.6%), pruritus (17.5%), and cough (15.6%). Conclusion: Gefitinib was observed in anti-tumor activity with favorable tolerability profile as a second-line therapy in these selected patients. When looking at EGFR mutation status, EGFR mutation-positive showed strong association with gefitinib by greater response and prolonged PFS, compared with that of EGFR mutation-negative.

• Tuberculosis and Respiratory Diseases
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• v.66 no.5
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• pp.349-357
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• 2009

Background: The treatment success rates in patients with tuberculosis are known to be lower in the private sector compared to the public sector. To improve treatment outcomes in the private sector we developed a public-private collaboration model for strengthening health education and case holding activities with public health nursing in the private sector. Methods: We performed a prospective cohort study in new smear positive pulmonary tuberculosis patients treated at private hospitals, selected by non-randomization, with an intervention consisting of health education and case holding activities by specially trained public health nurses (intervention group) results were compared with cases treated without the intervention (conventional group). Physicians were asked to treat both groups routinely. The treatment outcomes of patients under treatment by the National Tuberculosis Programme were also analyzed for comparison. Results: There were 172 cases each in the intervention and conventional groups. The mean age was 48.9${\pm}$19.0 and 48.2${\pm}$19.7 in the respective groups (p=0.66). The PHN interacted with the cases in the intervention group by initial face to face interview and telephone calls an average of 7.1${\pm}$9.2 times during the initial six months. The intervention group showed a significantly higher treatment success rate, 91.6%, (Rate Ratio [RR]; 1.23, 95% Confidence Interval [CI]; 1.12-1.36), lower default, 3.6%, (RR; 0.31, 95% CI; 0.13-0.75) and transfer-out rate, 3.0%, (RR; 0.32, 95% CI; 0.12-0.86) than the conventional group where they were: 75.0%, 11.6%, 9.3%, respectively. The success rate was even higher than the rate (80.5%) of 1,027 cases treated in health centers (RR; 1.11, 95% CI; 1.05-1.17). Of the completed cases in the intervention group, 82.2% regarded the role of the public health nurse as very helpful. Conclusion: The treatment success rate, of tuberculosis patients in the private sector, was significantly improved by an intervention using a public-private collaboration model.

• Tuberculosis and Respiratory Diseases
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• v.66 no.6
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• pp.457-462
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• 2009

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.

• Tuberculosis and Respiratory Diseases
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• v.81 no.4
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• pp.311-318
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• 2018

Background: The aim of this study was to examine the influence of body mass index (BMI) on the development of acute kidney injury (AKI) in critically ill patients in intensive care unit (ICU). Methods: Data of patients admitted to medical ICU from December 2011 to May 2014 were retrospectively analyzed. Patients were classified into three groups according to their BMI: underweight (< $18.5kg/m^2$), normal ($18.5-24.9kg/m^2$), and overweight (${\geq}25kg/m^2$). The incidence of AKI was compared among these groups and factors associated with the development of AKI were analyzed. AKI was defined according to the Risk, Injury, Failure, Loss of kidney function, and End-stage (RIFLE) kidney disease criteria. Results: A total of 468 patients were analyzed. Their mean BMI was $21.5{\pm}3.9kg/m^2$, including 102 (21.8%) underweight, 286 (61.1%) normal-weight, and 80 (17.1%) overweight patients. Overall, AKI occurred in 82 (17.5%) patients. The overweight group had significantly (p<0.001) higher incidence of AKI (36.3%) than the underweight (9.8%) or normal group (15.0%). In addition, BMI was significantly higher in patients with AKI than that in those without AKI ($23.4{\pm}4.2$ vs. $21.1{\pm}3.7$, p<0.001). Multivariate analysis showed that BMI was significantly associated with the development of AKI (odds ratio, 1.893; 95% confidence interval, 1.224-2.927). Conclusion: BMI may be associated with the development of AKI in critically ill patients.

