Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

고동률,정성필,유제성,조수형,박용진,전병조,문정미,김현,김용환,김현진,이경우,최상천,박준석,박정수,김승환,서정열,박하영,김수진,강형구,홍대영,홍정화 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.4

Purpose: In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completelybanned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-inducedpoisoning. Materials and Methods: This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis. Results: We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortalityrates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independentpredictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban. Conclusion: This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestationof regulatory measures outcomes.

A Case of Type B Lactic Acidosis in Acute Leukemia

이혜승,김현정,최수정,김찬규,이남수,이규택,원종호,박희숙,홍대식 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.3

Type B lactic acidosis is a rare condition in patients with solid tumors or hematological malignancies. Although there have been several theories to explain its mechanism, the exact cause of lactic acidosis remains to be discovered. Lactic acidosis is usually related to increased tumor burden in patients with malignancy. We experienced a case of lactic acidosis in a 39-year-old man who visited an emergency room because of dyspnea, and the cause of lactic acidosis turned out to be recurrent acute leukemia. Chemotherapy relieved the degree of lactic acidosis initially, but as the disease progressed, lactic acidosis became aggravated. Type B lactic acidosis can be a clinical presentation of acute exacerbation of acute leukemia.

Polymorphism of a COLIA1 Gene Sp1 Binding Site in Korean Women with Pelvic Organ Prolapse

조혜진,정현주,김세광,조남훈,배상욱,최종락 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.4

Purpose: To evaluate the possible influence of G T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP). Materials and Methods: The study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer. Results: Two groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57°C on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p < .05. Conclusion: The polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea. Purpose: To evaluate the possible influence of G T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP). Materials and Methods: The study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer. Results: Two groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57°C on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p < .05. Conclusion: The polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea.

Point Mutation of Hoxd12 in Mice

조경원,김재영,조재우,조규혁,송창우,정한성 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6

Purpose: Genes of the HoxD cluster play a major role in vertebrate limb development, and changes that modify the Hoxd12 locus affect other genes also, suggesting that HoxD function is coordinated by a control mechanism involving multiple genes during limb morphogenesis. In this study, mutant phenotypes were produced by treatment of mice with a chemical mutagen, N-ethyl-N-nitrosourea (ENU). We analyzed mutant mice exhibiting the specific microdactyly phenotype and examined the genes affected. Materials and Methods: We focused on phenotype characteristics including size, bone formation, and digit morphology of ENU-induced microdactyly mice. The expressions of several molecules were analyzed by genome-wide screening and quantitative real-time PCR to define the affected genes. Results: We report on limb phenotypes of an ENU-induced A-to-C mutation in the Hoxd12 gene, resulting in alanine-to-serine conversion. Microdactyly mice exhibited growth defects in the zeugopod and autopod, shortening of digits, a missing tip of digit I, limb growth affected, and dramatic increases in the expressions of Fgf4 and Lmx1b. However, the expression level of Shh was not changed in Hoxd12 point mutated mice. Conclusion: These results suggest that point mutation rather than the entire deletion of Hoxd12, such as in knockout and transgenic mice, causes the abnormal limb phenotype in microdactyly mice. The precise nature of the spectrum of differences requires further investigation.

Pleural Epithelioid Hemangioendothelioma

이영주,김이정,김용태,정문재,정기천,한창훈,홍기표 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6

Epithelioid hemangioendothelioma (EHE) is a rare tumor of vascular origin. While it can be found in any tissue, it is most often found in lung and liver and usually has an intermediate behavior. EHEs originating from pleural tissue have been less frequently described than those from other sites. Furthermore, to date, all of the cited pleural EHEs were described as highly aggressive. In the present report, we describe a rare case of pleural EHE extending to lung and bone in a 31-year-old woman. The histological diagnosis was confirmed by both conventional examination and immunohistochemistry. Her disease stabilized during the 4th course of adriamycin (45mg/m(2), day 1-3), dacarbazine (300mg/m(2), day 1-3) and ifosfamide (2,500mg/m(2), day 1-3) with mesna, and she survived for 10 months after the diagnosis.

Plasma Level of IL-6 and Its Relationship to Procoagulant and Fibrinolytic Markers in Acute Ischemic Stroke

송재우,송경순,최종락,김신영,이지혁 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.2

Procoagulant or impaired fibrinolytic states as well as inflammatory reactions mediated by cytokines are likely involved in the pathogenesis of acute ischemic stroke. We examined the potential relationship between interleukin 6 (IL-6) and hemostatic markers. The procoagulant and fibrinolytic states were assessed in 46 patients with acute stroke by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT), and plasminogen-antiplasmin complex (PAP). Circulating IL-6 levels were measured using ELISA (Quantikine, R & D systems, MN, USA). Circulating IL-6 (mean, 26.5pg/mL) and PAI-1 (mean, 19.9ng/mL) levels were higher in patients with acute stroke than in healthy subjects (mean, 3.0pg/mL, 10.4ng/mL, respectively). TAT levels were statistically different according to the etiologic subtypes of stroke (atherogenic, 2.5ng/mL; lacunar 3.2ng/mL; cardiogenic 9.9ng/mL, p=0.021). Neither procoagulant levels nor fibrinolytic markers significantly correlated with circulating IL-6 levels. Our findings suggest that elevated proinflammatory cytokines during the initial hours of ischemic stroke may be an independent pathogenic factor or a consequence of the thrombotic event with no relationship to the procoagulant or fibrinolytic states.

