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박진주,서유빈,이재갑 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.3
Background Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. Materials and Methods We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). Results Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. Conclusion Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
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박진주,최이슬,고영산,김영훈,표정수,장보건,김민아,이재선,장미수,박종완,이병란 대한암학회 2018 Cancer Research and Treatment Vol.50 No.1
Purpose Lapatinib is a candidate drug for treatment of trastuzumab-resistant, human epidermal growth factor receptor 2 (HER2)–positive gastric cancer (GC). Unfortunately, lapatinib resistance renders this drug ineffective. The present study investigated the implication of forkhead box O1 (FOXO1) signaling in the acquired lapatinib resistance in HER2-positive GC cells. Materials and Methods Lapatinib-resistant GC cell lines (SNU-216 LR2-8) were generated in vitro by chronic exposure of lapatinib-sensitive, HER2-positive SNU-216 cells to lapatinib. SNU-216 LR cells with FOXO1 overexpression were generated by stable transfection of a constitutively active FOXO1 mutant (FOXO1A3). HER2 and MET in SNU-216 LR cells were downregulated using RNA interference. The sensitivity of GC cells to lapatinib and/or cisplatin was determined by crystal violet assay. In addition, Western blot analysis, luciferase reporter assay and reverse transcription–polymerase chain reaction were performed. Results SNU-216 LR cells showed upregulations of HER2 and MET, but downregulation of FOXO1 compared to parental SNU-216 cells. FOXO1 overexpression in SNU-216 LR cells significantly suppressed resistance to lapatinib and/or cisplatin. In addition, FOXO1 negatively controlled HER2 and MET at the transcriptional level and was negatively controlled by these molecules at the post-transcriptional level. A positive crosstalk was shown between HER2 and MET, each of which increased resistance to lapatinib and/or cisplatin. Conclusion FOXO1 serves as an important linker between HER2 and MET signaling pathways through negative crosstalks and is a key regulator of the acquired lapatinib resistance in HER2-positive GC cells. These findings provide a rationale for establishing a novel treatment strategy to overcome lapatinib resistance in a subtype of GC patients.
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Influences of Tobacco-Related Knowledge on Awareness and Behavior towards Smoking
박진주,임민경,윤이화,오진경,정보윤,천예진,임수진 대한의학회 2018 Journal of Korean medical science Vol.33 No.47
Background: A considerable amount of research has shown that knowledge and appropriate awareness are essential for encouraging positive behaviors and promoting health. In Korea, the roles that behavioral changes play in the prevention of cancer have been an important issue since the introduction of the 10 codes for cancer prevention in 2006. Thus, the present study investigated the associations of tobacco-related knowledge with awareness and attitudes towards positive smoking-cessation behaviors. Methods: The present study analyzed data from the 2010 national questionnaire survey (n = 1,006). This study evaluated sociodemographic characteristics, smoking status, self-rated health status, health-related interests, and the accuracy of 12 tobacco-related statements to determine knowledge level and to investigate its impact on awareness and behaviors related to smoking. These parameters were examined and staged using the Precaution Adoption Process Model. Results: A higher level of tobacco-related knowledge was significantly associated with a positive attitude towards smoking cessation (5–8 correct answers: odds ratio [OR], 2.53; 95% confidence interval [CI], 1.57–4.08; ≥ 9 correct answers: OR, 3.90; 95% CI, 2.22–6.82; reference: ≤ 4 correct answers). Interestingly, among current smokers, only those who correctly responded to ≥ 9 of 12 tobacco-related statements were significantly associated with a positive attitude towards smoking cessation. Conclusion: This study found that having a higher level of tobacco-related knowledge had a significant impact on positive attitudes towards smoking cessation. This suggests that there is a need to disseminate appropriate knowledge to the general population to encourage positive attitudes and promote healthful behaviors in terms of smoking.
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Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans
박진주,김선화,김명아,차인호,최동주,윤창환 대한의학회 2019 Journal of Korean medical science Vol.34 No.29
Background: Diabetes mellitus (DM) causes macro- and microvasculopathy, but data on cardiac microvascular changes in large animals are scarce. We sought to determine the effect of DM on macro- and microvascular changes in diabetic pigs and humans. Methods: Eight domestic pigs (4 with type I diabetes and 4 controls) underwent coronary angiography with optical coherence tomography (OCT; at baseline and 1 and 2 months), coronary computed tomography angiography, cardiac magnet resonance (CMR) imaging, and histologic examination. Results: The diabetic pigs had more irregular capillaries with acellular capillaries and a smaller capillary diameter (11.7 ± 0.33 μm vs. 13.5 ± 0.53 μm; P < 0.001) than those of the control pigs. The OCT showed no significant epicardial stenosis in either group; however diabetic pigs had a greater intima-media thickness. CMR results showed that diabetic pigs had a lower relative upslope at rest (31.3 ± 5.9 vs. 37.9 ± 8.1; P = 0.011) and during stress (18.0 ± 3.0 vs. 21.6 ± 2.8; P = 0.007) than the control pigs, implying decreased myocardial perfusion. Among the 79 patients with ST elevation myocardial infarction, 25 had diabetes and they had lower myocardial perfusion on CMR as well. Conclusion: DM causes microvascular remodeling and a decrease in myocardial perfusion in large animals at a very early stage of the disease course. Early and effective interventions are necessary to interrupt the progression of vascular complications in diabetic patients.
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Epidemiology, Pathophysiology, Diagnosis and Treatment of Heart Failure in Diabetes
박진주 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.2
The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients with DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter- 2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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