• Tuberculosis and Respiratory Diseases
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• v.81 no.4
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• pp.339-346
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• 2018

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure to evaluate suspicious lymph node involvement of lung cancer because computed tomography (CT) and $^{18}F$-fluorodeoxyglucose positron emission tomography-CT (PET-CT) have limitations in their sensitivity and specificity. There are a number of benign causes of false positive lymph node such as anthracosis or anthracofibrosis, pneumoconiosis, old or active tuberculosis, interstitial lung disease, and other infectious conditions including pneumonia. The purpose of this study was to evaluate possible causes of false positive lymph node detected in chest CT or PET-CT. Methods: Two hundred forty-seven patients who were initially diagnosed with lung cancer between May 2009 and December 2012, and underwent EBUS-TBNA to confirm suspicious lymph node involvement by chest CT or PET-CT were analyzed for the study. Results: Of 247 cases, EBUS-TBNA confirmed malignancy in at least one lymph node in 189. The remaining 58 patients whose EBUS-TBNA results were negative were analyzed. Age ${\geq}65$, squamous cell carcinoma as the histologic type, and pneumoconiosis were related with false-positive lymph node involvement on imaging studies such as chest CT and PET-CT. Conclusion: These findings suggest that lung cancer staging should be done more carefully when a patient has clinically benign lymph node characteristics including older age, squamous cell carcinoma, and benign lung conditions.

• Biomedical Science Letters
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• v.2 no.2
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• pp.223-229
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• 1996

HLA-B27 gene, one of the HLA-class I molecule, is strongly associated with ankylosing spondylitis. It has been most frequently used as a disease-correlated HLA gene by clinicians. In most laboratories, conventional HLA-B27 typing is still performed by cell cytotoxicity tests or fluorescence serology with specific antibodies. In this study, DNA typing method for HLA-B27 was developed by using group specific Polymerase Chain Reaction (PCR). Four HLA-B27 cell lines (HOM-2, JESTHOM, WT24 and BTB) and fifty six B27 Korean individuals defined by serology were used. The results of control cell and B-27 positive individual samples were correlated well with the data which was performed by serological method. All of B27 positive PCR products gave positive signals on Southern blot hybridization with B27 specific probe. This study shows that the HLA-B27 DNA typing is a relatively simple, fast and practical tool for the determination of the HLA-B27 gene in routine clinical laboratory work.

• Biomedical Science Letters
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• v.5 no.1
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• pp.75-84
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• 1999

In order to study the effects of $\alpha$-tocopherol acetate in glomerular injury, the minimal change nephrosis disease was induced by puromycin aminonucleoside (PAN) in spontaneously hypertensive rats, and we examined biochemical analysis in serum and morphological changes. The experimental animals were divided to control, PAN-treated (30 mg/kg, I.p.), vitamin E-treated (200 mg/kg, P.O.), and PAN+vitamin E-treated groups. After PAN injection, the rate of increase of body weight was lower than the other treatments. In addition, at 8 days after PAN injection, total protein content in serum was the lowest, whereas both blood urea nitrogen and serum creatinine contents were the highest in all experimental groups, which their changes of serum parameters were statistically significant. In morphological changes, the glomerular tissue at 8 days after PAN injection clearly showed obstruction of urinary space and proliferation of mesangial cells, and that loss and fusion of pedicles, vacuolization and edema of endothelial cells, and thickness of basal lamina were ultrastructurally showed in the glomerulus. Glomerular injury was significantly prevented by administration of vitamin E having an antioxidant effect. It suggested that the glomerular injury induced by PAN was accelerated by hypertension, and renal dysfunction might be induced by oxidative injury.