Polymorphism of Haptoglobin in Patients with Premature Rupture of Membrane

조진경,박인양,신종철,오미경,박선주,김남훈,김인숙,김연희 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.1

Purpose: To investigate whether allelic polymorphism of haptoglobin (Hp) is associated with premature rupture of membrane (PROM), the Hp phenotypes of pregnant women with PROM were analyzed. Patients and Methods: The Hp phenotypes of 221 pregnant Korean women (187 control and 34 PROM patients) were determined by benzidine/hydrogen peroxide staining, following native polyacrylamide gel electrophoresis of hemoglobin-mixed sera. The Hp allele frequencies were calculated from the data of Hp phenotypes, and overall association with PROM was evaluated using Pearson Chi- Square test. Results: The polymorphic distribution of the patients cohort who underwent a normal delivery (control group) was similar to that of healthy Koreans. In contrast, however, patients with PROM showed significantly higher occurrence of the Hp 1-1 phenotype than control group (23.5% vs 8.0%). Hp 2-2 phenotype was lower in PROM cohort (38.2%) than in the control group (48.7%). The Hp1 allele frequency in PROM group was significantly higher than that in the control group (0.426 vs 0.297, p=0.034) with odds ratio of 1.762 (95% CI: 1.038-2.991). Conclusion: These findings suggest that pregnant Korean women who possess Hp1 allele (expressed as Hp 1-1 phenotype) have higher incidence of PROM than women with Hp2 allele (expressed as Hp 2-2 phenotype). This is the first study that evaluated the significance of Hp polymorphism with respect to the development of PROM.

Plasma Factor XIII Activity in Patients with Disseminated Intravascular Coagulation

송재우,최종락,송경순,이지혁 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.2

The objective of this study was to investigate the correlation between factor XIII (FXIII) activity and disseminated intravascular coagulation (DIC) parameters and also to evaluate the clinical usefulness of DIC diagnosis. Citrated plasma from eighty patients with potential DIC was analyzed for FXIII activity. The primary patient conditions (48 male and 32 female, mean age, 51 years) were malignancy (n= 29), infection (n=25), inflammation (n=6), heart disease (n=3), thrombosis (n=2), injury (n=2), and other miscellaneous conditions (n=13). FXIII testing was performed using the CoaLinkTM FXIII Incorporation Assay Kit (PeopleBio Inc.). Among 80 patients who were suspected to have DIC based on clinical analysis, 46 (57.5%) fulfilled the overt DIC criteria (DIC score>=5) according to the International Society of Thrombosis and Haemostasis. FXIII levels in the plasma were significantly decreased in overt DIC compared to non-overt DIC patients (mean 75.1% and 199.7% respectively, p<0.0001). Interestingly, we found a significant inverse correlation between DIC scores and FXIII activity. In addition, FXIII activity significantly correlated with other hemostatic markers that included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, and D-dimer. FXIII levels were significantly lower in patients with liver or renal dysfunction. In conclusion, FXIII cross-linking activity measurements may have differential diagnostic value as well as predictive value in patients who are suspected to have DIC.

Photodynamic Therapy for Subretinal New Vessels

이성철,배정훈,고형준,김성수,권오웅 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.2

Photodynamic therapy (PDT) involves the induction of endothelial cell death or occlusion of blood vessels. On the basis of this mechanism of action, PDT is used in the treatment of predominant classic choroidal neovascularization (CNV), if the classic component is over 50%, and in myopic CNV. This study describes 2 cases of distinctive, abnormal, large, subretinal new vessels that are thought to have originated from the choroids. Diminishment of the new vessels was observed following treatment with PDT.

Phenotypic Characterization of Ligamentum Flavum Cells from Patients with Ossification of Ligamentum Flavum

Zhao-Ming Zhong,Jian-Ting Chen 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.3

Purpose: The objective of this study was to determine the phenotypic characterization of ligamentum flavum cells from patients with ossification of the ligamentum flavum (OLF). Materials and Methods: Ligamentum flavum tissues were harvested from OLF and non-OLF patients during surgery. OLF and non-OLF cells were isolated from explant cultures. Cultured cells were analyzed using immunofluorescence staining and reverse transcriptionpolymerase chain reaction. Results: OLF cells exhibited various appearances compared with the typical fibroblastlike morphology of non-OLF cells. Expressions of collagen type I and collagen type III were observed in OLF and non-OLF cells. OLF cells uniquely expressed osteocalcin, which is a marker for osteoblasts, and collagen type II which is a marker for chondrocytes, whereas they were negative in non-OLF cells. Conclusion: These findings indicate that OLF cells have phenotypic characterization of osteoblasts and chondrocytes which could play a role in the pathophysiology of OLF. Purpose: The objective of this study was to determine the phenotypic characterization of ligamentum flavum cells from patients with ossification of the ligamentum flavum (OLF). Materials and Methods: Ligamentum flavum tissues were harvested from OLF and non-OLF patients during surgery. OLF and non-OLF cells were isolated from explant cultures. Cultured cells were analyzed using immunofluorescence staining and reverse transcriptionpolymerase chain reaction. Results: OLF cells exhibited various appearances compared with the typical fibroblastlike morphology of non-OLF cells. Expressions of collagen type I and collagen type III were observed in OLF and non-OLF cells. OLF cells uniquely expressed osteocalcin, which is a marker for osteoblasts, and collagen type II which is a marker for chondrocytes, whereas they were negative in non-OLF cells. Conclusion: These findings indicate that OLF cells have phenotypic characterization of osteoblasts and chondrocytes which could play a role in the pathophysiology of OLF.