• Biomedical Science Letters
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• v.23 no.3
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• pp.251-260
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• 2017

Platelet activation is essential at the sites of vascular injury, which leads to hemostasis through adhesion, aggregation, and secretion process. However, potent and continuous platelet activation may be an important reason of circulatory disorders. Therefore, proper regulation of platelet activation may be an effective treatment for vascular diseases. In this research, inhibitory effects of cordycepin (3'-deoxyadenosine) on platelet activation were determined. As the results, cordycepin increased cAMP and cGMP, which are intracellular $Ca^{2+}$-antagonists. In addition, cordycepin reduced collagen-elevated $[Ca^{2+}]_i$ mobilization, which was increased by a cAMP-dependent protein kinase (PKA) inhibitor (Rp-8-Br-cAMPS), but not a cGMP-protein kinase (PKG) inhibitor (Rp-8-Br-cGMPS). Furthermore, cordycepin increased $IP_3RI$ ($Ser^{1756}$) phosphorylation, indicating inhibition of $IP_3$-mediated $Ca^{2+}$ release from internal store via the $IP_3RI$, which was strongly inhibited by Rp-8-Br-cAMPS, but was not so much inhibited by Rp-8-Br-cGMPS. These results suggest that the reduction of $[Ca^{2+}]_i$ mobilization is caused by the cAMP/A-kinase-dependent $IP_3RI$ ($Ser^{1756}$) phosphorylation. In addition, cordycepin increased the phosphorylation of VASP ($Ser^{157}$) known as PKA substrate, but not VASP ($Ser^{239}$) known as PKG substrate. Cordycepin-induced VASP ($Ser^{157}$) phosphorylation was inhibited by Rp-8-Br-cAMPS, but was not inhibited by Rp-8-Br-cGMPS, and cordycepin inhibited collagen-induced fibrinogen binding to ${\alpha}IIb/{\beta}_3$, which was increased by Rp-8-Br-cAMPS, but was not inhibited by Rp-8-Br-cGMPS. These results suggest that the inhibition of ${\alpha}IIb/{\beta}_3$ activation is caused by the cAMP/A-kinase-dependent VASP ($Ser^{157}$) phosphorylation. In conclusion, these results demonstrate that inhibitory effects of cordycepin on platelet activation were due to inhibition of $[Ca^{2+}]_i$ mobilization through cAMP-dependent $IP_3RI$ ($Ser^{1756}$) phosphorylation and suppression of ${\alpha}IIb/{\beta}_3$ activation through cAMP-dependent VASP ($Ser^{157}$) phosphorylation. These results strongly indicated that cordycepin might have therapeutic or preventive potential for platelet activation-mediated disorders including thrombosis, atherosclerosis, myocardial infarction, or cardiovascular disease.

• Korean Journal of Biological Psychiatry
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• v.15 no.1
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• pp.5-13
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• 2008

Objectives : It was the aim of the present paper to examine the impact of the apolipoprotein E(APOE) ${\varepsilon}4$ on cognitive performance in community-dwelling elderly samples with 'questionable dementia'. Methods : Total 295 samples who were diagnosed with 'questionable dementia' in the recent year and completed the Korean version of the Consortium Establish a Registry for Alzheimer's Disease(CERAD-K) neuropsychological assessment protocol, were recruited. The CDR test established score of 0.5. Genomic DNA was extracted from the venous blood and APOE genotyping was done in this group. Their cognitive performance was compared by the occurrence of the APOE ${\varepsilon}4$ allele. Results : The impact of ${\varepsilon}4$ allele was significant in the Word List Recall Test(WLRT, F=4.511, df=1, p=0.035). The 'young-old' group aged 75 years and under had a significantly lower performance on the Word List Recall Test(WLRT, F=5.090, df=1, p=0.015), but the 'old-old' group over 75 years of age had not significantly different performance on the all the item of tests in ${\varepsilon}4$+ allele group. Conclusion : The conclusion to be drawn here is that community-dwelling elderly samples with ${\varepsilon}4$ allele in 'questionable dementia' had a significantly lower performance on the Word List Recall Test in the CERAD-K neuropsychological test batteries and the effect was prominent in the 'young-old' age group.